scholarly journals MYOCARDIAL INFARCTION

2011 ◽  
Vol 18 (03) ◽  
pp. 418-425
Author(s):  
LIAQAT ALI ◽  
ABDUL REHMAN ABID ◽  
JAHANGIR AHMED ◽  
Nusrat Niaz ◽  
Tahira Abdul Rehman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Family History ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Anterior Wall ◽  
History Of ◽  
Streptokinase Therapy ◽  
St Elevation ◽  
Anterior Wall Myocardial Infarction

Objective: To determine clinical predictors of in-hospital complications in patients presenting with acute ST elevation myocardial infarction. Design: Descriptive Study. Period: from October 2010 to January 2011. Setting: Faisalabad Institute of Cardiology, Faisalabad.. Materials and methods: A total 342 patients with AMI were recruited in this study. All patients presenting with acute ST elevation myocardial infarction and fulfilling inclusion and exclusion criteria were included in the study. A full history was taken, particularly age, sex, occupation, address, history of smoking, diabetes mellitus, hypertension, ischemic heart disease and family history of ischemic heart disease. Primary end point was death while secondary end point were patients who had mechanical, ischemic or electrical complications or all of them. Results: Mean age of the study population was 56.3±12.7 years. There were 255(74.6%) males and 87(25.4%) females. There were 103(30.1%) diabetics, 137(40.1%) hypertensive and 174(50.9%) smokers. Family history of IHD was present in 34(9.9%). Obesity was observed in 60(17.5%). Dyslipidemia was observed in 45(13.2%). Majority of patients 123(36%) presented between 4-8 hours after the onset of symptoms. Only 72(21.1%) patients presented to the hospital within 4 hours of onset of symptoms. Overall 194(56.7%) patients had anterior wall myocardial infarction followed by Inferior wall myocardial infarction 84(24.6%) patients. Streptokinase therapy for thrombolysis was given to 236(69%) patients. Overall in-hospital mortality was 28(8.2%). Most frequent in-hospital complication was cardiogenic shock occurring in 38(11.1%) followed by Ischemic complications (Post MI angina and Re-MI) 37(10.8%), heart failure in 37(10.8%) and 1st and 2nd degree AV blocks in 36(10.5%) patients. In-hospital mortality was most significantly associated with site of MI i.e. anterior wall myocardial infarction (X2=28.88, p=0.0001) followed by patients not receiving Streptokinase therapy (X2=18, p=0.001), Age (X2=10.13, p=0.006). Site of MI had the highest Contingency Coefficient value of 0.279 followed by Streptokinase therapy 0.195 and age 0.170. Conclusions: Cardiogenic shock was the most frequent complication. Major predictors of in-hospital mortality were anterior wall myocardial infarction, patients not receiving streptokinase therapy and old age.

scholarly journals Frequency of Left Bundle Branch Block in Patients with Acute Myocardial Infarction; A Cross-Sectional Study

2019 ◽  
Vol 8 ◽  
pp. 1576
Author(s):  
Reyhaneh Niknam ◽  
Mahmonir Mohammadi
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Family History ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Contributing Factors ◽  
Cross Sectional ◽  
Bundle Branch Block ◽  
History Of ◽  
St Elevation

Background: Cardiovascular disease (CVDs) is important problems in both developing and developed countries. Currently, non-invasive methods for diagnosis of CVD, especially myocardial infarction (MI), is an interesting subject in the cardiology field. Some evidence showed left bundle branch block (LBBB) is more prevalent among patients with MI. Hence, this study aimed to investigate the frequency of LBBB and their contributing factors in patients with MI. Materials and Methods: In this cross-sectional study, 150 patients with ST elevation or non-ST elevation on their admission electrocardiography who referred to Boo-Ali and Amir-Al-Momenin hospitals, Tehran from January 2016 to June 2017 entered the study. Frequency of LBBB and right bundle branch block (RBBB) in participants and the contributing factors were determined. Results: In this study, of 150 cases (mean age: 60.35±12.88 years), 109 (72.7%) were male, and 41 (27.3%) were female. Out of 150 cases, 12 (8%) had LBBB, 5 (3.3%) RBBB, and 133 (89.7%) had not RBBB or LBBB. Contributing factors were family history, hypertension, and history of ischemic heart disease (P<0.05). Conclusion: Eight percent of patients with myocardial infarction would develop LBBB, which is related to hypertension, and self and family history of ischemic heart disease. [GMJ.2019;8:e1576]

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend &lt;0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p&lt;0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

scholarly journals Intra-aortic Balloon Pump Therapy for Anterior ST-elevation Myocardial Infarction with Cardiogenic Shock: An Observational Cohort Study

2019 ◽  
Author(s):  
Kuo Zhou ◽  
Shuzheng Lyu ◽  
Jing Dai ◽  
Jinfan Tian ◽  
Kongyong Cui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Lower Limb ◽  
Cox Regression ◽  
Anterior Wall ◽  
St Elevation Myocardial Infarction ◽  
Rank Test ◽  
Control Group ◽  
Intra Aortic Balloon Pump ◽  
St Elevation

Abstract Background As a mechanical circulatory assistance, intra-aortic balloon pump (IABP) has been widely used for cardiogenic shock (CS), although recent clinical trials questioned its impact on acute myocardial infarction patients, nothing is hitherto known on the contribution of IABP to CS patients after anterior wall infarction. The aim of this study was to investigate the efficacy and safety of IABP therapy in patients presenting with anterior ST-elevation myocardial infarction (STEMI) complicated by CS.Methods We conducted a retrospective study of 215 consecutive patients presenting with CS after STEMI in the anterior wall between January 2006 and August 2017, including 125 patients in the IABP group and 90 patients in the control group.Results At 30 days, 60 (48.0%) patients in the IABP group and 58 (64.4%) patients in the control group had died (P=0.017). The Kaplan-Meier survival curves showed the cumulative survival rate in the IABP group was consistently higher than control group (P=0.009 by Log-Rank test). Nevertheless, IABP increased the occurrence of thrombocytopenia (21.6% vs. 2.2%, P<0.001) and lower limb complications (20.0% vs. 2.2%, P<0.001) at the same time. Subgroup analyses by Cox regression showed a better trend of prognoses in patients aged less than 60 years old (HR=0.49, 95% CI=0.26-0.91, P=0.025), male (HR=0.53, 95% CI=0.34-0.83, P=0.005), no history of hypertension (HR=0.47, 95% CI=0.26-0.87, P=0.017) and systolic blood pressure less than 80 mm Hg (HR=0.40, 95% CI=0.22-0.73, P=0.009). At 12-month follow-up, all-cause mortality in the IABP group was obviously lower than the control group (52.5% vs. 74.1%, P=0.002), there were no significant differences in other adverse cardiovascular events (P=1.000).Conclusions The combination of IABP use is associated with reduced 30-day and 12-month mortality in patients with anterior STEMI complicated by CS, though thrombocytopenia and lower limb complications are frequently observed.

P1722A new predictive score for mortality and cardiogenic shock in patients with ST-elevation myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Picarra ◽  
J A Pais ◽  
A R Santos ◽  
M Carrington ◽  
D Bras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
High Rate ◽  
Predictive Score ◽  
Predictive Capacity ◽  
End Point ◽  
Group A ◽  
St Elevation ◽  
Group B

Abstract Introduction Acute Myocardial Infarction with ST elevation (STEMI) presents a high rate of potentially fatal complications and in-hospital mortality. Objective To test the predictive capacity for Cardiogenic Shock (CS) and In-hospital Mortality (MIH) of a new risk score in patients (Pts) with STEMI. Population and methods Evaluated 5765 Pts with STEMI without CS at admission. The new score, was derived by previous studies in this population, and was calculated according to the following criteria: age ≥65 years (1 point), heart rate ≥100bpm (2 points), systolic blood pressure <100mmHg (2 points), blood glucose at admission above 180 mg/dL (1 point) and creatinine at admission >1.5mg/dL (2 points). The population was divided into three subgroups: group A low score (0–2 points), group B intermediate score (3–5 points) and group C score (6–8 points). The endpoints defined were CS during hospitalization, in-hospital mortality and combined end-point of MIH and CS. The relationship between each of the possible scores (from 0 to 8) and the various end-points was determined, and the sensitivity and specificity of the score as a predictor of MIH and CS was defined as the area under the ROC curve (ASC). Results After the application of the score, 3 subgroups were obtained: group A with 4819 Pts (83,6%), group B with 884 Pts (15,3%) and group C 62 Pts (1,1%). Patients of group C had a higher MIH (Group C: 45,2% vs B: 11,4% vs A: 2,0%, p<0,001), higher CS (C: 29,5% vs B: 12,0% vs A: 2,3%, p<0,001) and a higher combined end-point of MIH and CC (C: 53,2% vs B: 17,8% vs A: 3,4%, p<0,001) during hospitalization. The proposed score revealed a high predictive capacity of MIH (ASC 0,802, 95% CI 0,775–0,830, p=0,001), of CS (ASC 0,763, 95% CI 0,731–0,795, p=0,001) and for the combined endpoint (MIH and CC) ASC 0,781, 95% CI 0,756–0,806, p=0,001). The logistic regression models showed that Pts with a high score (group C) presented a 41-fold higher risk of MIH (OR 41,3; p<0,001) and 18-fold higher CS (OR 18,0; p<0.001) than patients with low score (group A). It was also found that the risk associated with an increase in one point score unit was 100% (OR 2,0 p<0.001) for MIH and 82% (OR 1,82, p<0,001) for CS. Conclusion This new score, with the use of practical and friendly variables, demonstrated a high predictive capacity of MIH and CS.

scholarly journals MON-643 Diabetes’ Cost to Us Taxpayers: Thirty-Day Readmission and Resource Utilization Among Diabetics Patients Admitted with ST-Elevation Myocardial Infarction: A Propensity Score Match Analysis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Shabnam Nasserifar ◽  
Kam Sing Ho
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hospital Cost ◽  
Primary Diagnosis ◽  
Total Hospital Cost ◽  
Secondary Diagnosis ◽  
Total Hospital ◽  
History Of ◽  
St Elevation

Abstract PURPOSE: To determine the relationship between diabetes and thirty-days readmission, mortality, morbidity, and health care resource utilization in patients who were admitted with ST-Elevation Myocardial Infarction (STEMI) in the United States. METHOD: A retrospective study was conducted using the AHRQ-HCUP Nationwide Readmission Database for the year 2014. Adults (≥ 18 years) with a primary diagnosis of STEMI (1), along with a secondary diagnosis of diabetes were identified using ICD-9 codes as described in the literature (2). The primary outcome was the rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity, and resource use (length of stay and total hospitalization costs and charges). Propensity score (PS) using the 1:1 nearest neighbor matching without replacement was utilized to adjust for confounders (3). Independent risk factors for readmission were identified using a Cox proportional hazards model (4). RESULTS: In total, 116,124 hospital admissions among adults with a primary diagnosis of STEMI were identified, of which 18.05% were diabetics. 1:1 PS matching was performed based on demographic (age, gender, hospital status, etc.) and clinical characteristics (Charlson comorbidity score. The 30-day rate of readmission among diabetics and non-diabetics with STEMI were 9.31% vs. 6.18% (p &lt;0.001). The most common readmission for both groups was recurrent myocardial infarction. During the index admission for STEMI, the length of stay (LOS) among diabetics and non-diabetics patients were not statistically different (4.74 vs 4.58 days, p=0.12). However, the total hospital cost for the diabetic patients was statistically different ($27,027 vs $24,807, p &lt;0.001). Most importantly, diabetics patients’ in-hospital mortality rate during their index admission was significant higher (10.20% vs 5.92%, p &lt;0.001). Amongst those readmitted, the LOS, total hospital cost, or in-hospital mortality among diabetics were not statistically different when compared to their counterparts during their readmission. Diabetes (HR 1.60, CI 1.27-2.02, p &lt;0.001) was an independent predictor associated with higher risks of readmission. Other independent predictors associated with increased 30-day readmission include acute exacerbation of CHF, acute exacerbation of COPD, acute kidney injury, secondary diagnosis of pneumonia, history of COPD, history of ischemic stroke, history of atrial fibrillation & atrial flutter, history of chronic kidney disease, history of iron deficiency, and use of mechanical ventilator. CONCLUSION: In this study, diabetics patients admitted with STEMI have a higher 30 days of readmission rate, total hospital cost, and in-hospital mortality (p &lt;0.001) than their non-diabetic counterparts.

P264 Comparison of in-hospital mortality between acute inferior wall STEMI patients with right ventricular infarction and without right ventricular infarction undergoing a primary PCI in KCMH

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
S Preechawuttidej ◽  
S Srimahachota
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Right Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Hospital Death ◽  
Inferior Wall ◽  
Right Ventricular Infarction ◽  
St Elevation ◽  
Ventricular Infarction

Abstract Background Patients with acute inferior wall ST elevation myocardial infarction, if there is a right ventricular myocardial infarction involvement, they have pretended a worse prognosis with hemodynamic and electrophysiologic complications causing higher in-hospital morbidity and mortality. However most patients in previous studies were mainly treated with intravenous fibrinolysis and also studied in the Caucasian populations. Objectives To compare the in-hospital mortality rate of patients with acute inferior wall ST elevation myocardial infarction with and without right ventricular infarction involvement, whom were treated with primary percutaneous coronary intervention (PPCI). Methods The study was a retrospective descriptive study which enrolled patients with acute inferior wall ST elevation myocardial infarction who were treated with PPCI in our hospital from 1 January 2007 - 31 December 2016. Results Among 452 acute inferior wall ST elevation myocardial infarction patients who were treated with PPCI, there were 99 patients who had right ventricular infarction involvement, the in-hospital mortality rate was 23.2%, mainly due to cardiogenic shock, compared with 5.1 % in patients who had no right ventricular infarction (p &lt; 0.001). Patients with right ventricular infarction had a significantly higher incidence of cardiogenic shock (48.5% versus 15.6%, P &lt; 0.001), the lower number of left ventricle ejection fraction (51.15 ± 17.27% versus 55.79 ± 12.46%, p = 0.037), the higher incidence of complete heart block (33.3% versus 11.9%, p &lt; 0.001) and ventricular tachycardia (15.2% versus 5.9%, p = 0.003). After adjustment for age, female sex, diabetes, hypertension, previous myocardial infarction, cardiogenic shock on admission, left ventricular ejection fraction, ventricular tachycardia and complete heart block, the right ventricular infarction remained the independent predictor of in-hospital death (adjusted hazard ratio, 1.69; 95% confidence interval, 0.38 to 7.48; P = 0.489) and significant independent predictor for 1-year mortality (adjusted hazard ratio, 2.76; 95% confidence interval, 1.08 to 7.03; P = 0.034). Conclusion Patients with acute inferior wall STEMI whom were treated with PPCI, if there was right ventricular infarction involvement, the in-hospital death and 1-year mortality were significantly higher than who were without right ventricular infarction.

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