scholarly journals Management strategies for acute STEMI in low- and middle-income countries: experience of the Tamil Nadu ST-segment elevation myocardial infarction programme

2021 ◽  
Vol 7 (1) ◽  
pp. 27-34
Author(s):  
Thomas Alexander ◽  
Ajit S. Mullasari ◽  
Brahmajee K. Nallamothu
Keyword(s):  
Myocardial Infarction ◽  
Tamil Nadu ◽  
Management Strategies ◽  
Middle Income ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Middle Income Countries ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Low And Middle Income

scholarly journals Resource and Infrastructure-Appropriate Management of ST-Segment Elevation Myocardial Infarction in Low- and Middle-Income Countries

Circulation ◽  
2020 ◽  
Vol 141 (24) ◽  
pp. 2004-2025 ◽  
Author(s):  
Y. Chandrashekhar ◽  
Thomas Alexander ◽  
Ajit Mullasari ◽  
Dharam J. Kumbhani ◽  
Samir Alam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Access To Health Care ◽  
Middle Income ◽  
St Segment Elevation ◽  
Middle Income Countries ◽  
Segment Elevation Myocardial Infarction ◽  
Consensus Document ◽  
Healthcare Regulation ◽  
St Segment ◽  
Low And Middle Income

The 143 low- and middle-income countries (LMICs) of the world constitute 80% of the world’s population or roughly 5.86 billion people with much variation in geography, culture, literacy, financial resources, access to health care, insurance penetration, and healthcare regulation. Unfortunately, their burden of cardiovascular disease in general and acute ST-segment–elevation myocardial infarction (STEMI) in particular is increasing at an unprecedented rate. Compounding the problem, outcomes remain suboptimal because of a lack of awareness and a severe paucity of resources. Guideline-based treatment has dramatically improved the outcomes of STEMI in high-income countries. However, no such focused recommendations exist for LMICs, and the unique challenges in LMICs make directly implementing Western guidelines unfeasible. Thus, structured solutions tailored to their individual, local needs, and resources are a vital need. With this in mind, a multicountry collaboration of investigators interested in LMIC STEMI care have tried to create a consensus document that extracts transferable elements from Western guidelines and couples them with local realities gathered from expert experience. It outlines general operating principles for LMICs focused best practices and is intended to create the broad outlines of implementable, resource-appropriate paradigms for management of STEMI in LMICs. Although this document is focused primarily on governments and organizations involved with improvement in STEMI care in LMICs, it also provides some specific targeted information for the frontline clinicians to allow standardized care pathways and improved outcomes.

Prognostic of Interatrial Block after an Acute ST-Segment Elevation Myocardial Infarction

Cardiology ◽  
2019 ◽  
Vol 142 (2) ◽  
pp. 109-115 ◽  
Author(s):  
Vanesa Bruña ◽  
Jesús Velásquez-Rodríguez ◽  
María Jesús Valero-Masa ◽  
Beatriz Pérez-Guillem ◽  
Lourdes Vicent ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sinus Rhythm ◽  
P Wave ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Wave Duration ◽  
Segment Elevation Myocardial Infarction ◽  
P Wave Duration ◽  
St Segment

Background: The influence of interatrial block (IAB) in the prognosis after an acute ST-segment elevation myocardial infarction (STEMI) is unknown. Objectives: To assess the prognostic impact of IAB after an acute STEMI regarding long-term mortality, development of atrial fibrillation, and stroke. Methods: Registry of 972 consecutive patients with STEMI and sinus rhythm at discharge, with a long-term follow-up (49.6 ± 24.9 months). P wave duration was analyzed using digital calipers, and patients were divided into three groups: normal P wave duration (<120 ms), partial IAB (pIAB) (P wave ≥120 ms and positive in inferior leads), and advanced IAB (aIAB) (P wave ≥120 ms plus biphasic [positive/negative] morphology in inferior leads). Results: Mean age was 62.6 ± 13.5 years. A total of 708 patients had normal P wave (72.8%), 207 pIAB (21.3%), and 57 aIAB (5.9%). Patients with aIAB were older (mean age 73 years) than the rest (62 years in the other two groups, p < 0.001). They also had a higher rate of hypertension (70 vs. 55% in pIAB and 49% in normal P wave, p = 0.006) and higher all-cause mortality (26.3 vs. 12.6% in pIAB and 10.3% in normal P wave, p = 0.001). However, multivariable analysis did not show an independent association between IAB and prognosis. Conclusion: About a quarter of patients discharged in sinus rhythm after an acute STEMI have IAB. Patients with aIAB have a poor prognosis, although this is explained mainly by the association of aIAB with age and other variables.

scholarly journals Association of Waist-Hip Ratio with Angiographic Severity of Coronary Artery Disease in Patients with Acute ST- Segment Elevation Myocardial Infarction

2018 ◽  
Vol 32 (2) ◽  
pp. 70-76
Author(s):  
Mohammad Anowar Hossain ◽  
Md Abdul Kader Akanda ◽  
Mohammad Ullah ◽  
Lakshman Chandra Barai ◽  
ABM Nizam Uddin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Significant Positive Correlation ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Artery Disease ◽  
Vessel Score

Objective: Coronary artery disease (CAD) is rising in South Asia and is taking a more malignant proportion in South Asians than in Caucasians. Having a similar socioeconomic and cultural background, the scenario is same in Bangladesh. Obesity, especially abdominal is concerned as an important and modifiable risk factor for CAD which is now also raising both in developed and under developed countries. Waist-Hip ratio (WHR) is considered as an important tool for assessing abdominal obesity. The aim of this study is to evaluate the association between WHR and the severity of CAD of acute ST-segment elevation myocardial infarction (STEMI) patients so that primary prevention, early detection and proper management strategy can be taken to reduce the disease burden, morbidity and mortality.Methods: This cross sectional observational study was carried out among 105 patients with acute STEMI who received thrombolytic and underwent coronary angiography (CAG) at National Institute of Cardiovascular Diseases (NICVD), Dhaka from May, 2016 to November, 2016. They were divided into two groups, Group I (normal WHR) = 51 and group II (increased WHR) = 54, according to WHR level. Angiographic severity of coronary artery disease was assessed by vessel score and Genseni’s score.Results: Significant positive correlation was found between WHR and vessel score (r= 0.62, p=0.003). Moderate to severe CAD patients were significantly higher in increased WHR group than in normal WHR group (77.8% vs. 29.4%, p=<0.001). Significant positive correlation was also found between WHR and Genseni’s score (r= 0.71, p=0.001). Logistic regression analysis showed that a patient with increased WHR had 2.75 times higher risk of having significant CAD compared with those with the normal WHR.Conclusions: Increased WHR group had more significant coronary artery disease in terms of vessel score and Genseni’s score and can be considered as a predictor of the severity of the CAD disease in acute STEMI patients.Bangladesh Heart Journal 2017; 32(2) : 70-76

scholarly journals Correlation between body mass index and in-hospital mortality in patients with ST-segment elevation myocardial infarction in Erbil city- Iraq

2021 ◽  
Vol 21 (1) ◽  
pp. 35-43
Author(s):  
Azad Ahmed Abdullah ◽  
◽  
Salam Naser Zangana
Keyword(s):  
Myocardial Infarction ◽  
Body Mass Index ◽  
Hospital Mortality ◽  
Body Mass ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Significant Difference

Background: Although High body mass index is associated with many cardiovascular diseases including coronary artery disease. Its effect on in-hospital death in patients with acute ST-segment elevation myocardial infarction (STEMI) is still a subject of controversy. Objective: To determine the correlation between body mass index (BMI) and in-hospital mortality in those patients. Patients and Methods: In this cross-sectional study, 180 adult patients with acute STEMI were enrolled and their BMI was measured. The participants were classified according to BMI into three groups as normal, overweight, and obese. A correlation between in-hospital mortality due to STEMI and BMI was evaluated. Results: Of the total participants, 62 (34.4%) were normally weighted, 61(33.8%) were over-weighted, and 57(31.6%) were obese. There was a significant difference (p= <0.001) between the groups concerning troponin I, hs-CRP, GRACE score, and the probability of in-hospital death. There were 16 (8.8%) in-hospital deaths during the study distributed as follows; 1(1.6%) in the normal-weight group, 5(8.1%) in the overweight group, and 10 (17.5%) in the obese group. In-hospital death showed a significant difference (p=0.04) between the study groups. In addition, a significant positive correlation(r=0.9) was found between BMI and in-hospital death. Conclusion: A robust positive correlation was detected between BMI and in-hospital mortality due to acute STEMI. When BMI increases, the number of deaths also increases exponentially. Keywords: Body mass index, ST-segment elevation myocardial infarction, mortality

scholarly journals The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial

2020 ◽  
Vol 12 (2) ◽  
pp. 90-96
Author(s):  
Behnaz Akbari ◽  
Samad Ghaffari ◽  
Naser Aslanabadi ◽  
Bahram Sohrabi ◽  
Leili Pourafkari ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcome ◽  
Coronary Angioplasty ◽  
Intervention Group ◽  
Secondary Outcome ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Primary Coronary Angioplasty

Introduction : Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI). Methods: A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke. Results: In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (P=0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, P=0.012). Conclusion: Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes.

scholarly journals Clinical Characteristics, Management Strategies, and Outcomes of Non–ST‐Segment–Elevation Myocardial Infarction Patients With and Without Prior Coronary Artery Bypass Grafting

2021 ◽  
Author(s):  
Ahmad Shoaib ◽  
Muhammad Rashid ◽  
Colin Berry ◽  
Nick Curzen ◽  
Evangelos Kontopantelis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Artery Bypass ◽  
Management Strategies ◽  
Coronary Intervention ◽  
Prior History ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Group 2 ◽  
Group 1

Background There are limited data on the management strategies, temporal trends and clinical outcomes of patients who present with non–ST‐segment–elevation myocardial infarction and have a prior history of CABG. Methods and Results We identified 287 658 patients with non–ST‐segment–elevation myocardial infarction between 2010 and 2017 in the United Kingdom Myocardial Infarction National Audit Project database. Clinical and outcome data were analyzed by dividing into 2 groups by prior history of coronary artery bypass grafting (CABG): group 1, no prior CABG (n=262 362); and group 2, prior CABG (n=25 296). Patients in group 2 were older, had higher GRACE (Global Registry of Acute Coronary Events) risk scores and burden of comorbid illnesses. More patients underwent coronary angiography (69% versus 63%) and revascularization (53% versus 40%) in group 1 compared with group 2. Adjusted odds of receiving inpatient coronary angiogram (odds ratio [OR], 0.91; 95% CI, 0.88–0.95; P <0.001) and revascularization (OR, 0.73; 95% CI, 0.70–0.76; P <0.001) were lower in group 2 compared with group 1. Following multivariable logistic regression analyses, the OR of in‐hospital major adverse cardiovascular events (composite of inpatient death and reinfarction; OR, 0.97; 95% CI, 0.90–1.04; P =0.44), all‐cause mortality (OR, 0.96; 95% CI, 0.88–1.04; P =0.31), reinfarction (OR, 1.02; 95% CI, 0.89–1.17; P =0.78), and major bleeding (OR, 1.01; 95% CI, 0.90–1.11; P =0.98) were similar across groups. Lower adjusted risk of inpatient mortality (OR, 0.67; 95% CI, 0.46–0.98; P =0.04) but similar risk of bleeding (OR,1.07; CI, 0.79–1.44; P =0.68) and reinfarction (OR, 1.13; 95% CI, 0.81–1.57; P =0.47) were observed in group 2 patients who underwent percutaneous coronary intervention compared with those managed medically. Conclusions In this national cohort, patients with non–ST‐segment–elevation myocardial infarction with prior CABG had a higher risk profile, but similar risk‐adjusted in‐hospital adverse outcomes compared with patients without prior CABG. Patients with prior CABG who received percutaneous coronary intervention had lower in‐hospital mortality compared with those who received medical management.

scholarly journals Association of Hyperglycemia and Final TIMI Flow with One-Year Mortality of Patients with Acute ST-Segment Elevation Myocardial Infarction Undergoing Primary PCI

2019 ◽  
Vol 28 (03) ◽  
pp. 182-187 ◽  
Author(s):  
Surya Dharma ◽  
Andi Mahavira ◽  
Nur Haryono ◽  
Renan Sukmawan ◽  
Iwan Dakota ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Tertiary Care ◽  
Primary Pci ◽  
Operating Characteristics ◽  
St Segment Elevation ◽  
Acute Stemi ◽  
Segment Elevation Myocardial Infarction ◽  
Timi Flow ◽  
St Segment ◽  
Increased Risk

The association of hyperglycemia at admission and final thrombolysis in myocardial infarction (TIMI) flow with 1-year mortality of patient with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) has not much been explored. We evaluated the association of hyperglycemia and final TIMI flow with 1-year mortality in patients with acute STEMI who underwent primary PCI.We retrospectively analyzed 856 patients with STEMI who underwent primary PCI in a tertiary care academic center between January 2014 and July 2016. Based on the receiver operating characteristics curve, the cutoff used for hyperglycemia in this study was greater than or equal to 169 mg/dL. Cox proportional hazard model was used to determine the association of hyperglycemia and TIMI flow with 1-year mortality.Compared with patients with lower blood glucose level (<169 mg/dL; n = 549), a greater proportion of patients who presented with hyperglycemia (≥169 mg/dL; n = 307) had final TIMI flow 0 to 1 (3.3 vs. 0.5%; adjusted odds ratio = 5.58, 95% confidence interval [CI] 1.30–23.9, p = 0.02). Hyperglycemia was associated with an increased risk for 1-year mortality (adjusted hazard ratio [HR]= 2.0, 95% CI: 1.13–3.53, p = 0.017). Multivariable Cox regression showed that the interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an elevated risk for 1-year mortality (adjusted HR= 9.4, 95% CI: 2.34–37.81, p = 0.002).A higher proportion of patients with acute STEMI who presented with hyperglycemia had final TIMI flow 0 to 1 after primary PCI. The interaction of hyperglycemia and final TIMI flow 0 to 1 was associated with an increased risk for 1-year mortality. This study suggests that aggressive control of hyperglycemia prior to primary PCI may facilitate better angiographic and clinical outcomes after primary PCI. Clinical Trial Registration Clinicaltrials.gov Identifier number: NCT02319473.

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