scholarly journals Can ischemic time predict the age of thrombus in ST elevation myocardial infarction?: an analysis from tertiary healthcare center in South India

2016 ◽  
pp. 952-958
Author(s):  
Louie Fischer ◽  
Elizabeth Joseph ◽  
Eapen Punnose ◽  
Anoop Mathew ◽  
Sunitha Thomas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
South India ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
Healthcare Center ◽  
Tertiary Healthcare ◽  
St Elevation

scholarly journals Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

2021 ◽  
Vol 10 (13) ◽  
pp. 2968
Author(s):  
Alessandro Bellis ◽  
Giuseppe Di Gioia ◽  
Ciro Mauro ◽  
Costantino Mancusi ◽  
Emanuele Barbato ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Reperfusion Injury ◽  
Therapeutic Strategy ◽  
Ventricular Remodeling ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
St Elevation

The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.

scholarly journals Impact of mobile intensive care unit use on total ischemic time and clinical outcomes in ST-elevation myocardial infarction patients – real-world data from the Acute Coronary Syndrome Israeli Survey

2017 ◽  
Vol 7 (6) ◽  
pp. 497-503 ◽  
Author(s):  
Edward Koifman ◽  
Roy Beigel ◽  
Zaza Iakobishvili ◽  
Nir Shlomo ◽  
Yitschak Biton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Odds Ratio ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
Mobile Intensive Care Unit ◽  
St Elevation ◽  
Mobile Intensive Care Units ◽  
One Year

Background: Ischemic time has prognostic importance in ST-elevation myocardial infarction patients. Mobile intensive care unit use can reduce components of total ischemic time by appropriate triage of ST-elevation myocardial infarction patients. Methods: Data from the Acute Coronary Survey in Israel registry 2000–2010 were analyzed to evaluate factors associated with mobile intensive care unit use and its impact on total ischemic time and patient outcomes. Results: The study comprised 5474 ST-elevation myocardial infarction patients enrolled in the Acute Coronary Survey in Israel registry, of whom 46% ( n=2538) arrived via mobile intensive care units. There was a significant increase in rates of mobile intensive care unit utilization from 36% in 2000 to over 50% in 2010 ( p<0.001). Independent predictors of mobile intensive care unit use were Killip>1 (odds ratio=1.32, p<0.001), the presence of cardiac arrest (odds ratio=1.44, p=0.02), and a systolic blood pressure <100 mm Hg (odds ratio=2.01, p<0.001) at presentation. Patients arriving via mobile intensive care units benefitted from increased rates of primary reperfusion therapy (odds ratio=1.58, p<0.001). Among ST-elevation myocardial infarction patients undergoing primary reperfusion, those arriving by mobile intensive care unit benefitted from shorter median total ischemic time compared with non-mobile intensive care unit patients (175 (interquartile range 120–262) vs 195 (interquartile range 130–333) min, respectively ( p<0.001)). Upon a multivariate analysis, mobile intensive care unit use was the most important predictor in achieving door-to-balloon time <90 min (odds ratio=2.56, p<0.001) and door-to-needle time <30 min (odds ratio=2.96, p<0.001). One-year mortality rates were 10.7% in both groups (log-rank p-value=0.98), however inverse propensity weight model, adjusted for significant differences between both groups, revealed a significant reduction in one-year mortality in favor of the mobile intensive care unit group (odds ratio=0.79, 95% confidence interval (0.66–0.94), p=0.01). Conclusions: Among patients with ST-elevation myocardial infarction, the utilization of mobile intensive care units is associated with increased rates of primary reperfusion, a reduction in the time interval to reperfusion, and a reduction in one-year adjusted mortality.

scholarly journals ISCHEMIC TIME IS A BETTER MORTALITY PREDICTOR THAN DOOR-TO-BALLOON TIME IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION

2014 ◽  
Vol 63 (12) ◽  
pp. A145
Author(s):  
Amirreza Solhpour ◽  
Kay-Won Chang ◽  
Prakash Balan ◽  
Stefano Sdringola-Maranga ◽  
Ali Denktas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
St Elevation ◽  
Door To Balloon

Ischemic Time VS Door-To-Balloon Time as A Predictor for Mortality in ST-Elevation Myocardial Infarction

2018 ◽  
Vol 273 ◽  
pp. 16
Author(s):  
Al Fazir Omar ◽  
Mohd Rahal Yusoff ◽  
Farina Mohd Salleh ◽  
Alzamani ldrose ◽  
Mahathar Abdul Wahab ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
St Elevation ◽  
Door To Balloon

Abstract 15557: Comparison of 30-day Mortality by Ischemic Times in ST-Elevation Myocardial Infarction Treated With Pre-Hospital Reduced Dose Fibrinolytic Followed by Percutaneous Coronary Intervention versus Percutaneous Coronary Intervention Alone

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Amirreza Solhpour ◽  
Kay-Won Chang ◽  
Prakash Balan ◽  
Stefano M Sdringola ◽  
Ali E Denktas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Mortality Rate ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Ischemic Time ◽  
Treatment Groups ◽  
Reduced Dose ◽  
Percutaneous Coronary ◽  
St Elevation

Introduction: The current standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPCI). Early reperfusion results in shorter ischemic time (IT) which reduces mortality. In general, fibrinolysis can be initiated earlier than PPCI. For over 7 years we have used a strategy of field evaluation for STEMI using 12 lead ECGs obtained and transmitted by emergency services personnel with over-read by emergency center physicians. Appropriate STEMI patients receive pre-hospital reduced dose fibrinolytic (10 units reteplase) along with aspirin, clopidogrel, and heparin, and are transported to our center for urgent PCI (termed FAST-PCI strategy). Hypothesis: Patients with STEMI in FAST-PCI group have lower 30-day mortality rate compared with those in PPCI group. Methods: Patients with STEMI at our tertiary center were prospectively included for retrospective analysis. Demographic, clinical, angiographic data and outcomes were investigated. Ischemic time was defined as time from onset of pain to device activation. Patients were divided into groups based on IT (<120, 120-179, 180-239, ≥ 240 minutes). Within each IT group, patients were compared by PPCI and FAST-PCI groups. The primary endpoint was 30-day mortality. Results: Between 02/2007 and 12/2013, we treated 1112 STEMI patients of which 551 (49.5%) underwent FAST-PCI and 561 (50.4%) had PPCI. The two treatment groups in each IT interval were well matched for age, cardiac risk factors, left main and left anterior descending artery infarct. Data are shown in the table. Conclusions: For STEMI patients who presented with IT < 180 minutes, FAST-PCI had reduced 30-day mortality rate compared to PPCI. However, a mortality difference was not seen in patients with IT ≥ 180 minutes between the two treatment groups. This suggests that in patients presenting within 3 hours of onset of symptoms FAST-PCI may confer an advantage over PPCI.

scholarly journals Cardiac Troponin Composition Characterization after Non ST-Elevation Myocardial Infarction: Relation with Culprit Artery, Ischemic Time Window, and Severity of Injury

2020 ◽  
Author(s):  
Sander A J Damen ◽  
Gilbert E Cramer ◽  
Hendrik-Jan Dieker ◽  
Helmut Gehlmann ◽  
Ton J M Oude Ophuis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Time Window ◽  
Peripheral Circulation ◽  
St Elevation Myocardial Infarction ◽  
Coronary Veins ◽  
Ischemic Time ◽  
Full Size ◽  
Large Size ◽  
Severity Of Injury ◽  
St Elevation

Abstract Background Troponin composition characterization has been implicated as a next step to differentiate among non-ST elevation myocardial infarction (NSTEMI) patients and improve distinction from other conditions with troponin release. We therefore studied coronary and peripheral troponin compositions in relation to clinical variables of NSTEMI patients. Methods Samples were obtained from the great cardiac vein (GCV), coronary sinus (CS), and peripheral circulation of 45 patients with NSTEMI. We measured total cTnI concentrations, and assessed both complex cTnI (binary cTnIC + all ternary cTnTIC forms), and large-size cTnTIC (full-size and partially truncated cTnTIC). Troponin compositions were studied in relation to culprit vessel localization (left anterior descending artery [LAD] or non-LAD), ischemic time window, and peak CK-MB value. Results Sampling occurred at a median of 25 hours after symptom onset. Of total peripheral cTnI, a median of 87[78-100]% consisted of complex cTnI; and 9[6-15]% was large-size cTnTIC. All concentrations (total, complex cTnI, and large-size cTnTIC) were significantly higher in the CS than in peripheral samples (P &lt; 0.001). For LAD culprit patients, GCV concentrations were all significantly higher; in non-LAD culprit patients, CS concentrations were higher. Proportionally, more large-size cTnTIC was present in the earliest sampled patients and in those with the highest CK-MB peaks. Conclusions In coronary veins draining the infarct area, concentrations of both full-size and degraded troponin were higher than in the peripheral circulation. This finding, and the observed associations of troponin composition with the ischemic time window and the extent of sustained injury may contribute to future characterization of different disease states among NSTEMI patients.

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