PROGRESSIVE ATHEROSCLEROTIC CORONARY ARTERIES IN PATIENTS WITH SEVERAL ISCHEMIC EVENTS IN ANAMNESIS

2021 ◽  
pp. 113-119
Author(s):  
Parkhomenko O.M. ◽  
Lozhkina N.G.
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Clinical Signs ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Syntax Score ◽  
One Year ◽  
The Moment ◽  
Microsoft Office ◽  
Ischemic Events

Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes; study and understanding of this process is necessary to identify the appropriate risk groups. Purpose of the study to study the dynamics of atherosclerotic lesions of the coronary arteries in patients with several ischemic events in history. Patient Characterization and Research Methods. The present subanalysis included 51 patients with recurrent nonfatal myocardial infarction (MI) out of the initially included 100 patients with index MI. All 100 patients had a history of two or more ischemic coronary or cerebral events, which corresponds to the clinical signs of progressive atherosclerosis. The dynamics of the degree of coronary stenosis from the moment of index MI to repeated MI was assessed according to the data of selective coronary angiography. The statistical program Microsoft Office Excel 2019 was used. Results. All patients with recurrent myocardial infarction (51 people) had signs of progression of coronary artery stenosis: "mild" progression - 82.3%, "moderate" and "severe" - 15.6% and 2.1%, respectively. SYNTAX Score> 22.5 points was a predictor of one-year adverse outcomes: OR 6.349, CI (2.548-15.823). The results obtained make it possible to distinguish a group of patients with accelerated atherosclerosis syndrome in order to stratify the risk and optimally manage this complex category of patients.

scholarly journals Predictors of Progressive Course of Multifocal Atherosclerosis in Patients With Myocardial Infarction

Kardiologiia ◽  
2019 ◽  
Vol 59 (5) ◽  
pp. 36-44 ◽  
Author(s):  
D. Yu. Sedykh ◽  
A. N. Kazantsev ◽  
R. S. Tarasov ◽  
V. V. Kashtalap ◽  
A. N. Volkov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Family History ◽  
Syntax Score ◽  
Coronary Syndrome ◽  
History Of ◽  
One Year ◽  
Ica Stenosis ◽  
The Impact ◽  
Progression Of Atherosclerosis ◽  
Progressive Course

Purpose. Determination of clinical and instrumental predictors of progressive course of multifocal atherosclerosis (MFA) in patients one year after myocardial infarction (MI), initially having hemodynamically insignificant stenoses of carotid arteries.Materials and methods. From database of patients with acute coronary syndrome treated in the Kemerovo Regional Clinical Cardiac Dispensary in 2009–2010 we selected for this study 141 patients with verified diagnosis of MI and hemodynamically insignificant lesions in the internal carotid artery (ICA) (stenosis up ≤ 55 %). All patients had coronary atherosclerosis verified on coronary angiography at admission because of MI. A multivariate analysis of possible predictors of the progressive course of multifocal atherosclerosis was made based on assessment of the development of cardiovascular complications (CVC) (death, MI, stroke and transient cerebral circulatory attacks [TIA]), as well as revascularizations and negative dynamics of parameters of color duplex scanning (CDS) of ICA during one year after MI. Results. One year after MI the overall incidence of CVC was 16.3 % (n=23). Structure of registered events was as follows: death from MI 7.1 % (n=10), deaths from stroke 2.1 % (n=3) and other causes 2.1 % (n=3), non-fatal MI 5.0 % (n=7), non-fatal stroke / TIA 2.1 % (n=3), carotid revascularization 2.8 % (n=4), coronary revascularization 14.9 % (n=21). CDC of ICAs was repeated in 125 patients. There were 17 (13.6 %) cases of progression of carotid atherosclerosis in the form of de novo bilateral stenoses in 14 (11.2 %) patients, stenoses in the left and right ICA 1 patient and 2 patients, respectively. The following predictors of progression of atherosclerosis of cerebral arteries were identified: family history of cardiovascular diseases (CVD),ICA stenosis ≥45 %, baseline circular atherosclerotic plaque (ASP). Predictors of high risk of stroke were family history of CVD, history of stroke,ICA stenosis ≥45 %, heterogeneous hypoechoic ASP. As predictors of lethal outcome, we identified history of MI, high functional class of angina preceding the index MI, severe coronary vascular bed involvement (SYNTAX score >23), presence of any bilateral atherosclerotic lesion in ICAs, and heterogeneous hypoechoic ASP. Assessment of the contribution of adherence to therapy in the prognosis 1 year after hospital discharge was fulfilled in 125 alive patients. It allowed to conclude that patients with progression of atherosclerosis and nonfatal CVC were characterized by insufficient adherence to standard therapy.Conclusion. Predictors of the progressive course of multifocal atherosclerosis during one year after MI were identified in this study. It is necessary to strengthen therapeutic and preventive measures aimed at minimization of the impact of these factors in this category of patients.   

scholarly journals Impact of the Residual SYNTAX Score on Outcomes of Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Disease

2016 ◽  
Vol 10 ◽  
pp. CMC.S35730 ◽  
Author(s):  
Mohamed Loutfi ◽  
Sherif Ayad ◽  
Mohamed Sobhy
Keyword(s):  
Myocardial Infarction ◽  
Multivessel Disease ◽  
Index Admission ◽  
Clinical Indication ◽  
Syntax Score ◽  
Complete Revascularization ◽  
Term Survival ◽  
Significant Difference ◽  
One Year ◽  
Residual Syntax Score

Primary percutaneous coronary intervention (P-PCI) has become the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed by an experienced team in a timely manner. However, no consensus exists regarding the management of multivessel coronary disease detected at the time of P-PCI. Aim The aim of this study was to evaluate the use of the residual SYNTAX score (rSS) following a complete vs. culprit-only revascularization strategy in patients with STEMI and multivessel disease (MVD) to quantify the extent and complexity of residual coronary stenoses and their impact on adverse ischemic outcomes. Methods Between October 1, 2012, and November 30, 2013, we enrolled 120 consecutive STEMI patients with angiographic patterns of multivessel coronary artery disease (CAD) who had a clinical indication to undergo PCI. The patients were subdivided into those who underwent culprit-only PCI (60 patients) and those who underwent staged-multivessel PCI during the index admission or who were staged within 30 days of the index admission (60 patients). Both the groups were well matched with regard to clinical statuses and lesion characteristics. Clinical outcomes at one year were collected, and the baseline SYNTAX score and rSS were calculated. Results The mean total stent length (31.07 ± 12.7 mm vs. 76.3 ± 14.1 mm) and the number of stents implanted per patient (1.34 ± 0.6 vs. 2.47 ± 0.72) were higher in the staged-PCI group. The rSS was higher in the culprit-only PCI group (9.7 ± 5.7 vs. 1.3 ± 1.99). The angiographic and clinical results after a mean follow-up of 343 ± 75 days demonstrated no significant difference in the occurrence of in-hospital Major Adverse Cardiac and Cerebrovascular Events (MACCE) between both the groups (6.7% vs. 5%, P = 1.000). However, patients treated with staged PCI with an rSS ≤8 had significant reductions in one-year MACCE (10.7% vs. 30.5%, P = 0.020*), death/Myocardial infarction (MI)/Cerebrovascular accident (CVA) (5% vs. 13.8%, P = 0.016*), and repeat revascularization (4.8% vs. 25%, P = 0.001*). We found that culprit-only, higher GRACE risk scores at discharge and an rSS >8 were independent predictors of MACCE at one year. Conclusions Staged PCI that achieves reasonable complete revascularization (rSS ≤8) improves mid-term survival and reduces the incidence of repeat PCI in patients with STEMI and MVD. Nonetheless, large-scale randomized trials are required to establish the optimal revascularization strategy for these high-risk patients.

THE CLINICAL COURSE OF MYOCARDIAL INFARCTION PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH ACUTE KIDNEY INJURY

2021 ◽  
pp. 17-22
Author(s):  
Balabanov A.S. ◽  
Tupitcyn V.V. ◽  
Tassybayev B.B.
Keyword(s):  
Myocardial Infarction ◽  
Clinical Signs ◽  
Kidney Injury ◽  
Functional Class ◽  
Control Group ◽  
Study Group ◽  
Type I ◽  
Psychic Disorders ◽  
Group A ◽  
The Moment

Relevance. Acute kidneys injury (AKI) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with AKI during MI to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with ACI - 25 patients; II - control, without it - 486 patients. A comparative assessment of the MI CF frequency in selected groups were performed. Results. In patients of the study group more often than in the control group, a combination of MI complications (64.0 and 36.9%; respectively; p = 0.009), psychic disorders (20.0 and 6.9%; p = 0.01), chronic heart failure (CHF) of the second functional class and above (NYHA) at the end of the eighth MI week (72.0 and 43.2%; p = 0.005), with a predominance of newly diagnosed CHF forms (36.0 and 28.0%; p = 0.006). In the study group, less often than in the control group, pulmonary hypertension was noted in the first 48 hours of MI (44.0 and 66.0%; p = 0.02) and at the end of the third MI week (38.1 and 60.3%; p = 0.04). Conclusions. There were no specific clinical signs of AKI in men under 60 y.o. with MI. At the same time, the study group has the worst prognosis during the observation period in terms of the frequency of MI complications combinations and CHF, which requires the start of prophylactic therapy from the moment of AKI verification.

scholarly journals Discharge against medical advice after hospitalisation for acute myocardial infarction

Heart ◽  
2018 ◽  
Vol 105 (4) ◽  
pp. 315-321 ◽  
Author(s):  
Chun Shing Kwok ◽  
Mary Norine Walsh ◽  
Annabelle Volgman ◽  
Mirvat Alasnag ◽  
Glen Philip Martin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Groups ◽  
Medical Advice ◽  
Adverse Outcomes ◽  
Unplanned Readmission ◽  
Crude Rate ◽  
Against Medical Advice ◽  
Discharge Against Medical Advice ◽  
Poor Outcomes

BackgroundDischarge against medical advice (AMA) occurs infrequently but is associated with poor outcomes. There are limited descriptions of discharges AMA in national cohorts of patients with acute myocardial infarction (AMI). This study aims to evaluate discharge AMA in AMI and how it affects readmissions.MethodsWe conducted a cohort study of patients with AMI in USA in the Nationwide Readmission Database who were admitted between the years 2010 and 2014. Descriptive statistics were presented for variables according to discharge home or AMA. The primary end point was all-cause 30-day unplanned readmissions and their causes.Results2663 019 patients were admitted with AMI of which 10.3% (n=162 070) of 1569 325 patients had an unplanned readmission within 30 days. The crude rate of discharge AMA remained stable between 2010 and 2014 at 1.5%. Discharge AMA was an independent predictor of unplanned all-cause readmissions (OR 2.27 95% CI 2.14 to 2.40); patients who discharged AMA had >twofold increased crude rate of readmission for AMI (30.4% vs 13.4%) and higher crude rate of admissions for neuropsychiatric reasons (3.2% vs 1.3%). After adjustment, discharge AMA was associated with increased odds of readmissions for AMI (OR 3.65 95% CI 3.31 to 4.03, p<0.001). We estimate that there are 1420 excess cases of AMI among patients who discharged AMA.ConclusionsDischarge AMA occurs in 1.5% of the population with AMI and these patients are at higher risk of early readmissions for re-infarction. Interventions should be developed to reduce discharge AMA in high-risk groups and initiate interventions to avoid adverse outcomes and readmission.

P4573In patients with acute myocardial infarction, PCSK9 levels do not predict severity and recurrence of cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Zeller ◽  
G Lambert ◽  
M Farnier ◽  
M Maza ◽  
B Mouhat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
Positive Association ◽  
Cardiovascular Death ◽  
University Hospital ◽  
Syntax Score ◽  
One Year

Abstract Background In patients with coronary artery disease (CAD), it remains unclear whether serum PCSK9 levels can predict the severity of the disease and the risk of future cardiovascular events. Methods Among the patients admitted for an acute myocardial infarction (MI) from September 2015 to December 2016 in an intensive care unit from a university hospital, serum PCSK9 levels were measured on admission in patients not previously receiving statin therapy. We aimed to evaluate the association between PCSK9 levels, metabolic parameters, severity of CAD on coronary angiography, and the risk of in-hospital events and at one-year follow-up. Results In a total of 648 patients (mean age: 66 years, 67% male), the median PCSK9 was 263 ng/ml, higher for females compared with males (270 vs 256 ng/ml, p=0.009). Serum PCSK9 was associated with LDL cholesterol (r=0.083, p=0.036), total cholesterol (r=0.136, p=0.001) and triglycerides (r=0.137, p=0.001). A positive association was also observed in the subgroup of patients with CRP >10 mg/L (p<0.001), but not with NT-proBNP, troponin and creatine kinase. PCSK9 levels were similar whatever the SYNTAX score or the number of significant coronary lesions. Moreover, PCSK9 levels were not predictive of in-hospital events (death, recurrent MI and stroke) and events (cardiovascular death, cardiovascular events, recurrent MI) at one-year follow-up. Conclusion In this large cohort of patients hospitalized for acute MI and not previously receiving statin therapy, PCSK9 levels was not associated with the severity or the recurrence of cardiovascular events. The clinical utility of measuring PCSK9 levels remains to be demonstrated for this category of patients.

scholarly journals Clinical Outcome and Echocardiographic Evaluation of Inferior Myocardial Infarction with Right Ventricular Involvement

2012 ◽  
Vol 4 (2) ◽  
pp. 132-138 ◽  
Author(s):  
B Guha ◽  
AAS Majumder ◽  
MNA Chowdhury ◽  
MM Hossain ◽  
AK Mandal
Keyword(s):  
Myocardial Infarction ◽  
Right Ventricular ◽  
Clinical Signs ◽  
Cost Effective ◽  
Risk Groups ◽  
Inferior Wall ◽  
Right Ventricular Myocardial Infarction ◽  
Ventricular Infarction ◽  
Severity Of The Disease ◽  
The Right

Background : Acute right ventricular myocardial infarction complicates inferior wall myocardial infarction with an incidence of 14-84%. ECG is the cornerstone in initial diagnosis as it is cost effective and done easily. Echocardiographic analysis of the right ventricular involvement can shed light on the severity of the disease. Hence we aimed to study right ventricular infarction in acute inferior wall myocardial infarction using right precordial lead as well as echocardiography. Methods: Present study is based on the analysis of 100 patients admitted to Coronary care unit of the National Institute of Cardiovascular Diseases & Hospital during July 2010 to June 2011, with acute inferior wall myocardial infarction. 12 lead ECG with thorough physical examination was done along with right precordial mapping. ST ³ 1mm in V4R was initial diagnostic of right ventricular involvement followed by echocardiographic assessment of RV and LV within 24 hours. Results: A total of 50 patients showed right ventricular involvement with V4R being the sensitive lead. Echocardiography showed mean RVEF of patients with 29.5 % ± 9.5 in comparison of 44.9%±12.2 without right ventricular involvement. Right ventricular involvement presented with bradycardia (40%) and hypotension, 80% Kussmaul’s sign, 14% with complete heart block. Mortality in right ventricular involvement was 6 times higher than without right ventricular involvement (12 %). Conclusion: Clinical signs and symptomatology are not fully diagnostic of RVI in inferior wall acute MI. ECG can diagnose (using right precordial mapping) this condition very early. Echocardiography help to assess the right ventricular function high-risk groups for aggressive management like primary PCI. Early diagnosis will help in careful monitoring and management of such cases. DOI: http://dx.doi.org/10.3329/cardio.v4i2.10457 Cardiovasc. j. 2012; 4(2): 132-138

scholarly journals GRACE, SYNTAX I and SYNTAX II scores as predictors of one-year mace outcome in patients with myocardial infarction treated with percutaneous coronary intervention

2021 ◽  
pp. 55-55
Author(s):  
Aleksandar Davidovic ◽  
Dane Cvijanovic ◽  
Jelica Davidovic ◽  
Snezana Lazic ◽  
Bratislav Lazic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Predictive Power ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Percutaneous Coronary ◽  
One Year

Background/Aim. The fundamental objective of primary percutaneous coronary intervention (PKI) in myocardial infarction is to provide early, complete and sustained flow in the occluded artery that has led to myocardial ischemia or necrosis. The aim of this study was to determine the predictive power of a combination of GRACE, SYNTAX I, and SYNTAX II scores in predicting major cardiovascular adverse events and one-year mortality in patients with STEMI and NSTEMI myocardial infarction after primary PCI. Methods. Our study included 400 patients who had their first acute myocardial infarction and underwent percutaneous coronary intervention, treated and followed for one year at the Clinical Hospital Center Zvezdara at the Department of Interventional Cardiology. By monitoring the defined clinical parameters, a comparative analysis of risk scores was performed: GRACE, SYNTAX I and SYNTAX II, their sensitivity, specificity as well as predictive possibilities in predicting adverse outcomes were determined. Results. The incidence of major adverse cardiovascular outcomes in our sample was 12,8%. Patients with STEMI entity had significantly higher values of GRACE, SYNTAX I and SYNTAX II scores. The highest value for predicting the occurrence of major adverse cardiovascular outcomes was shown by the SYNTAX II score (score value 29,3) with a sensitivity of 88,2% and a specificity of 76,8%. The GRACE score is a significant predictor of SYNTAX I and SYNTAX II scores, a two-way correlation was observed between the high score values of all three scores. Conclusion. The presented scores for assessment of clinical and angiographic indicators, showed good predictive power in assessing the outcome of adverse cardiovascular events in both clinical entities of acute myocardial infarction during one year follow up. By using the proposed scores to assess adverse outcomes, we can single out high-risk patients in order to prevent outcomes and reduce mortality. This suggests its suitability for clinical use in this patient population.

QUALITY OF LIFE IN MEN UNDER 60 YEARS OLD WITH MYOCARDIAL INFARCTION AND CHRONIC INFLAMMATORY PULMONARY DISEASE

2021 ◽  
pp. 11-16
Author(s):  
Balabanov A.S. ◽  
Tupitsyn V.V. ◽  
Trinh Van Nhan
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Control Group ◽  
Study Group ◽  
Type I ◽  
Social Significance

Relevance. Problems of chronic heart failure (HF) after myocardial infarction (MI) prevention of in young and middle-aged men with chronic inflammatory pulmonary diseases (CIPD) remain relevant due to their high prevalence and social significance. Aim. To evaluate changes in the quality of life (QL) indicator associated with heart failure (HF) in men under 60 years old with MI and CIPD to improve prevention and outcomes. Material and methods. The study included men aged 19-60 years old with type I MI. Patients are divided into two age-comparable groups: I - the study group, with CIPD - 166 patients; II - control, without it - 490 patients. A comparative analysis of the QL indicator associated with HF (HFQL) (V. Ironosov) was performed in the selected groups in the first 48 hours (I) and at the end of the third week (II) of MI. The changes and correlations (C. Spearmen) of HFQL with clinical features, metabolic parameters, central and peripheral hemodynamics were studied. Results. HFQL in patients with CIPD was worse than in the control group in both phases of the study (I: 63.6 ± 21.6 and 59.2±20.1; II: 20.7 ± 11.7 and 18.0 ± 12.0, respectively; p˂0.05). Reliable correlations between HFQL and heart rate, blood pressure, parameters of the left ventricle (LV) systolic and diastolic functions, its volume, indicators of the pulmonary circulation, lipid, nitrogen and electrolyte metabolism were revealed. Conclusions. The QL associated with HF is significantly worse in patients with CIPD in the acute and subacute MI periods. The most pronounced negative effect on this indicator in the study group is associated with tachycardia, LV dilatation, its systolic and diastolic dysfunction, pulmonary hypertension, impaired lipid and nitrogen metabolism. The HFQL method is useful as an addition to the complex of examination of patients with MI and MS, starting from the first hours of the disease, for early identification of risk groups for adverse outcomes and the formation of chronic HF.

scholarly journals Evaluation of endothelial function, of elasticity of vessel wall and their influence on one-year prognosis of patients with myocardial infarction with obstructive and non-obstructive coronary arteries

2020 ◽  
Vol 28 (4) ◽  
pp. 488-496
Author(s):  
Olga Fomina ◽  
Sergey Stepanovich Yakushin
Keyword(s):  
Myocardial Infarction ◽  
Endothelial Function ◽  
Coronary Arteries ◽  
Vessel Wall ◽  
Augmentation Index ◽  
Study Groups ◽  
Morphological Alterations ◽  
Significant Difference ◽  
One Year ◽  
The One

Aim. To carry out comparative analysis of the state of the endothelial function (EF), elasticity of the vessel wall and their influence on one-year prognosis of patients with myocardial infarction (MI) with obstructive and non-obstructive coronary arteries (CA). Materials and Methods. In the first stage, 206 patients were selected diagnosed with MI, of them 103 patients with MI with non-obstructive CA (MINOCA) according to the results of coronaroangiography, and 103 patients with MI with obstructive CA (MIOCA). Using the method of random numbers, 59 patients were selected (34 patients of the first group and 25 of the second group), in whom EF and elastic properties of the arterial wall were evaluated. Patients of both groups were initially comparable in age, gender, clinical and anamneustic characteristics, and also in frequency of application of the main groups of medical drugs that influence prognosis. One-year prognosis of the two groups of patients was studied depending on the presence/absence of functional and morphological alterations of the vessel wall. Results. In evaluation of EF in patients MINOCA, the occlusion index by amplitude (OIA) below threshold values was recorded in 22 of 34 (64.7%) cases of MINOCA and in 22 of 25 (88.0%, р0.05) cases of MIOCA. Here, the average values of OIA were 1.7 (1.5; 2.3) and 1.4 (1.2; 1.8), respectively (р0.05). The values of phase shifts between the channels below the norm were equally frequent in two groups (88.2 and 88.0%, р0.05), and comparison of the average values of this parameter did not show any statistically significant difference. The calculated augmentation index normalized to the pulse rate 75 beats per minute (AIp75), in the study groups was 12.5 (9.9; 17.9) and 18.8 (12.9; 20.8), respectively (р0.05). Reduction of the elasticity of the vessel wall in the group with MINOCA was noted in 82.4% of patients, in the group MIOCA in 100% of cases (р0.05). No statistically significant differences were found in the frequency of cardiovascular events between the groups during a year (р0.05). Conclusion. Functional alterations of the vessel wall (endothelial dysfunction and reduction of elasticity of the vessel wall) in patients with MINOCA were recorded almost in 2/3 of cases, however, their incidence in MIOCA was still higher (88.0%). The one-year prognosis in the study groups MINOCA and MIOCA showed no differences.

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