scholarly journals Percutaneous Cardiac Support during Myocardial Infarction Drastically Reduces Mortality: Perspectives from a Swine Model

2017 ◽  
Vol 40 (7) ◽  
pp. 338-344
Author(s):  
Maria Giovanna Trivella ◽  
Alessandra Piersigilli ◽  
Fabio Bernini ◽  
Gualtiero Pelosi ◽  
Silvia Burchielli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Near Infrared ◽  
Aortic Pressure ◽  
Early Mortality ◽  
Hospital Death ◽  
Swine Model ◽  
Risk Area ◽  
Term Survival ◽  
Before And After ◽  
Observation Period

Background/Aims Acute myocardial infarction (AMI) with cardiogenic shock (CS) remains the leading cause of in-hospital death in acute coronary syndromes. In the AMI-CS pig model we tested the efficacy of temporary percutaneous cardiorespiratory assist device (PCRA) in rescuing the failing heart and reducing early mortality. Methods In open-chest pigs we induced AMI by proximal left anterior descending coronary artery (LAD) ligation. Eight animals without PCRA (C group) were compared with 12 animals otherwise treated with PCRA (T group), starting approximately at 60 minutes post-occlusion and lasting 120–180 minutes. In 3 animals of the T group, regional myocardial oxygen content was also imaged by two-dimensional near infrared spectroscopy (2D-NIRS) with and without PCRA, before and after LAD reperfusion. Results All animals without PCRA died despite unrelenting resuscitation maneuvers (120 minutes average survival time). Conversely, animals treated with PCRA showed a reduction in life-threatening arrhythmia and maintenance of aortic pressure, allowing interruption of PCRA in all cases early in the experiments, with sound hemodynamics at the end of the observation period. During LAD occlusion, NIRS showed severe de-oxygenation of the LAD territory that improved with PCRA. After PCRA suspension and LAD reperfusion, the residual de-oxygenated area proved to be smaller than the initial risk area. Conclusions In AMI, PCRA initiated during advanced CS drastically reduced early mortality from 100% to 0% in a 4–5 hour observation period. PCRA promoted oxygenation of the ischemic area during LAD occlusion. Results support the use of PCRA as first line of treatment in AMI-CS, improving myocardial rescue and short-term survival.

In-hospital mortality after acute myocardial infarction in patients with diabetes mellitus

2000 ◽  
Vol 9 (3) ◽  
pp. 168-179 ◽  
Author(s):  
D Chyun ◽  
J Obata ◽  
J Kling ◽  
C Tocchi
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Odds Ratio ◽  
Hospital Death ◽  
Case Group ◽  
Term Survival ◽  
Control Subjects ◽  
Patients With Diabetes

OBJECTIVES: To examine in-hospital mortality after acute myocardial infarction in patients with diabetes mellitus. METHODS: All patients in an 800-bed teaching hospital who had a discharge diagnosis of myocardial infarction, verified by creatine kinase levels at admission, between 1991 and 1993 made up the study population. All 118 such patients who died during this period made up the case group. Two control subjects (n = 236), survivors of the hospitalization, matched by sex, age, and length of hospitalization, were selected randomly for each case. Information on the presence of diabetes mellitus, medical history, and data related to myocardial infarction were obtained through retrospective chart review. RESULTS: The mean age of all subjects in the study was 76 years. Thirty-three percent of the patients in the case group and 31% of the control subjects had a history of diabetes mellitus (odds ratio = 1.04; 95% CI, 0.64-1.70), indicating that diabetes mellitus was not associated with an increased risk of in-hospital death. The adjusted odds ratio was 1.10 (95% CI, 0.48-2.51) in patients with non-insulin-treated diabetes mellitus and 0.80 (95% CI, 0.34-1.86) in insulin-treated patients. Multivariate analysis, with conditional logistic regression, confirmed that known prognostic factors for myocardial infarction, rather than diabetic status, are predictive of in-hospital mortality. CONCLUSIONS: Once the effects of age are accounted for, the risk of in-hospital mortality is not greater in patients with diabetes mellitus than in patients without diabetes; however, diabetes mellitus may be an important factor for long-term survival.

Abstract 5372: In Vivo Myocardial Distribution of Adult Stem Cells Immediately Following Intracoronary Delivery in a Swine Model of Myocardial Infarction

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Hung Ly ◽  
Kozo Hoshino ◽  
Irina Pomerantseva ◽  
Yoshiaki Kawase ◽  
Ryuichi Yoneyama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adult Stem Cells ◽  
Near Infrared ◽  
Imaging System ◽  
High Sensitivity ◽  
Cell Loss ◽  
Swine Model ◽  
Peripheral Blood Mononuclear ◽  
Cell Based Therapy

Background: Cardiac cell-based therapy (CCT) has emerged as a promising therapeutic strategy. There are few data comparing the fate of different stem cell (SC) populations delivered by the intracoronary injection (ICI). Aim: Document the in vivo myocardial distribution of SC delivered by ICI following recent myocardial infarction. Methods: In a myocardial infarction swine model, near-infrared (NIR) fluorescence was used to provide high sensitivity in vivo tracking of SC in the immediate phase (< 60 minutes) after ICI of 2x107 cells. After labeling with the NIR fluorophore, IR-786, the NIR signal intensities and myocardial distribution patterns of mesenchymal (MSC), bone marrow-(BMMNC) and peripheral blood-mononuclear (PBMNC) cells were compared using an open-chested fluorescence imaging system. Results: The SC populations of interest were successfully loaded with IR-786. While all SC populations readily distributed along the vascular territory of the infarct-related artery immediately after injection, there was a mean SI intensity drop of 29.8% and 14.1% for PBMNC and BMNC (p<0.05), respectively, which correlated with poor cell retention. No significant SI change was found in MSC-injected swine, which was associated with less cell loss after delivery. There was also evidence of MSC-related vessel plugging in some swine (Figure ). Conclusion: Our in vivo findings suggest that immediately after injection (during the first 60min ICI), there is already evidence of poor SC retention and distribution vary depending on cell population, potentially impacting clinical efficacy and safety of CCT.

scholarly journals COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001497
Author(s):  
Satoshi Kitahara ◽  
Masashi Fujino ◽  
Satoshi Honda ◽  
Yasuhide Asaumi ◽  
Yu Kataoka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Late Presentation ◽  
Medical Attention ◽  
Hospital Death ◽  
Mechanical Complication ◽  
St Segment Elevation ◽  
Mechanical Complications ◽  
Before And After ◽  
The Impact

ObjectiveAlthough there are regional reports that the COVID-19 pandemic is associated with a reduction in acute myocardial infarction presentations and primary percutaneous coronary intervention (PCI) procedures, little is known about the impact of the COVID-19 pandemic on mechanical complications resulting from ST-segment elevation myocardial infarction (STEMI) and mortality.MethodsThis single-centre retrospective cohort study analysed presentations, incidence of mechanical complications, and mortality in patients with STEMI before and after a state of emergency was declared due to the COVID-19 pandemic by the Japanese government on 7 April 2020.ResultsWe analysed 359 patients with STEMI hospitalised before the declaration and 63 patients hospitalised after the declaration. The proportion of patients with late presentation was significantly higher after the declaration than before (25.4% vs 14.2%, p=0.03). The incidence of late presentation was significantly higher during the COVID-19 pandemic than before (incidence rate ratio (IRR), 2.41; 95% CI, 1.37 to 4.05; p=0.001, even after adjusting for month (IRR, 2.61; 95% CI, 1.33 to 5.13; p<0.01). Primary PCI was performed significantly less often after the declaration than before (68.3% vs 82.5%, p=0.009). The mechanical complication resulting from STEMI occurred in 13 of 359 (3.6%) patients before the declaration and 9 of 63 (14.3%) patients after the declaration (p<0.001). However, the incidence of in-hospital death (before, 6.2% vs after, 6.4%, p=0.95) was comparable.ConclusionsFollowing the COVID-19 pandemic, an increased incidence of mechanical complications resulting from STEMI was observed. Instructing people to stay at home, without effectively educating them to immediately seek medical attention when suffering symptoms of a heart attack, may worsen outcomes in patients with STEMI.

Abstract 129: Gasping During Cardiac Arrest Before Cardiopulmonary Resuscitation Increases Cerebral Oximetry in a Swine Model

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Nelly Rojas-Salvador ◽  
Bayert Salverda ◽  
Johanna C Moore ◽  
Michael Lick ◽  
Guillaume P Debaty ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Near Infrared ◽  
Venous Blood ◽  
Intrathoracic Pressure ◽  
Aortic Pressure ◽  
Cerebral Oximetry ◽  
Right Atrial ◽  
Swine Model ◽  
Therapeutic Implications ◽  
The Impact

Introduction: Spontaneous gasping (SG) during cardiac arrest is associated with favorable neurological outcomes. SG lowers intrathoracic pressure (ITP), enhancing flow of respiratory gases to the lungs and venous blood to the heart, while simultaneously lowering intracranial pressure (ICP). The impact of SG on regional cerebral oximetry (rSO2) is unknown. Hypothesis: During untreated ventricular fibrillation (VF), SG will increase rSO2 until the gasping effort declines. Methods: Swine (~40 kg) were intubated and anesthetized with isoflurane. After 8 min of untreated VF, conventional mechanical CPR at 100 compressions/min was performed. Intrathoracic pressure (ITP), mean aortic pressure (MAP), ICP, right atrial pressure (RAP) and calculated cerebral perfusion pressure (CerPP) were measured continuously. rSO2 was measured continuously with near-infrared spectroscopy (Equanox 7600, Nonin Medical). These parameters were assessed before and during SG, and during CPR. Data are expressed as mean ± SD. A paired Student’s t- test was used. Results: SG occurred in 19/22 pigs during untreated VF, with 9.2 ± 4.3 gasps/pig. For pigs that gasped, the individual gasp duration was 1.74 ± 0.52 sec and the maximum negative ITP (mmHg) was -3.24 ± 1.93 mmHg. rSO2 increased in 9/19 (47%) pigs from 54.7% ± 4.1 to 57.8% ± 4.8 during SG (p<0.001). Figure 1 shows rSO2 from 2 representative pigs, A) with and B) without SG. SG also decreased ITP (p<0.001), RAP (p=0.02) and ICP (p<0.001), and increased MAP (p<0.001) and CerPP (p<0.001). After 8 min of untreated VF, rSO2 for all 22 pigs was 49.3% ± 3.7. After 30 and 60 sec of CPR, rSO2 values were 54.6% ± 3.8 and 57.8% ± 3.8, respectively. Conclusions: rSO2 values increased in nearly half of animals with SG. This increase in rSO2 with SG was equal to the level of rSO2 achieved after 1 minute of CPR. Further study is warranted to determine potential prognostic and therapeutic implications of SG-induced increases rSO2 during cardiac arrest.

Management of Ventricular Fibrillation during Acute Myocardial Infarction

1984 ◽  
Vol 23 (04) ◽  
pp. 209-213
Author(s):  
B. J. Northover
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ventricular Fibrillation ◽  
Coronary Care Unit ◽  
Patient Survival ◽  
Left Ventricular ◽  
Ventricular Failure ◽  
Before And After ◽  
Coronary Care ◽  
The Creation

SummaryAnalysis of electrocardiograms tape-recorded from patients admitted to hospital with acute myocardial infarction revealed that the pattern of ventricular extrasystolic activity was not significantly different among those who subsequently developed ventricular fibrillation and those who did not. Episodes of ventricular fibrillation occurred predominantly within 4 hours from the start of infarction. Patients were 3 times less likely to survive an episode of ventricular fibrillation if they also had left ventricular failure than if this feature was absent. Management of episodes of ventricular fibrillation was compared in patients before and after the creation of a specially staffed and equipped coronary care unit. The success of electric shock as a treatment for ventricular fibrillation was similar before and after the creation of the coronary care unit. An attempt was made to determine which features in the management of ventricular fibrillation in this and in previously published series were associated with patient survival.

Changes in Platelet Aggregability after Ovariectomy

1979 ◽  
Vol 42 (04) ◽  
pp. 1332-1339 ◽  
Author(s):  
Hiroh Yamazaki ◽  
Takeshi Motomiya ◽  
Minoru Sonoda ◽  
Noboru Miyagawa
Keyword(s):  
Platelet Count ◽  
Platelet Activation ◽  
Ovarian Hormones ◽  
Control Group ◽  
Platelet Aggregability ◽  
Appearance Rate ◽  
Before And After ◽  
The Difference ◽  
Induced Aggregation ◽  
Observation Period

SummaryChanges in platelets in 48 patients with uterine myoma before and after hysterectomy with and without ovariectomy were examined. Bilateral ovariectomy in 25 cases (ovariec-tomized group) and unilateral or non-ovariectomy in 23 cases (control group) were performed at the hysterectomy. Platelet count and an appearance rate of secondary aggregation decreased at one day after and increased at one week after the operation, similarly in both the ovariectomized and the control group. The appearance rate of secondary aggregation was reflected in an intensity of aggregation at 5 min after the addition of reagent to PRP. At one month after the operation, the appearance rate of secondary aggregation induced by 3 μM ADP showed a statistically significant decrease in comparison with the preoperation value (P <0.05) and the enhancement of 5-min aggregation was still observed in the control group, while ceased in the ovariectomized group. The difference between the two groups was significant (P < 0.05). There was almost no change in the speed and intensity of primary and secondary aggregation during the observation period. No significant differences in collagen-induced aggregation were noted between the two groups. The results suggest that ovarian hormones, mainly estrogen, facilitate platelet activation which is mediated by the so-called secondary aggregation.

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