Electrocardiographic Changes and Coronary Findings in Patients with Acute non-ST-Elevation Myocardial Infarction: A Cross-Sectional Study

Background: Despite significant improvements in diagnosis and treatment, non-ST-Elevation Myocardial Infarction (NSTEMI) is still one of the health problems in developed and developing countries. Objectives: The present study was performed to assess the electrocardiographic changes and coronary findings in patients with NSTEMI. Methods: The study enrolled 158 patients with NSTEMI diagnosis at the discharge time. Demographic characteristics and electrocardiographic changes were collected using a checklist from the medical records of the patients. The angiography data were used to calculate a syntax score for each patient. Finally, patients were divided into three groups based on this score: high risk >32, intermediate risk 22-32, and low risk < 22. Involved vessels, including the left anterior descending artery, Right Coronary Artery (RCA), Left Circumflex Artery (LCX), and the left main stem, were also determined. Results: The mean age of the patients was 60.68 ± 12.15 years. The LAD, LCX, and RCA were the most common involved vessels, in sequence. About 27.73, 67.15, and 5.12% of the patients were assigned to low, moderate, and high-risk groups, respectively. Statistically significant differences were observed in the frequencies of ECG changes (P = 0.003) and types of involved vessels (P < 0.001) between low, moderate, and high-risk patients. In addition, there were statistically significant differences in the mean syntax scores between different types of involved vessels (P < 0.001). Conclusions: The findings of the present study showed a significant relationship between the types of vessel involvement and syntax score. Also, there was a high prevalence of ST changes in precordial leads that may improve the sensitivity of diagnosis. We did not find any significant relationship between the frequencies of ECG changes based on the types of involved vessels.

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Serial Electrocardiographic Changes in a Young Female with Acute Myocarditis

Cardiology and Angiology An International Journal ◽

10.9734/ca/2019/v8i430117 ◽

2019 ◽

pp. 1-7

Author(s):

Gurkirat Singh ◽

Mahesh Bodkhe ◽

Akshat Jain ◽

Narender Omprakash Bansal

Keyword(s):

Myocardial Infarction ◽

Heart Block ◽

Complete Heart Block ◽

Acute Myocarditis ◽

Young Female ◽

St Elevation Myocardial Infarction ◽

Ecg Changes ◽

Wide Range ◽

Electrocardiographic Changes ◽

St Elevation

Electrocardiographic changes in myocarditis mimic a wide range of ECG diagnoses ranging from ST-elevation myocardial infarction to complete heart block. We report a case of acute myocarditis in a young female with a wide range of ECG changes that mimic ST-elevation myocardial infarction and atrioventricular block.

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The impact of frailty on the management and outcome of ST-elevation myocardial infarction in older patients

European Heart Journal ◽

10.1093/eurheartj/ehab724.1457 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Bennett ◽

J A Batty

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Management Strategy ◽

St Elevation Myocardial Infarction ◽

Frail Patients ◽

Icd 10 ◽

St Elevation ◽

The Mean ◽

The Impact ◽

Invasive Management

Abstract Background Frailty is a clinical syndrome of increased vulnerability, resulting from age-associated decline in physiological reserve, compromising the ability to cope with acute stressors. Despite an increasing number of older, frail patients presenting with ST-elevation myocardial infarction (STEMI), there remains a paucity of guidance on how to approach the management of this complex group. Purpose To evaluate the impact of frailty on the management strategy and outcomes in older patients presenting with ST-elevation myocardial infarction. Methods A retrospective cohort study was performed, using linked patient records in The Nationwide Readmission Database. All patients aged ≥75 years that presented with STEMI (2015 – 2018) were included. International Classification of Disease (10th Edition; ICD-10) codes were used to ascertain exposures and outcomes. Frailty was quantified using the Hospital Frailty Risk Score (HFRS): an ICD-10-based scoring system that has been validated against established clinical frailty indices. Outcomes included: (i) management strategy (coronary angiography ± percutaneous coronary intervention, vs. conservative management), length of stay and 30-day mortality. Outcomes were modelled using multivariable binary logistic regression. Continuous variables are presented as: mean (standard deviation). Odds ratios (OR) are given with corresponding 95% confidence intervals (CI). Results From an overall dataset of 57,133,894 admissions, 368,201 patients presenting with STEMI were identified, of which 92,067 were aged ≥75 years. The mean age was 82.4 (5.1) years; 45,768 (49.7%) were female. The mean frailty score was 5.9 (SD 4.9, range 0 - 37.7). Patients were categorised by frailty status: low (HFRS <5; n=46,336 [50.3%]), intermediate (HFRS 5 - 15; n=40,493 [44.0%]) and high risk (HFRS >15; n=5,238 [5.7%]). Characteristics of the cohort are presented in Figure 1. Frail patients were less likely to undergo invasive management: 1,873 (35.5%) of the high risk group underwent coronary angiography vs. 36,888 (79.6%) of the low risk group; OR 0.14 (95% CI 0.13 - 0.15), P<0.001. Length of stay in hospital increased proportionately with frailty: a 2-unit increase in HRFS was associated with one additional day in hospital (p<0.001). 30-day mortality increased non-linearly with increasing HFRS and was markedly higher among patients at high risk for frailty, compared with those at low risk; OR 3.70 (95% CI 3.47 - 3.94; p<0.001). The relationship between frailty score and outcomes is presented in Figure 2. Frailty remained the greatest single predictor of outcome following adjustment for other covariates, including age. Conclusions Frail patients presenting with STEMI are less likely to undergo invasive management and more likely to experience adverse outcomes. Quantification of frailty offers an opportunity to identify and address modifiable risk factors to improve post-STEMI outcomes in this vulnerable group. FUNDunding Acknowledgement Type of funding sources: None.

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Relationship between Paraoxonase-1 and Arylesterase Enzyme Activities and SYNTAX I and II Scores in Patients with ST-Elevation Myocardial Infarction

The Journal of Tehran University Heart Center ◽

10.18502/jthc.v14i4.1989 ◽

2019 ◽

Author(s):

Erdoğan Sökmen ◽

Mustafa Çelik ◽

Serkan Sivri ◽

Kenan Güçlü

Keyword(s):

Myocardial Infarction ◽

Genetic Polymorphism ◽

Enzyme Activities ◽

St Elevation Myocardial Infarction ◽

Paraoxonase 1 ◽

Syntax Score ◽

Acute Stemi ◽

Coronary Arterial Disease ◽

St Elevation ◽

The Mean

Background: Although serum paraoxonase-1 (PON-1) and arylesterase (ARE) activities are linked to the presence of stable coronary arterial disease, their correlation with SYNTAX Score I (SS1) and SYNTAX Score II (SS2) has not been known well. Our aim was to determine the association between PON-1 and ARE activities, together with the genetic polymorphism of PON-1, and both SS1 and SS2 in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Consecutive patients with acute STEMI (n=102: 78 male, 24 female; mean age=61.14±12.25 y) admitted to the Emergency Department of Kırşehir Ahi Evran University Hospital between August 2018 and December 2018 were enrolled. PON-1 and ARE activities were determined on hospital admission. The SS1 and SS2 scores were calculated by using the angiographic and clinical data. Subsequently, the relationships between the activities of the enzymes, together with the genetic polymorphism of PON-1, and both SS1 and SS2 were interrogated. Results: The mean SS1 and the mean SS2 were 19.8±9.7 and 32.3±11.5, respectively. The phenotype distributions of PON-1 were Q192Q (n=60), R192Q (n=35), and R192R (n=7). The respective PON-1 (U/L) and ARE (kU/L) activities were 514.85±29.34 and 216.82±36.72 in the low SS1 category; 527.60±56.31 and 203.95±55.97 in the intermediate SS1 category; and, 690.10±11.07 and 238.48±45.65 in the high SS1 category.PON-1 and ARE activities did not correlate with the SS1 categories, and varying SS2 scores. The distribution of the Q192R polymorphism was homogenous among the different SS1 and SS2 scores. The localization of acute STEMI also did not associate with the activities of either enzyme. Conclusion: Admission serum PON-1 and ARE activities, together with the PON-1 Q192R genetic polymorphism, showed association neither with SS1 and SS2 nor with the localization of infarction in our acute STEMI patients. J Teh Univ Heart Ctr 2019;14(4):156-164 This paper should be cited as: Sökmen E, Çelik M, Sivri S, Güçlü K. Relationship between Paraoxonase-1 and Arylesterase Enzyme Activities and SYNTAX I and II Scores in Patients with ST-Elevation Myocardial Infarction. J Teh Univ Heart Ctr 2019;14(4):156-164.

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Circulating Levels of Dephosphorylated-Uncarboxylated Matrix Gla Protein in Patients with Acute Coronary Syndrome

Molecules ◽

10.3390/molecules26041108 ◽

2021 ◽

Vol 26 (4) ◽

pp. 1108

Author(s):

Admira Bilalic ◽

Tina Ticinovic Kurir ◽

Marko Kumric ◽

Josip A. Borovac ◽

Andrija Matetic ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

High Risk ◽

Hospital Mortality ◽

Vascular Calcification ◽

Matrix Gla Protein ◽

St Elevation Myocardial Infarction ◽

Coronary Syndrome ◽

Increased Risk ◽

St Elevation

Vascular calcification contributes to the pathogenesis of coronary artery disease while matrix Gla protein (MGP) was recently identified as a potent inhibitor of vascular calcification. MGP fractions, such as dephosphorylated-uncarboxylated MGP (dp-ucMGP), lack post-translational modifications and are less efficient in vascular calcification inhibition. We sought to compare dp-ucMGP levels between patients with acute coronary syndrome (ACS), stratified by ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) status. Physical examination and clinical data, along with plasma dp-ucMGP levels, were obtained from 90 consecutive ACS patients. We observed that levels of dp-ucMGP were significantly higher in patients with NSTEMI compared to STEMI patients (1063.4 ± 518.6 vs. 742.7 ± 166.6 pmol/L, p < 0.001). NSTEMI status and positive family history of cardiovascular diseases were only independent predictors of the highest tertile of dp-ucMGP levels. Among those with NSTEMI, patients at a high risk of in-hospital mortality (adjudicated by GRACE score) had significantly higher levels of dp-ucMGP compared to non-high-risk patients (1417.8 ± 956.8 vs. 984.6 ± 335.0 pmol/L, p = 0.030). Altogether, our findings suggest that higher dp-ucMGP levels likely reflect higher calcification burden in ACS patients and might aid in the identification of NSTEMI patients at increased risk of in-hospital mortality. Furthermore, observed dp-ucMGP levels might reflect differences in atherosclerotic plaque pathobiology between patients with STEMI and NSTEMI.

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Association of SYNTAX Score With Abdominal Aortic Intima–Media Thickness in Non-ST Elevation Myocardial Infarction

Angiology ◽

10.1177/0003319718804418 ◽

2018 ◽

Vol 70 (6) ◽

pp. 569-570 ◽

Cited By ~ 2

Author(s):

Adnan Kaya ◽

Muhammed Keskin ◽

Mustafa Adem Tatlisu ◽

Tufan Cinar

Keyword(s):

Myocardial Infarction ◽

Intima Media Thickness ◽

St Elevation Myocardial Infarction ◽

Syntax Score ◽

Media Thickness ◽

Abdominal Aortic ◽

St Elevation ◽

Aortic Intima

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Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction

Open Heart ◽

10.1136/openhrt-2018-000852 ◽

2018 ◽

Vol 5 (2) ◽

pp. e000852 ◽

Cited By ~ 5

Author(s):

Artin Entezarjou ◽

Moman Aladdin Mohammad ◽

Pontus Andell ◽

Sasha Koul

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

High Risk ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Clinical Event ◽

Left Ventricular Ejection ◽

Increased Risk ◽

St Elevation ◽

The Impact

BackgroundST-elevation myocardial infarction (STEMI) occurs as a result of rupture of an atherosclerotic plaque in the coronary arteries. Limited data exist regarding the impact of culprit coronary vessel on hard clinical event rates. This study investigated the impact of culprit vessel on outcomes after primary percutaneous coronary intervention (PCI) of STEMI.MethodsA total of 29 832 previously cardiac healthy patients who underwent primary PCI between 2003 and 2014 were prospectively included from the Swedish Coronary Angiography and Angioplasty Registry and the Registry of Information and Knowledge about Swedish Heart Intensive care Admissions. Patients were stratified into three groups based on culprit vessel (right coronary artery (RCA), left anterior descending artery (LAD) and left circumflex artery (LCx)). The primary outcome was 1-year mortality. The secondary outcomes included 30-day and 5-year mortality, as well as heart failure, stroke, bleeding and myocardial reinfarction at 30 days, 1 year and 5 years. Univariable and multivariable analyses were done using Cox regression models.ResultsOne-year analyses revealed that LAD infarctions had the highest increased risk of death, heart failure and stroke compared with RCA infarctions, which had the lowest risk. Sensitivity analyses revealed that reduced left ventricular ejection fraction on discharge partially explained this increased relative risk in mortality. Furthermore, landmark analyses revealed that culprit vessel had no significant influence on 1-year mortality if a patient survived 30 days after myocardial infarction. Subgroup analyses revealed female sex and multivessel disease (MVD) as significant high-risk groups with respect to 1-year mortality.ConclusionsLAD and LCx infarctions had a relatively higher adjusted mortality rate compared with RCA infarctions, with LAD infarctions in particular being associated with an increased risk of heart failure, stroke and death. Culprit vessel had limited influence on mortality after 1 month. High-risk patient groups include LAD infarctions in women or with concomitant MVD.

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Utilization of an ICU Severity of Illness Scoring System to Triage Patients With ST-Elevation Myocardial Infarction

Journal of Intensive Care Medicine ◽

10.1177/0885066620928263 ◽

2020 ◽

pp. 088506662092826

Author(s):

Jonathan M. Norton ◽

Prathibha K. Reddy ◽

Keshab Subedi ◽

Carly A. Fabrizio ◽

Neil J. Wimmer ◽

...

Keyword(s):

Myocardial Infarction ◽

High Risk ◽

Scoring System ◽

Intermediate Level ◽

Low Risk ◽

St Elevation Myocardial Infarction ◽

Level Of Care ◽

Apache Iii ◽

Risk Patients ◽

St Elevation

Objective: To subjectively identify low-risk ST-elevation myocardial infarction (STEMI) patients and triage this low-risk population to an intermediate level of care. Background: Many patients with STEMI are admitted to the intensive care unit (ICU), however, a large portion do not merit ICU admission. We sought to examine whether, among post-STEMI patients admitted to the ICU, if an easily obtainable subjective scoring system could predict low-risk patients and safely triage them to an intermediate level of care. Methods: Retrospective observational study at Christiana Hospital, a 900-bed regional referral center. Data were defined by the ACTION Registry and CathPCI Registry. Acute Physiology and Chronic Health Evaluation (APACHE) predictions were retrieved for all patients with STEMI and were analyzed for complications, length of stay, and inhospital mortality. We then examined subjective criteria to triage patients with STEMI out of the ICU. Results: Among 253 patients with STEMI, 179 (70.75%) were classified as low risk (intermediate level care appropriate) and 74 (29.25%) were classified as high risk (ICU appropriate). The mean age was 64.95 years. The APACHE III score was right skewed with a mean of 36.97 and a median of 31. There was a significant difference between the APACHE III score of low-risk patients and the APACHE III score of high-risk patients (P < .001). Conclusion: In conclusion, patients characterized as low risk, as defined by our criteria, had low APACHE III scores and a low likelihood of complications post-STEMI. This low-risk population could potentially be admitted to an intermediate level of care, avoiding the ICU altogether.

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