scholarly journals Coronary Flow in Patients with Three-Vessel Disease: Simulated Hemodynamic Variables in relation to Angiographically Assessed Collaterality and History of Myocardial Infarction

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Issam Abouliatim ◽  
Majid Harmouche ◽  
Agnès Drochon ◽  
Mahmoud Maasrani ◽  
Hervé Corbineau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Collateral Flow ◽  
Anterior Myocardial Infarction ◽  
Ventricular Ejection Fraction ◽  
Flow Rates ◽  
Chronic Occlusion ◽  
History Of

We study patients with stenoses of the left main coronary artery (LMCA), left anterior descending artery (LAD), and left circumflex branch (LCx) and with chronic occlusion of the right coronary artery (RCA), undergoing off-pump coronary surgery. An analog electrical model is used to provide quantitative estimations of the distribution of flows and pressures across the coronary network (in the stenosed native arteries, the collateral branches, the capillary areas, and so forth). The present paper demonstrates that the clinical information collected for the 10 patients included in the study (Rentrop score, history of myocardial infarction, left ventricular ejection fraction (LVEF)) are well correlated with the predicted hydrodynamic data. Patients with a good collaterality (Rentrop score = 3) or patients without anterior myocardial infarction have (i) less severe stenoses on the LMCA, (ii) lower microvascular resistances, (iii) higher grafts flow rates when the revascularization is performed, (iv) higher collateral flow rates towards the territory of the occluded artery, (v) better perfusion of this area, and (vi) better total perfusion of the heart.

scholarly journals Implications of transient ischaemic dilatation and impaired left ventricular ejection fraction reserve in patients with normal stress myocardial perfusion imaging and elevated coronary artery calcium

2021 ◽  
Vol 22 (Supplement_3) ◽  
Author(s):  
JJJ Wong ◽  
MS Yew
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Myocardial Perfusion Imaging ◽  
Left Ventricular Ejection Fraction ◽  
Cardiac Death ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Post Stress ◽  
Fatal Myocardial Infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Stress only (SO) instead of stress/rest single photon emission computed tomography myocardial perfusion imaging (MPI) is encouraged if perfusion and left ventricular ejection fraction (LVEF) are normal on SO images.  Concurrent coronary artery calcium (CAC) scoring has also been recommended to assess atherosclerotic burden in ‘normal’ MPIs.  However, the safety of SO MPI in high CAC cases is unclear as additional rest imaging may show transient ischaemic dilation (TID) and/or impaired LVEF reserve (iLVEFr) which are markers of severe coronary artery disease (CAD) and indicate ‘balanced ischaemia’. Purpose We aim to assess the incidence and outcomes of TID and iLVEFr in stress/rest MPIs with normal SO images and elevated CAC.   Methods Retrospective analysis of all normal stress/rest MPIs performed between 1 March 2016 to 31 January 2017 with concurrently measured CAC >300.  A SO protocol was not in place then.  Prone post stress images were routinely done.  Known CAD cases were excluded.  A reader reviewed only the post stress supine/prone images and excluded cases ineligible for SO MPI (non-homogenous perfusion, LVEF ≤50%, abnormal wall motion). The remaining cases were assessed for TID (software derived TID ratio >1.20) and iLVEFr (stress LVEF – rest LVEF ≤-5%).  Coronary angiography (CAG) and major adverse cardiac events (MACE, defined as cardiac death, non fatal myocardial infarction, revascularisation) within 24 months post MPI were traced using electronic medical records. Results There were 230 cases included (mean age 71, 56.5% male) of which 43 (18.7%) had TID and/or iLVEFr (9 TID, 22 iLVEFr, 12 both).  There were no significant differences in baseline characteristics, CAC and aspirin/statin use between cases with or without TID and/or iLVEFr (Table 1).  More patients in the TID and/or iLVEFr group underwent elective CAG [10 (23.3%) vs 10 (5.3%), p = 0.001] although CAG diagnosis of severe CAD (left main, 3-vessel or 2-vessel disease with proximal left anterior descending involvement) was not different [4/6 (40.0%) vs 5/10 (50.0%), p = 1.000).  MACE was significantly higher in the TID and/or iLVEFr group [10 (23.3%) vs 16 (8.6%), p = 0.013], driven by higher elective revascularisation [8 (18.6%) vs 8 (4.3%), p = 0.003] with no significant differences in cardiac death or non fatal myocardial infarction (Table 2). Conclusion TID and/or iLVEFr is seen in <20% of cases eligible for SO MPI with high CAC, suggesting that routine rest scan in these cases exposes the majority to unnecessary radiation.  Identification of TID and/or iLVEFr is associated with higher 24 month MACE, driven by higher elective revascularisation from more CAG referral.  Approximately half of cases in each group had revascularisation for non severe CAD not typically associated with TID and/or impaired LVEFr.  Overall cardiac death and non fatal myocardial infarction rates were low and not significantly different between groups with or without TID and/or iLVEFr.

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.

Thirty-Five Day Impella 5.0 Support via Right Axillary Side Graft Cannulation for Acute Cardiogenic Shock

2013 ◽  
Vol 8 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Mario A Castillo-Sang ◽  
Sunil M. Prasad ◽  
Jasvindar Singh ◽  
Gregory A. Ewald ◽  
Scott C. Silvestry
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Cardiogenic Shock ◽  
Artery Bypass ◽  
Complete Recovery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Severe Coronary Artery ◽  
Artery Disease

We describe the use of an Impella 5.0 for mechanical support in acute cardiogenic shock after an acute myocardial infarction. A 61-year-old man with a history of severe coronary artery disease who underwent coronary artery bypass grafting with ischemic cardiomyopathy presented with cardiogenic shock after an ST-elevation myocardial infarction. An Impella Recover LP 5.0 (Abiomed, Danvers, MA USA) was inserted via a right axillary side graft, using transesophageal echocardiographic and fluoroscopic guidance. The patient remained in the intensive care unit, where he required a tracheostomy to beweaned off the ventilator. He required renal replacement therapy with subsequent complete recovery. His Impella support was weaned, and on postoperative day 35, the device was removed. The patient developed axillary thrombosis the morning after removal, requiring thrombectomy. Discharge echocardiogram showed mild left ventricular enlargement with global hypokinesis and left ventricular ejection fraction of 25%. The Impella 5.0 device can safely and effectively be used in the long-term support of cardiogenic shock.

scholarly journals Usefulness of non-invasive myocardial work to predict left ventricular recovery and acute complications after acute anterior myocardial infarction treated by primary angioplasty

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Meimoun ◽  
S Abdani ◽  
M Gannem ◽  
V Stracchi ◽  
F Elmkies ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Global Longitudinal Strain ◽  
Primary Angioplasty ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Anterior Myocardial Infarction ◽  
Ventricular Ejection Fraction ◽  
Non Invasive ◽  
2D Strain

Abstract Background Predicting left ventricular (LV) recovery after acute ST-elevation myocardial infarction (STEMI) is challenging and of prognostic importance. Objective To evaluate the usefulness of non-invasive myocardial work (MW), a new index of global and regional myocardial performance, to predict LV recovery and in-hospital complications after STEMI. Methods Ninety-three consecutive patients with anterior STEMI (mean age, 59±12 years) treated by primary angioplasty underwent transthoracic echocardiography (TTE) within 24–48 hours after angioplasty and a median of 92 days at follow-up. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Segmental LV recovery was defined as a normalization of segmental wall motion abnormalities of the affected segments and global recovery as an absolute improvement of left ventricular ejection fraction (LVEF) greater than 5% in patients with baseline LVEF &lt;50%. In-hospital complications were defined as a composite of death, reinfarction, heart failure, and LV apical thrombus. Results 1642 segments were studied and MW was impaired in infarct segments, more severely in no recovery versus recovery segments (MW index, constructive MW, MW efficiency, all, p&lt;0.01). Furthermore, global MW was significantly correlated to acute and follow-up LVEF and global longitudinal strain (GLS) (all, p&lt;0.01). Constructive MW was the best indice to predict segmental (p&lt;0.01 versus MW index, MW efficiency, and wasted work), and global recovery (p&lt;0.05 versus GLS) with an independent association (all, p&lt;0.01). Moreover, global constructive MW was independently associated to in-hospital complications which occurred in 18 patients (p&lt;0.01). Conclusion In patients with anterior STEMI treated by primary angioplasty, acute constructive MW is an independent predictor of segmental and global LV recovery, as well as in-hospital complications. Funding Acknowledgement Type of funding source: None

scholarly journals In-hospital results of rheolytic catheter thrombectomy in patients with STEMI

2016 ◽  
Vol 20 (3) ◽  
pp. 54
Author(s):  
M V Malkhasyan ◽  
V A Kuznetsov ◽  
I S Bessonov ◽  
P I Pavlov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
Contractile Function ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Old Myocardial Infarction ◽  
Mean Time

<p><strong>Aim.</strong> The article focuses on the evaluation of short-term efficacy of rheolytic thrombectomy (AngioJet) in patients with STEMI. <br /><strong>Methods.</strong> 188 patients (85.6% men) with STEMI underwent primary PCI by means of rheolytic catheter thrombectomy (AngioJet). The mean age was 54.1 ± 10.7 years. 32 (17 %) of patients had old myocardial infarction. 104 (55.9 %) patients were diagnosed with ST-elevated inferior myocardial infarction. 22 (12 %) patients were operated under cardiogenic shock. Mean time from the appearance of symptoms to admission was 222.5 [70, 584] min. Anterior interventricular artery (38.3 %) and right coronary artery (43.6 %) were the main infarction-related arteries. <br /><strong>Results.</strong> Complete thrombotic occlusion of the coronary artery occurred in 144 (77.4%) patients. Mean “door-to-balloon” time amounted to 41.5 [30; 60]. Coronary thrombus was fully removed in 107 (60.8%) of patients. Stents with antiproliferative effect were implanted in 48.8 % of patients. Immediate angiographic success was achieved in 177 (94.1%) cases. Mean time of PCI was 60 [50; 80] min. PCI complications were registered in 3 (1.6%) patients. Intraoperative life-threatening arrhythmias happened in 22 (11.7 %) patients. The phenomenon of "no-reflow" occurred in 6 (3.2%) PCI cases. The rate of in-hospital mortality was 5.9%, including patients with cardiogenic shock (36.4%) and those without it (1.9 %). MACCE (main adverse cardio-cerebral events) were observed in 15 (8%) cases. According to ECG data obtained postoperatively, 26 % of patients demonstrated no regional asynergy, while a decrease in myocardial contractile function occurred in just 26 % of cases, with the average left ventricular ejection fraction running to 57.5±9 %. Mean in-hospital stay was 9.5±0.6 days.<br /><strong>Conclusion.</strong> The results of this study suggest that rheolytic catheter thrombectomy (AngioJet) is a safe and effective modality. Immediate hospital results show low rate complications and low in-hospital mortality.</p><p>Received 13 April 2016. Accepted 9 June 2016.</p><p><strong>Conflict of interest:</strong> The authors declare no conflict interests.</p>

scholarly journals Effect of late culprit coronary artery revascularization on prognosis of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 25 (8) ◽  
pp. 3796
Author(s):  
A. A. Frolov ◽  
K. V. Kuzmichev ◽  
I. G. Pochinka ◽  
E. G. Sharabrin ◽  
A. G. Savenkov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Artery Revascularization ◽  
St Elevation ◽  
Group 2 ◽  
Group 1

Aim. To evaluate the effect of culprit coronary artery revascularization after 48 hours from the symptoms’ onset on the prognosis of patients with ST-elevation myocardial infarction (STEMI).Material and methods. Of the 1172 patients admitted to City Clinical Hospital № 13 in 2018 due to STEMI, 43 patients (4%) were included in the retrospective study. There were following inclusion criteria: hospitalization after 48 hours from the symptoms’ onset, no clinical signs of myocardial ischemia, and complete coronary artery occlusion according to angiography. The mean age of the subjects was 61,3±10,6 years, 34 (79%) men and 9 (21%) women. The subjects were divided into two groups: group 1 (n=22) — management with percutaneous coronary intervention (PCI), group 2 (n=21) — management with medications. The groups differ only in the severity of coronary atherosclerosis according to SYNTAX score: group 1 — 14,0 [11.0; 19.5], group 2 — 26,0 [16,5; 31,0] (p=0,009). At the end of inpatient treatment, patients underwent echocardiography. Death and myocardial infarction were monitored during hospitalization and for 12 months after discharge.Results. During hospitalization, 2 patients died (4,7%; one in each group, p=1,00). No recurrent MI were reported. The left ventricular ejection fraction in the PCI group was 50 [46; 54] %, in the group with drug therapy — 43 [38; 50] % (p=0,01). Out of 43 included patients, long-term outcomes were followed up in 32 (74%). Among them, 1 (5,8%) patient died in group 1, 6 (33,3%) patients — in group 2 (p=0,04). In total, death or recurrent MI in the first group was observed in 2 (12%) patients, in the second group — in 5 (33%) patients (p=0,14).Conclusion. Revascularization of a fully occluded culprit coronary artery in stable patients with STEMI after 48 hours of symptoms’ onset is associated with a higher inhospital left ventricular ejection fraction and a decrease in 12-month mortality.

scholarly journals Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)—How Can We Identify These Patients?

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1196
Author(s):  
Irmina Morawska ◽  
Rafał Niemiec ◽  
Maria Stec ◽  
Karolina Wrona ◽  
Paweł Bańka ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Total Occlusion ◽  
Ventricular Ejection Fraction ◽  
Infarct Related Artery ◽  
History Of ◽  
St Elevation ◽  
One Year

Background and Objectives: Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain unclear. Aim: The study aimed to assess the incidence and predictors of TO of IRA in patients with NSTEMI, and its clinical significance. Material and Methods: The study was a single-center retrospective cohort analysis of 399 consecutive patients with NSTEMI (293 male, mean age: 71 ± 10.1 years) undergoing percutaneous coronary intervention. The study population was categorized into patients with TO and non-TO of IRA on coronary angiography. In-hospital and one-year mortality were analyzed. Results: TO of IRA in the NSTEMI population occurred in 138 (34.6%) patients. Multivariate analysis identified the following independent predictors of TO of IRA: left ventricular ejection fraction (odds ratio (OR) 0.949, p < 0.001); family history of coronary artery disease (CAD) (OR 2.652, p < 0.001); and high-density lipoprotein (HDL) level (OR 0.972, p = 0.002). In-hospital and one-year mortality were significantly higher in the TO group than the non-TO group (2.8% vs. 1.1%, p = 0.007 and 18.1% vs. 6.5%, p < 0.001, respectively). The independent predictors of in-hospital mortality were: left ventricular ejection fraction (LVEF) at admission (OR 0.768, p = 0.004); and TO of IRA (OR 1.863, p = 0.005). Conclusions: In the population of patients with NSTEMI, TO of IRA represents a considerably frequent phenomenon, and corresponds with impaired outcomes. Therefore, the utmost caution should be paid to prevent delay of coronary angiography in NSTEMI patients with impaired left ventricular systolic function, metabolic disturbances, and a family history of CAD, who are at increased risk of TO of IRA.

P879Discharge medication and 1-year outcomes in patients with myocardial infarction and nonobstructive coronary artery disease: a nationwide registry-based study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P M Azevedo ◽  
T Mota ◽  
J Bispo ◽  
J Guedes ◽  
D Carvalho ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Antiplatelet Therapy ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Cox Regression Analysis ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 5% to 10% of all patients with myocardial infarction. Although these patients are often treated as if they had obstructive coronary artery disease (OCAD), optimal medical therapy for secondary prevention in MINOCA patients have not been prospectively studied. We hypothesize that the same treatment strategy as for OCAD is unlikely to be beneficial in MINOCA patients due to their heterogeneous nature. Purpose Characterize and assess the impact of discharge medication on 1-year mortality or hospitalization in patients with MINOCA. Methods Retrospective cohort study of consecutive patients with acute myocardial infarction (AMI) recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 1017. All patients who underwent coronary angiography and had no obstructive lesions (defined as <50% diameter stenosis) were included for analysis (n=829, 4.8% of a total of 17213). Patient demographics, clinical characteristics and medication at discharge were analyzed. The association between treatment and outcome was estimated by comparing treated and untreated groups using Cox proportional hazard models. The exposures considered were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers (BB), aspirin (ASA) or dual antiplatelet therapy (DAPT). The outcomes evaluated were 1-year all-cause mortality and 1-year hospitalization due to cardiovascular disease (CVD) Results 829 patients (54% male, mean age 65±13 years) were included. 67% had hypertension, 20% diabetes mellitus, 45% hyperlipidemia, 66% were overweight, 23% were current smokers, 5.5% had history of heart failure, 4.3% valvular heart disease, 8% cerebrovascular disease and 4.7% chronic kidney disease. The admission diagnosis was most frequently non-ST elevation MI (79.3%) and mean left ventricular ejection fraction (%) was 56±12. 4 patients died during hospitalization (0.5%). At discharge, aspirin was prescribed in 85.7% patients, clopidogrel in 54.8%, ticagrelor in 7.5%, DAPT in 57.7%, ACEi/ARB in 79.2%, beta-blocker in 69% and statins in 90.2%. 1-year mortality and 1-year CVD hospitalization was 3.8% and 9%, respectively. After adjusting for covariates in Cox regression analysis, we found no association between any medication at discharge and 1-year outcomes. Conclusion A high proportion of patients are prescribed antiplatelet therapy, including DAPT. We found no significant 1-year beneficial effect of treatment with statins, ACEi/ARBs, BB, aspirin or DAPT in MINOCA. This may be partially explained by the highly heterogenous population and relative short-term follow-up. In MINOCA patients, treatment should be individualized after an exhaustive diagnostic workup to identify the underlying cause (e.g. CAD with spontaneous autolysis of an intracoronary thrombus, myocarditis or takotsubo syndrome).

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