How to decide which COVID-19 patient with myocardial infarction to send to the Cath Lab? - A case series of COVID-19 patients with myocardial infarction (Preprint)

2021 ◽  
Author(s):  
Denis Nikolov ◽  
Iana Simova ◽  
Nikolay Dimitrov ◽  
Vladimir Kornovski ◽  
Vesela Tomova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statistical Significance ◽  
Case Series ◽  
High Morbidity ◽  
Ecg Changes ◽  
Infarct Related Artery ◽  
The Mean ◽  
Typical Chest Pain ◽  
Marginal Statistical Significance ◽  
Single Center Observational Study

BACKGROUND The Coronavirus pandemic has hit the world with its vast contagiousness, high morbidity, and mortality. Apart from the direct damage to the lung tissue, the corona virus infection is able to predispose patients to thrombotic disease, thus causing cerebral or coronary incidents. OBJECTIVE The aim of this study was to find a clinical or laboratory parameter, that would help in distinguishing between COVID-19 patients with myocardial infarction (MI), who have an infarct-related artery (IRA) and therefore, require immediate revascularization, and those, who have no IRA. METHODS This was a single-center, observational study of 10 consecutive patients with COVID-19, who were admitted with confirmed MI. RESULTS In our study group the mean age was 67.5 ± 8.3 years, half of the patients were female; all of them had arterial hypertension; 8 patients (80%) had dyslipidemy; 4 (40%) had diabetes. 30% of the patients with MI did not have an IRA, and did not require pPCI. Patients with MI and IRA had significantly higher hsTrI values (48.9 ± 43.2 vs 0.6 ± 0.7, p=0.007) and exclusively typical chest pain 100% vs 0%, p=0.007), compared to patients with MI without an IRA. The ECG changes had only marginal statistical significance. Our results suggest that using a higher cut-off value for hsTrI (>7.5 times upper reference range) increases the specificity and positive predictive value for diagnosing a MI with the presence of IRA and need for pPCI, to 100% CONCLUSIONS In our analysis we confirm that a higher cut-off value for hsTrI helps distinguish between COVID patients with MI, who have IRA and therefore, require immediate revascularization, compared to those, who have no IRA.

scholarly journals How to decide which COVID-19 patient with myocardial infarction to send to the Cath Lab? - A case series of COVID-19 patients with myocardial infarction

2021 ◽  
Author(s):  
Iana Simova ◽  
Denis Nikolov ◽  
Nikolay Dimitrov ◽  
Vladimir Kornovski ◽  
Vesela Tomova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statistical Significance ◽  
Case Series ◽  
High Morbidity ◽  
Ecg Changes ◽  
Infarct Related Artery ◽  
The Mean ◽  
Typical Chest Pain ◽  
Marginal Statistical Significance ◽  
Single Center Observational Study

AbstractINTRODUCTIONThe Coronavirus pandemic has hit the world with its vast contagiousness, high morbidity, and mortality. Apart from the direct damage to the lung tissue, the corona virus infection is able to predispose patients to thrombotic disease, thus causing cerebral or coronary incidents.AIMSThe aim of this study was to find a clinical or laboratory parameter, that would help in distinguishing between COVID-19 patients with myocardial infarction (MI), who have an infarct-related artery (IRA) and therefore, require immediate revascularization, and those, who have no IRA.METHODSThis was a single-center, observational study of 10 consecutive patients with COVID-19, who were admitted with confirmed MI.RESULTSIn our study group the mean age was 67.5 ± 8.3 years, half of the patients were female; all of them had arterial hypertension; 8 patients (80%) had dyslipidemy; 4 (40%) had diabetes. 30% of the patients with MI did not have an IRA, and did not require pPCI. Patients with MI and IRA had significantly higher hsTrI values (48.9 ± 43.2 vs 0.6 ± 0.7, p=0.007) and exclusively typical chest pain 100% vs 0%, p=0.007), compared to patients with MI without an IRA. The ECG changes had only marginal statistical significance. Our results suggest that using a higher cut-off value for hsTrI (>7.5 times upper reference range) increases the specificity and positive predictive value for diagnosing a MI with the presence of IRA and need for pPCI, to 100%CONCLUSIONIn our analysis we confirm that a higher cut-off value for hsTrI helps distinguish between COVID patients with MI, who have IRA and therefore, require immediate revascularization, compared to those, who have no IRA.

Clinical and endoscopic aspects of metastases to the gastrointestinal tract

Endoscopy ◽  
2019 ◽  
Vol 51 (07) ◽  
pp. 646-652 ◽  
Author(s):  
Luiza Haendchen Bento ◽  
Mauricio Kazuyoshi Minata ◽  
Clelma Pires Batista ◽  
Bruno da Costa Martins ◽  
Luciano Henrique Lenz Tolentino ◽  
...  
Keyword(s):  
Survival Rate ◽  
Palliative Treatment ◽  
Survival Rates ◽  
Case Series ◽  
Gastric Body ◽  
Gi Tract ◽  
Cancer Disease ◽  
Primary Tumors ◽  
The Mean ◽  
Single Center Observational Study

Abstract Background Studies that describe metastases to the gastrointestinal (GI) tract are restricted to small case series. An increase in the frequency of this condition is expected, so it would be useful to better characterize the endoscopic aspects of metastasis to the GI tract. The aims of this study were to describe the frequency and endoscopic features of the lesions, and to analyze the survival rate after diagnosis of metastasis. Methods This was a retrospective, single-center, observational study, conducted between 2009 and 2017. Patients with metastasis to the GI tract were included. Results 95 patients were included. Melanoma (25.3 %), lung (15.8 %), and breast (14.7 %) were the most frequent primary tumors. The most common endoscopic presentation was a solitary, ulcerated lesion in the gastric body. Conventional biopsy was diagnostic in 98.9 % of the cases. The mean and median survival rates were 13.3 months (95 % confidence interval [CI] 8.2 – 18.3) and 4.7 months (95 %CI 3.7 – 5.6), respectively. Palliative treatment with chemo- and/or radiotherapy after the diagnosis of the metastasis was related to a higher survival rate. Conclusions Melanoma, lung, and breast cancer were the most common primary tumors to metastasize to the GI tract. The endoscopic features could not predict the primary site of the tumor. The finding of metastasis in the GI tract is related to the final stage of the cancer disease but patients who received palliative treatment with chemo- and/or radiotherapy after diagnosis of GI metastasis had higher survival rates.

P4617Early electrocardiographic changes as markers of coronary microvascular obstruction in acute myocardial infarction with ST segment elevation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C S Garcia Talavera ◽  
A Camblor Blasco ◽  
A L Rivero Monteagudo ◽  
M B Arroyo Rivera ◽  
M Cortes Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analysis ◽  
Poor Prognosis ◽  
Microvascular Obstruction ◽  
Univariate Analysis ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
St Segment ◽  
Increased Risk ◽  
The Mean

Abstract Background Coronary microvascular obstruction (CMVO), occurs frequently even after a quickly epicardial revascularization of the infarct-related artery (IRA), and has been associated with an increased risk of adverse cardiovascular events and poor prognosis in patients with ST-segment myocardial infarction (STEMI). After primary coronary intervention (PCI), incomplete ST-segment elevation (STE) resolution in the ECG has been related to CMVO and worse clinical outcome. However, there is lack of information regarding other ECG changes. The aim of this study is to describe the initial ECG changes in STEMI and evaluate their association with CMVO. Methods From January 2007 to December 2017, all patients with the diagnosis of STEMI that underwent urgent coronary angiography were retrospectively included. Clinical, echocardiographic, and electrocardiographic data were taken from medical records. A univariate and multivariate analysis was performed to evaluate the relationship between initial ECG changes (before PCI) and CMVO defined as final TIMI <3 in the IRA. Results 1022 patients were included; the mean age was 67.8 years (±14), 73.7% were male and 14.4% had previous coronary artery disease. The most frequent IRA was the anterior descending artery in 43.2% of the cases and CMVO was found in 18.3% of the patients. The mean value of STE sum (defined as the sum of STE in V1-V6, I and aVL in anterior STEMI and the sum of II, III, aVF, V5 and V6 in non-anterior STEMI), maximum STE in one lead and number of leads with STE was 11.36mm (± 8.2), 3.65mm (± 2.3) and 4.14mm (± 1.4), respectively. After a univariate analysis, STE sum, maximum STE in one lead and number of leads with STE were associated with CMVO, while only STE sum remained significantly associated with the presence of CMVO after a multivariate analysis (Table). The resolution of STE in the first 2 hours after PCI was a protector factor for CMVO. Univariate and Multivariate Analysis Univariate Multivariate Variables OR 95% CI p OR IC 95% p Sum of STE 1.03 1.01–1.04 0.013 1.03 1.01–1.05 0.005 Number of leads with STE 1.13 1.02–1.26 0.021 1.04 0.87–1.23 0.67 Maximum STE 1.09 1.02–1.16 0.016 1.04 0.92–1.17 0.49 Resolution of STE 0.35 0.25–0.49 <0.001 0.36 0.25–1.18 <0.001 STE, ST-segment elevation. Conclusion Initial ECG changes such as STE sum, number of leads with STE and maximum STE in one lead can be used as early predictors of CMVO and poor prognosis. STE resolution in the first 2 hour was associated with a lower incidence of CMVO as reported in previous studies. Acknowledgement/Funding None

scholarly journals Frequency of Hyperuricemia in the patients with Acute Myocardial Infarction.

2020 ◽  
Vol 27 (02) ◽  
pp. 284-288
Author(s):  
Samreen Zafar Memon ◽  
Shahid Hussain Memon ◽  
Shazia Kazi ◽  
Zain Islam Arain ◽  
Abdul Ghaffar Memon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Case Series ◽  
Health Sciences ◽  
Scientific Data ◽  
St Elevation ◽  
Laboratory Investigations ◽  
The Mean

Objectives: This study aims to scientifically fill the gap and provide the scientific data regarding frequency of hyperuricemia in the patients with acute myocardial Infarction admitted at Liaquat University of Medical & Health Sciences, Hyderabad. Study Design: Prospective descriptive case series. Setting: Department of Cardiology, Liaquat University of Medical & Health Sciences, Hyderabad. Period: From 7th Feb 2016 to 6th August 2018. Material and Methods: Was conducted on either gender having age ≥35 to ≤70 years presented with ST elevation myocardial infarction was included in the study. ECG and laboratory investigations were carried out. Relevant investigation like serum uric acid was sent to laboratory. Final outcome was assessed at the end of 5th day, hyperuricemia was labeled if serum uric acid levels above 6.5 mg/dl. All the information was noted in proforma and analyzed using SPSS version 21.0. Results: There were 95 male and 50 female patients. The mean age was 49.57 ± 8.53 years, with range 35 (35 - 70) years. The age of 49 (33.8%) patients was ≤45 years and age of 96 (66.2%) patients was >45 years. 17.9% patients were obese and 50.3% patients were hypertensive. The hyperuricemia was present in 27 (18.6%) patients.  Among patients who were found with hyperuricemia, the mean age was 49.41 ± 8.34 years. The results showed that significant association of hyperuricemia was observed with obesity.  No significant association of hyperuricemia was observed with gender, age, and hypertension. Conclusion: Based on the findings of our study, raised serum uric acid levels are associated with adverse cardiovascular outcome. The prevalence of hyperuricemia is high in a population of patients with acute myocardial infarction.

scholarly journals COMPLICATIONS AFTER PARTIAL, TOTAL OR EXTENDED SACRECTOMY: A CASE SERIES

2021 ◽  
Vol 20 (3) ◽  
pp. 229-231
Author(s):  
DANILO DE SOUZA FERRONATO ◽  
MAURO COSTA MORAIS TAVARES JUNIOR ◽  
DOUGLAS KENJI NARAZAKI ◽  
CESAR SALGE GHILARDI ◽  
WILLIAM GEMIO JACOBSEN TEIXEIRA ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Case Series ◽  
Hemodynamic Instability ◽  
Spinal Tumors ◽  
Posterior Fixation ◽  
High Morbidity ◽  
Hospitalization Time ◽  
Case Series Study ◽  
Tertiary Center ◽  
The Mean

ABSTRACT Objective The aim of this study was to conduct a survey of the different complications of partial, total or extended sacrectomy for the treatment of spinal tumors. Method This study is a descriptive analysis of medical records from a series of 18 patients who underwent sacrectomy between 2010 and 2019 at a tertiary center specializing in spinal tumor surgeries. The variables analyzed were sex, age, hospitalization time, oncologic diagnosis, posterior fixation pattern, rate of complications, and Frankel, ASA and ECOG scales. Results Of the 18 patients, 10 (55.5%) were male and 8 (44.5%) were female, and the mean age was 48 years. The mean hospitalization time was 23 days. Of the 18 patients, 8 (44.5%) contracted postoperative infections requiring surgery. Perioperative complications included liquoric fistula (22.25%), hemodynamic instability requiring vasoactive drugs in the immediate postoperative period (22.25%), wound dehiscence (11.1%), acute obstructive abdomen (11.1%), occlusion of the left external iliac artery (11.1%), immediate postoperative death due to acute myocardial infarction (11.1%), and intraoperative death due to hemodynamic instability (11.1%). Conclusions Partial, total or extended sacrectomy is a complex procedure with high morbidity and mortality, even in centers specializing in the treatment of spinal tumors. Level of evidence IV; case series study.

Late Intervention on an Occluded Infarct-Related Artery: A Meta-analysis of the Randomized Controlled Trials

2007 ◽  
Vol 1 ◽  
pp. CMC.S356
Author(s):  
Axel Zagler ◽  
Todd B. Heimowitz ◽  
Esteban Escolar ◽  
Steven J. Hussein ◽  
Zaheer R. Yousef ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Clinical Benefit ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Eligibility Criteria ◽  
Late Intervention ◽  
Infarct Related Artery

Context Late intervention to open an occluded infarct-related artery (IRA) after initial acute myocardial infarction was postulated to lead to clinical benefit. Objective To conduct a meta-analysis of the randomized trials. Study Selection Eligibility criteria were: 1) randomized trials comparing percutaneous coronary intervention (PCI) in a totally occluded artery (TIMI flow 0-1) versus medical therapy, 2) in stable post myocardial infarction (MI) patients without spontaneous or low level exercise induced ischemia, 3) trials with a time from the onset of symptoms to randomization >24 hours, but <6 weeks, and 4) trials reporting mortality and recurrent MI as an endpoint. Of 961 citations reviewed, 3 disagreements were easily resolved by discussion and 6 trials were selected for inclusion. Data Synthesis The primary endpoint was the composite of recurrent MI or death. The secondary endpoints were the development of heart failure or recurrent myocardial infarction. In a meta-analysis of the 6 trials, which included 2642 patients, late intervention of an IRA had a RR of death or recurrent MI of 1.12 (95% CI 0.91-1.38). Data regarding the development of heart failure was available for 4 trials. In a meta-analysis of these 4 trials, which included 2527 patients, late intervention of an IRA had a RR of 0.79 (95% CI 0.58-1.08). Data regarding the occurrence of recurrent MI was available for 5 trials. In a meta-analysis of these 5 trials, which included 2598 patients, late intervention of an IRA had a RR of 1.28 (95% CI 0.91-1.79). Conclusions Our meta-analysis of the currently available randomized data addressing late intervention of an occluded IRA failed to reveal clinical benefit with regard to the clinical endpoints of death, heart failure or reinfarction. The trend towards an increase in reinfarction among the PCI treated patients suggested by the Open Artery Trial (OAT) investigators persisted, but did not achieve statistical significance.

scholarly journals Gastric perforation mimicking ST-segment elevation myocardial infarction

2021 ◽  
Vol 14 (3) ◽  
pp. e237470
Author(s):  
Ryan Enast Intan ◽  
Fani Suslina Hasibuan ◽  
Parama Gandi ◽  
Firas F Alkaff
Keyword(s):  
Myocardial Infarction ◽  
Gastric Perforation ◽  
Management Strategies ◽  
High Morbidity ◽  
Ecg Changes ◽  
St Segment Elevation ◽  
Presenting Symptoms ◽  
Acute Peritonitis ◽  
St Segment ◽  
Main Instrument

ST-elevation myocardial infarction (STEMI) is one of the medical emergencies in cardiology with high morbidity and mortality rate which requires rapid response. In elderly patients, its presenting symptoms may be atypical which may cause the diagnosis of MI to be delayed or missed. Therefore, ST-segment elevation on ECG has become the main instrument for initial diagnosis. However, there are a variety of conditions mimicking the ECG changes of STEMI. We report a case of 70-year-old patient with acute peritonitis and pneumoperitoneum secondary to gastric perforation with dynamic ECG changes mimicking anteroseptal STEMI. After the surgery, the ECG dynamically reverted to normal. He was then discharged after 4 days without any remaining symptoms. Misinterpretation of ECG findings may lead to unnecessary aggressive intervention, costly management strategies and delay in appropriate treatment.

scholarly journals Correlation of Severity of ST Segment Elevation with Respect to the Site of Right Coronary Artery Lesion

2013 ◽  
Vol 52 (191) ◽  
Author(s):  
Rabindra Simkhada
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Inferior Wall ◽  
St Segment Elevation ◽  
St Segment ◽  
Infarct Related Artery ◽  
St Elevation ◽  
The Mean ◽  
St Segments ◽  
Lesion Severity

Introduction: Electrocardiogram a widely available tool may predict infarct related artery in acute inferior wall myocardial infarction. Severity of ST segment elevation may correlate with proximity of lesion in right coronary artery.Methods: Patient with acute ST segment elevation inferior wall myocardial infarction who underwent coronary angiogram was studied. Differences in electrocardiogram among right coronary and left circumflex groups were evaluated. Severity of ST segments elevation in relation to site of lesion in right coronary was studied.Results: The mean age of presentation was 59.52 ± 11.01 years. Total 36 (72%) were men. A total of 42 (84%) had lesion in right and 8 (16%) in left circumflex. Age, sex,diabetes,hypertension, smoking, dyslipidemia and physical activity showed no correlation with lesion in right or circumflex coronary artery. ST segment elevation in III>II (P=0.01), ST segment depression in AVL> I (P<0.01) and ST elevation in V4R (P=0.04), correlated with right coronary lesion. Sum of ST elevation in inferior leads were 10.90 ±1.30 mm for proximal, 7.38±1.19 mm for mid and 5.50± 0.53 mm for distal right coronary with significant correlation (P<0.01).Conclusions: Electrocardiogram was reliable tool to difference right and left circumflex lesion. Severity of sum of ST segment elevations in inferior leads correlated with the proximity of lesion in right coronary._______________________________________________________________________________________Keywords: acute inferior myocardial infarction; electrocardiogram; infarct related artery._______________________________________________________________________________________

scholarly journals Electrocardiographic Changes and Coronary Findings in Patients with Acute non-ST-Elevation Myocardial Infarction: A Cross-Sectional Study

2020 ◽  
Vol 9 (4) ◽  
Author(s):  
Fardin Mirbolouk ◽  
Arsalan Salari ◽  
Fatemeh Riahini ◽  
Mani Moayerifar ◽  
Sama Norouzi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Significant Relationship ◽  
St Elevation Myocardial Infarction ◽  
Syntax Score ◽  
Ecg Changes ◽  
Left Circumflex Artery ◽  
Electrocardiographic Changes ◽  
St Elevation ◽  
The Mean

Background: Despite significant improvements in diagnosis and treatment, non-ST-Elevation Myocardial Infarction (NSTEMI) is still one of the health problems in developed and developing countries. Objectives: The present study was performed to assess the electrocardiographic changes and coronary findings in patients with NSTEMI. Methods: The study enrolled 158 patients with NSTEMI diagnosis at the discharge time. Demographic characteristics and electrocardiographic changes were collected using a checklist from the medical records of the patients. The angiography data were used to calculate a syntax score for each patient. Finally, patients were divided into three groups based on this score: high risk >32, intermediate risk 22-32, and low risk < 22. Involved vessels, including the left anterior descending artery, Right Coronary Artery (RCA), Left Circumflex Artery (LCX), and the left main stem, were also determined. Results: The mean age of the patients was 60.68 ± 12.15 years. The LAD, LCX, and RCA were the most common involved vessels, in sequence. About 27.73, 67.15, and 5.12% of the patients were assigned to low, moderate, and high-risk groups, respectively. Statistically significant differences were observed in the frequencies of ECG changes (P = 0.003) and types of involved vessels (P < 0.001) between low, moderate, and high-risk patients. In addition, there were statistically significant differences in the mean syntax scores between different types of involved vessels (P < 0.001). Conclusions: The findings of the present study showed a significant relationship between the types of vessel involvement and syntax score. Also, there was a high prevalence of ST changes in precordial leads that may improve the sensitivity of diagnosis. We did not find any significant relationship between the frequencies of ECG changes based on the types of involved vessels.

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