scholarly journals Association of Total Ischemic Times and In-Hospital Outcomes of Acute STEMI Patients who Underwent Primary Angioplasty at a Tertiary Cardiac Care Facility

2021 ◽  
pp. 827-833
Author(s):  
Arshad Ali Shah ◽  
Syed Dilbahar Ali Shah ◽  
Muhammad Sami Khan ◽  
Faisal Ahmed ◽  
Iftikhar Ahmed ◽  
...  
Keyword(s):  
Prospective Observational Study ◽  
Care Facility ◽  
Primary Angioplasty ◽  
Cardiac Care ◽  
Time Analysis ◽  
Balloon Inflation ◽  
Ischemic Time ◽  
Hospital Outcome ◽  
St Segment ◽  
St Elevation

Aims: To determine the association between total ischemic time and in-hospital outcome of acute ST elevation myocardial infarction (STEMI) patients who underwent primary angioplasty. Study Design: Prospective observational study. Place & Duration of Study: Department of Cardiology, Dow university of health sciences Karachi between October 2017 till March 2021. Methodology: Data for total ischemic time analysis were collected from 366 STEMI patients who consecutively underwent primary angioplasty. Total ischemic time was measured from the onset of chest pain to o the first balloon inflation during primary angioplasty and in hospital outcome was measured. Results: Total ischemic times were available in 366 STEMI patients which was ≥ 30 minutes and < 24 hours: ≤ 2 hours in 15.5%, >2-3 hours in 11.4%, >3-5 hours in 25.4%, and >5 hours in 47.5% of STEMI patients. In addition, STEMI patients with total ischemic times <5 hours demonstrated complete ST-segment resolution and reduced death rate than those with total ischemic times >5 hours. Conclusion: This study showed that shorter ischemic times are significantly related to improved myocardial reperfusion and decreased mortality.

ST-segment elevation myocardial infarction

2021 ◽  
pp. 479-493
Author(s):  
Borja Ibanez ◽  
Stefan James
Keyword(s):  
Myocardial Infarction ◽  
Primary Angioplasty ◽  
Special Focus ◽  
St Segment Elevation ◽  
St Segment ◽  
Life Threatening ◽  
St Elevation ◽  
Reperfusion Strategy ◽  
Early Phases

ST-elevation myocardial infarction (STEMI) is a life-threatening conditioning caused by an abrup occlusion of an epicardial coronary artery. Reperfusion (ideally by primary angioplasty, and if not timely available by systemic fibrinolysis) massively improves survival in STEMI patients. Healthcare systems attending STEMI patients in the early phase are critical for a correct triage, reperfusion strategy selection and initial treatment. Besides reperfusion, coadjuvant therapies are critical to improve the success of management and in turn improves long-term mortality and morbidility associated with STEMI. The present chapter presents the state-of-art evidence guiding recommendations for treatment of STEMI with a special focus on the early phases of the process.

Abstract 3009: Major Subgroup Analyses from the FINESSE Trial: Evaluation of Abciximab + Half -Dose Reteplase, Abciximab Alone, or Placebo for Facilitation of Primary PCI for ST Segment Elevation MI

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Michal Tendera ◽  
Klinika I Katedra ◽  
Stephen G Ellis ◽  
A.J. van Boven ◽  
Mark A de Belder ◽  
...  
Keyword(s):  
Symptom Onset ◽  
Study Endpoint ◽  
Primary Study ◽  
Primary Pci ◽  
Balloon Inflation ◽  
St Segment ◽  
Study Results ◽  
Subgroup Analyses ◽  
Half Dose ◽  
St Elevation

Introduction: Whereas primary PCI is the preferred reperfusion strategy for acute ST elevation MI if performed promptly, treatment delays are common. Methods: We tested the hypothesis in a randomized placebo-controlled double-blind trial of 2452 subjects from 20 countries that early pharmacologic therapy with half dose reteplase and abciximab, followed by PCI would improve the outcome in ST elevation MI patients presenting within 6 hours of symptom onset with anticipated first medical contact to catheterization time of 1– 4 hours, relative to patients receiving abciximab at the time of primary PCI; with a third randomized arm of early abciximab to better evaluate the contribution of reteplase to the combination therapy. The primary study endpoint was a composite of all cause mortality, ventricular fibrillation beyond 48 hours, cardiogenic shock or heart failure requiring re-hospitalization or an emergency room visit within 90 days. A major secondary endpoint was % ST segment resolution (>70%) 60 –90 min after randomization. Final patient enrollment was completed December 30, 2006, and 90 day follow up results will be available fall 2007. Results: Enrollment demographics are as follows: mean age = 62 years (16% ≥75), 26% female, 10% Killip II-IV, 11% prior MI, 16% diabetics, 48% anterior MI and 61% enrolled ≤ 3h after symptom onset. The median times from symptom onset to randomization, and randomization to first balloon inflation by tertiles were 1.5, 2.6, and 4.4 hours and 1.2, 1.8, and 2.6 hours, respectively. Pre specified subgroup analyses for the primary and major secondary study endpoints included time from symptom onset to randomization (≥3 vs >3 hours), randomization time to first balloon inflation (by tertiles), Killip Class (I vs II-IV), gender, age (<75 vs ≤75 years), history of prior MI, diabetes, and anterior vs non-anterior MI. Conclusion: The findings from these analyses will supplement the primary study results from this, the largest randomized trial of facilitated angioplasty, to help define the proper management of this important group of high-risk patients.

12-lead ST-segment monitoring vs single-lead maximum ST-segment monitoring for detecting ongoing ischemia in patients with unstable coronary syndromes

1998 ◽  
Vol 7 (5) ◽  
pp. 355-363 ◽  
Author(s):  
BJ Drew ◽  
MM Pelter ◽  
MG Adams ◽  
SF Wung ◽  
TM Chou ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Care ◽  
Computer Assisted ◽  
Balloon Inflation ◽  
Routine Monitoring ◽  
St Segment ◽  
Coronary Syndromes ◽  
Ecg Leads ◽  
Ischemic Events ◽  
Cardiac Care Unit

BACKGROUND: 12-lead ECG monitoring of the ST segment is more sensitive than patients' symptoms for detecting ischemia after thrombolytic therapy or catheter-based interventions, but it is unclear whether monitoring of the single lead showing maximum ST deviation would be as efficacious. OBJECTIVE: To determine whether monitoring all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes. METHODS: Continuous 12-lead ST segment monitoring was performed in 422 patients from the onset of myocardial infarction or during balloon inflation in catheter-based interventions until the patient's discharge from the cardiac care unit. Computer-assisted techniques were used to determine (1) which lead showed the maximum ST deviation at the onset of myocardial infarction or during balloon inflation and (2) what proportion of later ischemic events were associated with ST deviation in this lead. RESULTS: The lead with the maximum ST deviation could be determined in 312 patients (74%). The remaining 110 (26%) had non-Q wave infarction without ST deviation or no ST changes during balloon inflation. During 18,394 hours of 12-lead ST monitoring, 118 (28%) of the 312 patients had a total of 463 ischemic events, 80% of which were silent. Of 377 ischemic events in which a maximum ST lead was detected, 159 (42%) did not show ST deviation in this lead (sensitivity, 58%; 95% CI, 53%-63%). Routine monitoring of leads V1 and II showed ST deviation in only 152 of the 463 events (sensitivity, 33%; 95% CI, 29%-37%). CONCLUSIONS: Monitoring of all 12 ECG leads for changes in the ST segment is necessary to detect ongoing ischemia in patients with unstable coronary syndromes.

scholarly journals Suspected ST segment elevation myocardial infarction referred for primary angioplasty: a masquerader

2019 ◽  
Vol 12 (1) ◽  
pp. bcr-2018-227687
Author(s):  
Abhivrath Yennu Nandan ◽  
Abhinav Singh ◽  
Navin Mukundu Nagesh ◽  
Manish M Gandhi
Keyword(s):  
Myocardial Infarction ◽  
Aortic Dissection ◽  
Aortic Root ◽  
Primary Angioplasty ◽  
St Segment Elevation ◽  
St Segment ◽  
Retrosternal Pain ◽  
Aorta Replacement ◽  
St Elevation ◽  
Ascending Aorta Replacement

A 50-year-old man collapsed at the roadside with retrosternal pain, shortness of breath and generalised weakness. An ECG in the emergency department was reported as demonstrating ST segment elevation of up to 1.5 mm in leads V1 to V3, leading to a diagnosis of an acute ST-elevation myocardial infarction. He was immediately transferred to the cardiac catheterisation laboratory. Introduction of a coronary catheter produced signs that raised suspicion of aortic dissection. An aortogram revealed a grossly dilated aortic root of 7.3 cm with a type A ascending aortic dissection. The patient was urgently transferred to the cardiothoracic surgical centre and underwent emergency aortic root and ascending aorta replacement. Following a 20-day hospital admission, and postoperative atrial fibrillation, the patient made a steady and full recovery.

scholarly journals Influence of the speed of deflation of the stent delivery system in the myocardial blush and ST-segment resolution in primary angioplasty: a randomized study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Lozano Martinez-Luengas ◽  
C Cuellas ◽  
B Vega ◽  
F Fernandez-Vazquez ◽  
J Rondan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Analysis ◽  
Ejection Fraction ◽  
Delivery System ◽  
Primary Angioplasty ◽  
Ischemic Time ◽  
Maximal Diameter ◽  
St Segment ◽  
Direct Stenting ◽  
Group 1

Abstract Introduction Distal embolization may compromise the results of primary angioplasty. Our aim is to analyze the influence of the speed of deflation of the stent delivery system on the myocardial blush ≥2 and on the ST-Segment resolution ≥70%. Methods From December 2016 to February 2019, all consecutive patients with ST-elevation myocardial infarction who underwent urgent coronary angiography at our institution who were susceptible of thrombectomy, IIB-IIIA inhibitors and direct stenting were randomized 1:1 to fast deflation of the stent delivery system (group 1, n=103) or to slow deflation at 1 atm/second (group 2, n=107). Pre- and postdilatation was not allowed per protocol. The primary outcomes were the myocardial blush ≥2 and the ST-Segment resolution ≥70% while the size of myocardial damage, ejection fraction at discharge and at 12 months and total and cardiovascular mortality at 12 months were the secondary outcomes. A multivariate analysis was performed to analyze the influence of the speed of deflation of the stent delivery system in both primary end-points in case of possible imbalances among groups despite the randomization. Results Both groups represented 47% of the 447 procedures of primary angioplasty performed in that period. Baseline characteristics of the whole cohort: female gender 46 (21.9%), age 59.5±10.6 years, diabetes 35 (16.7%), Killip class IV 5 (2.4%), total ischemic time 177.5 (124–275) minutes and door to balloon time 84 (66–120.5) minutes. There were not differences in clinical or angiographic characteristics between both groups, although there was a non-significant trend towards larger reference vessel diameter in the slow deflation group (2.74±0.42 vs. 2.86±0.47, p=0.07). The study was prematurely stopped with 50% of the calculated sample size due to futility. The primary endpoint of myocardial blush ≥2 occurred in 77 (74.7%) vs. 79 (75.2%), p=0.93 and ST-Segment resolution ≥70% in 54 (53.9%) vs. 59 (55.5%), p=0.75 in group 1 and 2, respectively, without differences in any of the secondary endpoints. The speed of deflation of the stent delivery system did not show any influence on the MB or ST-Segment resolution ≥70% in the multivariate analysis. Predictors of myocardial blush ≥2 were systolic blood pressure at admission, creatinine clearance &lt;60 ml/min and maximal diameter postprocedure. Diabetes, previous infarction, left anterior descending, TIMI ≥2 before intervention, TIMI 3 after intervention and collateral supply grade ≥2 were predictors of ST segment resolution≥70% with an area under the curve of 0.71 (0.63–0.80) and 0.75 (0.68–0.82), respectively. Conclusions In our series, the speed of deflation of the stent delivery system in primary angioplasty did not modified the myocardial blush ≥2 or ST-Segment resolution ≥70% and neither showed any influence in clinical outcomes, size of myocardial infarction by biomarkers and ejection fraction. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Laboratories

scholarly journals Posterior myocardial infarction with isolated ST elevations in V8 and V9: Is this an “ST elevation MI”?

CJEM ◽  
2003 ◽  
Vol 5 (02) ◽  
pp. 115-118
Author(s):  
Lance Brown ◽  
Jessica Sims ◽  
Alessandra Conforto
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Occlusion ◽  
Primary Angioplasty ◽  
Artery Occlusion ◽  
St Segment Elevation ◽  
St Segment ◽  
St Elevation ◽  
Artery Disease ◽  
Electrocardiogram Ecg

ABSTRACT We report a case of a 53-year-old man whose first manifestation of coronary artery disease was an acute isolated posterior myocardial infarction (IPMI). Acute IPMI is relatively uncommon and predominantly due to occlusion of the left circumflex coronary artery. IPMI is challenging to diagnose due to the absence of ST segment elevation on a standard 12-lead electrocardiogram (ECG) even in the setting of total coronary artery occlusion and transmural (Q-wave) infarct. We discuss the diagnostic implications of the absence of tall R waves in leads V1 and V2 on this patient’s ECG. The utility of posterior leads (V7 through V9) is demonstrated. The controversy surrounding the use of thrombolytic therapy or primary angioplasty in the setting of acute IPMI without ST segment elevation on a standard 12-lead ECG is reviewed.

Relationship between Serum Inflammatory Biomarkers and Thrombus Characteristics in Patients with ST Segment Elevation Myocardial Infarction

Cardiology ◽  
2016 ◽  
Vol 137 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Giampaolo Niccoli ◽  
Alberto Menozzi ◽  
Davide Capodanno ◽  
Carlo Trani ◽  
Vasile Sirbu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Optical Coherence Tomography ◽  
Gender Diversity ◽  
Primary Angioplasty ◽  
Optical Coherence ◽  
St Segment Elevation ◽  
Reactive Protein ◽  
St Segment ◽  
St Elevation ◽  
Primary Percutaneous Intervention

Objectives: To compare angiographic and optical coherence tomography (OCT) data pertinent to thrombi, along with the histologic characteristics of aspirated thrombi in patients presenting with ST elevation myocardial infarction (STEMI) with or without inflammation, as assessed by C-reactive protein (CRP) and myeloperoxidase (MPO). Methods: In the OCTAVIA (Optical Coherence Tomography Assessment of Gender Diversity in Primary Angioplasty) study, 140 patients with STEMI referred for primary percutaneous intervention were enrolled. The patients underwent OCT assessment of the culprit vessel, along with blood sampling of CRP and MPO, and histologic analysis of the thrombus. Results: Biomarkers were available for 129 patients, and histology and immunohistochemistry of the thrombi were available for 78 patients. Comparisons were made using the median thresholds of CRP and MPO (2.08 mg/L and 604.124 ng/mL, respectively). There was no correlation between CRP and MPO levels in the whole population (p = 0.685). Patients with high CRP levels had higher thrombus grades and more frequent TIMI flow 0/1 compared with those with low CRP levels (5 [1st quartile 3; 3rd quartile 5] vs. 3.5 mg/L [1; 5], p = 0.007, and 69.3 vs. 48.5%, p = 0.04, respectively). Patients with high MPO levels more commonly had early thrombi than had those with low MPO levels (42.5 vs. 20.0%, p = 0.04). Conclusions: CRP and MPO were not correlated in STEMI patients, possibly reflecting different pathogenic mechanisms, with CRP more related to thrombus burden and MPO to thrombus age.

Abstract P80: Lack of English Comprehension is Associated with Delays in Hospital Presentation in Patients with ST-Segment Elevation Myocardial Infarction

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Dayana J Eslava ◽  
Juan P Cordova ◽  
Aleksandr Korniyenko ◽  
Girish N Nadkarni ◽  
Carlos L Alviar ◽  
...  
Keyword(s):  
Previous History ◽  
Primary Angioplasty ◽  
Educational Outreach ◽  
Ischemic Time ◽  
St Segment Elevation ◽  
Telephone Interviews ◽  
St Segment ◽  
The Usa ◽  
Presentation Time ◽  
Top 40

Background: Prior studies have demonstrated an association between ethnicity and symptom onset to presentation time (S2PT) among patients presenting with ST elevation MI (STEMI) in the USA, with a shorter S2PT among Caucasians when compared with other ethnicities. However, little is known regarding whether or not a patient's ability to comprehend English impacts the S2PT. Methods: Consecutive patients presenting to 4 hospitals in NYC with STEMI referred for primary angioplasty were included in the analysis. S2PT was recorded on the day of the infarct based on the patient's account of the onset of symptoms. We assessed a patient's ability to comprehend English through telephone interviews conducted during routine follow-up. Results: Among 210 patients, 83.8% (176 of 210) had either some English comprehension or were fluent in English (E) and 16.2% (34 of 210) reported no English comprehension (non-E). Of the non-E patients, 65% (22 of 34) spoke Spanish, 6% (2 of 34) spoke Russian, 6% (2 of 34) spoke Chinese and 23% (8 of 34) spoke another language. The baseline variables and mean S2PT are depicted in the table. Non-E patients had a significantly higher S2PT compared to E patients even after adjusting for differences in baseline variables. Increased odds were also observed among non-E patients with a longer S2PT (adjusted odds ratio for S2PT > 120 minutes 2.17; 95% CI 01.03-4.54; p=0.04). This association remained constant even after adjusting for confounders like age, sex, ethnicity, level of education and comorbidities (diabetes, previous history of MI and PCI). Conclusions: S2PT is strongly influenced by a patient's ability to comprehend English. This information emphasizes the need for more aggressive “multi-lingual” educational outreach and the use of multi-lingual emergency lines in an effort to decrease total ischemic time during STEMI. English Comprehension Fair or Good (N=176) No English Comprehension (N=34) P Age Mean (SD) 62 (14.2) 65 (11) 0.22 Male sex n (%) 129 (73) 26 (76) 0.70 Diabetes n (%) 25 (14) 9 (27) 0.09 Hypertension n (%) 107 (66) 20 (62.5) 0.70 Prior MI n (%) 21 (12) 2 (6) 0.284 Prior PCI or CABG n (%) 12 (6.8) 2 (6) 0.960 Education: n (%) 40 (23) 12 (35) 0.09 Less than HS 62 (35) 8 (23) HS Diploma 8 (4) 0 (0) College Diploma Unknown 66 (38) 14 (42) Mean S2P time (SD) 225 (315) 387 (820.6) 0.05 S2P time > 120 minutes n (%) 70 (40) 20 (62.5) 0.04

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