scholarly journals Prevalence of Myocardial Infarction with Non-Obstructive Coronary Arteries in Western Nepal

2020 ◽  
Vol 17 (2) ◽  
pp. 39-42
Author(s):  
Ram Chandra Kafle ◽  
Girija Shankar Jha ◽  
Dibya Sharma ◽  
Vijay Madhav Alurkar
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Systemic Hypertension ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Prior Use

Background and Aims: It is well known that ST segment elevation myocardial infarction results from complete occlusion of a coronary artery supplying that area. However, in up to 15% of patients with clinical diagnosis of myocardial infarction, early angiography reveal either non-obstructive or normal coronary artery. This subgroup of disease, myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), represent a diagnostic and therapeutic challenge to clinicians. We aimed to determine prevalence and clinical profile of patients with MINOCA in current study. Methods: This is a retrospective, observational study conducted in cardiology department of Manipal Teaching Hospital, Pokhara, Nepal from 6th April 2014 to 5th April 2019. Patients with age ≥18 years and clinically diagnosed acute myocardial infarction who underwent coronary angiography without prior use of thrombolytic agents were selected. Data were analyzed using the software SPSS for windows version 18. Results: A total of 177 patients’ underwent early coronary angiography without prior use of thrombolytic agent. The prevalence of MINOCA was 13.5% (n=24) in our study population. MINOCA patients were younger (p<0.001) compared to non-MINOCA. Smoking, systemic hypertension, access through femoral route and depressed left ventricular ejection fraction were significantly lower in MINOCA patients (p<0.05, for all). Conclusion: The prevalence of MINOCA was high (13.5%) in our study. Prospective studies are needed to conclude its high prevalence and to look for other associated factors and etiology.

scholarly journals Incidence of coronary artery disease before valvular replacement in isolated severe aortic stenosis patients in Western Rajasthan

2021 ◽  
Vol 9 (11) ◽  
pp. 3347
Author(s):  
Ramesh Patel ◽  
Sandeep Aggarwal
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Background: The aim of the study was to evaluate the incidence of Coronary artery disease (CAD) and predictors of CAD in patients with severe AS in western Rajasthan population.Methods: Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Udaipur were entered in a prospective registry beginning in 2015. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery.Results: Mean age of 55 enrolled patients was 52.64±15.5 years. Diabetes mellitus and hypertension were present in 3.64% and 5.45% of patients, respectively. Moderate and severe Left ventricular ejection fraction (LVEF) was found in 16.36% and 10.91% patients, respectively. Only 5.45% patient had severe CAD and thus underwent AVR and coronary artery bypass grafting, and rest 94.55% patients underwent AVR. Mean age of patients who underwent AVR was 51.75±15.36 years and who underwent AVR and CABG was 68±11.14 years with no significant association (p=0.078). Proportion of patients requiring AVR and CABG was significantly higher in moderate (22.22%) and severe LVEF (16.67%) as compared to normal or mild (p=0.034).Conclusions: Coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients above 68 years of age without risk factors for cardiovascular disease. However, larger studies on heterogeneous population are required to prove our findings. 

scholarly journals Inferior acute myocardial infarction caused by left anterior descending coronary artery, worse prognosis? experience in our center

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
IR Martinez Primoy ◽  
J Carmona Carmona ◽  
T Seoane Garcia ◽  
R Martinez Nunez ◽  
DF Arroyo Monino ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Inferior Wall ◽  
Circumflex Artery ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. I Key diagnostic test in acute myocardial infarction with ST segment elevation(STEMI)is 12-lead electrocardiogram, which guides initial treatment and informs about area at necrosis risk, necrosis extension, and culprit coronary artery. ST elevation in leads II, III, aVF is related to obstruction of right coronary artery(RCA)or circumflex artery. Inferior STEMI with occlusion of left anterior descending artery(LAD)has been described. Our goal is to analyse incidence and characteristics of inferior STEMI due to LAD occlusion. M Observational retrospective study, of patients admitted to our Coronary Care Unit due to inferior STEMI, between08/2011-12/2020. We analysed all patients whose culprit artery was LAD and a random sample of138patients among those with RCA as culprit. Chi-square, Student-t or Mann-Whitney tests were used. R there were a total of2498acute coronay syndromes, 1541were STEMI. 47.7%of them(n:735)were from inferior wall. From inferior STEMI, 12were caused by LAD occlusion(1.6%, 95%confidence interval0.8-2.8%), representing0.8%of all STEMI. There were21.3%women(n:32)and a mean age of61.6 ± 12.5years, without differences by culprit artery. STEMI related with RCA presented a 28.3% of  either right ventricular dysfunction or atrioventricular block, versus none of those related to LAD(p0.037). There was difference in dominance: STEMI caused by LAD presented right dominance in72.7%of cases, while caused by RCA in94.4%(p0.034). All inferior LAD STEMIs had normal left ventricular ejection fraction(LVEF) at admission. There was no statistically significant difference in LVEF at discharge(RCA54.3 ± 7.6vsLAD50.5 ± 13.6), but there was in maximum troponin, which was higher in those STEMI related to RCA(2208 ± 1756mg/dl vs 4095 ± 3833mg/dl, p0.040). Complementary comparisons in Table. Conclusion we found that1.6%of inferior STEMI are caused by LAD occlusion instead of RCA or circumflex coronary artery. These STEMI do not cause more severe affectation of left ventricle and run without typical complications of inferior STEMI. RCALADSite of occlusion-nProximal65(47.1%)5(41.7%)Medium41(29.7%)5(41.7%)Distal32(23.2%)2(16.7%)Worst Killip-Kimbal-nI112(81.2%)10(83.3%)II11(8.0%)1(8.3%)III2(1.4%)1(8.3%)IV13(9.4%)0

scholarly journals The outcome of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and impaired kidney function: a 3-year observational study

2021 ◽  
Author(s):  
Malgorzata Zalewska-Adamiec ◽  
Jolanta Malyszko ◽  
Ewelina Grodzka ◽  
Lukasz Kuzma ◽  
Slawomir Dobrzycki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Incidence Rate ◽  
Kidney Function ◽  
Coronary Arteries ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

Abstract Background Myocardial infarction with nonobstructive coronary arteries (MINOCA) constitutes about 10% of the cases of acute coronary syndromes (ACS). It is a working diagnosis and requires further diagnostics to determine the cause of ACS. Methods In this study, 178 patients were initially diagnosed with MINOCA over a period of 3 years at the Department of Invasive Cardiology of the University Clinical Hospital in Białystok. The value of estimated glomerular filtration rate (eGFR) was calculated for all patients. The patients were divided into 2 groups depending on the value of eGFR: group 1—53 patients with impaired kidney function (eGFR < 60 mL/min/1.73 m2; 29.8%) and group 2—125 patients with normal kidney function (eGFR ≥ 60 mL/min/1.73 m2; 70.2%). Results In group 1, the mean age of patients was significantly higher than that of group 2 patients (77.40 vs 59.27; p < 0.0001). Group had more women than group 2 (73.58% vs 49.60%; p = 0.003). Group 1 patients had higher incidence rate of arterial hypertension (92.45% vs 60.80%; p < 0.0001) and diabetes (32.08% vs 9.60%; p = 0.0002) and smoked cigarettes (22.64% vs 40.80%; p = 0.020). Group 1 patients had higher incidence rate of pulmonary edema, cardiogenic shock, sudden cardiac arrest (13.21% vs 4.00%; p = 0.025), and pneumonia (22.64% vs 6.40%; p = 0.001). After the 37-month observation, the mortality rate of the patients with MINOCA was 16.85%. Among group two patients, more of them became deceased during hospitalization (7.55% vs 0.80%; p = 0.012), followed by after 1 year (26.42% vs 7.20%; p = 0.0004) and after 3 years (33.96% vs 9.6%; p < 0.0001). Multivariate analysis revealed that the factors increasing the risk of death in MINOCA are as follows: older age, low eGFR, higher creatinine concentration, low left ventricular ejection fraction, and ST elevation in ECG. Conclusion Impaired kidney function is diagnosed in every third patient with MINOCA. Early and late prognosis of patents with MINOCA and renal dysfunction is poor, and their 3-year mortality is comparable to patients with myocardial infarction with significant stenosis of the coronary arteries and impaired kidney function.

scholarly journals The stress hyperglycaemia ratio is associated with left ventricular remodelling after first acute ST-segment elevation myocardial infarction

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuai Meng ◽  
Yong Zhu ◽  
Kesen Liu ◽  
Ruofei Jia ◽  
Jing Nan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Stress Hyperglycaemia ◽  
St Segment ◽  
Significant Difference ◽  
First Time

Abstract Background Left ventricular negative remodelling after ST-segment elevation myocardial infarction (STEMI) is considered as the major cause for the poor prognosis. But the predisposing factors and potential mechanisms of left ventricular negative remodelling after STEMI remain not fully understood. The present research mainly assessed the association between the stress hyperglycaemia ratio (SHR) and left ventricular negative remodelling. Methods We recruited 127 first-time, anterior, and acute STEMI patients in the present study. All enrolled patients were divided into 2 subgroups equally according to the median value of SHR level (1.191). Echocardiography was conducted within 24 h after admission and 6 months post-STEMI to measure left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD). Changes in echocardiography parameters (δLVEF, δLVEDD, δLVESD) were calculated as LVEF, LVEDD, and LVESD at 6 months after infarction minus baseline LVEF, LVEDD and LVESD, respectively. Results In the present study, the mean SHR was 1.22 ± 0.25 and there was significant difference in SHR between the 2 subgroups (1.05 (0.95, 1.11) vs 1.39 (1.28, 1.50), p < 0.0001). The global LVEF at 6 months post-STEMI was significantly higher in the low SHR group than the high SHR group (59.37 ± 7.33 vs 54.03 ± 9.64, p  = 0.001). Additionally, the global LVEDD (49.84 ± 5.10 vs 51.81 ± 5.60, p  = 0.040) and LVESD (33.27 ± 5.03 vs 35.38 ± 6.05, p  = 0.035) at 6 months after STEMI were lower in the low SHR group. Most importantly, after adjusting through multivariable linear regression analysis, SHR remained associated with δLVEF (beta = −9.825, 95% CI −15.168 to −4.481, p  < 0.0001), δLVEDD (beta = 4.879, 95% CI 1.725 to 8.069, p  = 0.003), and δLVESD (beta = 5.079, 95% CI 1.421 to 8.738, p  = 0.007). Conclusions In the present research, we demonstrated for the first time that SHR is significantly correlated with left ventricular negative remodelling after STEMI.

Correlation between procollagen propeptides end echocardiography indices in patients with ST segment elevation myocardial infarction (STEMI)

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Osokina ◽  
V.N Karetnikova ◽  
O.M Polikutina ◽  
Y.S Slepynina ◽  
T.P Artemova ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Contractility ◽  
Imaging System ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Enzyme Linked Immunosorbent Assay ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Objective To investigate the correlation between Procollagen I C-Terminal Propeptide (PICP), Procollagen III N-Terminal Propeptide (PIIINP), indices of echocardiography and anamnestic data in patients with ST segment elevation myocardial infarction (STEMI) and preserved myocardial contractility. Materials and methods 60 men and 23 women diagnosed with STEMI were examined. Echocardiographic studies were performed using SONOS 2500 Cardiac – Vascular Ultrasound (Hewlett Packard, USA). Myocardial contractility was considered to be preserved with left ventricular ejection fraction (LVEF) ≥50%. In addition to standard indices of echocardiography, mitral flow propagation velocity (FPV) was evaluated to diagnose diastolic dysfunction. Coronary angiography was performed using INNOVA 3100 Cardiovascular Imaging System (USA). All patients, during the first twelve hours of the disease, underwent percutaneous coronary intervention (PCI) with stenting of the occluded culprit infarct-related artery. On the 1st and 12th days of hospitalization, the concentrations of PICP and PIIINP were determined for all patients by enzyme-linked immunosorbent assay (ELISA) using laboratory BCM Diagnostics kits (USA). All patients at the hospital received standard therapy. Results The following marker values were obtained: 1st day: PICP 609 (583; 635) ng/ml, PIIINP 26 (18.9; 34.9) ng/ml; 12th day: PICP 588 (580; 561) ng/ml, PIIINP 24.2 (18.6; 30.3) ng/ml. The following significant correlations were revealed: PICP 1st day / isovolumic contraction time – IVCT (m/s) 12th day, r=−0.68, p=0.042; PICP 1st day / Tei Index 12th day, r=−0.72, p=0.028; PICP 1st day / diastolic rigidity 12th day, r=−0.74, p=0.021; PIIINP 1st day/age, r=0.55, p=0.016; PIIINP 1st day/ body mass index (BMI), r=−0.59, p=0.009; PIIINP 1st day / E (cm/s) 1st day, r=0.72, p=0.018; PIIINP 1st day / Em /FPV 1st day, r=0.78, p=0.007; PIIINP 12th day / Em / FPV 1st day, r=0.65, p=0.041; PIIINP 12th day / E (cm/s) 1st day, r=0.67, p=0.033; PIIINP 12th day / E / Em) 12th day, r=0.70, p=0.023; PIIINP 12th day / Em/FPV 12th day, r=0.73, p=0.014. Conclusions The data obtained indicates the correlation between serum markers of myocardial fibrosis and the indices of echocardiography, as well as age. We conclude that, all the markers listed above, are able to represent myocardial remodeling in patients with STEMI. Funding Acknowledgement Type of funding source: None

P6393Differences in coronary inflammation between the culprit and non-culprit vessels assessed by fat attenuation index on computed tomography in patients with acute coronary syndromes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Sugiyama ◽  
M Hoshino ◽  
Y Kanaji ◽  
T Horie ◽  
H Yuki ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Perivascular Adipose Tissue ◽  
Ventricular Ejection Fraction ◽  
Attenuation Index ◽  
Coronary Syndromes

Abstract Background Inflammation is linked with progression of coronary atherosclerosis. Recent studies have reported the association between elevated perivascular fat attenuation index (FAI) on computed tomography (CT) and worse cardiac outcomes in patients with coronary artery disease. Purpose We aimed to investigate the differences in FAI-defined peri-coronary inflammation status between the culprit and non-culprit vessels in patients with acute coronary syndromes (ACS). Methods A total of 78 ACS patients with left anterior descending coronary arteries (LAD) as a culprit vessel who underwent coronary CT angiography and invasive coronary angiography were studied. Proximal 40-mm segments of the LAD and the right coronary artery (RCA) were traced. Coronary inflammation was assessed by the FAI defined as the mean CT attenuation value of perivascular adipose tissue (−190 to −30 Hounsfield units [HU]) in a layer of tissue within a radial distance from the outer coronary artery wall equal to the diameter of the vessel. All patients were divided into two groups according to the values of FAI in the LAD: high FAI group (FAI-LAD > median; n=39) and low FAI group (FAI-LAD ≤ median; n=39). Patient characteristics, angiographic and CT findings were compared between the two groups. Results In a total of 78 patients, median FAI in the LAD was −70.20 (interquartile range, −74.81 to −64.58) HU. High FAI group was associated with male sex and lower left ventricular ejection fraction compared with Low FAI group. Minimal lumen diameter, reference diameter, diameter stenosis, and lesion length on quantitative coronary angiography analysis and coronary artery calcium score on CT was not different between the groups. FAI in the RCA was also higher in High FAI group than that in Low FAI group (−67.64±8.31 vs. −76.47±6.25 HU, P<0.001). Paired t-test comparison demonstrated that culprit vessel showed higher FAI than the non-culprit vessel (−69.85±7.74 vs. −72.11±8.54 HU, P=0.013). Conclusions In ACS patients with culprit LAD lesions, FAI-defined peri-coronary inflammation status is higher in the culprit vessel than in the non-culprit vessel.

Residual SYNTAX Score Is Associated With Contrast-Induced Nephropathy in Patients With Non-ST Segment Elevation Myocardial Infarction With Preserved LVEF

Angiology ◽  
2020 ◽  
Vol 71 (9) ◽  
pp. 799-803
Author(s):  
Mehmet Kucukosmanoglu ◽  
Yahya Kemal İçen ◽  
Hilmi Erdem Sumbul ◽  
Hasan Koca ◽  
Mevlut Koc
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Contrast Induced Nephropathy ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Residual Syntax Score

The purpose of this study is to investigate the relation between residual SYNTAX score (rSS) and contrast-induced nephropathy (CIN) development in patients with non-ST segment elevation myocardial infarction (NSTEMI) with normal or near-to-normal left ventricular ejection fraction (LVEF) who underwent percutaneous coronary intervention (PCI). A total of 306 patients who underwent PCI with NSTEMI were included in our study. SYNTAX scores were calculated for the periods before and after PCI. Patients were divided into 2 groups as developed CIN following PCI (CIN +) and patients did not (CIN −). Fifty-four (17.6%) of patients who were included in the study developed CIN. Age ( P = .001) and rSS ( P = .002) were significantly higher and LVEF was lower ( P = .034) in the CIN (+) group. Age ( P = .031, odds ratio [OR]: 1.031, 95% CI, 1.003-1.059) and rSS ( P = .04, OR: 1.036, 95% CI, 1.002-1.071) were independent predictors for CIN. In receiver operating characteristic analyses, when the cutoff value of rSS was taken as 3.5, it determined CIN with 79% sensitivity and 65% specificity. Contrast-induced nephropathy may develop more frequently in patients with increased rSS value. The rSS may be useful to follow-up these patients for CIN development.

scholarly journals Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e001027 ◽  
Author(s):  
Davorin Sef ◽  
Janko Szavits-Nossan ◽  
Mladen Predrijevac ◽  
Rajna Golubic ◽  
Tomislav Sipic ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Artery Bypass ◽  
Myocardial Ischaemia ◽  
Graft Failure ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction

ObjectivesUpdated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome.MethodsAmong 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints.ResultsOverall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op).ConclusionsUrgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.

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