Gender-Related Particularities in Acute Myocardial Infarction – a Study on a Patient Cohort from North East Romania

Abstract Introduction: Cardiovascular disease is the leading cause of death among women irrespective of race or ethnicity, and about half of these deaths are caused by coronary artery disease. Several studies have reported that cardiovascular diseases manifest themself with a delay of about 7–10 years in women and that they have higher in-hospital mortality. It has not yet been established whether female gender itself, through biological and sociocultural differences, represents a risk factor for early in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI). The aim of our study was to identify the angiographic particularities in women with STEMI from North East Romania. Material and Methods: For one year, 207 (31.7%) women and 445 (68.3%) men diagnosed with acute myocardial infarction were hospitalized in the Cardiology Clinic of the “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases in Iași, Romania. Results: The highest incidence of symptom onset was between 6:00 a.m. and 12:00 a.m., this morning polarization being more obvious in women. Within the first two hours of admission to the hospital, coronary angiography was performed in 78.1% of men and only 67.3% of women, the difference being statistically significant (p <0.05). We found that a large number of women had multivascular coronary disease (47.9% vs. 42.3%). At the same time, we found that left main disease and multivascular disease were more frequent in women than in men (3.8% vs. 0.7%, p = 0.001 for left main plus two-vessel disease, and 19.4% vs. 14.8%, p = 0.0005 for three-vessel disease). Conclusions: In women, coronary events began more frequently in the morning, with atypical symptoms; also, fewer women presented to the hospital within the first 12 hours after the onset of the acute event. Compared to men, women from North East Romania present a higher incidence of multivascular atherosclerotic coronary lessions, indicating a higher severity of STEMI in the female population from this geographical area.

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P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0452 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Soeda ◽

M Ishihara ◽

F Fujino ◽

H Ogawa ◽

K Nakao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiac Troponin ◽

Clinical Characteristics ◽

St Segment Elevation ◽

The Poor ◽

St Segment ◽

Universal Definition ◽

Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

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Left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction and low-risk GRACE score: Prevalence, clinical outcomes and predictors

Revista Portuguesa de Cardiologia ◽

10.1016/j.repc.2018.03.016 ◽

2018 ◽

Vol 37 (11) ◽

pp. 911-919 ◽

Cited By ~ 2

Author(s):

João Filipe Carvalho ◽

Adriana Belo ◽

Kisa Congo ◽

David Neves ◽

Ana Rita Santos ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcomes ◽

Low Risk ◽

Left Main ◽

St Segment Elevation ◽

Vessel Disease ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Grace Score

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Predictive Value of ST-Segment Elevation in Lead aVR for Left Main and/or Three-Vessel Disease in Non-ST-Segment Elevation Myocardial Infarction

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12272 ◽

2015 ◽

Vol 21 (1) ◽

pp. 91-97 ◽

Cited By ~ 16

Author(s):

Naoki Misumida ◽

Akihiro Kobayashi ◽

John T. Fox ◽

Sam Hanon ◽

Paul Schweitzer ◽

...

Keyword(s):

Myocardial Infarction ◽

Predictive Value ◽

Left Main ◽

St Segment Elevation ◽

Vessel Disease ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Lead Avr

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Outcome of Patients Having Acute Myocardial Infarction with and without Streptokinase

Medicine Today ◽

10.3329/medtoday.v31i2.41946 ◽

2019 ◽

Vol 31 (2) ◽

pp. 68-71

Author(s):

Faruque Uddin ◽

AK Fazlul Hoque

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Time Of Arrival ◽

College Hospital ◽

Medical College ◽

North East ◽

Acute Mi ◽

Medicine Today ◽

Mean Time

Introduction: Acute myocardial infarction is the leading cause of death. Streptokinase is the most commonly used thrombolytic agent. This study was conducted to compare in-hospital outcome of patients with acute myocardial infarction receiving streptokinase with those not receiving it. Materials & Methods: This descriptive observational study was conducted at Coronary Care Unit, North East Medical College Hospital from 1st July August 2016 to 30th June 2018. 340 patients having acute MI were in- cluded in the study. Two groups were formed: sk group receiving streptokinase and non-sk group not receiving. In-hospital mortality was the primary end point while mechanical and electrical complications were the secondary end points. Results: Among 340 patients, 255(75%) were males and 85(25%) females. Out of those 218 received strep-tokinase, while 122 did not. Mean age of sk group was 53.15±10.30 years and non-sk group 60.5±16 ears. Mean time of arrival to the hospital after symptom onset was 10.41±9.97 hours. SK group patients reached in 5.9±4.76 hours while non-sk group in 19.4±10.5 hours. In-hospital mortality in sk and non-sk group was 19(8.7%) and 25(20.5%) respectively, p=0.002. Complication rate was significantly higher in the non-sk group, 54.09% vs 34.86%, p=0.04. Conclusion: Patients of acute myocardial infarction receiving streptokinase have significantly lesser in-hospital mortality and complications as compared to patients not receiving it. Medicine Today 2019 Vol.31(2): 68-71

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Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction with high Killip class: Data from the Japan Acute Myocardial Infarction Registry

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872620926681 ◽

2020 ◽

pp. 204887262092668

Author(s):

Motoki Fukutomi ◽

Kensaku Nishihira ◽

Satoshi Honda ◽

Sunao Kojima ◽

Misa Takegami ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Short Term ◽

Term Outcome ◽

Killip Class ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Significant Difference

Background ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear. Methods We analyzed 3704 acute myocardial infarction patients with Killip II–IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction ( n = 2943) and non-ST-segment elevation myocardial infarction ( n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years. Results In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction ( n = 2001) and non-ST-segment elevation myocardial infarction ( n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction ( n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction ( n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204–3.722; p = 0.009) in patients ≥80 years of age. Conclusion Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.

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Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome

Journal Of Cardiovascular Emergencies ◽

10.1515/jce-2015-0010 ◽

2015 ◽

Vol 1 (2) ◽

pp. 68-74 ◽

Cited By ~ 1

Author(s):

Andreea Barcan ◽

Istvan Kovacs ◽

Ciprian Blendea ◽

Marius Orzan ◽

Monica Chitu

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Culprit Lesion ◽

Left Main ◽

St Segment Elevation ◽

Factors Associated ◽

Coronary Syndrome ◽

St Segment

Abstract Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented in the emergency department of a county clinical hospital which serves as a regional center for a STEMI network. Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed. Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients. Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial Infarction associate higher in-hospital mortality rates. In-hospital mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

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Abnormal P-Wave Terminal Force in LeadV1Predicts Left Main and/or Three-Vessel Disease in Patients withNon-ST-Segment Elevation Myocardial Infarction P-Wave Abnormality and Extensive Coronary Artery Disease

Annals of Noninvasive Electrocardiology ◽

10.1111/anec.12290 ◽

2015 ◽

Vol 20 (6) ◽

pp. 612-614 ◽

Cited By ~ 2

Author(s):

Akihiro Kobayashi ◽

Naoki Misumida ◽

Daniel Luger ◽

Yumiko Kanei

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

P Wave ◽

Left Main ◽

St Segment Elevation ◽

Vessel Disease ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Artery Disease

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Complete percutaneous myocardial revascularization in patients with STEMI complicated by cardiogenic shock

Vojnosanitetski pregled ◽

10.2298/vsp180128183p ◽

2019 ◽

Vol 76 (2) ◽

pp. 152-160

Author(s):

Milovan Petrovic ◽

Milana Jarakovic ◽

Milenko Cankovic ◽

Ilija Srdanovic ◽

Mila Kovacevic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Myocardial Revascularization ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Vessel Disease ◽

Early Revascularization ◽

Infarct Related Artery

Background/Aim. Despite considerable progress in terms of early myocardial revascularization and the use of mechanical circulatory support, cardiogenic shock continues to be the leading cause of death in acute myocardial infarction. The current recommendations of the European Society of Cardiology advocate early revascularization of all critical stenosis or highly unstable lesions in the state of cardiogenic shock, while recently published studies favour the early revascularization of the infarct related artery only, in patients with acute myocardial infarction with the ST segment elevation (STEMI) presenting with cardiogenic shock. The aim of the study was to assess the impact of the complete early percutaneous myocardial revascularization in an acute myocardial infarction complicated by cardiogenic shock on intra- hospital mortality. Methods. The research was conducted as a retrospective observational analysis of data obtained from the hospital registry for cardiogenic shock. The study group consisted of 235 patients treated in the period from August 2007 until October 2016 for STEMI complicated by cardiogenic shock. Three groups were formed. The first group consisted of patients with one vessel disease who underwent revascularization of infarct related artery; the second group of patients had multi-vessel disease and only culprit lesions were revascularized and the third one consisted of patients with multi-vessel disease and the complete myocardial revascularization performed. Additional subgroups were formed in reference to the intra-aortic balloon pump (IABP) implantation. Intra-hospital mortality was analyzed in all groups and subgroups. Results. Revascularization of the culprit lesion alone among patients with multivessel disease was performed in 142 (60.4%) patients while the complete revascularization (revascularization of ?culprit? and other significant lesions) was performed in 28 (11.9%) patients with multi-vessel disease. There were 65 (27.7%) patients with single-vessel disease who underwent revascularization of infarct related artery. The lowest mortality was found in the group of patients with multi-vessel coronary disease who underwent complete myocardial revascularization and had IABP implanted (mortality was 35.7%). The difference in the mean value of the left ventricular ejection fraction (EF) between the surviving and deceased patients was statistically significant (p < 0.005). The average EF of survivors was 44% (35%?50%) while 30% (25%?39.5%) deceased of patients. Based on the obtained data, the mathematically predictive model was tested. The receiver operating characteristic (ROC) curve showed that our model is a good predictor of fatal outcome (p < 0.0005; AUROC = 0.766) with the sensitivity of 80.3%, and the specificity of 67%. Conclusion. STEMI complicated by cardiogenic shock is still associated with a high mortality rate. Complete myocardial revascularization independently as well as in combination with an IABP, significantly reduces mortality in patients with acute STEMI complicated by cardiogenic shock.

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