scholarly journals Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment

2020 ◽  
Author(s):  
Qun Lu ◽  
Ping Liu ◽  
Jian-Hua Huo ◽  
Yan-Ni Wang ◽  
Ai-Qun Ma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Features ◽  
Multivariate Logistic Regression Analysis ◽  
Reperfusion Therapy ◽  
Cardiac Rupture ◽  
Hospital Death ◽  
Post Surgery ◽  
Group 2 ◽  
Hs Crp ◽  
Group 1

Abstract Background. Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice. Methods. Two studies were conducted. In Study 1, Data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12.~2018.12. were analyzed. In Study 2, 83 male C57BL/6 mice were operated to MI, 39 mice were allocated for MI (group-1) and 21 mice for 1 h (group-2 ) and 23 mice for 4 h (group-3) ischemia followed by reperfusion. All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results. CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases, present in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. There were 17 deaths in group-1 during day 3–6 post MI. In the two IR groups, one mouse died of acute heart failure at day-5 post surgery and the rest of mice survived to the end of experiment without onset of rupture. Conclusion. CR remains as a major cause of in-hospital death in STEMI patients. CR Patients are characterized of being elderly, having larger infarct and more server inflammation. Reperfusion therapy can decrease CR incidence sharply.

scholarly journals Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Qun Lu ◽  
Ping Liu ◽  
Jian-Hua Huo ◽  
Yan-Ni Wang ◽  
Ai-Qun Ma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Features ◽  
Multivariate Logistic Regression Analysis ◽  
Reperfusion Therapy ◽  
Study Data ◽  
Cardiac Rupture ◽  
Hospital Death ◽  
Group 3 ◽  
Group 2 ◽  
Hs Crp

Abstract Background Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice. Methods Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi’an Jiaotong University during 2015.12. ~ 2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1 ~ 14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3–6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure. Conclusion CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.

scholarly journals Cardiac rupture complicating acute myocardial infarction: the clinical features from an observational study and animal experiment

2020 ◽  
Author(s):  
Qun Lu ◽  
Ping Liu ◽  
Jian-Hua Huo ◽  
Yan-Ni Wang ◽  
Ai-Qun Ma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Features ◽  
Multivariate Logistic Regression Analysis ◽  
Reperfusion Therapy ◽  
Study Data ◽  
Cardiac Rupture ◽  
Hospital Death ◽  
Group 3 ◽  
Group 2 ◽  
Hs Crp

Abstract Background. Cardiac rupture (CR) is a fatal complication of ST-elevation myocardial infarction (STEMI) with its incidence markedly declined in the recent decades. However, clinical features of CR patients now and the effect of reperfusion therapy to CR remain unclear. We investigated the clinical features of CR in STEMI patients and the effect of reperfusion therapy to CR in mice.Methods. Two studies were conducted. In clinical study, data of 1456 STEMI patients admitted to the First Hospital, Xi'an Jiaotong University during 2015.12.~2018.12. were analyzed. In experimental study, 83 male C57BL/6 mice were operated to induce MI. Of them, 39 mice were permanent MI (group-1), and remaining mice received reperfusion after 1 h ischemia (21 mice, group-2) or 4 h ischemia (23 mice, group-3). All operated mice were monitored up to day-10. Animals were inspected three times daily for the incidence of death and autopsy was done for all mice found died to determine the cause of death. Results. CR was diagnosed in 40 patients: free-wall rupture in 17, ventricular septal rupture in 20, and combined locations in 3 cases. CR presented in 19 patients at admission and diagnosed in another 21 patients during 1~14 days post-STEMI, giving an in-hospital incidence of 1.4%. The mortality of CR patients was high during hospitalization accounting for 39% of total in-hospital death. By multivariate logistic regression analysis, older age, peak CK-MB and peak hs-CRP were independent predictors of CR post-STEMI. In mice with non-reperfused MI, 17 animals (43.6%) died of CR that occurred during 3-6 days post-MI. In MI mice received early or delayed reperfusion, all mice survived to the end of experiment except one mouse died of acute heart failure.Conclusion. CR remains as a major cause of in-hospital death in STEMI patients. CR patients are characterized of being elderly, having larger infarct and more server inflammation. Experimentally, reperfusion post-MI prevented CR.

scholarly journals Efficacy of Clopidrogel on Reperfusion and High-Sensitivity C-Reactive Protein in Patients with Acute Myocardial Infarction

2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Mehmet Akbulut ◽  
Makbule Kutlu ◽  
Yılmaz Ozbay ◽  
Veli Polat ◽  
Mehmet Nail Bilen ◽  
...  
Keyword(s):  
Therapy Group ◽  
High Sensitivity ◽  
Reperfusion Therapy ◽  
Early Reperfusion ◽  
Unfractioned Heparin ◽  
Reactive Protein ◽  
St Segment ◽  
Group 2 ◽  
Hs Crp ◽  
Group 1

We investigated the effects of clopidogrel on reperfusion and inflammatory process in STEMI. A total of 175 STEMI patients with similar clinical characteristics were included to this study. One was the standard pharmacological reperfusion therapy group (group 1,n: 90), who received 300 mg aspirin, 70 U/kg bolus, and 12 U/kg/hr continuous infusion of unfractioned heparin and accelerated t-PA. Clopidogrel 450 mg loading and 75 mg/d thereafter was added to standard reperfusion therapy in the other group (group 2,n: 85). The ST-segment resolution, CK-MB, and high-sensitive CRP (hs-CRP) parameters were measured. Complete ST resolution was observed in 32 patients (36.8%) in group 1 and 53 patients (63.8%) in group 2 (). Also in the first 24 hours, the CK-MB levels of patients in group 1 were significantly higher than those of group 2 (). The hs-CRP values were greater in group 1 than group 2 at 48th hour (gruop 1:  mg/L, group 2:  mg/L; ). We concluded that adding clopidogrel to standard treatment in STEMI patients provided early reperfusion and suppression of inflammatory response.

scholarly journals Effects of High Loading Dose of Clopidogrel in ST Elevated Myocardial Infarction Treated with Fibrinolytic Agent

2013 ◽  
Vol 36 (1) ◽  
pp. 18 ◽  
Author(s):  
Hatice Solmaz ◽  
Mehmet Akbulut ◽  
Hasan Korkmaz ◽  
Mustafa F Yavuzkir ◽  
Oğuz K Kaya ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Sensitivity ◽  
Serum Levels ◽  
Fibrinolytic Therapy ◽  
Loading Dose ◽  
Cardiology Clinic ◽  
Group 3 ◽  
Group 2 ◽  
Hs Crp ◽  
Group 1

Purpose: The purpose of the present study was to evaluate the effects of different loading doses of clopidogrel on ST segment resolution on ECG, changes in cardiac enzyme levels and serum levels of high-sensitivity C-reactive protein (Hs-CRP) in patients with ST elevated myocardial infarction (STEMI) treated with fibrinolytic therapy. Methods: Patients admitted to our cardiology clinic with a diagnosis of STEMI and treated with fibrinolytic therapy were included: Group 1 (n=58) received a 300 mg loading dose of clopidogrel, Group 2 (n=55) a 450 mg loading dose and Group 3 (n=59) a 600 mg loading dose. A 75 mg/d maintanence dose of clopidogrel was given in all groups. Results: All demographic characteristics and baseline laboratory parameters were statistically similar among three groups (p > 0.05). When ST resolution periods were compared, most patients in Group 3 had ST resolution at 30 minutes; Group 2 at 60 minutes and Group 1 at 90 minutes (p < 0.05). Peak levels of creatine kinase (CK) and CK-MB were as follows: Group 3, 8th hour, Group 1 and 2, 12th hour. Peak levels of those enzymes were significantly lower in Group 3 than in Group 1 and 2 ( < 0.05). Although basal hs-CRP levels of all groups were similar, the increase in hs-CRP levels at 48 hours was lower with higher clopidogrel loading doses (p < 0.05). Conclusion: In this study comparing three different clopidogrel loading doses, the higher doses provided earlier ECG resolution, earlier and lower peak CK and CK-MB levels and lower levels of hs-CRP.

ST Depression, No ST Change, or ST Elevation in Inferior Derivations: Which Has the Worst Outcomes in Acute Anterior Myocardial Infarction?

Cardiology ◽  
2017 ◽  
Vol 139 (1) ◽  
pp. 53-61
Author(s):  
Mert İlker Hayıroğlu ◽  
Ahmet Okan Uzun ◽  
Ceyhan Türkkan ◽  
Muhammed Keskin ◽  
Edibe Betül Börklü ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Death ◽  
Anterior Myocardial Infarction ◽  
St Depression ◽  
St Segment ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: The combination of electrical phenomena and remote myocardial ischemia is the pathophysiological mechanism of ST segment changes in inferior leads in acute anterior myocardial infarction (MI). We investigated the prognostic value of ST segment changes in inferior derivations in patients with first acute anterior MI treated with primary percutaneous coronary intervention (PCI). Methods: In this prospective single-center analysis, we evaluated the prognostic impact of ST segment changes in inferior derivations on 354 patients with acute anterior MI. Patients were divided into the following 3 groups according to admission ST segment changes in inferior derivations: ST depression (group 1), no ST change (group 2), and ST elevation (group 3). Results: In-hospital multivariate analysis revealed notably high rates of in-hospital death for patients in group 3 compared to patients in group 2 (OR 2.5; 95% CI 1.6-7.6, p < 0.001). Group 1 and group 2 had similar in-hospital and long-term mortality rates. After adjusting for confounding baseline variables, group 3 had higher rates of 18-month mortality (HR 3.3; 95% CI 1.5-8.2, p < 0.001). Conclusion: In patients with a first acute anterior MI treated with primary PCI, ST elevation in inferior leads had significantly worse short-term and long-term outcomes compared to no ST change or ST segment depression.

Abstract 17011: Gender Differences in the Cardiovascular Risk Factors in First acute myocardial infarction in a Middle Eastern Country over a 20-year period

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Emad Ahmed ◽  
Ayman El-Menyar ◽  
Jassim Al Suwaidi ◽  
Hajar AH AlBinAli ◽  
Rajvir Singh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Middle Eastern ◽  
Temporal Trends ◽  
Multivariate Logistic Regression Analysis ◽  
Group 2 ◽  
Group 1

Introduction: Coronary artery disease (CAD) is a global health problem and a leading cause of death worldwide. Hypothesis: In Middle East, the rate of CAD is expected to rise in parallel with the increase in per capita income and cardiovascular risk factors (CVRFs) burden. The present study evaluates temporal trends in CVRFs stratified by gender over a 20-year period in Qatar. Methods: All patients hospitalized with first acute myocardial infarction (AMI) during the study period were analyzed and compared in 2 groups: group 1 (1991-2000) and group 2 (2001-2010). Results: Among 10,915 patients who were admitted with first AMI, 9610 (88%) were men and 1305 (12%) were women. The overall mean age was 52.7±11.8 years. The overall rate of hospitalization increased from 34% to 66% (p<0.001), representing a relative increase by 48%.The proportion of men to women remained relatively constant.During the study period. most of the measured CVRFs have shown a steady upward trend in both sexes. Compared to men, women were older, had a higher burden of CVRFs and presented mainly with non-ST-elevation MI. However, in comparison to group 1, women in group 2 had significant increases in the prevalence of dyslipidemia and obesity. Multivariate logistic regression analysis showed that female gender was independent predictor of in-hospital mortality (odd ratio 1.92, 95% CI 1.60-2.77). Conclusions: Over the study period, the rate hospitalization increased by nearly half, this potentially could be explained by the unfavorable alteration in the major modifiable CVRFs. Furthermore, women with acute myocardial infarction represent a higher risk group.

scholarly journals Assessment of Growth Differentiation Factor 15 Levels on Coronary Flow in Patients with STEMI Undergoing Primary PCI

Diseases ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 16
Author(s):  
Orhan Dogdu
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Coronary Blood Flow ◽  
Primary Pci ◽  
Growth Differentiation Factor 15 ◽  
Risk Of Death ◽  
Differentiation Factor ◽  
Group 2 ◽  
Hs Crp ◽  
Group 1

Growth Differentiation Factor-15 (GDF-15) is a strong predictor of decreased myocardial salvage and subsequent higher risk of death in patients with STEMI, but no information has been published regarding the association of GDF-15 levels with coronary blood flow in STEMI. We hypothesized that elevated GDF-15 levels would be associated with impaired flow and perfusion in the setting of STEMI treated with primary PCI. Eighty consecutive patients who were admitted with STEMI within 6 h from symptom onset were enrolled in the study. Patients were divided into two groups based upon the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Group 1 was defined as TIMI Grade 0, 1 and 2 flows. Angiographic success was defined as TIMI 3 flow (group 2). GDF-15 and high sensitive CRP were measured. Major adverse cardiac events (MACE) were defined as stent thrombosis, nonfatal myocardial infarction and in-hospital mortality. There were 35 patients (mean age 64 ± 11.8 and 20% female) in group 1 and 45 patients (mean age 66.8 ± 11.5 and 29% female) in group 2. GDF-15 and hs-CRP levels were significantly higher in group 1 than in group 2 (1670 ± 831pg/mL vs. 733 ± 124 pg/mL, p < 0.001; and 19.8 ± 10.6 vs. 11.3 ± 4.9, p < 0.001). GDF-15 level ≥920 pg/mL measured on admission had a 94% sensitivity and 91% specificity in predicting no-reflow at ROC curve analysis. In-hospital MACE was also significantly higher in group 1 (28.6% vs. 2.2%, p: 0.001). Additionally, there was a significant correlation between hs-CRP and GDF-15 (r: 0.6030.56; p < 0.001). The GDF-15 level on admission is a strong and independent predictor of poor coronary blood flow following primary PCI and in hospital MACE among patients with STEMI. Except for predictive value, GDF-15 levels may be a useful biomarker for the stratification of risk in patients with STEMI, and may carry further therapeutic implications.

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

scholarly journals Surgically treated acromegaly patients have a similar quality of life whether controlled by surgery or requiring additional medical therapy (QuaLAT Study)

Pituitary ◽  
2021 ◽  
Author(s):  
Muhammad Fahad Arshad ◽  
Oluwafunto Ogunleye ◽  
Richard Ross ◽  
Miguel Debono
Keyword(s):  
Quality Of Life ◽  
Medical Treatment ◽  
Physical Component Score ◽  
Healthy Controls ◽  
Component Score ◽  
Post Surgery ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Purpose There is no consensus on quality of life (QOL) in patients with acromegaly requiring medical treatment after surgery compared with those achieving remission by surgery alone. Methods QuaLAT is a cross-sectional study comparing QOL in surgery-only treated acromegaly patients versus those requiring medical treatment post-surgery. Patients attending clinics were identified and divided into—Group 1: patients who had surgery only and were in biochemical remission, Group 2: all patients on medical treatment post-surgery, Group 3: patients from Group 2 with biochemical control. Participants were asked to fill three questionnaires; Acromegaly Quality of Life Questionnaire (ACROQOL), 36-Item Short Form Survey (SF36), and Fatigue Severity Scale (FSS). Results There were 32 patients in Group 1 and 25 in Group 2. There was no difference in QOL scores between groups 1 and 2, as measured by ACROQOL (mean difference [MD] = − 2.5, 95% CI − 16.6 to 11.6; p = 0.72), SF36v2 [Physical component score (PCS) MD = − 4.9, 95% CI − 10.9 to 1.2; p = 0.12; mental component score MD = − 3.0, 95% CI − 10.5 to 4.4; p = 0.44], or FSS (MD = − 0.004, 95% CI − 1.14 to 1.33; p = 0.1). Comparison between groups 1 and 3 however showed that PCS (and 3 subdomains) was significantly better in group 3 (MD = − 8.3, 95% CI − 14.8 to -1.8; p = 0.01). All three QOL scores were lower when compared with healthy controls. Conclusions Medical treatment not only achieves a QOL comparable to surgery, it may also be associated with better QOL in physical subdomains. When compared with healthy controls, QOL remains worse in treated acromegaly patients compared to controls.

Predictive Value of Endocan Based on TIMI Risk Score on Major Adverse Cardiovascular Events After Acute Coronary Syndrome

Angiology ◽  
2018 ◽  
Vol 70 (10) ◽  
pp. 952-959 ◽  
Author(s):  
Mojtaba Ziaee ◽  
Sina Mashayekhi ◽  
Samad Ghaffari ◽  
Javad Mahmoudi ◽  
Parvin Sarbakhsh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Risk Score ◽  
Troponin I ◽  
Multivariate Logistic Regression Analysis ◽  
Major Adverse Cardiovascular Events ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Creatine Kinase Mb ◽  
Timi Risk Score

We assessed the prognostic value of serum levels of endocan in patients with the acute coronary syndrome (ACS) through its correlation with the Thrombolysis in Myocardial Infarction (TIMI) risk score and compared the possible association with clinical outcomes. In this prospective cross-sectional study, we enrolled 320 patients with documented ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA) who underwent diagnostic coronary angiography. Endocan was measured soon after admission in the emergency department. In-hospital death, heart failure, and recurrent infarction were considered major adverse cardiac events (MACEs). There was a significant positive correlation between endocan level and TIMI risk score and MACE. The optimal cutoff values of endocan to predict clinical end points were 3.45 ng/mL in patients with STEMI and 2.85 ng/mL in patients with UA/NSTEMI. Multivariate logistic regression analysis indicated that endocan independently correlated with MACE. Moreover, cardiac troponin I, creatine kinase-MB, and circulating endocan were found to be independently associated with MACE in patients with ACS. In conclusion, a high endocan level on hospital admission is an independent predictor of worse cardiovascular outcomes and higher TIMI risk score in patients with ACS.

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