scholarly journals Surgical management of acute limb ischemia, the first experience from Ethiopia

2020 ◽  
Author(s):  
Nebyou Seyoum Abebe ◽  
Berhanu Daba Mekonnen ◽  
Berhanu Nega Alemu
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Mortality Rate ◽  
Surgical Outcomes ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
Delayed Presentation ◽  
Previous Myocardial Infarction ◽  
Hypertensive Patients

Abstract Background Acute Limb Ischemia is a devastating emergency condition due to a sudden decrease in limb perfusion that threatens life or limb viability. It carries a high morbidity and mortality rate. This is the first experience to report on risk factors, etiologies and surgical outcomes of acute limb ischemia in Ethiopian.Methods A Prospective Cross-sectional Study on patients operated for acute limb ischemia at Tikur Anbessa Specialized Hospital and Teklehaimanot General Hospitals from January 1, 2018, to December 31, 2018, Addis Ababa, Ethiopia was done. They were followed for 3 months to determine risk factors, etiologies and surgical outcomes of the disease. Data were collected using a structured questionnaire. Findings were analyzed using SPSS version 20 and compared with current literature.Result A total of 102 patients were operated with a male to female ratio of 2:1 and the mean age at presentation was 54±17 years. Hypertension, 40 (39.2%), and diabetes mellitus, 32 (31.4%), were the most common risk factors followed by combined hypertension & diabetes mellitus, 20 (19.6%). The most common cause of acute limb ischemia was thrombosis, 77 (75.5%) and followed by embolism 14 (13.7%) and trauma 11 (10.8%). The source of emboli in all cases was cardiac disease due to atrial fibrillation, 9 (7.8%), myocardial infarction, 6 (5.9%) & rheumatic valvular heart disease, 4 (3.9%). The overall Presentation was very late with an average duration of 9±4.8 days and all of them arrive after 24 hours of symptom onset. One hundred eight procedures were done in 102 patients. Type of procedure performed were, thrombectomy 51(47.2%), primary amputation 24(22.2%), bypass or interposition vascular grafts 10(9.2%), embolectomy 10(9.2%), primary vascular repair 7(6.4%), and Femoro-femoral graft 6(5.5%). The 30-day amputation & mortality rate was 52.9% and 9.8% respectively. The rate of limb loss after revascularization surgery was 32.4%. Systemic complications occurred in 17.6% and local complications occurred in 35.3% of patients. On logistic regression analysis, age older than 60 years showed a four-fold risk of amputation (p = 0.017) and ten times the risk of mortality (p = 0.037) compared to 20-40 years age group. Hypertensive patients had 3 times more risk of amputation (p = 0.031) as compared to non-hypertensive patients. The duration of presentation beyond 9 days showed 4 folds risk of amputation (p = 0.021) as compared to those presented within 3 days. Previous Myocardial infarction was associated with 5 folds increase in mortality (p = 0.036) as compared to those without myocardial infarction.Conclusion This review has tried to show the overall perspective of acute limb ischemia specific to the population we serve. Patients generally presented very late with a significant number of them arrived with irreversible ischemia and tissue loss. Age ≥ 60 years; hypertension, previous myocardial infarction and delayed presentation were associated with poor surgical outcomes. An awareness to create the importance of early arrival, optimizing co-morbidities, timely detection and treating immediately on arrival of the patient, play a key role in improving surgical outcomes of acute limb ischemia. Keywords: Acute ischemia, Thrombosis, Embolism, Re-vascularization, Limb amputation

Characteristics of ST-elevation myocardial infarction with failed thrombolysis

2020 ◽  
Vol 28 (5) ◽  
pp. 266-272
Author(s):  
Ashish Mishra ◽  
Jayesh Prajapati ◽  
Gajendra Dubey ◽  
Iva Patel ◽  
Mukesh Mahla ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Fibrinolytic Therapy ◽  
St Elevation Myocardial Infarction ◽  
Delayed Presentation ◽  
Killip Class ◽  
Clinical Variables ◽  
Percutaneous Coronary ◽  
St Elevation

Background Fibrinolytic therapy is an important reperfusion strategy, especially when primary percutaneous coronary interventions cannot be offered to ST-elevation myocardial infarction patients. Given that failed reperfusion after fibrinolytic therapy is common, it is pragmatic that the predictors, outcomes, and angiographic profiles of patients with failed thrombolysis are carefully scrutinized. Methods We prospectively studied clinical variables and outcomes over 30 months in 243 ST-elevation myocardial infarction patients who received fibrinolytics as primary treatment. Logistic regression analysis was used to identify predictors of failed thrombolysis. Results Failed thrombolysis occurred in 38.68% of patients with a mean window period of 6.58 ± 1.42 h, and 55.32% of patients with failed thrombolysis had Killip class >I on presentation. Risk factors such as diabetes mellitus (55.32%), dyslipidemia (60.64%) and obesity (77.66%) were frequently associated with failed thrombolysis; 73.40% of patients with failed thrombolysis had Thrombolysis in Myocardial Infarction flow grade 0/1 in the infarct-related artery, and 58.51% of such patients needed a rescue percutaneous coronary intervention. The mean Thrombolysis in Myocardial Infarction risk score was 5.46 ± 2.77 in failed thrombolysis patients, with mortality of 4.25% at the 6-month follow-up. Conclusion Non-resolution of presenting symptoms and ST changes on electrocardiography at 90 min served as the earliest indicators of failed thrombolysis, with a significant angiographic correlation. Clinical variables such as delayed presentation (>6 h), dyspnea, Killip class >I, cardiogenic shock, Thrombolysis in Myocardial Infarction score, and conventional risk factors including diabetes mellitus, dyslipidemia, and obesity represented cluster of predictors of failed thrombolysis.

scholarly journals Rupture of the myocardium in autopsied MI hearts

2017 ◽  
Vol 63 (9) ◽  
pp. 733-735
Author(s):  
Valesca Bizinoto Monteiro ◽  
Bianca Gonçalves Silva Torquato ◽  
Guilherme Ribeiro Juliano ◽  
Bárbara Cecílio da Fonseca ◽  
Flávia Aparecida de Oliveira ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
Cardiogenic Shock ◽  
Arterial Hypertension ◽  
High Mortality ◽  
Systemic Arterial Hypertension ◽  
Myocardial Rupture

Summary Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Prevalence and prognostic impact of left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T.J Jernberg ◽  
E.O Omerovic ◽  
E.H Hamilton ◽  
K.L Lindmark ◽  
L.D Desta ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Risk Factor ◽  
Reperfusion Therapy ◽  
Left Ventricular ◽  
Funding Source ◽  
Additional Risk Factor ◽  
Additional Risk

Abstract Background Left ventricular dysfunction after an acute myocardial infarction (MI) is associated with poor outcome. The PARADISE-MI trial is examining whether an angiotensin receptor-neprilysin inhibitor reduces the risk of cardiovascular death or worsening heart failure (HF) in this population. The aim of this study was to examine the prevalence and prognosis of different subsets of post-MI patients in a real-world setting. Additionally, the prognostic importance of some common risk factors used as risk enrichment criteria in the PARADISE-MI trial were specifically examined. Methods In a nationwide myocardial infarction registry (SWEDEHEART), including 87 177 patients with type 1 MI between 2011–2018, 3 subsets of patients were identified in the overall MI cohort (where patients with previous HF were excluded); population 1 (n=27 568 (32%)) with signs of acute HF or an ejection fraction (EF) <50%, population 2 (n=13 038 (15%)) with signs of acute HF or an EF <40%, and population 3 (PARADISE-MI like) (n=11 175 (13%)) with signs of acute HF or an EF <40% and at least one risk factor (Age ≥70, eGFR <60, diabetes mellitus, prior MI, atrial fibrillation, EF <30%, Killip III-IV and STEMI without reperfusion therapy). Results When all MIs, population 1 (HF or EF <50%), 2 (HF or EF <40%) and 3 (HF or EF <40% + additional risk factor (PARADISE-MI like)) were compared, the median (IQR) age increased from 70 (61–79) to 77 (70–84). Also, the proportion of diabetes (22% to 33%), STEMI (38% to 50%), atrial fibrillation (10% to 24%) and Killip-class >2 (1% to 7%) increased. After 3 years of follow-up, the cumulative probability of death or readmission because of heart failure in the overall MI population and in population 1 to 3 was 17.4%, 26.9%, 37.6% and 41.8%, respectively. In population 2, all risk factors were independently associated with death or readmission because of HF (Age ≥70 (HR (95% CI): 1.80 (1.66–1.95)), eGFR <60 (1.62 (1.52–1.74)), diabetes mellitus (1.35 (1.26–1.44)), prior MI (1.16 (1.07–1.25)), atrial fibrillation (1.35 (1.26–1.45)), EF <30% (1.69 (1.58–1.81)), Killip III-IV (1.34 (1.19–1.51)) and STEMI without reperfusion therapy (1.34 (1.21–1.48))) in a multivariable Cox regression analysis. The risk increased with increasing number of risk factors (Figure 1). Conclusion Depending on definition, post MI HF is present in 13–32% of all MI patients and is associated with a high risk of subsequent death or readmission because of HF. The risk increases significantly with every additional risk factor. There is a need to optimize management and improve outcomes for this high risk population. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis

scholarly journals RISK FACTORS ASSOCIATED WITH THE OCCURRENCE OF EARLY COMPLICATIONS OF ACUTE MYOCARDIAL INFARCTION AFTER CARDIO-INTERVENTION TREATMENT

2020 ◽  
Vol 73 (6) ◽  
pp. 1245-1251
Author(s):  
Iryna A. Holovanova ◽  
Grygori A. Oksak ◽  
Iryna M. Tkachenko ◽  
Maxim V. Khorosh ◽  
Mariia M. Tovstiak ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Risk Indicators ◽  
Interventional Treatment ◽  
Early Complications ◽  
Cox Regression Analysis ◽  
Intervention Treatment

The aim of our study was to identify the main risk factors for the occurrence of early complications of acute myocardial infarction after cardio-interventional treatment and to evaluate prognostic risk indicators. Materials and methods: Risk factors of myocardial infarction were determined by copying the case history data and calculating on their basis of the odds ratio and ±95% confidence interval. After it, we made a prediction of the risk of early complications of AMI with cardiovascular intervention by using a Cox regression that took into account the patient’s transportation time by ambulance. Results: Thus, the factors that increase the chances of their occurrence were: summer time of year; recurrent myocardial infarction of another specified localization (I122.8); the relevance of the established STEMI diagnosis; diabetes mellitus; renal pathology; smoking; high rate of BMI. Factors that reduce the chances of their occurrence: men gender – in 35%; the age over of 70 – by 50%; the timely arrival of an emergency medical team – by 55%. The factors that increase the chances of their occurrence were: age over 70 years; subsequent myocardial infarction of unspecified site; diabetes mellitus. Using of a Cox regression analysis, it was proved that the cumulative risk of early complications of AMI with cardio-intervention treatment increased from the 10th minute of ambulance arrival at place, when ECG diagnosis (STEMI), presence of diabetes mellitus, smoking and high BMI. Conclusions: As a result of the conducted research, the risk factors for early complications of AIM with cardio-interventional treatment were identified.

Abstract 17605: Cost-Effectiveness of Contemporary Endovascular Treatment Compared to Open Surgical Revascularization for Cardioembolic Acute Limb Ischemia

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Elizabeth A Genovese ◽  
Kenneth J Smith ◽  
Neal R Barshes ◽  
Michel S Makaroun ◽  
Donald T Baril
Keyword(s):  
Mortality Rate ◽  
Endovascular Treatment ◽  
Cost Effective ◽  
Limb Ischemia ◽  
Morbidity And Mortality ◽  
Adverse Event Rate ◽  
Parameter Estimates ◽  
Acute Limb Ischemia ◽  
Technical Success ◽  
Life Years

Introduction: Treatment of acute limb ischemia (ALI) has a high morbidity and mortality given patients’ multiple comorbidities, poor physiologic reserve, and the need for emergent intervention. Traditionally ALI of embolic origin has been treated with open revascularization (OR), however with increasing experience with thrombolytic therapy and adjuvant techniques, endovascular revascularization (ER) for ALI has become a more common treatment due to the lower associated morbidity and mortality. Hypothesis: Although associated with higher initial costs and lower technical success rates, ER will be cost effective given the decreased adverse event rate and mortality in a frail patient population. Methods: A Markov state-transition model was created to simulate patient oriented outcomes, including technical success, adverse events, limb salvage, discharge facility and quality adjusted life years (QALY) for patients presenting with Rutherford Classification I/IIa/IIb ALI secondary to cardiac embolism. A societal perspective was assumed with a 10-year time horizon. Parameter estimates were derived from published literature and primary data of cardioembolic ALI patients treated at our institution from 2005-2011 with either ER or OR. Costs were adjusted to 2013 U.S. dollars. Results: In the model, OR was technically successful in 87% patients, with a $23,881 cost for the initial hospitalization and a 11.5% perioperative mortality rate; ER was technically successful in 71% of patients, with a $39,619 initial cost, and a 4% mortality rate. At 10 years, the ER strategy cost $92,659/QALY gained compared to OR. Sensitivity analyses demonstrated that ER was favorable at a willingness to pay (WTP) threshold of $100,000/QALY when ER technical success was >70%, initial ER hospitalization cost was <$41,052 or if OR mortality was >10%. At a WTP of $50,000/QALY, ER was cost effective if technical success reached 79%, if ER cost was <$31,287 or if OR mortality was >23%. Conclusions: Contemporary endovascular treatment of cardioembolic ALI carries a greater cost compared to open revascularization, however it is associated with a decreased mortality rate. ER is potentially cost-effective in patients who are at high risk of post-operative mortality following OR.

scholarly journals Temporal trends in the presentation of cardiovascular and cerebrovascular emergencies during the COVID-19 pandemic in Germany: an analysis of health insurance claims

2020 ◽  
Vol 109 (12) ◽  
pp. 1540-1548 ◽  
Author(s):  
Moritz Seiffert ◽  
Fabian J. Brunner ◽  
Marko Remmel ◽  
Götz Thomalla ◽  
Ursula Marschall ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Health Insurance ◽  
Hospital Admissions ◽  
Limb Ischemia ◽  
Acute Limb Ischemia ◽  
St Segment Elevation ◽  
Admission Rates ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Health Insurance Claims

Abstract Aims The first reports of declining hospital admissions for major cardiovascular emergencies during the COVID-19 pandemic attracted public attention. However, systematic evidence on this subject is sparse. We aimed to investigate the rate of emergent hospital admissions, subsequent invasive treatments and comorbidities during the COVID-19 pandemic in Germany. Methods and results This was a retrospective analysis of health insurance claims data from the second largest insurance fund in Germany, BARMER. Patients hospitalized for acute myocardial infarction, acute limb ischemia, aortic rupture, stroke or transient ischemic attack (TIA) between January 1, 2019, and May 31, 2020, were included. Admission rates per 100,000 insured, invasive treatments and comorbidities were compared from January–May 2019 (pre-COVID) to January–May 2020 (COVID). A total of 115,720 hospitalizations were included in the current analysis (51.3% females, mean age 72.9 years). Monthly admission rates declined from 78.6/100,000 insured (pre-COVID) to 70.6/100,000 (COVID). The lowest admission rate was observed in April 2020 (61.6/100,000). Administration rates for ST-segment elevation myocardial infarction (7.3–6.6), non-ST-segment elevation myocardial infarction (16.8–14.6), acute limb ischemia (5.1–4.6), stroke (35.0–32.5) and TIA (13.7–11.9) decreased from pre-COVID to COVID. Baseline comorbidities and the percentage of these patients treated with interventional or open-surgical procedures remained similar over time across all entities. In-hospital mortality in hospitalizations for stroke increased from pre-COVID to COVID (8.5–9.8%). Conclusions Admission rates for cardiovascular and cerebrovascular emergencies declined during the pandemic in Germany, while patients’ comorbidities and treatment allocations remained unchanged. Further investigation is warranted to identify underlying reasons and potential implications on patients’ outcomes. Graphic abstract

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