scholarly journals Predictors of Progressive Course of Multifocal Atherosclerosis in Patients With Myocardial Infarction

Kardiologiia ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 36-44 ◽  
Author(s):  
D. Yu. Sedykh ◽  
A. N. Kazantsev ◽  
R. S. Tarasov ◽  
V. V. Kashtalap ◽  
A. N. Volkov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Family History ◽  
Syntax Score ◽  
Coronary Syndrome ◽  
History Of ◽  
One Year ◽  
Ica Stenosis ◽  
The Impact ◽  
Progression Of Atherosclerosis ◽  
Progressive Course

Purpose. Determination of clinical and instrumental predictors of progressive course of multifocal atherosclerosis (MFA) in patients one year after myocardial infarction (MI), initially having hemodynamically insignificant stenoses of carotid arteries.Materials and methods. From database of patients with acute coronary syndrome treated in the Kemerovo Regional Clinical Cardiac Dispensary in 2009–2010 we selected for this study 141 patients with verified diagnosis of MI and hemodynamically insignificant lesions in the internal carotid artery (ICA) (stenosis up ≤ 55 %). All patients had coronary atherosclerosis verified on coronary angiography at admission because of MI. A multivariate analysis of possible predictors of the progressive course of multifocal atherosclerosis was made based on assessment of the development of cardiovascular complications (CVC) (death, MI, stroke and transient cerebral circulatory attacks [TIA]), as well as revascularizations and negative dynamics of parameters of color duplex scanning (CDS) of ICA during one year after MI. Results. One year after MI the overall incidence of CVC was 16.3 % (n=23). Structure of registered events was as follows: death from MI 7.1 % (n=10), deaths from stroke 2.1 % (n=3) and other causes 2.1 % (n=3), non-fatal MI 5.0 % (n=7), non-fatal stroke / TIA 2.1 % (n=3), carotid revascularization 2.8 % (n=4), coronary revascularization 14.9 % (n=21). CDC of ICAs was repeated in 125 patients. There were 17 (13.6 %) cases of progression of carotid atherosclerosis in the form of de novo bilateral stenoses in 14 (11.2 %) patients, stenoses in the left and right ICA 1 patient and 2 patients, respectively. The following predictors of progression of atherosclerosis of cerebral arteries were identified: family history of cardiovascular diseases (CVD),ICA stenosis ≥45 %, baseline circular atherosclerotic plaque (ASP). Predictors of high risk of stroke were family history of CVD, history of stroke,ICA stenosis ≥45 %, heterogeneous hypoechoic ASP. As predictors of lethal outcome, we identified history of MI, high functional class of angina preceding the index MI, severe coronary vascular bed involvement (SYNTAX score >23), presence of any bilateral atherosclerotic lesion in ICAs, and heterogeneous hypoechoic ASP. Assessment of the contribution of adherence to therapy in the prognosis 1 year after hospital discharge was fulfilled in 125 alive patients. It allowed to conclude that patients with progression of atherosclerosis and nonfatal CVC were characterized by insufficient adherence to standard therapy.Conclusion. Predictors of the progressive course of multifocal atherosclerosis during one year after MI were identified in this study. It is necessary to strengthen therapeutic and preventive measures aimed at minimization of the impact of these factors in this category of patients.   

scholarly journals Delayed presentation of acute coronary syndrome with mechanical complication during COVID-19 pandemic: a case report

2020 ◽  
Author(s):  
Joo Hor Tan ◽  
Jieli Tong ◽  
Hee Hwa Ho
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Left Ventricular ◽  
World Health ◽  
Mechanical Complication ◽  
Delayed Presentation ◽  
Left Circumflex Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
The Impact

Abstract Background The World Health Organization declared coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. We report a patient with acute myocardial infarction (AMI) who presented late due to fears of contracting COVID-19. Case summary A 65-year-old man with a history of hypertension presented late to the emergency department (ED) with AMI. He gave a 2-month history of exertional angina but avoided seeking medical consult due to fears of contracting COVID-19. On the day of admission, he had 4 h of severe chest pain before presenting to the ED. He was hypotensive and tachycardic on arrival. Electrocardiogram showed inferolateral ST-elevation myocardial infarction. Chest radiograph revealed widened superior mediastinum and bedside echocardiogram revealed inferoseptal and inferolateral hypokinesia with features of cardiac tamponade. An urgent computed tomography aortogram showed possible left ventricular (LV) wall perforation with resulting haemopericardium and cardiac tamponade. Subsequent coronary angiogram showed 100% occlusion of mid left circumflex artery and a contained LV wall rupture was confirmed with LV ventriculogram. He was transferred to a tertiary centre and underwent successful emergency surgical repair. Discussion Our index case demonstrates the impact of the COVID-19 pandemic on health seeking behaviour due to fears of contracting COVID-19 and the ensuing impact of delayed medical intervention. Cardiologists worldwide are seeing an alarming rate of rare complications of AMI in patients who present late. Physicians need to be aware of this phenomenon and have an active role to play in public education.

scholarly journals In Hospital Outcome of Myocardial Infarcton in Nondiabetic Patients with High on Admission Blood Glucose Level

1970 ◽  
Vol 3 (2) ◽  
pp. 143-148
Author(s):  
M Ullah ◽  
LA Sayami ◽  
MR Khan ◽  
A Jahan ◽  
Z Rahman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Glucose ◽  
Blood Sugar ◽  
Blood Sugar Level ◽  
Diabetic Patients ◽  
Hospital Outcome ◽  
Coronary Syndrome ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: Patients without a history of diabetes often develop hyperglycemia during an acute coronary syndrome (ACS). Our aim was to evaluate the impact of admission hyperglycemia on in hospital outcome of non-diabetic patients admitted for acute coronary syndromes. Methods: The retrospective study was conducted in National Institute of Cardiovascular Diseases among the patients with acute myocardial infarction without history of diabetes. 50 patients with ST elevation MI (STEMI) with complications, 50 patients with STEMI without complications, 50 patients with non-ST elevation MI (NSTEMI) with complications and 50 patients without complications were included in the study. Every patient got the treatment as per protocol of the institute. On admission blood glucose of the patients was recorded. Level of blood glucose was correlated with the frequency of complications. Results : Average on admission blood sugar level was higher in patients who developed complications with STEMI (11.4 vs 8.78 mmol/L). On admission blood sugar level was also significantly higher in patients with NSTEMI with complications (10.6 vs 8.6 mmol/L). The frequency of individual complications had no significant relation with the blood sugar level. Conclusion : Higher level of admission blood glucose is related to poor in hospital outcome in both STEMI & NSTEMI even in nondiabetic patients. It may be used as a predictor of poor outcome of patients with myocardial infarction. Keywords: STEMI; NSTEMI; Blood glucose. DOI: http://dx.doi.org/10.3329/cardio.v3i2.9183 Cardiovasc. J. 2011; 3(2): 143-148

Abstract 4013: The Impact of Atrial Fibrillation on the outcomes of patients suffering a second Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Yingzi Deng ◽  
William J Kostis ◽  
Alan C Wilson ◽  
Nora Cosgrove ◽  
Yu-Hsuan Shao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Hospital Admissions ◽  
Strong Predictor ◽  
Mortality Rates ◽  
Percutaneous Coronary ◽  
History Of ◽  
Short And Long Term ◽  
One Year ◽  
The Impact

In the past 20 years, significant increases in hospital admissions for atrial fibrillation (AF) and in survival of acute myocardial infarction (MI) have been observed. We examined the occurrence of AF and its effect on short and long term outcomes of first MI(FMI) and second MI(SMI). Hospitalized MIs from MIDAS (Myocardial Infarction Data Acquisition System, N=269,110) in New Jersey from 1986 to 2005 were included in the analysis. The rate of the co-exiting MI and AF and 30-day and 1 year mortality were investigated. Approximately 11 %( N=26,631) of FMI patients had a second event. The rate of co-existing AF for the FMI was 9.6% in 1986 and 16.2% in 2005, a 40.9% increase; while AF increased 60.4%, from 7.7% to 20.5% for SMI. Patients with AF were older (76.5 vs 69.3), more likely to be female (43.6% vs 39.4%), to have subendocardial infarction (58.5% vs 49.2%). Patients AF were less likely to be black in racial (4.2% vs 8.4%) and to receive percutaneous coronary interventions (PCI) (6.1% vs 10.4 %). There were more strokes (2% vs 0.9%) and heart failure hospitalizations (HF, 58% vs 39%) in the AF group(p<0.0001). Thirty-day mortality rates (AF vs non-AF) were 20.9% and 13.8% for the FMIs; and 21.5% vs 14.2% for SMIs. One-year mortality rates were 37.4% and 20.5% at FMI, and 43.3% and 28.1% at the SMI, respectively. When adjusting for age, gender, race, MI site, PCI, year of MI, diabetes, stroke and HF, AF increased the 30 day mortality by 36%( OR1.36 95% CI 1.32–1.41) for FMI, and by 33% (OR 1.33(1.22–1.46)] for SMI. The effect of AF on mortality was more pronounced at 1 year [FMI 1.54(1.50 –1.58), SMI:1.44(1.34 –1.55)]. Current AF as well as the history of AF increased both 30-day [OR for current AF: 1.35(1.22–1.50), history of AF: 1.17(1.04 –1.32)] and 1-year mortality [current AF: 1.5(1.4 –1.6), history of AF: 1.21(1.11–1.33)]. The rate of AF in MI patients has increased, especially SMIs. AF remains as a strong predictor of worse outcome for patients suffering a second MI. Both the history of AF and current AF were associated with higher mortality in MI patients.

scholarly journals PATTERN OF CORONARY ARTERY DISEASES IN PATIENTS UNDER 40 YEARS OF AGE WITH ACUTE CORONARY SYNDROME

2021 ◽  
Vol 54 (2) ◽  
pp. 144-147
Author(s):  
Iram Jehan Balouch ◽  
Iftikhar Ahmed ◽  
Faiza Farooq ◽  
Syed Ahsan Raza ◽  
Najia Aslam Soomro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Family History ◽  
Positive Family History ◽  
Young Patients ◽  
Coronary Artery Diseases ◽  
Coronary Syndrome ◽  
Single Vessel ◽  
History Of

Objectives: To determine the pattern of coronary artery diseases (CAD) in patients under 40 years of age with acute coronary syndrome (ACS) presenting at Hyderabad Satellite Center of National Institute of Cardiovascular Disease (NICVD), Pakistan. Methodology: This cross-sectional study was conducted at cardiology department of the NICVD, Hyderabad Satellite Center. Both male and female patients, between 18 to 40 years of age, diagnosed with acute coronary syndrome (ACS), and undergone coronary angiography were included in this study. Angiographic patterns in terms of extent of the disease (number of diseased vessels and localization of lesion) were assessed. Results: Total of 220 young patients included. Patients were predominantly male (91.8%) with the mean age of 35.3 ± 5 years. Smoking was observed 30.5% followed by hypertension (24.5%) and positive family history of CAD (19.1%). A majority of the patients (79.1%) were diagnosed as with ST-elevation myocardial infarction (STEMI) with anterior wall myocardial infarction (MI) as the most common (57.3%) type of MI. Most of the patients (70%) had single vessel diseases (SVD) with left anterior descending artery (LAD) as the most commonly diseases vessel (53.6%). Nine (4.1%) patients had significant left main disease and 6.4% had non-obstructive CAD. Conclusion: The common clinical presentation of ACS in younger patients is STEMI. Smoking is the commonest risk factor followed by hypertension and family history of CAD. More than 2/3rd of the young patients are expected to have single vessel diseases with LAD as the most commonly diseased vessel.

scholarly journals Prediction of clinical outcomes of patients treated with percutaneous coronary intervention for ST-Elevation myocardial infarction using familial history of premature coronary artery disease

2018 ◽  
Vol 6 (4) ◽  
pp. 172-178
Author(s):  
Bahram Sohrabi ◽  
Ahmad Separham ◽  
Hadi Habibolahi ◽  
Elgar Enamzadeh ◽  
Behnaz Ghamari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Family History ◽  
Clinical Outcomes ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
History Of ◽  
St Elevation ◽  
Premature Cad ◽  
The Mean ◽  
One Year

Introduction: ST-elevation myocardial infarction (STEMI) is a relatively common cause of mortality among patients. The effects of risk factors as predictors of mortality in patients has been shown in different studies. The present study was performed aiming to evaluate the association between a family history of premature coronary artery diseases (CADs) with clinical outcomes among patients treated with percutaneous coronary intervention (PCI) for STEMI. Methods: This descriptive-analytical study was conducted in Shahid Madani Hospital of Tabriz University of Medical Sciences, Tabriz, Iran, on 200 patients with STEMI with a PCI. 100 out of these 200 patients had a family history of premature CAD. Patients were followed up within 48 hours after PCI, as well as one year after admission, and the secondary outcomes including myocardial infarction (MI), heart failure, ventricular arrhythmias (VAs), pulmonary edema, and death were evaluated. Results: The mean age of the patients with positive and negative family history of premature CAD was 56.37 ± 8.20 and 61.72 ± 7.42 years, respectively. The mean age of the patients with a family history of a premature CAD was significantly lower than that of patients without a family history of a premature CAD (P = 0.001). There was no significant difference in the frequency of CAD risk factors, angiographic findings, and its complications, ST-segment resolution and frequency of secondary outcomes during 48 hours and one year after admission between the study groups (P > 0.050). Conclusion: The present study showed that a family history of premature CAD does not predict the clinical outcomes in patients treated with PCI for STEMI which should be validated across future studies.

Validation of a machine learned model to predict the diagnosis of myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
D Doudesis ◽  
J Yang ◽  
A Tsanas ◽  
C Stables ◽  
A Shah ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
High Probability ◽  
Cardiovascular Death ◽  
Gradient Boosting ◽  
Funding Source ◽  
Coronary Syndrome ◽  
Low Probability ◽  
One Year

Abstract Introduction The myocardial-ischemic-injury-index (MI3) is a promising machine learned algorithm that predicts the likelihood of myocardial infarction in patients with suspected acute coronary syndrome. Whether this algorithm performs well in unselected patients or predicts recurrent events is unknown. Methods In an observational analysis from a multi-centre randomised trial, we included all patients with suspected acute coronary syndrome and serial high-sensitivity cardiac troponin I measurements without ST-segment elevation myocardial infarction. Using gradient boosting, MI3 incorporates age, sex, and two troponin measurements to compute a value (0–100) reflecting an individual's likelihood of myocardial infarction, and estimates the negative predictive value (NPV) and positive predictive value (PPV). Model performance for an index diagnosis of myocardial infarction, and for subsequent myocardial infarction or cardiovascular death at one year was determined using previously defined low- and high-probability thresholds (1.6 and 49.7, respectively). Results In total 20,761 of 48,282 (43%) patients (64±16 years, 46% women) were eligible of whom 3,278 (15.8%) had myocardial infarction. MI3 was well discriminated with an area under the receiver-operating-characteristic curve of 0.949 (95% confidence interval 0.946–0.952) identifying 12,983 (62.5%) patients as low-probability (sensitivity 99.3% [99.0–99.6%], NPV 99.8% [99.8–99.9%]), and 2,961 (14.3%) as high-probability (specificity 95.0% [94.7–95.3%], PPV 70.4% [69–71.9%]). At one year, subsequent myocardial infarction or cardiovascular death occurred more often in high-probability compared to low-probability patients (17.6% [520/2,961] versus 1.5% [197/12,983], P&lt;0.001). Conclusions In unselected consecutive patients with suspected acute coronary syndrome, the MI3 algorithm accurately estimates the likelihood of myocardial infarction and predicts probability of subsequent adverse cardiovascular events. Performance of MI3 at example thresholds Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council

Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Arroyo-Espliguero ◽  
M.C Viana-Llamas ◽  
A Silva-Obregon ◽  
A Estrella-Alonso ◽  
C Marian-Crespo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Primary Angioplasty ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
One Year ◽  
The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI&lt;97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P&lt;0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P&lt;0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P&lt;0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

Primary care physician services and the frequency of comorbidities in patients with acute myocardial infarction

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
R King ◽  
D Giedrimiene
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Acute Myocardial Infarction ◽  
Primary Care Physician ◽  
Care Physician ◽  
Adverse Outcomes ◽  
Coronary Syndrome ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: None. Background The management of patients with multiple comorbidities represents a significant burden on healthcare each year. Despite requiring regular medical care to treat chronic conditions, a large number of these patients may not receive proper care. Significant disparities have been identified in patients with multiple comorbidities and those who experience acute coronary syndrome or acute myocardial infarction (AMI). Only limited data exists to identify the impact of comorbidities and utilization of primary care physician (PCP) services on the development of adverse outcomes, such as AMI. Purpose The primary objective was to analyze how PCP services utilization can be associated with comorbidities in patients who experienced an AMI. Methods This study was based on retrospective data analysis which included 250 patients admitted to the Hartford Hospital Emergency Department (ED) for an AMI. Out of these, 27 patients were excluded due to missing documentation. Collected data included age, gender, medications and recorded comorbidities, such as hypertension, hyperlipidemia, diabetes mellitus (DM), chronic kidney disease (CKD) and previous arrhythmia. Each patient was assessed regarding utilization of PCP services. Statistical analysis was performed in order to identify differences between patients with documented PCP services and those without by using the Chi-square test. Results The records allowed for identification of documented PCP services for 172 out of 223 (77.1%) patients. The most common comorbidities were hypertension and hyperlipidemia: in 165 (74.0%) and 157 (70.4%) cases respectively. The most frequent comorbidity was hypertension: 137 out of 172 (79.7%) in pts with PCP vs 28 out of 51 (54.9%) without PCP, and significantly more often in patients with PCP, p&lt; 0.001. Hyperlipidemia was the second most frequent comorbidity: in 130 out of 172 (75.6%) vs 27 out of 51 (52.9%) accordingly, and also significantly more often (p&lt; 0.002) in patients with PCP services. The number of comorbidities ranged from 0-5, including 32 (14.3%) patients without comorbidities: 16 (9.3%) with a PCP and 16 (31.4%) without PCP services. The majority of patients - 108 (48.5% of 223), had 2-3 documented comorbidities: 89 (51.8%) had two and 19 (34.6%) had three. The remaining 40 (17.9%) patients had 4-5 comorbidities: 37 (21.5%) of them with a PCP and 3 (10.3%) without, with a significant difference (p &lt; 0.001) found for patients with a higher number of comorbidities who utilized PCP services. Conclusions Our study shows that the majority of patients who presented with an AMI had one or more comorbidities. Furthermore, patients who did not utilize PCP services had fewer identified comorbidities. This suggests that there may be a significant number of patients who experienced AMI with undiagnosed comorbidities due to not having access to PCP services.

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