Myocardial Infarction
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2021 ◽  
Vol 9 (27) ◽  
pp. 8104-8113
Delia Lidia Șalaru ◽  
Cristina Andreea Adam ◽  
Dragos Traian Marius Marcu ◽  
Ionut Valentin Șimon ◽  
Liviu Macovei ◽  

2021 ◽  
Ömer Şen ◽  
Sıdıka B Şen ◽  
Ayşe N Topuz ◽  
Mustafa Topuz

Aim: No-reflow phenomenon (NRP) is an undesirable result of coronary interventions, and usually occurred during the primary percutaneous coronary intervention (PPCI). On the other hand, there is growing evidence of epidemiological studies suggest that serum 25 hydroxy-vitamin D (25(OH)D3) level is significantly associated with cardiovascular mortality and morbidity. Objective: To investigate whether there is a relationship between admission serum 25(OH)D3 levels and NRP in patients with ST elevation myocardial infarction (STEMI). Methods: This study consisted of 496 consecutive acute STEMI patients who underwent PPCI. After the restoration of antegrade flow, the patients were divided into the normal flow and no-reflow groups. No-reflow defined as; thrombosis in myocardial infarction (TIMI) flow grade ≤2, or a TIMI flow grade = 3 with a myocardial perfusion grade ≤1. Results: Angiographic no-reflow occurred 18.2% of all study patients. Serum 25(OH)D3 levels were significantly lower when compared with the normal flow group (14.6 ± 7.3 vs 22.6 ± 9.6 ng/ml; p < 0.001). 25(OH)D3 level was significantly negatively correlated with Neutrophil/lymphocyte (N/L) ratio. In multivariate analysis, 25(OH)D3 level on admission (OR: 0.738; 95% CI: 0.584–0.878; p = 0.001) was found an independent predictor of NRP together with N/L ratio, N-Terminal-proBNP, balloon pre dilatation and syntax score I. On receiver operating curve analysis (ROC), the cut-off value of admission 25(OH)D3 level was 10.5 ng/ml for the prediction of NRP with a sensitivity of 93% and specificity of 68%. The area under the ROC curve (AUC) was 0.772 (95% CI: 0.697–0.846; p < 0.001). Conclusion: We have shown that lower 25(OH)D3 level on admission is associated with higher NRP frequency and may be used as a predictor for NRP in STEMI patients undergoing PPCI.

Samian Sulaiman ◽  
Akram Kawsara ◽  
Mohamed O. Mohamed ◽  
Harriette G. C. Van Spall ◽  
Nadia Sutton ◽  

Background Women are less likely to receive primary percutaneous coronary intervention (pPCI) than men. A potential reason is risk aversion because of the worse outcomes with pPCI among women. However, whether pPCI is associated with a comparable mortality benefit in men and women remains unknown. Methods and Results We selected patients admitted with a principal diagnosis of ST‐segment–elevation myocardial infarction in the National Inpatient Sample (2016–2018). We used propensity‐score matching to calculate average treatment effects of pPCI for in‐hospital mortality, major complications, length of stay, and cost. As a sensitivity analysis, we used logit models followed by a marginal command to calculate the average marginal effect. We included 413 500 weighted hospitalizations (30.7% women, 69.3% men). Women had more comorbidities except smoking and prior sternotomy. Compared with men, women were less likely to undergo angiography (81.0% versus 87.0%; adjusted odds ratio [OR], 0.77; 95% CI, 0.74–0.81; P <0.001) or pPCI (74.0% versus 82.0%; adjusted OR, 0.76; 95% CI, 0.73–0.79; P <0.001). There were no significant differences in average treatment effects of pPCI on mortality between men (−8.4% [−9.3% to −7.6%], P <0.001), and women (−9.5% [−10.8% to −8.3%], P <0.001) ( P interaction=0.16). This persisted in age‐stratified analyses (≥85, 65–84, 45–64, <45 years) and sensitivity analysis, excluding emergent admissions. The average treatment effects of pPCI on major complications were comparable except for acute stroke, leaving against medical advice, and palliative encounter. There were no differences in the average treatment effects of pPCI on length of stay, but the proportional increase in cost with pPCI was higher in women. Conclusions pPCI results in a comparable reduction in in‐hospital mortality in men and women. Nonetheless, risk‐adjusted rates of pPCI remain lower in women in contemporary US practice.

Medicine ◽  
2021 ◽  
Vol 100 (37) ◽  
pp. e27027
Yingying Hua ◽  
Mingjing Shao ◽  
Yan Wang ◽  
Jinhang Du ◽  
Jiaxing Tian ◽  

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257618
Manuel Chacón-Díaz ◽  
Akram Hernández-Vásquez ◽  
Rodrigo Vargas-Fernández ◽  
Guido Bendezu-Quispe

Background Myocardial infarction (MI) is the most prevalent cardiovascular disease globally and is considered a public health problem. In Peru, MI is the second leading cause of death at the national level, with a mortality rate that exceeds 10% in the hospital setting. The study aims to determine the clinical and epidemiological characteristics of ST-segment elevation myocardial infarction (STEMI) in tertiary care facilities belonging to the Peruvian public health system. Methods and analysis This will be a prospective, observational, multicenter study, with baseline and two follow-up assessments: at admission to the health service, and 30 days and 12 months after admission. This multicenter study will be conducted in 27 hospitals located in the main cities of Peru. The patients included in the study will be over 18 years of age, of either sex, and will have been admitted to the health facility with a diagnosis of acute coronary syndrome with ST-segment elevation. The Kaplan-Meier method will be used to estimate the cumulative in-hospital mortality of patients at 30 days and 12 months of follow-up, and the log-rank test will be used to evaluate the differences between the survival curves between reperfused and non-reperfused patients. Subsequently, to evaluate the risk factors for successful reperfusion and cardiovascular adverse events, generalized linear models of the binomial family with log link function will be used to estimate the bivariate and multivariate relative risk (RR) with their respective 95% confidence intervals. This project was approved by the Ethics and Research Committee of the National Cardiovascular Institute (Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo”—INCOR [in Spanish]; Approval report 21/2019-CEI). Discussion Among the strengths, the observational design will allow the inclusion of a large sample of patients, which will significantly contribute to the knowledge base on STEMI in Peru. It should be noted that this study is the first to examine the clinical-epidemiological characteristics of STEMI in high-resolution hospital centers in Peru with follow-up one year after the event, providing knowledge of these observable characteristics in daily clinical routine. Likewise, the multicenter nature of the study will increase the external validity of the findings. In terms of limitations, the observational design of the study can only describe associations and not causality. Furthermore, since data from medical records will be used, there could be imprecision in the data.

Yuki Obayashi ◽  
Hiroki Shiomi ◽  
Takeshi Morimoto ◽  
Yodo Tamaki ◽  
Moriaki Inoko ◽  

Background It remains controversial whether long‐term clinical impact of newly diagnosed atrial fibrillation (AF) in the acute phase of acute myocardial infarction (AMI) is different from that of prior AF diagnosed before the onset of AMI. Methods and Results The current study population from the CREDO‐Kyoto AMI (Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction) Registry Wave‐2 consisted of 6228 patients with AMI who underwent percutaneous coronary intervention. The baseline characteristics and long‐term clinical outcomes were compared according to AF status (newly diagnosed AF: N=489 [7.9%], prior AF: N=589 [9.5%], and no AF: N=5150 [82.7%]). Median follow‐up duration was 5.5 years. Patients with newly diagnosed AF and prior AF had similar baseline characteristics with higher risk profile than those with no AF including older age and more comorbidities. The cumulative 5‐year incidence of all‐cause death was higher in newly diagnosed AF and prior AF than no AF (38.8%, 40.7%, and 18.7%, P <0.001). The adjusted hazard ratios (HRs) for mortality of newly diagnosed AF and prior AF relative to no AF remained significant with similar magnitude (HR, 1.31; 95% CI, 1.12–1.54; P <0.001, and HR, 1.32; 95% CI, 1.14–1.52; P <0.001, respectively). The cumulative 5‐year incidence of stroke decreased in the order of newly diagnosed AF, prior AF and no AF (15.5%, 12.9%, and 6.3%, respectively, P <0.001). The higher adjusted HRs of both newly diagnosed AF and prior AF relative to no AF were significant for stroke, with a greater risk of newly diagnosed AF than that of prior AF (HR, 2.05; 95% CI, 1.56–2.69; P <0.001, and HR, 1.33; 95% CI, 1.00–1.78; P =0.048, respectively). The higher stroke risk of newly diagnosed AF compared with prior AF was largely driven by the greater risk within 30 days. The higher adjusted HRs of newly diagnosed AF and prior AF relative to no AF were significant for heart failure hospitalization (HR, 1.73; 95% CI, 1.35–2.22; P <0.001, and HR, 2.23; 95% CI, 1.82–2.74; P <0.001, respectively) and major bleeding (HR, 1.46; 95% CI, 1.23–1.73; P <0.001, and HR, 1.36; 95% CI, 1.15–1.60; P <0.001, respectively). Conclusions Newly diagnosed AF in AMI had risks for mortality, heart failure hospitalization, and major bleeding higher than no AF, and comparable to prior AF. The risk of newly diagnosed AF for stroke might be higher than that of prior AF.

Medical Care ◽  
2021 ◽  
Vol Publish Ahead of Print ◽  
Vinayak Bhardwaj ◽  
Erin M. Spaulding ◽  
Francoise A. Marvel ◽  
Sarah LaFave ◽  
Jeffrey Yu ◽  

А.Н. Гращенкова ◽  
С.Н. Пузин ◽  
О.Т. Богова ◽  
В.Н. Потапов ◽  
Е.Е. Ачкасов ◽  

На всех этапах восстановления после инфаркта миокарда (ИМ) увеличение физической активности пациентов пожилого возраста - одна из важных составляющих реабилитационного процесса. Безусловно, на ранних стадиях ИМ определенные ограничения физической активности позволяют уменьшить нагрузку на миокард, снизить его потребности в кислороде и создать условия для скорейшего заживления. В последующем, в зависимости от динамики и показателей работы сердечно-сосудистой системы, пациента пожилого возраста переводят с одной ступениактивностинадругую, оцениваютуровень АД, ЧСС, наличие аритмии, данные электрокардиограммы, данные эхо-КГ показателей, а также индивидуальную переносимость нагрузок. На сегодняшний день для медицинской реабилитации пациентов пожилого возраста, перенесших ИМ, актуальным является применение различных вариантов механотерапии. Представляет интерес применение механотерапии по программе комплекса David Back Concept (силовая тренировка). Он представляет собой комплект из тренажеров для работы над мышцами спины. Настоящий лечебно-диагностический комплекс предназначен для диагностики, лечения и профилактики патологий опорно-двигательной системы, а также для реабилитации пациентов после хирургических вмешательств и травм позвоночника. Для восстановления физического статуса до оптимально достижимого уровня, определяемого возможностями адаптационных механизмов пожилого человека, в программе медицинской реабилитации пациентов пожилого возраста с ИБС и после перенесенного ИМ нами применен программный комплекс David Back Concept и оценено его влияние на гемодинамические показатели. At all stages of recovery after myocardial infarction (MI), the expansion of physical activity of elderly patients is one of the most important components. Of course, certain restrictions can reduce the load on the myocardium, reduce its oxygen needs and create conditions for early healing. Subsequently, depending on the dynamics and indicators of the cardiovascular system, the elderly patient is transferred from one stage of activity to another, the level of blood pressure, the number of heartbeats, the presence of arrhythmia, electrocardiogram data, EchoCG data, as well as individual load tolerance are evaluated. To date, there is a huge selection of optimal options for selecting methods of medical rehabilitation for elderly patients who have suffered a MI, and one of them is mechanotherapy. The mechanical therapy program of the David Back Concept complex - strength training is a set of simulators for working on the back muscles. The medical and diagnostic complex is designed for the diagnosis, treatment and prevention of pathologies of the musculoskeletal system, as well as for the rehabilitation of patients after surgical interventions and spinal injuries. Medical rehabilitation of elderly patients with coronary heart disease and after a MI through mechanotherapy, the program of the David Back Concept complex, provides for the restoration of their physical and social status to an optimally achievable level, determined by the capabilities of adaptive mechanisms.

Gennaro Ratti ◽  
Antonio Maglione ◽  
Emilia Biglietto ◽  
Cinzia Monda ◽  
Ciro Elettrico ◽  

Long term treatment with ticagrelor 60 mg and low-dose aspirin are indicated after acute coronary syndrome (ACS). We retrospectively reviewed aggregate data of 187 patients (155 M and 38 F) (mean age 63.8±9 years) in follow up after ACS with at least one high risk condition (Multivessel disease, diabetes, GFR<60 mL/min, history of prior myocardial infarction, age >65 years) treated with ticagrelor 60 mg twice daily (after 90 mg twice daily for 12 months). The results were compared with findings (characteristics of the patients at baseline, outcomes, bleeding) of PEGASUS-TIMI 54 trial and Eu Label. The highrisk groups were represented as follows: multivessel disease 105 pts (82%), diabetes 63 pts (33%), GFR< 60 mL/min 27 pts (14%), history of prior MI 33 pts (17%), >65 year aged 85 pts (45%). Treatment was withdrawn in 7 patients: 3 cases showed atrial fibrillation and were placed on oral anticoagulant drugs, one developed intracranial bleeding, in three patients a temporary withdrawal was due to surgery (1 colon polyposis and 2 cases of bladder papilloma). Chest pain without myocardial infarction occurred in 16 patients (revascularization was required in 9 patients). Dyspnea was present in 15 patients, but was not a cause for discontinuation of therapy. Long term treatment with ticagrelor 60 mg twice daily plus aspirin 100 mg/day showed a favourable benefit/risk profile after ACS.  In this study all patients had been given ticagrelor 90 mg twice daily for 12 months and the 60 mg twice daily dosage was started immediately thereafter, unlike PEGASUS-TIMI 54 trial in which it was prescribed within a period ranging from 1 day to 1 year after discontinuation of the 90 mg dose. This makes our results more consistent with current clinical practice. However, a careful outpatient follow-up and constant counseling are mandatory to check out compliance to therapy and adverse side effects.

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