scholarly journals Application of enoxaparin simultaneously with fibrinolysis in patients with acute myocardial infarction with ST-elevation

2009 ◽  
Vol 62 (1-2) ◽  
pp. 13-16 ◽  
Author(s):  
Nebojsa Despotovic ◽  
Goran Loncar ◽  
Maja Nikolic-Despotovic ◽  
Marjan Ilic ◽  
Sinisa Dimkovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adverse Effects ◽  
Fibrinolytic Therapy ◽  
Control Group ◽  
Study Group ◽  
Unfractioned Heparin ◽  
St Elevation ◽  
Coronary Events ◽  
Recurrent Ischemia

Introduction Applied simultaneously with fibrinolytic therapy, low-molecular heparin enoxaparin is showing the potential of improving efficacy with rare adverse effects. Our objective was to investigate if enoxaparin with streptokinase (SK) in patients with acute myocardial infarction (AMI) had better effect than unfractioned heparin (UFH). Material and methods The patients with AMI with ST elevation where SK was applied, were divided into two groups: 1. in the study group (N=32, SK+E) both SK and enoxaparin were administered (E, 30 mg intravenously before SK, then after SK 80 mg subcutaneously every 12 hours for 3 days); 2. the patients of the control group were given continuous infusion of UFH 4 hours after SK (1000 i.j. per hour, 3 days). Two groups were similar regarding average age, previous coronary events and diabetes mellitus. Results The reperfusion, depending mostly on fibrinolytic therapy, was successful in both groups (71.9% vs. 65.8%). The recurrent ischemia was less frequent in the group where enoxaparin was used (18.8% vs. 40.6%, p=0.055), as well as heart failure (15.6% vs. 53.2%, p=0,095). There was no difference in adverse effects. Conclusions Enoxaparin used simultaneously with streptokinase in patients with AMI with ST elevation was safe and effective. The recurrent ischemia, the parameter of 'infarcted' coronary artery reoclusion, is less frequent in patients who had enoxaparin than unfractioned heparin with fibrinolytic therapy.

The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Fu ◽  
C.X Song ◽  
X.D Li ◽  
Y.J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Large Scale ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Funding Source ◽  
St Elevation

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p<0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

Telephonic transmission of 12-lead electrocardiograms during acute myocardial infarction

2005 ◽  
Vol 11 (4) ◽  
pp. 185-190 ◽  
Author(s):  
K Mischke ◽  
M Zarse ◽  
M Perkuhn ◽  
C Knackstedt ◽  
K Markus ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Final Diagnosis ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Call Centre ◽  
Coronary Syndrome ◽  
False Positive Diagnosis ◽  
St Segment ◽  
St Elevation

To test the feasibility of a small and simple system for telephonic transmission of 12-lead electrocardiograms (ECGs), 70 patients with acute coronary syndrome admitted to the cardiac care unit (CCU) were included in a feasibility study. The transmission system consisted of a belt with multiple electrodes, which was positioned around the chest. The ECG signal was sent to a call centre via a standard telephone line. In parallel, a standard 12-lead ECG was recorded on site. In a retrospective analysis, each lead of the transmitted ECG was compared with the on-site 12-lead ECG with regard to ST-segment changes and final diagnosis. In all 37 patients with acute ST-elevation myocardial infarction, the diagnosis was correctly established on the basis of telephone-transmitted ECGs. In 96% of limb and 88% of chest leads, ST elevations which were visible in standard ECGs were correctly displayed on telephonically transmitted ECGs. In the remaining 33 patients no false-positive diagnosis was made using transtelephonic ECG analysis. A control group of 31 patients without apparent heart disease showed high concordance between standard ECGs and telephonically transmitted ECGs. Telephonically transmitted 12-lead ECGs interpreted by a hospital-based internist/cardiologist might allow a rapid and accurate diagnosis of ST-elevation myocardial infarction and may increase diagnostic safety for the emergency staff during prehospital decision making and treatment of acute myocardial infarction.

scholarly journals Assessment of Serum Uric Acid Levels in Patients with Acute Myocardial Infarction

2020 ◽  
Vol 3 (2) ◽  
pp. 46-48
Author(s):  
Manjiri Ravindra Kulkarni
Keyword(s):  
Myocardial Infarction ◽  
Uric Acid ◽  
Serum Uric Acid ◽  
Uric Acid Level ◽  
Acid Level ◽  
Control Group ◽  
Study Group ◽  
Acute Mi ◽  
St Elevation

Background : Aim of the study was to discover if there is the efficacy of serum uric acid in the prognostication of myocardial infarction subjects. Subjects and Methods: A total of 200 subjects were incorporated into the research. Of them, 74 patients had ST- elevated myocardial infarction, as in 26 subjects they were diagnosed with non-ST elevation myocardial infarction. Of the total of 100 subjects in the study group, there were 70 males and 30 females. A total of 100 healthy individuals as a control group were also incorporated in the study. Serum uric acid was measured on day 0, 3, 7 as well on day 30 of MI. Results: Serum uric acid was calculated on day 0, day 3, and day 7 and on day 30 of the myocardial infarction in the case study group. The mean uric acid levels on day 0 were found to be 6.32 1.45 mg/dl, mean uric acid level on day 3 was found to be 5.98 0.98 mg/dl, mean uric acid level on day 7 was found to be 5.14 2.18 mg/dl and mean uric acid level on day 30 was found to be 4.98 0.44 mg/dl. Conclusion: Serum uric acid stages are elevated in subjects of acute MI in contrast to standard well individuals. Subjects with higher Serum uric acid levels have an elevated probability of transience and it can be measured as a marker of appalling prediction.

CARDIAC ENZYME RELEASE AFTER FIBRINOLYTIC THERAPY WITH INTRAVENOUS (i.v.) APSAC OR INTRACORONARY (i.e.) STREPTOKINASE IN ACUTE MYOCARDIAL INFARCTION

1987 ◽  
Author(s):  
J J R M Bonnier ◽  
J B R M de Swart ◽  
J J M L Hoffmann
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Randomized Trial ◽  
Fibrinolytic Therapy ◽  
Study Group ◽  
Enzyme Release ◽  
Blood Samples ◽  
Significant Difference ◽  
Activator Complex ◽  
Peak Value

The release of CK, CK-MB and ASAT in patients with acute myocardial infarction (AMI) was studied on the relation to reperfusion. In a randomized trial 85 patients with proven AMI entered the study. The occlusion of the infarct related vessel and reperfusion were all assessed angiographically. Fibrinolytic therapy with anisoylated plasminogen streptokinase activator complex (APSAC) i.v. or with streptokinase (SK) i.e. was started within 4 (mean 2.4) hours of the onset of symptoms. 42 were treated with a single i.v. injection over 3-5 min. of APSAC (30U) and 43 with an i.e. infusion over 60 min. of SK (250.000U). Reperfusion was assessed angiographically at 90 min. after the start of treatment. Blood samples were taken before and every 4 hours after dosing up to 24 hours. 74 patients were evaluable for this analysis. The results are:Conclusion: a statistically significant difference (p < .05)** between the reperfused and non reperfused patients could only be demonstrated for the peak value of CK in the APSAC group and of CK-MB in the SK group.*On behalf of the Dutch Invasive Reperfusion Study Group.

scholarly journals Circulating Matrix Metalloproteinase-28 Levels Are Related to GRACE Scores and Short-Term Outcomes in Patients with Acute Myocardial Infarction

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Ke Zhou ◽  
Yuanmin Li ◽  
Yawei Xu ◽  
Rong Guo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Matrix Metalloproteinase ◽  
Cardiovascular Events ◽  
St Elevation Myocardial Infarction ◽  
Cardiac Events ◽  
Short Term ◽  
St Elevation ◽  
Coronary Events ◽  
Grace Score

Objective. To investigate the relationship between the level of matrix metalloproteinase-28 (MMP-28) in patients with acute myocardial infarction (AMI) and the global registry of acute coronary events (GRACE) scores as well as their short-term prognosis. Methods. Two hundred eleven patients with AMI were enrolled, and their basic clinical characteristics were collected for determining the GRACE score. We measured the plasma levels of MMP-28 and other biomarkers in the study population. The association of MMP-28 levels with cardiac events and cardiac deaths occurring within 30 days of discharge was evaluated with multivariable Cox proportional hazard models. Results. The MMP-28 levels were significantly higher in patients with acute ST-elevation myocardial infarction (STEMI) than in patients with non-ST-elevation myocardial infarction (NSTEMI) (P<0.01). Correlation analysis showed that the level of MMP-28 was positively correlated with the GRACE score in patients with AMI (R2=0.366, P<0.05). Cox multivariate regression results showed that MMP-28 was associated with cardiovascular events during the hospitalization and 30 days after discharge (P<0.01). In addition, Kaplan–Meier analysis showed that cardiac events and deaths were significantly higher in patients with MMP-28≥1.21 ng/mL (all P<0.01). Conclusion. There is a correlation between the plasma MMP-28 level and GRACE score in patients with AMI. MMP-28 is also associated with cardiovascular events and cardiovascular deaths during the hospitalization of patients and within 30 days of discharge.

Abstract 13864: In-hospital Management and Outcomes of Acute Myocardial Infarction Before and During the Coronavirus Disease 2019 Epidemic

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Bing Huang ◽  
Hui Yan ◽  
Guiqiu Cao ◽  
Jing Chen ◽  
Hong Jiang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Treatment Options ◽  
Hospital Management ◽  
Fold Increase ◽  
Mortality Rates ◽  
Control Group ◽  
Case Group ◽  
St Elevation ◽  
Matched Case

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. This study sought to share our experiences with in-hospital management and outcomes of acute myocardial infarction (AMI) before and during the COVID-19 epidemic. Methods and Results: We retrospectively analyzed consecutive AMI patients, including those with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI), from February 1, 2020, to April 15, 2020 (case group), and from January 1, 2019, to December 31, 2019 (control group) and conducted a 1:1 ratio-matched case-control study. Fifty-three AMI (31 STEMI, 22 NSTEMI) patients during the COVID-19 epidemic were matched to 53 AMI patients before the epidemic. Baseline characteristics were comparable between the groups. STEMI patients in the case group had a longer delay time, less primary or remedial PCI and more emergency thrombolysis than those in the control group. Less coronary angiography and stenting were performed in AMI patients in the case group than in the control group. Although there were no statistically significant differences in clinical outcomes between the two groups, STEMI patients in the case group had more than a three-fold increase in mortality rates. AMI combined with COVID-19 infection was associated with higher rates of mortality than AMI alone. Conclusions: The COVID-19 epidemic has resulted in significant reperfusion delays in STEMI patients and has a marked impact on the treatment options selection in AMI patients. This epidemic also results in more than a three-fold increase in mortality rates in STEMI patients, although the differences were not statistically significant.

scholarly journals Effect of sulfonylureas on attenuation of electrocardiographic ST- segment elevation during an acute myocardial infarction in diabetics

2018 ◽  
Vol 7 (4) ◽  
pp. 579
Author(s):  
Bapugouda Sahebagouda Patil ◽  
Naser Ashraf Tadvi
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Control Group ◽  
Diabetic Patients ◽  
Study Group ◽  
St Segment Elevation ◽  
St Segment ◽  
Significant Difference ◽  
The Mean

Background: Sulfonylureas are primarily used in the treatment of diabetes mellitus act by inhibiting ATP sensitive potassium ATP (K-ATP) channels. Similar channels are also present are also present in heart venticular muscle. Previous studies reveal that these drugs are able to reduce the electrocardiographic ST- segment elevation changes during an acute myocardial infarction. Hence, the present study was designed to evaluate the attenuating effect of sulfonylureas on ST- segment elevation in diabetic patients presenting with acute myocardial infarction.Methods: This cross sectional study included 73 diabetic patients presenting with the signs and symptoms of acute myocardial infarction of less than 24 hours duration along with CPK levels of more than 25 IU/L. Of them 5 were excluded from the study. The remaining 68 patients were included in the study, out of which 36 patients were in the study group (sulfonylurea group), and 32 patients were in the control group (non-sulfonylurea group).Results: No statistically significant difference was seen in the demographic parameters like age, sex, duration of diabetes mellitus and CPK levels (p>0.05). Among 68 patients 38 patients were diagnosed as STEMI. The mean magnitude of ST-elevation in the study group (n=16) was 2.3±0.12 and in control group (n=22) patients it was 3.7±0.33. The percentage of NSTEMI was significantly higher in study group compared to control. Statistically significant difference (p<0.05) was seen only between CPK level of range 25 and 100IU/L and mean magnitude of ST-segment elevation in STEMI patients. Significant difference in the mean magnitude of ST-segment elevation was observed in case of females among the study and control groups (p<0.05).Conclusions: Sulfonylureas drugs play a significant role in attenuation of ST-segment in diabetic patients presenting with acute myocardial infarction. Further, large multicentric studies are required to confirm the exact correlation between sulfonylureas and ST-segment.

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