scholarly journals Management and outcomes of significant non-culprit coronary artery lesions in STEMI: a retrospective cohort study

2015 ◽  
Vol 3 ◽  
pp. 14 ◽  
Author(s):  
Robert Erich Michael Weitemeyer ◽  
Shane Peter Murphy ◽  
Ruth Gillen ◽  
Catriona Ahern ◽  
Yousif Abusalma ◽  
...  
Keyword(s):  
Medical Management ◽  
University Hospital ◽  
Cardiac Events ◽  
Index Procedure ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
St Elevation ◽  
Percutaneous Revascularization ◽  
The University

<p>BACKGROUND<br /> In the setting of ST-elevation myocardial infarction (STEMI) and multi-vessel disease (MVD), guidelines recommend revascularization of the culprit lesion (CL) only, due to poor evidence supporting intervention in non-culprit lesions (non-CLs) during the same index procedure. Debate over management for significant non-CLs is of interest i.e. medical management vs. percutaneous revascularization. We describe a cohort of patients with STEMI and MVD and compare the occurrence of major adverse cardiac events (MACE) by therapeutic strategies for non-CLs with regard to follow-up outcomes.</p><p>METHODS<br /> 86 patients with STEMI and MVD were identified from a database of STEMI presentations to the University Hospital Limerick from Jan 2011 to April 2013. The occurrence of MACE was established by follow up with patients’ general practitioners.</p><p>RESULTS<br /> 48% of presentations had MVD. Predominant management for non-CLs was medical therapy alone comprising 58% (n=50) of patients, while 23% (n=20) of patients underwent PCI for non-CL, and 19% (n=16) had CABG.</p><p>Median follow up was 1.8 years (range 9–36 months).  We found no significant difference in the occurrence of MACE  between medical management of non-CLs and PCI of non-CLs (OR 1.10 95%CI 0.34, 3.56; p= 0.88). CABG however does show a trend to be superior to both PCI (OR 3.10 95%CI 0.54, 17.88; p= 0.21) and medical management (OR 2.83 95%CI 0.65, 12.27; P= 0.17) in non-CLs.</p><p>CONCLUSIONS<br /> CABG appears superior to both PCI or medical management in preventing MACE over time, and PCI is not superior to medical management alone.</p>

Single Centre Experience in Patients with Primary Hyperparathyroidism: Sporadic, Lithium-associated and in Multiple Endocrine Neoplasia

2019 ◽  
Vol 128 (10) ◽  
pp. 693-698
Author(s):  
Sabine Dillenberger ◽  
Detlef K. Bartsch ◽  
Elisabeth Maurer ◽  
Peter Herbert Kann
Keyword(s):  
Primary Hyperparathyroidism ◽  
Multiple Endocrine Neoplasia ◽  
University Hospital ◽  
Primary Surgery ◽  
Endocrine Neoplasia ◽  
Single Centre Experience ◽  
Significant Difference ◽  
History Of ◽  
The University

Abstract Purpose It is assumed that primary hyperparathyroidism (pHPT) in Multiple Endocrine Neoplasia (MEN) and lithium-associated pHPT (LIHPT) are associated with multiple gland disease (MGD), persistence and recurrence. The studies purpose was to determine frequencies, clinical presentation and outcome of sporadic pHPT (spHPT), LIHPT and pHPT in MEN. Additional main outcome measures were the rates of MGD and persistence/recurrence. Methods Retrospective analysis of medical records of 682 patients with pHPT who had attended the University Hospital of Marburg between 01–01–2004 and 30–06–2013. All patients were sent a questionnaire asking about their history of lithium medication. Results Out of 682 patients, 557 underwent primary surgery (532 spHPT, 5 LIHPT, 20 MEN), 38 redo-surgery (31 spHPT, 7 MEN), 55 were in follow-up due to previous surgery (16 spHPT, 1 LIHPT, 38 MEN) and 37 were not operated (33 spHPT, 1 LIHPT, 3 MEN). Primary surgeries were successful in 97.4%, revealed singular adenomas in 92.4%, double adenomas in 2.9% and MGD in 3.4% of the cases. Rates of MGD in MEN1 (82.35%) were significantly higher than in spHPT (3.8%), while there was no significant difference between LIHPT (20%) and spHPT. Rates of persistence/recurrence did not significantly differ due to type of surgery (bilateral/unilateral) or type of HPT (spHPT/LIHPT/MEN). Conclusions History of lithium medication is rare among pHPT patients. While MGD is common in MEN1, rates of MGD, persistence or recurrence in LIHPT were not significantly higher than in spHPT.

scholarly journals Impact of Admission Glycosylated Hemoglobin A1c on Angiographic Characteristics and Short Term Clinical Outcomes of Nondiabetic Patients with Acute ST-Segment Elevation Myocardial Infarction

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Islam El-sherbiny ◽  
Baher Nabil ◽  
Tamer Saber ◽  
Fathy Elsayed Abdelgawad
Keyword(s):  
Hba1c Level ◽  
Glycosylated Hemoglobin ◽  
University Hospital ◽  
Complete Revascularization ◽  
Cardiac Events ◽  
Short Term ◽  
Acute Stemi ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
Hba1c Levels

We aimed to assess the predictive value of admission HbA1c level in nondiabetic patients presented by acute STEMI, on outcome of PCI and short term outcome of adverse cardiac events.Methods. 60 nondiabetic patients were admitted to Cardiology Department, Zagazig University Hospital, with acute STMI: 27 patients with HbA1c levels of 4.5% to 6.4% (group 1), 17 patients with HbA1c levels of 6.5% to 8.5% (group 2), and 16 patients with HbA1c levels higher than 8.5% (group 3). Either invasive intervention was done at admission by (pPCI) or coronary angiography was done within month (3–28 days) from taking thrombolytic. Participants were followed up for 6 months.Results. There was significant difference among different groups of HbA1c as regards the number of diseased vessels, severity of CAD lesions (pvalue < 0.01), and TIMI flow grades (pvalue < 0.05). There was significant difference among different groups as regards the adverse cardiac events on short term follow-up period (pvalue < 0.05).Conclusion. The present study showed that admission higher HbA1c level in patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization, and higher incidence of adverse cardiac events.

scholarly journals Circulating Platelet-Derived Microparticles Associated with Postdischarge Major Adverse Cardiac Events in ST-Elevation Acute Myocardial Infarction

2020 ◽  
Vol 2020 ◽  
pp. 1-10
Author(s):  
Anggoro Budi Hartopo ◽  
Dyah Samti Mayasari ◽  
Ira Puspitawati ◽  
Hasanah Mumpuni
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Prognostic Implication ◽  
Adverse Cardiac Events ◽  
St Elevation ◽  
Elevation Acute Myocardial Infarction

Introduction. Platelet-derived microparticles (PDMPs) measurement adds prognostic implication for ST-elevation acute myocardial infarction (STEMI). The long-term implication of PDMPs in STEMI needs to be corroborated. Methods. The research design was a cohort study. Subjects were STEMI patients and were enrolled consecutively. The PDMPs were defined as microparticles bearing CD41(+) and CD62P(+) markers detected with flow cytometry. The PDMPs were measured on hospital admission and 30 days after discharge. The outcomes were major adverse cardiac events (MACE), i.e., a composite of cardiac death, heart failure, cardiogenic shock, reinfarction, and resuscitated ventricular arrhythmia, occurring from hospitalization until 1 year after discharge. Results. We enrolled 101 subjects with STEMI. During hospitalization, 17 subjects (16.8%) developed MACE. The PDMPs were not different between subjects with MACE and those without (median (IQR): 3305.0/μL (2370.0–14690.5/μL) vs. 4452.0/μL (2024.3–14396.8/μL), p=0.874). Forty-five subjects had increased PDMPs in 30 days after discharge as compared with on-admission measurement. Subjects with increased PDMPs had significantly higher 30-day MACE as compared to subjects with decreased PDMPs 17 (37.8%) vs. 6 (16.7%, p=0.036). There was a trend toward higher MACE in subjects with increased PDMPs as compared to those with decreased PDMPs in 90 days after discharge (48.9% vs. 30.6%, p=0.095) and 1 year after discharge (48.9% vs. 36.1%, p=0.249). Conclusion. The PDMPs level was increased from the day of admission to 30 days after discharge in patients with STEMI. The persistent increase in the PDMPs level in 30 days after the STEMI event was associated with the 30-day postdischarge MACE and trended toward increased MACE during the 90-day and 1-year follow-up.

scholarly journals LONG-TERM CONSEQUENCES OF PRIMARY PERCUTANEOUS CORONARY INTERVENTION IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

2020 ◽  
Vol 73 (4) ◽  
pp. 662-667
Author(s):  
Nataliya V. Izhytska ◽  
Dmytro I. Besh ◽  
Olesya M. Besh ◽  
Adrian Y. Fil
Keyword(s):  
Coronary Intervention ◽  
Main Group ◽  
Therapeutic Window ◽  
Long Term Effects ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Percutaneous Coronary ◽  
St Elevation

The aim: To investigate long-term effects of primary percutaneous coronary interventions (pPCI) in patients with STEMI basing on the prevalence of clinically relevant endpoints. Materials and methods: Totally 200 patients with STEMI hospitalized within a period of “therapeutic window” for revascularization were included into the study. 100 patients who additionally to pPCI underwent manual thromboaspiration entered the main group. The comparison group consisted of 100 patients who underwent standard pPCI. Results: Six months after the pPCI, the incidence of either major adverse cardiac events and the combined endpoint did not differ in the main and comparative groups (11.8% vs. 12.5%, p = 0.888 and 18.2% vs. 20.8%, p = 0.658, respectively). There were no significant differences in these endpoints taken separately. In twelve months after procedure, also there were no significant differences between the groups. However, a tendency toward lower incidence of chest pain was observed in the main group (p = 0.08) during this period that was lost in 24 months after pPCI. None of these techniques demonstrated significant advantages during the whole duration of the follow-up period. Conclusions: The addition of manual thromboaspiration to the standard pPCI in patients with STEMI and severe thrombosis of the culprit artery did not significantly influence the prognosis.

Prognostic implications of Neutrophil Extracellular Traps in coronary thrombi of patients with ST-elevation myocardial infarction

2021 ◽  
Author(s):  
Ana Blasco ◽  
María José Coronado ◽  
Paula Vela ◽  
Paloma Martin ◽  
Jorge Solano ◽  
...  
Keyword(s):  
Coronary Thrombosis ◽  
Neutrophil Extracellular Traps ◽  
Cardiac Events ◽  
Treatment Groups ◽  
Extracellular Traps ◽  
Adverse Cardiac Events ◽  
St Elevation

Aims: The mechanisms of coronary thrombosis can influence prognosis after STEMI and allow for different treatment groups to be identified; an association between neutrophil extracellular traps (NETs) and unfavorable clinical outcomes has been suggested. Our aim was to determine the role played by NETs in coronary thrombosis and their influence on prognosis. The role of other histological features in prognosis and the association between NETs and bacteria in the coronary thrombi were also explored. Methods and Results: We studied 406 patients with STEMI in which coronary thrombi were consecutively obtained by aspiration during angioplasty between 2012 and 2018. Analysis of NETs in paraffin-embedded thrombi was based on the colocalization of specific NET components by means of confocal microscopy. Immunohistochemistry stains were used to identify plaque fragments. Fluorescence in situ hybridization was used to detect bacteria. NETs were detected in 51% of the thrombi [NET density, median (IQR): 25% (17–38%)]. The median follow-up was 47 months (95% CI 43-51); 105 (26%) patients experienced major adverse cardiac events (MACE). A significant association was found between the presence of NETs in coronary aspirates and the occurrence of MACE in the first 30 days after infarction (HR 2.82; 95% CI 1.26–6.35, p=.012), mainly due to cardiac deaths and stent thrombosis. Conclusions: The presence of NETs in coronary thrombi was associated with a worse prognosis soon after STEMI. In some patients, NETs could be a treatment target and a feasible way to prevent reinfarction.

scholarly journals Prediction of major adverse cardiac events of patients with acute coronary syndrome by using TIMI risk index

2013 ◽  
Vol 18 (2) ◽  
pp. 52-57 ◽  
Author(s):  
Mohammad Abul Ehsan ◽  
Md Manzoor Mahmood ◽  
Laila Farzana Khan ◽  
Md Abu Salim
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Index ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Adverse Cardiac Events ◽  
St Elevation ◽  
Group 1

Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TRI. This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & physical examinations were done. TIMI risk index were calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Major adverse events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 0%, 3.7%, 12.9% & 19.2% respectively in UA/NSTEMI group. In STEMI group major adverse cardiac events of TIMI risk index group 1, 2, 3, 4 & 5 were 0%, 4.7%, 12.5%, 17.1% & 24.1% respectively. Increasing TRI were associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/jdnmch.v18i2.16024 J. Dhaka National Med. Coll. Hos. 2012; 18 (02): 52-57

scholarly journals Impact of Admission Glycated Hemoglobin on Angiographic Characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A I Elabd ◽  
H G M Helmi ◽  
E M A Alfiky ◽  
R A Y Bassily
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
Study Population ◽  
St Elevation ◽  
Artery Disease

Abstract Background Coronary artery disease is the most important cause of death in industrialized countries. Diabetes mellitus is one of the most important modifiable risk factors of coronary artery disease. It increases the risk of coronary artery disease by 2 to 4-fold. Interestingly, this increased risk is not confined to patients with DM, but non-diabetic patients with impaired glucose tolerance (IGT) also may have an increased incidence of cardiovascular complications. Moreover, increased admission glucose levels may be related to a higher mortality rates in patients with acute myocardial infarction (AMI), regardless of diabetic status. Objective To assess the prognostic impact of admission HbA1c in patients without known diabetes mellitus who were admitted with acute ST elevation myocardial infarction, on outcome of 1ry PCI and short-term outcome of adverse cardiac events. Material and Methods This is an observational, this study was conducted at Coronary care unit & coronary catheterization lab unit of cardiology department in Ain Shams University & specialized hospitals. The study period was 6 months (From 1-9-2018 till 1-3-2019). Results 100 patients without prior diagnosis of DM were included in our study population Three categories of patients were created according to HbA1c level: Group 1 (&lt; 5.7%): 46 patients (46%); Group 2 (5.5 to 6.4%): 38patients (38%); Group 3 (&gt;6.5%): 16 patients (16%). Baseline characteristics of the study population are shown in Table 1. The mean age of our sample was 55.06 ± 11.73 years and 96% were males. There was highly statistically significant difference found between DM groups regarding SYNTAX score with P-value (0.002) & another highly significant difference in EF between the 3 groups. Conclusion The present study showed that admission higher HbA1c level in non-diabetic patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization TIMI 3, and higher incidence of adverse cardiac events and mortality. Introducing measurement of HbA1c in the CCU seems to be a simple method to obtain important information on mortality risk.

scholarly journals Prediction of Major Adverse Cardiac Events of Patients with Acute Coronary Syndrome by Using TIMI Risk Score

2013 ◽  
Vol 8 (2) ◽  
pp. 73-79
Author(s):  
Mohammad Abul Ehsan ◽  
Manzoor Mahmood ◽  
Md Abu Siddique ◽  
Sajal Krishna Kanerjee ◽  
Laila Farzana Khan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Major Adverse Cardiac Events ◽  
Cardiac Events ◽  
Coronary Syndrome ◽  
Timi Score ◽  
Adverse Cardiac Events ◽  
St Elevation ◽  
Timi Risk Score

Background: Patient with acute coronary syndrome (ACS) has considerable variability in outcome and mortality risk. The Thrombolysis in Myocardial Infarction (TIMI) risk score for unstable angina/non ST elevation myocardial infarction & ST elevation myocardial infarction were a convenient bedside clinical risk score for predicting 30 days mortality at presentation with ACS. Aim & objectives: This study was done to predict and validate major adverse cardiac events in patients of ACS thus it will help us to quantify risk, observe the prognostic value and to guide appropriate therapy by using TIMI risk score. Methods: This prospective study was carried out in the department of cardiology, BSMMU, Dhaka from April, 2011 to March, 2012. After considering all ethical issues, data were collected from 279 patients attending at cardiac emergency department with the presentation of ACS. History & complete physical examinations were done. ST changes in electrocardiogram & CKMB/Troponin value were noted in data sheet. TIMI risk score was calculated for each patient. The major adverse cardiac events (recurrent myocardial infarction, urgent revascularization, and all-cause mortality) were measured for next 30 days in hospital setting & outpatient department by follow up. After follow-up, Cox univariate and multivariate regression analysis were used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the outcome. Results: In patient with UA/NSTEMI major adverse cardiac events were 0%, 4.2%, 6.9%, 12.5%, 13.6% and 33.3% with TIMI score 0/ 1, 2, 3, 4, 5 and 6/7 respectively. . In patients with STEMI group major adverse cardiac events were 0%, 0%, 0%, 0%, 7.1%, 9.5%, 10%, 17.6%, 19% and 38.5% with TIMI score 0, 1, 2, 3, 4, 5, 6, 7, 8 and more than 8 respectively. Conclusions: Increasing TIMI risk score was associated with increased risk of major adverse cardiac events. These score were a valid tool for risk assessment. DOI: http://dx.doi.org/10.3329/uhj.v8i2.16063 University Heart Journal Vol. 8, No. 2, July 2012

Prospective evaluation for gastrointestinal bleedings at the University Hospital St. Pölten – one year of follow-up

2019 ◽  
Author(s):  
M Stättermayer ◽  
F Riedl ◽  
S Bernhofer ◽  
A Stättermayer ◽  
A Mayer ◽  
...  
Keyword(s):  
University Hospital ◽  
Prospective Evaluation ◽  
One Year ◽  
The University
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