scholarly journals PEMERIKSAAN CKMB DAN HS-TROPONIN T PADA PASIEN INFARK JANTUNG DENGAN PENINGKATAN SEGMEN NON-ST

2018 ◽  
Vol 20 (2) ◽  
pp. 160
Author(s):  
AK Salim ◽  
M Suryaatmadja ◽  
DA Hanafi
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Troponin T ◽  
Coronary Insufficiency ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Grade Ii ◽  
High Sensitive Troponin

Acute Coronary Syndrome (ACS)1 is a typical chest pain symptom due to ischemic coronary insufficiency caused by blockage of acoronary artery thrombus. There are three different states: Unstable Angina (UA), Non-ST segment Elevation Myocardial Infarction(NSTEMI) and ST segment Elevation Myocardial Infarction (STEMI).1 Cardiac Troponin (cTn) is a myocardial ischemia marker.6 A clinicalcontext is very important for the interpretation of the value of cTn, the increase of cTn is not always due to Acute Myocardial Infarction(AMI). According to a research, a new cTn examination called ‘high sensitive troponin T’ (hs-cTropT) has a higher sensitivity than theprevious generations for the diagnosis of AMI.7 A 60- year- old female patient entered the ER of Cardiovascular Hospital Harapan Kitasuffering from chest pain since the day before. From the examination it seemed that the patient had a risk factor of dyslipidemia. Thelaboratory results showed normal routine hematology, CKMB , renal function, glucose and electrolytes, however, hs - cTropT and lipidprofile were shown above normal. The differential diagnosis of the symptoms shown was: UA/NSTEMI, with Congestive Heart Failure(CHF) grade II and overweight.

scholarly journals Survey of clinical practice pattern in Germany’s certified chest pain units

Herz ◽  
2021 ◽  
Author(s):  
Frank Breuckmann ◽  
Stephan Settelmeier ◽  
Tienush Rassaf ◽  
Felix Post ◽  
Winfried Haerer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Antiplatelet Therapy ◽  
Utilization Rate ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Impact ◽  
High Sensitive Troponin

Abstract Background We aimed to analyze the 2020 standard of care in certified German chest pain units (CPU) with a special focus on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) through a voluntary survey obtained from all certified units, using a prespecified questionnaire. Methods The assessment included the collection of information on diagnostic protocols, risk assessment, management and treatment strategies in suspected NSTE-ACS, the timing of invasive therapy in non-ST-segment elevation myocardial infarction (NSTEMI), and the choice of antiplatelet therapy. Results The response rate was 75%. Among all CPUs, 77% are currently using the European Society of Cardiology (ESC) 0/3‑h high-sensitive troponin protocol, and only 20% use the ESC 0/1‑h high-sensitive troponin protocol as a default strategy. Conventional ergometry is still the commonly performed stress test with a utilization rate of 47%. Among NSTEMI patients, coronary angiography is planned within 24 h in 96% of all CPUs, irrespective of the day of the week. Prasugrel is the P2Y12 inhibitor of choice in ST-segment elevation myocardial infarction (STEMI), but despite the impact of the ISAR-REACT 5 trial on selection of antiplatelet therapy, ticagrelor is still favored over prasugrel in NSTE-ACS. If triple therapy is used in NSTE-ACS with atrial fibrillation, it is maintained up to 4 weeks in 51% of these patients. Conclusion This survey provides evidence that Germany’s certified CPUs ensure a high level of guideline adherence and quality of care. The survey also identified areas in need of improvement such as the high utilization rate of stress electrocardiogram (ECG).

Approach to the Patient Presenting with Chest Pain

2017 ◽  
Author(s):  
John Tobias Nagurney
Keyword(s):  
Myocardial Infarction ◽  
Emergency Department ◽  
Pulmonary Embolism ◽  
Acute Coronary Syndrome ◽  
Chest Pain ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pain History

Caring for the emergency department patient with chest pain represents an important challenge to the emergency physician. Chest pain is the second most common presentation among all emergency department patients, accounting for approximately 6 million visits per year in the United States. Chest pain may represent a benign condition or a time-critical life threat; symptom overlap between benign and serious conditions can make an accurate chest pain diagnosis challenging. This review covers the pathophysiology, assessment, stabilization, diagnosis and treatment, and disposition and outcomes of chest pain. The figure shows an algorithm outlining the approach to the patient with chest pain. Tables list critical and noncritical diagnoses in patients presenting with chest pain: history, physical examination, and bedside testing; risk factors or associations for acute coronary syndrome, pulmonary embolism, and aortic dissection; characteristics of the chest pain story to diagnose acute coronary syndrome; ABCDEs of resuscitation for patients with unstable vital signs; critical and noncritical diagnoses in patients presenting with chest pain: history, diagnosis, and treatment; prevalence of pulmonary embolism in patients classified as low or high probability for this diagnosis by Wells score, modified Geneva score, and gestalt; commonly recognized pitfalls in the workup and diagnosis of chest pain in the emergency department; critical diagnoses in patients presenting with chest pain: history, disposition, and outcome; and summary of current recommendations. This review contains 1 highly rendered figure, 11 tables, and 54 references. Key words: acute coronary syndrome, acute myocardial infarction, anginal pain, aortic dissection, cardiac-related pain, chest pain, coronary artery disease, non–ST segment elevation myocardial infarction, pulmonary embolism, ST segment elevation myocardial infarction

scholarly journals Prognostic Value of Serum Concentration of Heart-Type Fatty Acid–Binding Protein Relative to Cardiac Troponin T on Admission in the Early Hours of Acute Coronary Syndrome

2005 ◽  
Vol 51 (8) ◽  
pp. 1397-1404 ◽  
Author(s):  
Junnichi Ishii ◽  
Yukio Ozaki ◽  
Jingchao Lu ◽  
Fumihiko Kitagawa ◽  
Takahiro Kuno ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Fatty Acid Binding Protein ◽  
Troponin T ◽  
Cardiac Events ◽  
Fatty Acid Binding ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background: Heart-type fatty acid–binding protein (H-FABP) is proposed as an early biomarker for acute myocardial infarction (AMI), but its prognostic value is unclear in acute coronary syndrome (ACS). We evaluated the prognostic value of the H-FABP concentration relative to cardiac troponin T (cTnT) in the early hours of ACS. Methods: Serum concentrations of H-FABP and cTnT were measured on admission in 328 consecutive patients hospitalized for ACS within 6 h after the onset of chest pain [AMI, 241 (73.5%) patients; ST-segment elevation myocardial infarction, 154 (47.0%) patients; and emergent coronary angiography within 24 h after admission, 287 (87.5%) patients]. Cardiac events, which were defined as cardiac death or subsequent nonfatal AMI, were monitored for 6 months after admission. Results: During the 6-month follow-up period, there were 25 cardiac events, including 15 cardiac deaths and 10 subsequent nonfatal AMIs. Stepwise multivariate analyses including clinical, electrocardiographic, and biochemical variables revealed that increased H-FABP (above the median of 9.8 μg/L), but not increased cTnT (above the median of 0.02 μg/L), was independently associated with cardiac events in all patients [relative risk (RR) = 8.96; P = 0.0004], the subgroup of patients with ST-segment elevation myocardial infarction (RR = 11.3; P = 0.02), and the subgroup of patients with unstable angina and non-ST-segment elevation myocardial infarction (RR = 8.31; P = 0.007). The area under the ROC curve was higher for H-FABP than for cTnT (0.711 vs 0.578; P = 0.08), suggesting that H-FABP concentrations have a greater predictive capacity for cardiac events than cTnT. Conclusion: Serum H-FABP is a potential independent predictor of cardiac events within 6 months of patient admission and may provide prognostic information superior to cTnT in the early hours of ACS.

Diagnostic value of circulating microRNAs compared to high-sensitivity troponin T for the detection of non-ST-segment elevation myocardial infarction

2021 ◽  
Author(s):  
Moritz Biener ◽  
Evangelos Giannitsis ◽  
Thomas Thum ◽  
Christian Bär ◽  
Alessia Costa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin T ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
High Sensitivity Troponin ◽  
St Segment ◽  
High Sensitivity Troponin T

Abstract Aims To assess the diagnostic value of microRNAs (miRNAs) for the detection of non-ST-segment elevation myocardial infarction (NSTEMI). Methods and results A total of 1042 patients presenting between August 2014 and April 2017 to the emergency department with the suspected acute coronary syndrome were included. Non-ST-segment elevation myocardial infarction was diagnosed per criteria of the fourth Universal definition of myocardial infarction (UDMI) using high-sensitivity troponin T (hs-cTnT). Expression levels of eleven microRNAs (miR-21, miR-22, miR-29a, miR-92a, miR-122, miR-126, miR-132, miR-133, miR-134, miR-191, and miR-423) were determined using RT-qPCR. Discrimination of NSTEMI was assessed for individual and a panel of miRNAs compared to the hs-cTnT reference using C-statistics and reclassification analysis. NSTEMI was diagnosed in 137 (13.1%) patients. The area under the curve (AUC) of the hs-cTnT based reference was 0.937. In a multivariate model, three miRNAs (miR-122, miR-133, and miR-134) were found to be associated with NSTEMI with AUCs between 0.506 and 0.656. A panel consisting of these miRNAs revealed an AUC of 0.662 for the diagnosis of NSTEMI. The AUC of the combination of the miRNA panel and troponin reference was significantly lower than the reference standard (AUC: 0.897 vs. 0.937, P = 0.006). Despite a significant improvement of NSTEMI reclassification measured by IDI and NRI, miRNAs did not improve the specificity of hs-cTnT kinetic changes for the diagnosis of NSTEMI (ΔAUC: 0.04). Conclusion Although single miRNAs are significantly associated with the diagnosis of NSTEMI a miRNA panel does not add diagnostic accuracy to the hs-cTnT reference considering baseline values and kinetic changes as recommended by the fourth version of UDMI. Clinical Trials Identifier NCT02116153

scholarly journals Diagnostic value of circulating microRNAs compared to high-sensitivity troponin T for the detection of non-ST-segment elevation myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Biener ◽  
E G Giannitsis ◽  
T Thum ◽  
C Baer ◽  
A Costa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin T ◽  
High Sensitivity ◽  
Diagnostic Value ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
High Sensitivity Troponin ◽  
St Segment ◽  
High Sensitivity Troponin T

Abstract Background/Introduction MicroRNAs (miRNAs) are promising biomarkers due to their high specificity and may facilitate differential diagnosis of patients presenting with suspected acute coronary syndrome (ACS) to the emergency department (ED). Purpose To assess the diagnostic value of eleven miRNAs for the detection of non-ST-segment elevation myocardial infarction (NSTEMI). Methods 1,042 patients presenting between August 2014 and April 2017 to the ED with suspected ACS were included. NSTEMI was diagnosed per criteria of the 4th Universal definition of myocardial infarction (UDMI) using high-sensitivity troponin T (hs-cTnT). Expression levels of eleven microRNAs (miR-21, miR-22, miR-29a, miR-92a, miR-122, miR-126, miR-132, miR-133, miR-134, miR-191, miR-423) were determined using RT-qPCR. Discrimination of NSTEMI was assessed for individual and a panel of miRNAs compared to the hs-cTnT reference using C-statistics and reclassification analysis. Results NSTEMI was diagnosed in 137 (13.1%) patients. The AUC of the hs-cTnT based reference was 0.937. In a multivariate model three miRNAs (miR-122, miR-133 and miR-134) were found to be associated with NSTEMI with AUCs between 0.506 and 0.656. A panel consisting of these miRNAs revealed an AUC of 0.662 for the diagnosis of NSTEMI. The AUC of the combination of the miRNA panel and troponin reference was significantly lower than the reference standard (AUC: 0.897 vs. 0.937, p=0.006). Despite a significant improvement of NSTEMI reclassification measured by IDI and NRI, miRNAs did not improve specificity of hs-cTnT kinetic changes for the diagnosis of NSTEMI (ΔAUC: 0.04). Conclusion Although single miRNAs are significantly associated with the diagnosis of NSTEMI a miRNA panel does not add diagnostic accuracy to the hs-cTnT reference considering baseline values and kinetic changes as recommended by 4th version of UDMI. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): German Heart Foundation/German Foundation of Heart Research.CIBERES (CB07/06/2008 to DdGC) is a project from Carlos III Health Institute. Central illustration

scholarly journals Effect of PCSK9 E670G and R46L Polymorphisms on Major Adverse Cardio-Cerebrovascular Events in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Anwar Santoso ◽  
Yulianto Yulianto ◽  
Hendra Simarmata ◽  
Abhirama Nofandra Putra ◽  
Erlin Listiyaningsih
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Cerebrovascular Events ◽  
St Segment ◽  
Significant Difference

AbstractMajor adverse cardio-cerebrovascular events (MACCE) in ST-segment elevation myocardial infarction (STEMI) are still high, although there have been advances in pharmacology and interventional procedures. Proprotein convertase subtilisin/Kexin type 9 (PCSK9) is a serine protease regulating lipid metabolism associated with inflammation in acute coronary syndrome. The MACCE is possibly related to polymorphisms in PCSK9. A prospective cohort observational study was designed to confirm the association between polymorphism of E670G and R46L in the PCSK9 gene with MACCE in STEMI. The Cox proportional hazards model and Spearman correlation were utilized in the study. The Genotyping of PCSK9 and ELISA was assayed.Sixty-five of 423 STEMI patients experienced MACCE in 6 months. The E670G polymorphism in PCSK9 was associated with MACCE (hazard ratio = 45.40; 95% confidence interval: 5.30–390.30; p = 0.00). There was a significant difference of PCSK9 plasma levels in patients with previous statin consumption (310 [220–1,220] pg/mL) versus those free of any statins (280 [190–1,520] pg/mL) (p = 0.001).E670G polymorphism of PCSK9 was associated with MACCE in STEMI within a 6-month follow-up. The plasma PCSK9 level was higher in statin users.

scholarly journals Analysis of risk factors for different subtypes of acute coronary syndrome

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110083
Author(s):  
Lei Zhang ◽  
Juledezi Hailati ◽  
Xiaoyun Ma ◽  
Jiangping Liu ◽  
Zhiqiang Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Brain Natriuretic Peptide ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Amino Terminal ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Aims To investigate the different risk factors among different subtypes of patients with acute coronary syndrome (ACS). Methods A total of 296 patients who had ACS were retrospectively enrolled. Blood and echocardiographic indices were assessed within 24 hours after admission. Differences in risk factors and Gensini scores of coronary lesions among three groups were analyzed. Results Univariate analysis of risk factors for ACS subtypes showed that age, and levels of fasting plasma glucose, amino-terminal pro-brain natriuretic peptide, and creatine kinase isoenzyme were significantly higher in patients with non-ST-segment elevation myocardial infarction (NSTEMI) than in those with unstable angina pectoris (UAP). Logistic multivariate regression analysis showed that amino-terminal pro-brain natriuretic peptide and the left ventricular ejection fraction (LVEF) were related to ACS subtypes. The left ventricular end-diastolic diameter was an independent risk factor for UAP and ST-segment elevation myocardial infarction (STEMI) subtypes. The severity of coronary stenosis was significantly higher in NSTEMI and STEMI than in UAP. Gensini scores in the STEMI group were positively correlated with D-dimer levels (r = 0.429) and negatively correlated with the LVEF (r = −0.602). Conclusion Different subtypes of ACS have different risk factors. Our findings may have important guiding significance for ACS subtype risk assessment and clinical treatment.

Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.P De Sousa Bispo ◽  
T.F Mota ◽  
R Fernandes ◽  
P Azevedo ◽  
D Carvalho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Discharge ◽  
Public Institution ◽  
Categorical Variables ◽  
Funding Source ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Discharge Medication ◽  
St Segment

Abstract Objectives To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal. Methods A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0.05 was considered statistically significant. Results During the study, a total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74.3% were male and average age of 63.9±13.6 years. We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24.3% to 98.4%, p<0.001), in coronary angioplasties (36.4% to 73.2%, p<0.001), in the use of drug-eluting stents (0% to 70.1%, p<0.001), and a decrease in the patients that underwent surgery (6.8% to 1.3%, p<0.001) and intra-aortic balloon pump (1.8% to 0%, p=0.009), resulting in a decrease in in-hospital mortality from 9.9% to 6.1% (p<0.001). At discharge, we report a progressive increase in the prescription of P2Y12 inhibitors (21.1% to 95.2%, p<0.001), beta-blockers (68.8% to 83.8%, p<0.001), RAAS inhibitors (69.5% to 86.7%, p<0.001) and statins (79.6% to 94.9%, p<0.001), while the prescription of aspirin (94.1% para 94.8%, p=0.428), calcium channel blockers (5.3% to 5.6%, p<0.684) stayed stable, and there was a decrease in the prescription of nitrates (52.9% to 5.8%, p<0.001). Hospital admissions at 6 months consistently and progressively reduced over time (18.6% to 8.5%, p<0.001) as well as mortality (6.7% para 4.3%, p<0.001). Conclusion Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality. 6 Month Outcomes over the years Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Sociedade Portuguesa de Cardiologia

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