scholarly journals Evaluation and Comparison of the STIMUL Extended and Simplified Risk Scores for Predicting Two-Year Death in Patients Following ST-Segment Elevation Myocardial Infarction

Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1349
Author(s):  
Svitlana Korol ◽  
Agnieszka Wsol ◽  
Alexander Reshetnik ◽  
Alexander Krasyuk ◽  
Kateryna Marushchenko ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Risk Estimation ◽  
Simplified Model ◽  
Death Risk ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
C Statistic ◽  
St Segment ◽  
Cardiac Troponins

Background and Objectives: The management of ST-segment elevation myocardial infarction (STEMI) requires a patient’s long-term risk to be estimated. The objective of this study was to develop extended and simplified models of two-year death risk estimation following STEMI that include and exclude cardiac troponins as prognostic factors and to compare their performance with each other. Materials and Methods: Extended and simplified multivariable logistic regression models were elaborated using 1103 patients with STEMI enrolled and followed up in the STIMUL (ST-segment elevation Myocardial Infarctions in Ukraine and their Lethality) registry. Results: The extended STIMUL risk score includes seven independent risk factors: age; Killip class ≥ II at admission; resuscitated cardiac arrest; non-reperfused infarct-related artery; troponin I ≥ 150.0 ng/L; diabetes mellitus; and history of congestive heart failure. The exclusion of cardiac troponin in the simplified model did not influence the predictive value of each factor. Both models divide patients into low, moderate, and high risk groups with a C-statistic of 0.89 (95% CI 0.84–0.93; p < 0.001) for the extended STIMUL model and a C-statistic of 0.86 (95% CI 0.83–0.99; p < 0.001) for the simplified model. However, the addition of the level of troponin I to the model increased its prognostic value by 10.7%. Conclusions: The STIMUL extended and simplified risk estimation models perform well in the prediction of two-year death risk following STEMI. The simplified version may be useful when clinicians do not know the value of cardiac troponins among the population of STEMI patients.

scholarly journals Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis with ECG change mimicking acute non-ST-segment elevation myocardial infarction: A case report

2020 ◽  
Author(s):  
Fan-xin Kong ◽  
Meng Li ◽  
Chun-Yan Ma ◽  
Ping-ping Meng ◽  
Yong-huai Wang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Differential Diagnosis ◽  
Coronary Artery ◽  
Troponin I ◽  
Hypereosinophilic Syndrome ◽  
Coronary Spasm ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background Loeffler’s endocarditis is an inflammatory cardiac condition of hypereosinophilic syndrome which rarely involves coronary artery. When coronary artery is involved, known as eosinophilic coronary periarteritis, the clinical presentation, electrocardiographic changes and troponin level are extremely nonspecific and may mimic acute coronary syndrome. It is very important to make differential diagnosis for ECPA in order to avoid the unnecessary further invasive coronary angiography. Case presentation We report a case with chest pain, ST-segment depression in electrocardiogram and increased troponin-I mimicking acute non-ST-segment elevation myocardial infarction. However, quick echocardiography showed endomyocardial thickening with normal regional wall motion, which corresponded to the characteristics of Loeffler’s endocarditis. Emergent blood analysis showed marked increase in eosinophils and computed tomography angiography found no significant stenosis of coronary artery. Manifestations of magnetic resonance imaging consisted with findings of echocardiography. Finally, the patient was diagnosed as Loeffler’s endocarditis and possible coronary spasm secondary to eosinophilic coronary periarteritis. Conclusion This case exhibits the crucial use of quick transthoracic echocardiography and the emergent hematological examination for differential diagnosis in such scenarios as often if electrocardiogram change mimicking myocardial infarction.

scholarly journals Ejection Fraction by Echocardiography for a Selective Use of Magnetic Resonance After Infarction

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Victor Marcos-Garces ◽  
Jose Gavara ◽  
Maria P. Lopez-Lereu ◽  
Jose V. Monmeneu ◽  
Cesar Rios-Navarro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Magnetic Resonance ◽  
Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Net Reclassification Improvement ◽  
C Statistic ◽  
St Segment ◽  
Integrated Discrimination Improvement ◽  
Improvement Index

Background Cardiac magnetic resonance (CMR) permits robust risk stratification of discharged ST-segment–elevation myocardial infarction patients, but its indiscriminate use in all cases is not feasible. We evaluated the utility of left ventricular ejection fraction (LVEF) by echocardiography for a selective use of CMR after ST-segment–elevation myocardial infarction. Methods Echocardiography and CMR were performed in 1119 patients discharged for ST-segment–elevation myocardial infarction included in a multicenter registry. The prognostic power of CMR beyond echocardiography-LVEF was assessed using adjusted C statistic, net reclassification improvement index, and integrated discrimination improvement index. Results During a 4.8-year median follow-up, 136 (12%) first major adverse cardiac events (MACE) occurred (47 cardiovascular deaths and 89 readmissions for acute heart failure). In the entire group, CMR-LVEF (but not echocardiography-LVEF) independently predicted MACE occurrence. The MACE rate significantly increased only in patients with CMR-LVEF<40% (≥50%: 7%, 40%–49%: 9%, <40%: 27%, P <0.001). Most patients displayed echocardiography-LVEF≥50% (629, 56%), and they had a low MACE rate (57/629, 9%). In patients with echocardiography-LVEF<50% (n=490, 44%), the MACE rate was also low in those with CMR-LVEF≥40% (24/278, 9%) but significantly increased in patients with CMR-LVEF<40% (55/212, 26%; P <0.001). Compared with echocardiography-LVEF, CMR-LVEF significantly improved MACE prediction in the group of patients with echocardiography-LVEF<50% (C statistic, 0.80 versus 0.72; net reclassification improvement index, 0.73; integrated discrimination improvement index, 0.10) but not in those with echocardiography-LVEF≥50% (C statistic 0.66 versus 0.66; net reclassification improvement index, 0.17; integrated discrimination improvement index, 0.01). Conclusions A straightforward strategy based on a selective use of CMR for risk prediction in ST-segment–elevation myocardial infarction patients with echocardiography-LVEF<50% can provide insights into patient care. The cost-effectiveness of this approach, as well as the direct implications in clinical management, should be further explored.

scholarly journals Elevated Plasma IL-38 Concentrations in Patients with Acute ST-Segment Elevation Myocardial Infarction and Their Dynamics after Reperfusion Treatment

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
Yucheng Zhong ◽  
Kunwu Yu ◽  
Xiang Wang ◽  
Xiaoya Wang ◽  
Qingwei Ji ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Atheromatous Plaque ◽  
Ventricular Ejection Fraction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Objective.Recent studies suggest that IL-38 is associated with autoimmune diseases. Furthermore, IL-38 is expressed in human atheromatous plaque. However, the plasma levels of IL-38 in patients with ST-segment elevation myocardial infarction (STEMI) have not yet to be investigated.Methods.On admission, at 24 h, at 48 h, and at 7 days, plasma IL-38, C-reactive protein (CRP), cardiac troponin I (cTNI), and N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) levels were measured and IL-38 gene in peripheral blood mononuclear cells (PBMCs) was detected in STEMI patients.Results.The results showed that plasma IL-38 levels and IL-38 gene expression in PBMCs were significantly increased in STEMI patients compared with control group and were time dependent, peaked at 24 h. In addition, plasma IL-38 levels were dramatically reduced in patients with reperfusion treatment compared with control group. Similar results were also demonstrated with CRP, cTNI, and NT-proBNP levels. Furthermore, IL-38 levels were found to be positively correlated with CRP, cTNI, and NT-proBNP and be weakly negatively correlated with left ventricular ejection fraction (LVEF) in STEMI patients.Conclusions.The results indicate that circulating IL-38 is a potentially novel biomarker for patients with STEMI and IL-38 might be a new target for MI study.

scholarly journals Impact of COVID-19 pandemic on admissions and management of acute coronary syndrome: a single tertiary cardiac centre experience in the United Kingdom

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
J Tomson ◽  
D Khanra ◽  
T Ntoskas ◽  
B Wrigley
Keyword(s):  
Myocardial Infarction ◽  
United Kingdom ◽  
Troponin I ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Cardiac Centre ◽  
Time Of Admission

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction: Global reports are suggestive of decline in number of patients attending hospital with acute coronary syndromes (ACS) and a reduction in the number of cardiac procedures since the onset of COVID-19 pandemic. Purpose The aim of the study was to compare the trend of presentations and management among ACS patients in a single tertiary cardiac centre in the West midlands of United Kingdom (UK) during the early lock down period of COVID-19 pandemic (Group 2020) in comparison to the same period of 2019 (Group 2019). Methods In this descriptive study patients’ records were extracted retrospectively from the electronic database who presented with ST segment elevation myocardial infarction (STEMI), non- ST segment elevation myocardial infarction (NSTEMI) and Unstable angina (UA), during the 30 day period from mid-March to mid-April of 2020 (Group 2020), and the same period of 2019 (Group 2019). Results In comparison to group 2019, total number of ACS (153 vs 91) including STEMI (70 vs 59), NSTEMI (76 vs 31) and UA (7 vs 1) were lower in group 2020 (Fig 1A). Inter-hospital transfer (IHT) dropped from 2019 to 2020 (55 vs 17). In group 2020, percutaneous coronary angioplasty (PCI) for STEMI was similar to group 2019 (83.05% vs 88.57%) but PCI for NSTEMI were higher (80.65% vs 48.68%). No coronary artery bypass graft (CABG) services were available during the studied period (Fig 1B).  In terms of troponin I (Trop I) levels at the time of admission, 47.25% of all ACS presentations were over 1000ng/L in group 2020 compared to 28.76% in group 2019 (Fig 1C). On assessment of left ventricular ejection fraction (LVEF) at the time of admission, 24% of all ACS were severely impaired (LVEF &lt; 40%) compared to 13.79% in 2019 (Fig 1D). 37 (31 IHT) patients in group 2019 and 16 (11 IHT) patients in group 2020 had no transthoracic echocardiogram data. There was an overall reduction in number of days spent in hospital per ACS patient from 4.78 days in 2019 to 3.70 days in 2020 and a further reduction for STEMI patients from 5.16 days in 2019 to 3.83 days in 2020. 5 ACS patients died in 2020 in comparison to 6 patients in 2019. Conclusion The reduced number of admissions is likely to be a result of nation-wide lock-down and public fear. Proportion of ACS patients with high level of troponin I values and severely impaired LVEF may be explained due to late presentation. It remains necessary to address public fear and to ensure that ACS patients are managed in accordance with ACS management guidelines even in the times of COVID-19 pandemic. Abstract Figure.

scholarly journals High Sensitivity Troponin in Infarcted Patients with History of Myocardial In-farction

2019 ◽  
pp. 1-5
Author(s):  
Orlando Victorino de Moura Junior ◽  
Arthur Augusto Souza Bordin ◽  
Sibele Sauzem Milano ◽  
Gustavo Lenci Marques
Keyword(s):  
Myocardial Infarction ◽  
Troponin I ◽  
High Sensitivity ◽  
Serum Levels ◽  
Previous Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
High Sensitivity Troponin ◽  
St Segment ◽  
History Of

Design of the Study: Historical Cohort. Objectives: This study aimed to verify which risk factors contribute to increase hs-cTnI in patients with Myocardial Infarcion with ST segment elevation, to ana-lyze which prognostic impacts it may have and to evaluate troponin levels in pa-tients that had previous acute myocardial infarction and assess how this com-pared to patients without previous history of an acute event. Methodology: It was assessed medical records of patients admitted in the Cor-onary Unit of the Hospital de Clínicas (HC-UFPR) in Curitiba, South of Brazil, diagnosed with ST segment elevation Myocardial Infarction and whose serum levels of high sensitivity troponin I (hs-cTnI) were collected at admission moment. The select data were: gender, age, high blood pressure, smoking, diabetes, previous myocardial infarction, dyslipidemia and serum levels of high sensitivity troponin I. For prognostic proposes, it was analysed intra-hospital death and ventricular function, based on left ventricular ejection fraction. Findings: Patients admitted with previous myocardial infarction had lower levels of hs-TnI. Gender, age, presence of high blood pressure, tabagism, diabetes and dyslipidemia didn’t reveal correlation with troponin values, allowing the in-ference that high sensitivity troponin values at first presentation of these patients have no direct relation to these variables. Regarding prognosis, levels of high sensitivity troponin could not be associated to mortality or ventricular malfunction. Conclusions: At admission, high-sensitivity troponin I levels were lower in pa-tients with prior myocardial infarction. Relevance: This work correlates the values of the high-sensitivity troponin of    patients with ST segment Elevation Myocardial Infarction to cardiovascular risks factors and to the prognosis of these patients. This approach is not found in cur-rent medical literature, whose works mainly relates to acute events.

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