No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
American College of Emergency Physicians; Society for Cardiovascular Angiography and Interventions. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
... Acute coronary syndromes (ACS), the most prevalent cardiovascular disease, is one of the leading causes of high morbidity and mortality worldwide, especially acute myocardial infarction (AMI) (O'Gara et al. 2013), AMI is employed when there is evidence of ischemic damage resulting in necrosis of the cardiac muscle. AMI can be divided into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on whether the ST segment is elevated on the electrocardiogram (ECG), and they share a common pathophysiological basis (O'Gara et al. 2013;Grines and Mehta 2021), both STEMI and NSTEMI require percutaneous coronary intervention (PCI) to open the culprit vessel to restore myocardial blood supply and reduce mortality (Davis and Blankenship 2023). ...
... Acute coronary syndromes (ACS), the most prevalent cardiovascular disease, is one of the leading causes of high morbidity and mortality worldwide, especially acute myocardial infarction (AMI) (O'Gara et al. 2013), AMI is employed when there is evidence of ischemic damage resulting in necrosis of the cardiac muscle. AMI can be divided into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) based on whether the ST segment is elevated on the electrocardiogram (ECG), and they share a common pathophysiological basis (O'Gara et al. 2013;Grines and Mehta 2021), both STEMI and NSTEMI require percutaneous coronary intervention (PCI) to open the culprit vessel to restore myocardial blood supply and reduce mortality (Davis and Blankenship 2023). Studies have confirmed that the lesion morphology of culprit vessel in STEMI is relatively simple compared to NSTEMI (Murakami et al. 2022;Mayr This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. ...
... Obesity rates may also be slightly higher in men than in women. As we all know that smoking and obesity themselves are the risks for MACE events in myocardial infarction (O'Gara et al. 2013;Ibanez et al. 2017). ...
Background
Patients with ST‐segment elevation myocardial infarction (STEMI) may have higher hospitalization costs and poorer prognosis than non‐ST‐segment elevation myocardial infarction (NSTEMI).
Methods
A single‐center retrospective study was conducted on 758 STEMI patients and 386 NSTEMI patients from January 1, 2020 to May 30, 2023 aimed to investigate the differences in cost and mortality.
Results
STEMI patients had higher maximal troponin I (15,222.5 (27.18, 40,000.00) vs. 2731.5 (10.73, 27,857.25), p < 0.001) and lower left ventricular ejection fraction (LVEF) (56% (53%, 59%) vs. 57% (55%, 59%), p < 0.001) compared to NSTEMI patients. The clinical symptoms were mainly persistent or interrupted chest pain/distress in either STEMI or NSTEMI patients. STEMI patients had a significantly higher risk of combined hypotension than NSTEMI patients (8.97% vs. 3.89%, p = 0.002), and IABP was much more frequently used in the STEMI group with a statistical difference (2.90% vs. 0.52%, p = 0.015). STEMI patients have statistically higher hospitalization costs (RMB, ¥) (31,667 (25,337.79, 39,790) vs. 30,506.91 (21,405.96, 40,233.75), p = 0.006) and longer hospitalization days (10 (8, 11) vs. 9 (8, 11), p = 0.001) compared to NSTEMI patients. Although in‐hospital mortality was higher in STEMI patients, the difference was not statistically significant (3.56% vs. 2.07%, p = 0.167). Multivariable logistic regression was performed and found that systolic blood pressure and NT‐proBNP were risk factors for patient death (OR ≥ 1).
Conclusion
STEMI patients are more likely comorbid cardiogenic shock, heart failure complications with higher hospitalization costs and longer hospitalization days. And relatively more use of acute mechanical circulatory support devices such as IABP.
Trial Registration
ChiCTR2300077885
... To investigate the robustness of our main findings we perform some sensitivity analysis on the group of movers and visitors, focusing on potential heterogeneity by gender, age and comorbidities. 18 The results are shown in Table 3. Columns (1) and (3) report the parameter estimates of postdischarge spending, while columns (2) and (4) report the estimates for in-hospital costs. The results are based on our baseline estimate presented in column (4) of Table 2. ...
... Robust absolute t statistics clustered at the HSA level in parentheses *p < 0.10 , **p < 0.05 , ***p < 0.001 17 Note that a power calculation to find a minimum effect of 0.5 for a similar Cox proportional hazards model, assuming power of 0.8, significance of 0.10 and event probability equal to 0.20 (sample postdischarge mortality) requires minimum sample size of N = 495 and a minimum number of events 99. 18 Appendix 1 presents a straightforward and simple analysis using linear probability models for in-hospital and post-discharge mortality of patients who suffered from a heart attack. The results suggest that mortality of both locals and visitors are affected by personal characteristics and residence characteristics. ...
... We include the first-hospital treatment intensity since the crucial treatment decisions determining survival of patients such as whether or not to administer reperfusion therapy or PCI are time-dependent and are unlikely to be performed after more than 24-48 h since the diagnosis (O'Gara et al.[18]).15 The quarter of year is included, since there is a well-documented seasonality of cardiovascular diseases, with greater incidence and mortality observed during winter months. ...
This paper investigates the effects of health-care spending on mortality rates of patients who experienced a heart attack. We relate in-hospital deaths to in-hospital spending and post-discharge deaths to post-discharge health-care spending. In our analysis, we use detailed administrative data on individual personal characteristics including comorbidities, information about the type of medical treatment and information about health-care expenses at the regional level. To account for potential selectivity in the region of health-care treatment we compare local patients with visitors and stayers with recent movers from a different region. We find that in regions with higher health-care spending mortality after heart attacks is substantially lower. From this we conclude that there are long-term returns to local health-care spending.
... For this instance, it is recommended that a high-intensity statin is initiated as soon as possible in MI sufferers after admission and that a lipid profile is obtained during admission, preferably within 24 h of presentation [9][10][11]. Theoretically, knowing the basal lipid profile of the patient will allow for tailored lipid-lowering therapy (LLT) after discharge, choosing the most appropriate drug or drug combination in order to reach LDL-C goals. ...
... Fortunately, a diverse and growing therapeutic armamentarium for lowering LDL-C is available to the clinician, and in recent years several drugs have been incorporated that can lower LDL-C as much as 85% in combination therapy [30,31]. High-intensity statin treatment with either atorvastatin or rosuvastatin is systematically recommended after an MI [9][10][11], given that they further reduce cardiovascular risk compared to lower-intensity statins [32] and that other statins could hardly achieve the required LDL-C target. The addition of other agents such as ezetimibe or iPCSK9 are recommended in patients who remain uncontrolled despite previous LLT, but economic, social, and healthcare barriers exist, and variability in prescription is common in daily clinical practice. ...
... As discussed, the first strategy that can enhance lipidic control after MI is the generalized use of high-intensity statin therapy. It is recommended that a high-intensity statin is initiated as soon as possible in MI sufferers after admission to increase patient adherence after discharge and to rapidly and steadily improve cardiovascular outcomes [9][10][11]. In our hospital, we use oral atorvastatin 80 mg o.d. per protocol in patients admitted for MI. ...
We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 ± 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4–6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (−39.23 ± 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1–2 and 40–45% in subsequent days (R² 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4–6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription.
... This approach is especially crucial for determining the appropriateness of therapy. The intensity and location of care can be determined to inform patients and families more clearly about adverse outcomes and prognosis [3,4]. Hierarchical agglomerative clustering (HAC), among the machine learning (ML) algorithms, is a relatively new method utilized in this study to categorize STEMI patients with similar clinical, laboratory and angiographic features. ...
... DTB was defined as the time between hospital admission and reperfusion that provides coronary flow distal to the occlusion. TIT is the sum of patient and system time delay to wire crossing or lytic bolus [4,11,12]. Transthoracic echocardiography was performed at admission to measure the left ventricular ejection fraction (LVEF) and valvular function by an expert echocardiographer in all patients in the left lateral decubitus position (GE Vivid™ 8 Ultrasound Machine; GE Healthcare, Piscataway, NJ, USA). Images of the parasternal long and short axes and apical four-and two-chamber regions were taken according to the criteria of the American Society of Echocardiography [13]. ...
Introduction
ST-segment elevation myocardial infarction (STEMI) represents the most harmful clinical manifestation of coronary artery disease. Risk assessment plays a beneficial role in determining both the treatment approach and the appropriate time for discharge. Hierarchical agglomerative clustering (HAC), a machine learning algorithm, is an innovative approach employed for the categorization of patients with comparable clinical and laboratory features. The aim of the present study was to investigate the role of HAC in categorizing STEMI patients and to compare the results of these patients.
Methods
A total of 3205 patients who were diagnosed with STEMI at the university hospital emergency clinic between 2015 and 2023 were included in the study. The patients were divided into 2 different phenotypic disease clusters using the HAC method, and their outcomes were compared.
Results
In the present study, a total of 3205 STEMI patients were included; 2731 patients were in cluster 1, and 474 patients were in cluster 2. Mortality was observed in 147 (5.4%) patients in cluster 1 and 108 (23%) patients in cluster 2 (chi-square P value < 0.01). Survival analysis revealed that patients in cluster 2 had a significantly greater risk of death than patients in cluster 1 did (log-rank P < 0.001). After adjustment for age and sex in the Cox proportional hazards model, cluster 2 exhibited a notably greater risk of death than did cluster 1 (HR = 3.51, 95% CI = 2.71–4.54; P < 0.001).
Conclusion
Our study showed that the HAC method may be a potential tool for predicting one-month mortality in STEMI patients.
... Whereas the US guidelines do not mention PPA treatment in STEMI, the recent European Society of Cardiology guidelines on the management of acute coronary syndrome suggested discontinuation of anticoagulants after invasive procedures but with a C level of evidence and no mention of primary PCI. 2,3 A previous study with bivalirudin suggested that PPA (with bivalirudin or unfractionated heparin [UFH], with or without a glycoprotein IIb/IIIa inhibitor) did not reduce adverse ischemic events but increased bleeding complications, 4 whereas another analysis in acute coronary syndromes reported a possible ischemic benefit with a higher dose of bivalirudin given for up to 4 hours, without bleeding excess. 5 Prolongation of enoxaparin anticoagulation after primary PCI with a single dose of 40 mg once daily was used in the ATOLL study (Acute Myocardial Infarction Treated With Primary Angioplasty and Intravenous Enoxaparin or Unfractionated Heparin to Lower Ischemic and Bleeding Events at Short-and Long-Term Follow-up), 6,7 but there was no randomization to evaluate the effect of PPA. ...
... 5,8,[24][25][26][27][28][29] In contrast to PCI performed in more stable clinical conditions, the current European Society of Cardiology guidelines do not provide a clear recommendation for PPA after primary PCI for STEMI except when there is a separate indication for anticoagulation. 2 The American College of Cardiology Foundation/American Heart Association guidelines neither discuss nor give recommendations for PPA after primary PCI. 3 The RIGHT trial was thus designed to evaluate the efficacy and safety of PPA versus interruption of anticoagulation after primary PCI for STEMI. Based on the previous literature, 15,[19][20][21][30][31][32] we selected low doses of anticoagulants for the prevention of thrombotic events after primary PCI, and these regimens proved to be safe for ≥48 hours after primary PCI, which often corresponds to the period of intensive cardiac care for uncomplicated MI. ...
BACKGROUND
Postprocedural anticoagulation (PPA) is frequently administered after primary percutaneous coronary intervention in ST-segment–elevation myocardial infarction, although no conclusive data support this practice.
METHODS
The RIGHT trial (Comparison of Anticoagulation Prolongation vs no Anticoagulation in STEMI Patients After Primary PCI) was an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted at 53 centers in China. Patients with ST-segment–elevation myocardial infarction undergoing primary percutaneous coronary intervention were randomly assigned by center to receive low-dose PPA or matching placebo for at least 48 hours. Before trial initiation, each center selected 1 of 3 PPA regimens (40 mg of enoxaparin once daily subcutaneously; 10 U·kg·h of unfractionated heparin intravenously, adjusted to maintain activated clotting time between 150 and 220 seconds; or 0.2 mg·kg·h of bivalirudin intravenously). The primary efficacy objective was to demonstrate superiority of PPA to reduce the primary efficacy end point of all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), or urgent revascularization (any vessel) within 30 days. The key secondary objective was to evaluate the effect of each specific anticoagulation regimen (enoxaparin, unfractionated heparin, or bivalirudin) on the primary efficacy end point. The primary safety end point was Bleeding Academic Research Consortium 3 to 5 bleeding at 30 days.
RESULTS
Between January 10, 2019, and September 18, 2021, a total of 2989 patients were randomized. The primary efficacy end point occurred in 37 patients (2.5%) in both the PPA and placebo groups (hazard ratio, 1.00 [95% CI, 0.63 to 1.57]). The incidence of Bleeding Academic Research Consortium 3 or 5 bleeding did not differ between the PPA and placebo groups (8 [0.5%] vs 11 [0.7%] patients; hazard ratio, 0.74 [95% CI, 0.30 to 1.83]).
CONCLUSIONS
Routine PPA after primary percutaneous coronary intervention was safe but did not reduce 30-day ischemic events.
REGISTRATION
URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03664180.
... pPCI is a favorable treatment strategy for patients with ST-segment elevation myocardial infarction (STEMI). The American College of Cardiology Foundation/American Heart Association guidelines 2013 for STEMI recommends that pPCI should be conducted within 90 min of arrival at the hospital [9]. The Japanese circulation society 2018 Guideline on Diagnosis and Treatment of Acute Coronary Syndrome recommends a door-to-device time shorter than 90 min as the minimum acceptable time, and total ischemic time should be as short as possible [10]. ...
Background
Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-fold: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories.
Methods
We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories.
Results
The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group.
Conclusion
The trajectory of the proportion of pPCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends.
... A implementação de protocolos padronizados no pronto-socorro tem demonstrado melhorar a adesão às diretrizes e os desfechos clínicos dos pacientes com SCA (Cannon et al., 2015). A educação contínua dos profissionais de saúde e a integração de equipes multidisciplinares são essenciais para garantir um manejo eficaz e baseado em evidências (Anderson et al., 2013). ...
This article presents a narrative literature review on the management of Acute Coronary Syndrome (ACS) in the emergency department. The research was conducted using Google Scholar, LILACS, and SCIELO databases, covering publications from 2000 to 2024. The review followed six methodological steps: identifying the topic, establishing inclusion and exclusion criteria, defining the information to be extracted, evaluating the included studies, interpreting the results, and presenting the review. Key findings include the importance of early administration of antithrombotic therapies, such as aspirin and glycoprotein IIb/IIIa inhibitors, to prevent thrombus progression and improve coronary blood flow. The use of high-sensitivity biomarkers, such as troponin, has improved diagnostic accuracy, allowing for early identification of at-risk patients. Early revascularization, especially in patients with ST-segment elevation myocardial infarction (STEMI), is associated with a significant reduction in mortality and incidence of heart failure. Primary angioplasty is the treatment of choice for STEMI patients, while the treatment strategy for non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina may vary depending on risk assessment and clinical stability. The implementation of standardized protocols and the creation of chest pain units in the emergency department have shown to improve the triage and management of ACS patients, resulting in better clinical outcomes. Continuous education of healthcare professionals and the integration of multidisciplinary teams are essential to ensure effective and evidence-based management.
... Multiple studies have repeatedly shown that promptly restoring blood flow to the ischemic myocardium decreases the size of the infarction, maintains the function of the left ventricle, and eventually enhances survival rates (O'Gara et al., 2013). The comprehensive study has verified that patients who have early reperfusion therapy within the specified timeframe have considerably lower mortality rates in comparison to those who receive delayed or no reperfusion therapy. ...
Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality globally, driven by the blockage of blood flow to the heart muscle. Timely reperfusion therapy, which aims to restore blood flow, is essential for minimizing tissue damage and improving outcomes. This review examines the impact of early reperfusion therapy utilizing novel pharmacological agents and advanced imaging techniques on mortality and functional outcomes in AMI. Recent advances in pharmacology, including the development of fibrin-specific thrombolytics and new-generation P2Y12 inhibitors, have enhanced the efficacy of reperfusion therapy by reducing the risk of recurrent ischemic events and improving survival rates. Concurrently, advanced imaging techniques, such as cardiac magnetic resonance imaging (MRI) and positron emission tomography (PET), have improved the precision of diagnosis, guiding therapeutic decisions, and evaluating the success of interventions. However, the phenomenon of reperfusion injury remains a significant challenge, with ongoing research exploring pharmacological strategies to mitigate this issue. The integration of these innovative approaches represents a significant advancement in AMI management, offering the potential to improve both immediate and long-term patient outcomes. Further research is needed to refine these therapies and optimize their clinical application.
... The American College of Cardiology (ACC) and the American Heart Association (AHA) recommend anticoagulation therapy with warfarin for at least 3 months in patients with LVT. Thereafter, a TTE is recommended to confirm resolution, after which anticoagulation can be stopped if there is no longer an LVT visualized [7][8][9]. In the clinical settings, a number of patients present with recurrence of LVT and/or with a complication from it including thromboembolic events. ...
Background
Evidence regarding the duration of anticoagulation (AC) therapy for left ventricular thrombus (LVT) is lacking. This study aims to evaluate the rate and risk factors for LVT recurrence in patients with Anterior ST-Segment elevation Myocardial Infarction (STEMI) complicated by LVT.
Methods
This was a retrospective analysis of patients with Anterior STEMI complicated by LVT and reduced ejection fraction (<35 %) from 2010 to 2020. Patients with atrial fibrillation and hypercoagulable state were excluded. Recurrence of LVT was defined as a new LVT on transthoracic echocardiography (TTE) after interval resolution and AC discontinuation. Demographics, comorbidities, guideline directed medical therapy, TTE, and angiographic characteristics were assessed and compared in patients with and without LVT recurrence.
Results
87 patients met the inclusion criteria. Nine (10.3 %) had LVT recurrence of which three (33.3 %) had cardioembolic events. More patients with recurrence had ventricular aneurysm/scarring (33 % vs 10.3 %) and multi-vessel disease (22.2 % vs 9 %).
Conclusion
This study reveals that a portion of patients with Anterior STEMI complicated by LVT are at a higher risk of recurrence after initial resolution and AC discontinuation. Larger prospective trials are needed to re-address the appropriate duration of anticoagulation.
... A previous report on the lack of significant improvement in long-term clinical outcomes with dual antiplatelet therapy in MINOCA patients serves as one example [91]. Furthermore, while heparin is the recommended drug of choice for peri-procedural and adjunctive anticoagulation to reperfusion therapy [92], evidence suggests that anticoagulation with unfractionated heparin poses a particularly high bleeding risk among women. Even when administered weight-adjusted doses, women undergoing treatment with unfractionated heparin for MI experience greater activation of partial thromboplastin time than men, putting them at a greater risk for bleeding complications [93]. ...
... Secondly, the optimal timing for MCS deployment is still undetermined, with a lack of clear guidance in the existing literature. Lastly, despite the fact that the IABP was largely abandoned after 2012, choices for the best available device [14,15] still remain unclear. In light of these uncertainties, MCS currently holds a Class IIa recommendation in European Guidelines, while its use has decreased in the last decade, indicating a decline in routine MCS use and the need for careful patient selection [13,16]. ...
(1) Background: Mechanical circulatory support (MCS) in myocardial infarction-associated cardiogenic shock is subject to debate. This analysis aims to elucidate the impact of MCS’s timing on patient outcomes, based on data from the PREPARE CS registry. (2) Methods: The PREPARE CS prospective registry includes patients who experienced cardiogenic shock (SCAI classes C–E) and were subsequently referred for cardiac catheterization. Our present analysis included a subset of this registry, in whom MCS was used and who underwent coronary intervention due to myocardial infarction. Patients were categorized into an Upfront group and a Procedural group, depending on the timing of MCS’s introduction in relation to their PCI. The endpoint was in-hospital mortality. (3) Results: In total, 71 patients were included. MCS was begun prior to PCI in 33 (46%) patients (Upfront), whereas 38 (54%) received MCS during or after the initiation of PCI (Procedural). The groups’ baseline characteristics and hemodynamic parameters were comparable. The Upfront group had a higher utilization of the Impella® device compared to extracorporeal membrane oxygenation (67% vs. 33%), while the Procedural group exhibited a balanced use of both (50% vs. 50%). Most patients suffered from multi-vessel disease in both groups (82% vs. 84%, respectively; p = 0.99), and most patients required a complex PCI procedure; the latter was more prevalent in the Upfront group (94% vs. 71%, respectively; p = 0.02). Their rates of complete revascularization were comparable (52% vs. 34%, respectively; p = 0.16). Procedural CPR was significantly more frequent in the Procedural group (45% vs. 79%, p < 0.05); however, in-hospital mortality was similar (61% vs. 79%, respectively; p = 0.12). (4) Conclusions: The upfront implantation of MCS in myocardial infarction-associated CS did not provide an in-hospital survival benefit.
... DES have played a significant role in the management of ST segment elevation myocardial infarction (STEMI), a severe cardiovascular condition often caused by the abrupt blockage of coronary arteries, leading to inadequate blood supply to the heart muscle and subsequent ischemic necrosis. PCI has emerged as the preferred treatment approach for STEMI, offering rapid vessel dilation, restoration of blood flow, reduction of myocardial injury, and potential reduction in mortality and recurrent ischemia rates (41, 67,68). This technique replaced the conventional pharmacologic therapy and introduced stent-based interventions to the treatment landscape (69)(70)(71)(72). ...
Drug-eluting stents (DES) play a crucial role in treating coronary artery disease (CAD) by preventing restenosis. These stents are coated with drug carriers that release antiproliferative drugs within the vessel. Over the past two decades, DES have been employed in clinical practice using various materials, polymers, and drug types. Despite optimizations in their design and materials to enhance biocompatibility and antithrombotic properties, evaluating their long-term efficacy and safety necessitates improved clinical follow-up and monitoring. To delineate future research directions, this study employs a bibliometric analysis approach. We comprehensively surveyed two decades' worth of literature on DES for CAD using the Web of Science Core Collection (WOSCC). Out of 5,778 articles, we meticulously screened them based on predefined inclusion and exclusion criteria. Subsequently, we conducted an in-depth analysis encompassing annual publication trends, authorship affiliations, journal affiliations, keywords, and more. Employing tools such as Excel 2021, CiteSpace 6.2R3, VOSviewer 1.6.19, and Pajek 5.17, we harnessed bibliometric methods to derive insights from this corpus. Analysis of annual publication data indicates a recent stabilisation or even a downward trend in research output in this area. The United States emerged as the leading contributor, with Columbia University and CRF at the forefront in both publication output and citation impact. The most cited document pertained to standardized definitions for clinical endpoints in coronary stent trials. Our author analysis identifies Patrick W. Serruys as the most prolific contributor, underscoring a dynamic exchange of knowledge within the field.Moreover, the dual chart overlay illustrates a close interrelation between journals in the “Medicine,” “Medical,” and “Clinical” domains and those in “Health,” “Nursing,” and “Medicine.” Frequently recurring keywords in this research landscape include DES coronary artery disease, percutaneous coronary intervention, implantation, and restenosis. This study presents a comprehensive panorama encompassing countries, research institutions, journals, keyword distributions, and contributions within the realm of DES therapy for CAD. By highlighting keywords exhibiting recent surges in frequency, we elucidate current research hotspots and frontiers, thereby furnishing novel insights to guide future researchers in this evolving field.
... New ST elevation at the J point in at least 2 contiguous leads of 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2-V3 and/or of 1 mm (0.1mV) in other contiguous chest leads or the limb leads. 11 The 12-lead ECG is a pivotal diagnostic tool. Level of serum cardiac biomarkers CKMB and Troponin are elevated. ...
... Acute coronary syndrome (ACS) is a severe cardiovascular disease characterized by ischemic symptoms in the cardiac supply region due to coronary artery disease [1]. ACS includes ST elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. ...
BACKGROUND
Elevated levels of cardiac troponin and abnormal electrocardiogram changes are the primary basis for clinical diagnosis of acute coronary syndrome (ACS). Troponin levels in ACS patients can often be more than 50 times the upper reference limit. Some patients with subarachnoid hemorrhage (SAH) also show electrocardiogram abnormalities, myocardial damage, and elevated cardiac biomarkers. Unlike ACS patients, patients with SAH only have a slight increase in troponin, and the use of anticoagulants or antiplatelet drugs is prohibited. Because of the opposite treatment modalities, it is essential for clinicians to distinguish between SAH and ACS.
CASE SUMMARY
A 56-year-old female patient was admitted to the emergency department at night with a sudden onset of severe back pain. The final diagnosis was intraspinal hematoma in the thoracic spine. We performed an emergency thoracic spinal canal hematoma evacuation procedure with the assistance of a microscope. Intraoperatively, diffuse hematoma formation was found in the T7-T10 spinal canal, and no obvious spinal vascular malformation changes were observed. Postoperative head and spinal magnetic resonance imaging (MRI) showed a small amount of SAH in the skull, no obvious abnormalities in the cervical and thoracic spinal canals, and no abnormal signals in the lumbar spinal canal. Thoracoabdominal aorta CT angiography showed no vascular malformation. Postoperative motor system examination showed Medical Research Council Scale grade 1/5 strength in both lower extremities, and the patient experienced decreased sensation below the T12 rib margin and reported a Visual Analog Scale score of 3.
CONCLUSION
Extremely elevated troponin levels (more than 50 times the normal range) are not unique to coronary artery disease. SAH can also result in extremely high troponin levels, and antiplatelet drugs are contraindicated in such cases. Emergency MRI can help in the early differential diagnosis, as a misdiagnosis of ACS can lead to catastrophic neurological damage in patients with spontaneous spinal SAH.
... NSTEMI was defined as symptoms of ischemia with positive cardiac biomarkers but without ST-segment elevation. UA was defined as symptoms or accelerating patterns of anginal symptoms with or without ECG changes indicative of ischemia but without elevation in cardiac biomarkers 13,14) . ...
Aim: A close relationship exists between resting heart rate (RHR) and obstructive sleep apnea (OSA). Still, the prognostic importance of nighttime RHR in patients with acute coronary syndrome (ACS) with or without OSA remains unclear.
Methods: In this prospective cohort study, OSA was defined as an apnea–hypopnea index of ≥ 15 events/h, and the high nighttime RHR (HNRHR) was defined as a heart rate of ≥ 70 bpm. The primary endpoint was a major adverse cardiovascular and cerebrovascular event (MACCE), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for heart failure.
Results: Among the 1875 enrolled patients, the mean patient age was 56.3±10.5 years, 978 (52.2%) had OSA, and 425 (22.7%) were in HNRHR. The proportion of patients with HNRHR is higher in the OSA population than in the non-OSA population (26.5% vs. 18.5%; P＜0.001). During 2.9 (1.5, 3.5) years of follow-up, HNRHR was associated with an increased risk of MACCE in patients with OSA (adjusted HR: 1.56, 95% CI: 1.09–2.23, P=0.014), but not in patients without OSA (adjust HR: 1.13, 95% CI: 0.69–1.84, P=0.63).
Conclusions: In patients with ACS, a nighttime RHR of ≥ 70 bpm was associated with a higher risk of MACCE in those with OSA but not in those without it. This identifies a potential high-risk subgroup where heart rate may interact with the prognosis of OSA. Further research is needed to determine causative relationships and confirm whether heart rate control impacts cardiovascular outcomes in patients with ACS-OSA.
... Diabetes mellitus is a metabolic disease that causes high blood sugar. Diabetes complications can lead to heart stroke, kidney failure, lower limb amputation etc.Retinal damage is incurable in the advanced stage of diabetes [15].About 75% of deaths in people with diabetes are due to coronary artery disease [16].The adverse microvascular and macrovascular effects of elevated plasma glucose levels behave in a linear or exponential manner and do not change dramatically when patients' FPG or OGTT results pass the threshold we have defined as "diabetes" [6]. Hypertension is a common comorbid condition of diabetes, affecting ~ 20-60% of patients with diabetes, depending on ethnicity, age, and obesity [10]. ...
The main objective of this research project is to predict the diabetes of a patient using machine learning algorithm. The early detection and prevention of diabetes complications are critical for improving health outcomes and reducing healthcare costs. Machine learning algorithms have shown promising results in predicting the risk of complications in patients with diabetes.
BACKGROUND
Myocardial ischemia-reperfusion injury (MIRI) poses a prevalent challenge in current reperfusion therapies, with an absence of efficacious interventions to address the underlying causes.
AIM
To investigate whether the extracellular vesicles (EVs) secreted by adipose mesenchymal stem cells (ADSCs) derived from subcutaneous inguinal adipose tissue (IAT) under γ-aminobutyric acid (GABA) induction (GABA-EVsIAT) demonstrate a more pronounced inhibitory effect on mitochondrial oxidative stress and elucidate the underlying mechanisms.
METHODS
We investigated the potential protective effects of EVs derived from mouse ADSCs pretreated with GABA. We assessed cardiomyocyte injury using terminal deoxynucleotidyl transferase dUTP nick end-labeling and Annexin V/propidium iodide assays. The integrity of cardiomyocyte mitochondria morphology was assessed using electron microscopy across various intervention backgrounds. To explore the functional RNA diversity between EVsIAT and GABA-EVsIAT, we employed microRNA (miR) sequencing. Through a dual-luciferase reporter assay, we confirmed the molecular mechanism by which EVs mediate thioredoxin-interacting protein (TXNIP). Western blotting and immunofluorescence were conducted to determine how TXNIP is involved in mediation of oxidative stress and mitochondrial dysfunction.
RESULTS
Our study demonstrates that, under the influence of GABA, ADSCs exhibit an increased capacity to encapsulate a higher abundance of miR-21-5p within EVs. Consequently, this leads to a more pronounced inhibitory effect on mitochondrial oxidative stress compared to EVs from ADSCs without GABA intervention, ultimately resulting in myocardial protection. On a molecular mechanism level, EVs regulate the expression of TXNIP and mitigating excessive oxidative stress in mitochondria during MIRI process to rescue cardiomyocytes.
CONCLUSION
Administration of GABA leads to the specific loading of miR-21-5p into EVs by ADSCs, thereby regulating the expression of TXNIP. The EVs derived from ADSCs treated with GABA effectively ameliorates mitochondrial oxidative stress and mitigates cardiomyocytes damage in the pathological process of MIRI.
Purpose
Remote ischemic periconditioning (RIPC) has demonstrated cardioprotective effects and improved clinical outcomes as an adjunct to emergent percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). However, whether RIPC affects the cardiac sympathetic nerve activity in patients with STEMI remains unclear. This study investigated the effects of RIPC on cardiac sympathetic nerve activity in patients with STEMI.
Methods
We prospectively assigned patients with STEMI who underwent emergent PCI to receive RIPC or no procedure (control group) upon arrival at the cardiac catheterization laboratory. The primary endpoint was cardiac sympathetic nerve activity assessed through the washout rate (WR) in cardiac ¹²³I-metaiodobenzylguanidine (¹²³I-MIBG) imaging.
Results
Patients in the RIPC (n = 62) and control (n = 60) groups had similar demographic and clinical characteristics at baseline. Multivariable linear regression models revealed that the culprit lesion of the left anterior descending artery and hemoglobin level were significantly and independently associated with WR at discharge. WRs of the groups differed insignificantly at discharge. However, the RIPC group (n = 49) showed significantly lower WR than the control group (n = 47) at 1 year after discharge (p = 0.027). In the single-photon emission computed tomography analysis at 1 year after discharge, the RIPC group demonstrated significantly higher late uptake (p = 0.021) and lower WR (p = 0.013) in the nonculprit lesion, with a non-significant decrease in WR for the culprit lesion.
Conclusion
RIPC can suppress augmented cardiac sympathetic nerve activity in patients with STEMI, particularly in nonculprit lesions.
Background
Cardiovascular disease (CVD) remains one of the major causes of death around the world in which ST elevation MI (STEMI) is in the lead. Although the mortality rate from STEMI seems to decline, this result might not be demonstrated in young adults who basically have different baseline characteristics and outcomes compared with older patients.
Methods
Data of the STEMI patients aged 18 years or older who underwent PCI during May 2018 to August 2019 from Thai PCI Registry, a prospective, multi-center, nationwide study, was included and aimed to investigate the predisposing factors and short-term outcomes of patients aged < 40 years compared with age 41–60, and > 61 years.
Results
Data of 5,479 STEMI patients were collected. The patients’ mean age was 62.6 (SD = 12.6) years, and 73.6% were males. There were 204, 2,154, and 3,121 patients in the youngest, middle, and oldest groups. The young patients were mainly male gender (89.2% vs. 82.4% and 66.6%; p < 0.001), were current smokers (70.6%, 57.7%, 34.1%; p < 0.001), had BMI ≥ 25 kg/m2 more frequently (60.8%, 44.1%, 26.1%; p < 0.001), and had greater family history of premature CAD (6.9%, 7.2%, 2.9%; p < 0.001). The diseased vessel in the young STEMI patients was more often single vessel disease with the highest percentage of proximal LAD stenosis involvement. Interestingly, there were trends of higher events of procedural failure (2.9%, 2.1%, 3.3%; p = 0.028) and procedural complications (8.8%, 5.8%, 9.4%; p < 0.001) in both youngest and oldest groups compared to the middle-aged group. In-hospital death was found in 3.4% in the youngest group compared to 3.3% in the middle-aged patients and 9.2% in the older patients (p < 0.001).
Conclusions
Despite experiencing higher rates of procedural failure and complications during treatment compared to middle-aged and older patients, young STEMI individuals demonstrate a significantly lower risk of death during hospitalization and within one year of the event. Younger patients might have a more robust physiological reserve or benefit from more aggressive post-procedure management. However, the higher prevalence of modifiable risk factors like smoking and obesity in younger individuals underscores the need for preventative measures. Encouraging smoking cessation and weight control in this demographic is crucial not only to prevent STEMI but also to potentially improve their long-term survival prospects.
The production of pro-coagulation factors can affect the development and prognosis of acute myocardial infarction (AMI). The clinical value of coagulation-related genes (CRGs) was investigated to discover new targets for diagnosing and treating AMI. We screened 335 differentially expressed genes (DEGs) between AMI and healthy individuals based on the GSE66360 dataset. We took the intersection of the obtained DEGs with 139 CRGs. Finally, 10 differentially expressed CEGs were screened out. The random forest algorithm was constructed to identify 6 signature CRGs (THBS1, SERPINA1, THBD, MMP9, MAFF, and PLAU). Subsequently, the established predictive model was found to have good diagnostic accuracy (AUC = 0.9694 in the training cohort [GSE66360 dataset] and 0.9076 in the external validation cohort [GSE48060 dataset]). Consensus clustering identified the CRG clusters, and the accuracy of the grouping was verified. We found that AMI patients can be divided into two distinct subgroups based on the differentially expressed CRGs. Immune cell infiltration level was consistent with the expression levels of CRGs based on single sample gene set enrichment analysis. These findings reveal the potential role of CRGs in AMI. Characterizing the coagulation features of AMI patients can help in the risk stratification of patients and provide personalized treatment strategies.
Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations.
Background
The optimal timing for the initiation of oral beta-blockers after acute myocardial infarction (MI) remains unclear within the context of current primary percutaneous coronary intervention (PCI) practice.
Methods
This retrospective cohort study included 412 consecutive patients admitted with a diagnosis of acute MI between January 2007 and August 2016 who underwent successful primary PCI and were given oral carvedilol during hospitalization. Early and late carvedilol groups were based on initiation within the first 24 h or after. Propensity score matching (1:1) incorporating 21 baseline characteristics yielded 47 matched pairs. Timing of carvedilol initiation was evaluated in relation to patient outcomes including time to all-cause mortality, using Kaplan-Meier estimates on the matched cohort and additional confirmation in multivariable regression analysis among the entire cohort.
Results
Median follow-up period was 828 days. All-cause death occurred in 14 patients (4.7%) and 18 patients (15.8%) of the early and late carvedilol groups. After propensity score matching, initiation of oral carvedilol within the first 24 h was associated with lower all-cause mortality (6.4% vs. 25.5%, hazard ratio 0.28, 95% confidence interval 0.06 − 0.89, p = 0.036), as well as lower in-hospital mortality (0 vs. 14.9%, p = 0.018).
Conclusions
These results provide evidence that initiation of oral carvedilol within the first 24 h reduces the risk of long-term mortality, in acute MI patients who underwent primary PCI, supporting current guidelines recommendation.
Forty percent of patients with acute coronary occlusion myocardial infarction (OMI) do not present with STEMI criteria, which delays their treatment and increases morbidity and mortality. The need to identify these patients promptly is crucial, and this sets the stage for the proposed reclassification. Many of these patients can be identified by other ECG and clinical features. Background/Objectives: We sought to evaluate cases of STEMI and NSTEMI that result in OMI. Additionally, we focused on the consequences of delayed revascularization in NSTEMI patients with acute coronary occlusion (NSTEMI-OMI). Methods: The study is a retrospective analysis conducted on 334 patients who underwent coronary angiography for acute coronary syndrome at UHC “Mother Teresa”, Tirana, Albania, during January–May 2023. “OMI was defined as an acute culprit lesion with TIMI 0–2 flow, or an acute culprit lesion with TIMI 3 flow intervened upon and with highly elevated troponin (cTnI > 10.0 ng/mL, hs-cTnI > 5000 ng/L)”. The presence or absence of STEMI criteria were determined in the final diagnosis written on the chart by a cardiologist using the third universal definition of MI. Ejection fraction (EF), total ischemia time, length of stay, and complications were compared between groups. Mechanical complications include acute ventricular failure, cardiogenic shock, rupture of the interventricular septum, rupture of the free wall, rupture of the papillary muscle, and pericarditis. Electrical complications include ventricular arrhythmias, supraventricular arrhythmias, and atrioventricular and interventricular blocks. Results: There were 334 patients included, 98 (29.3%) of whom were NSTEMI-OMI patients. Ninety-six patients (40%) of OMI patients did not fulfill the STEMI criteria. Only 11 patients (11%) of STEMI(−)OMI had PCI performed within the first 12 h vs. 76 patients (77%) with STEMI(+)OMI, p < 0.001. There was no difference in the percent of patients requiring PCI between the STEMI(+)OMI 98 patients (93%) and STEMI(−)OMI 87 patients (89%) (p = 0.496). The overall in-hospital mortality was 19 patients (5.7%), with subgroup mortality of 14 patients (4.2%) with STEMI(+)OMI, 2 patients (0.6%) with STEMI(+) NOMI, and 3 patients (0.9%) with STEMI(−)OMI, 0% STEMI(−)NOMI, (p = 0.013). Patients with mechanical complications included 67 patients (46.8%) with STEMI(+)OMI and 45 patients (46.4%) with STEMI(−)OMI. In addition, 26 patients (18.5%) with STEMI(+)OMI and 13 patients (13.1%) with STEMI(−)OMI developed electrical complications. Conclusions: STEMI(−)OMI patients had significant delays in catheterization, yet had angiographic findings, rates of PCI, and complications similar to STEMI(+)OMI. These data add further support to refocusing the paradigm of acute MI to improve recognition and rapid reperfusion of all OMIs, rather than only those with STEMI criteria.
Acute coronary syndrome (ACS) is associated with high mortality rates. Although the goal was to achieve a missed diagnosis rate of <1%, the actual data showed a rate of >2%. Chest pain diagnosis has remained unchanged over the years and is based on medical interviews and electrocardiograms (ECG), with biomarkers playing complementary roles. We aimed to summarize the key points of medical interviews, ECG clinics, use of biomarkers, and clinical scores, identify problems, and provide directions for future research. Medical interviews should focus on the character and location of chest pain (is it accompanied by radiating pain?) and the duration, induction, and ameliorating factors. An ECG should be recorded within 10 minutes of the presentation. The serial performance of an ECG is recommended for emergency department (ED) evaluation of suspected ACS. Characteristic ECG traces, such as Wellens syndrome and De Winter T-waves, should be understood. Therefore, troponin levels in all patients with suspected ischemic heart disease should be examined using a highly sensitive assay system. Depending on the ED facility, the patient should be risk stratified by serial measurements of cardiac troponin levels (re-testing at one hour would be preferred) to determine the appropriate time to perform an invasive strategy for a definitive diagnosis. The diagnostics should be based on Bayes’ theorem; however, care should be taken to avoid the influence of heuristic bias.
Background
In patients resuscitated from cardiac arrest and displaying no ST-segment elevation on initial electrocardiogram (ECG), recent randomized trials indicated no benefits from early coronary angiography. How the results of such randomized studies apply to a real-world clinical context remains to be established.
Methods
We retrospectively analyzed a clinical database including all patients 18 yo or older admitted to our tertiary University Hospital from January 2017 to August 2020 after successful resuscitation of out-of-Hospital (OHCA) or In-Hospital (IHCA) cardiac arrest of presumed cardiac origin, and undergoing immediate coronary angiography, regardless of the initial rhythm and post-resuscitation ECG. The primary outcome of the study was survival at day 90 after cardiac arrest. Demographic data, characteristics of cardiac arrest, duration of resuscitation, laboratory values at admission, angiographic data and revascularization status were collected. Comparisons were performed according to the initial ECG (ST-segment elevation or not), and between survivors and non-survivors. Variables associated with the primary outcome were evaluated by univariate and multivariate regression analyses.
Results
We analyzed 147 patients (130 OHCA and 17 IHCA), including 67 with STEMI and 80 without STEMI (No STEMI). Immediate revascularization was performed in 65/67 (97%) STEMI and 15/80 (19%) no STEMI. Day 90 survival was significantly higher in STEMI (48/67, 72%) than no STEMI (44/80, 55%). In the latter patients, survival was not influenced by the revascularization status. In univariate and multivariate analyses, lower age, a shockable rhythm, shorter durations of no flow and low flow, and a lower initial blood lactate were associated with survival in both STEMI and no STEMI. In contrast, metabolic abnormalities, including lower initial plasma sodium and higher potassium were significantly associated with mortality only in the subgroup of no STEMI patients.
Conclusions
Our results, obtained in a real-world clinical setting, indicate that an immediate coronary angiography is not associated with any survival advantage in patients resuscitated from cardiac arrest of presumed cardiac etiology without ST-segment elevation on initial ECG. Furthermore, we found that some early metabolic abnormalities may be associated with mortality in this population, which should deserve further investigation.
Background
Acute coronary syndrome (ACS) is one of the common causes of cardiovascular death. The related lncRNAs were novel approaches for early diagnosis and intervention. This paper focused on the clinical function of SNHG7 for patients after PCI.
Methods
The expression of SNHG7 was assessed in ACS patients. The predictive roles of SNHG7 were unveiled by the ROC curve. The relationship between SNHG7 and Gensini scores was judged by Pearson analysis. One-year follow-up was conducted and all patients were catalogued into different groups based on the prognosis. The qRT-PCR, K-M curve, and Cox regression analysis were performed to document the prognostic significance of SNHG7.
Results
SNHG7 was highly expressed in ACS and its three subtypes. SNHG7 showed a certain value in predicting ACS, UA, NSTEMI, and STEMI. Gensini is a closely correlated indicator of SNHG7. The declined expression of SNHG7 was observed in the non-MACE and survival groups. The risk of MACE and death was increased in the group with high expression of SNHG7. SNHG7 was an independent biomarker in patients with ACS after PCI.
Conclusions
SNHG7 might be a diagnostic and prognostic tool for ACS patients.
The morbidity and mortality of out-of-hospital cardiac arrest (OHCA) due to presumed cardiac causes have remained unwaveringly high over the last few decades. Less than 10% of patients survive until hospital discharge. Treatment of OHCA patients has traditionally relied on expert opinions. However, there is growing evidence on managing OHCA patients favorably during the prehospital phase, coronary and intensive care, and even beyond hospital discharge. To improve outcomes in OHCA, experts have proposed the establishment of cardiac arrest centers (CACs) as pivotal elements. CACs are expert facilities that pool resources and staff, provide infrastructure, treatment pathways, and networks to deliver comprehensive and guideline-recommended post-cardiac arrest care, as well as promote research. This review aims to address knowledge gaps in the 2020 consensus on CACs of major European medical associations, considering novel evidence on critical issues in both pre- and in-hospital OHCA management, such as the timing of coronary angiography and the use of extracorporeal cardiopulmonary resuscitation (eCPR). The goal is to harmonize new evidence with the concept of CACs.
Objective
In this study, we explored the determinants of ventricular aneurysm development following acute myocardial infarction (AMI), thereby prompting timely interventions to enhance patient prognosis.
Methods
In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People’s Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves.
Results
In our analysis of 291 AMI patients, spanning an age range of 32–91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit.
Conclusion
Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies.
A BSTRACT
Background
Thromboembolic events are serious left ventricular thrombus (LVT) complications. Despite the limitations of vitamin K antagonist (VKA) drugs, it continues to be the recommended oral anticoagulation for LVT. Recently, nonvitamin K oral antagonist (NOAC) has gained popularity as an off-labeled treatment for systemic embolism prevention in LVT.
Objective
In this study, we aim to compare the outcomes (stroke and bleeding) of warfarin versus NOAC therapy in patients with LVT.
Methods
This retrospective cohort study compares NOAC and VKA therapy in LVT patients. We enrolled 201 patients with an echocardiography-confirmed LVT from January 2018 to December 2022. Patients who received NOAC therapy (NOAC, n = 77) were compared to VKA patients (VKA, n = 124). The primary endpoint was a composite of stroke, minor and major bleeding.
Results
The median follow-up time was 17 months (25 th –75 th percentiles: 8–38). On unmatched analysis, both groups had no difference in major bleeding (log-rank, P = 0.61) and stroke (log-rank, P = 0.77). However, all bleeding events were higher with NOAC (log-rank, P = 0.01). On matched analysis, there was no difference between both groups in the overall bleeding events ( P = 0.08), major bleeding ( P = 0.57), and stroke ( P = 0.66). Minor bleeding was significantly lower in the VKA group ( P = 0.04).
Conclusion
In patients with LVT, NOAC was as effective as VKA in stroke prevention without increasing the risk of major bleeding.
Percutaneous coronary intervention is the main strategy of revascularization and has been shown to improve outcomes in some patients with ST-segment elevation myocardial infarction (STEMI). However, multivessel disease (MVD), a common condition in these patients, is associated with worse clinical outcomes compared to single-vessel disease. Despite intervention being a standard treatment for coronary artery disease, optimal strategies and timings for patients with STEMI and MVD remain unclear. Numerous studies and meta-analyses have investigated this topic; however, many current conclusions are based on observational studies. Furthermore, clinical guidelines regarding the management of patients with STEMI and MVD contain conflicting recommendations. Therefore, we aimed to compile relevant studies and newly available evidence-based medicines to explore the most effective approach.
Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
Despite advancements in algorithms concerning the management of cardiogenic shock, current guidelines still lack the adequate integration of mechanical circulatory support devices. In recent years, more and more devices have been developed to provide circulatory with or without respiratory support, when conservative treatment with inotropic agents and vasopressors has failed. Mechanical circulatory support can be contemplated for patients with severe, refractory, or acute-coronary-syndrome-related cardiogenic shock. Through this narrative review, we delve into the differences among the types of currently used devices by presenting their notable advantages and inconveniences. We address the technical issues emerging while choosing the best possible device, temporarily as a bridge to another treatment plan or as a destination therapy, in the optimal timing for each type of patient. We also highlight the diverse implantation and removal techniques to avoid major complications such as bleeding and limb ischemia. Ultimately, we hope to shed some light in the gaps of evidence and the importance of conducting further organized studies around the topic of mechanical circulatory support when dealing with such a high mortality rate.
Objetivo: Analisar o impacto da localização geográfica dos serviços de reperfusão coronariana (RC) na mortalidade por infarto agudo do miocárdio (IAM) no estado do Paraná, Brasil. Métodos: É um estudo ecológico transversal baseado na mortalidade por IAM, entre 2015 e 2019, em indivíduos de 30 a 79 anos. O índice de acesso espacial ao serviços de RC em até 60 minutos de transporte terrestre foi calculado usando a técnica aprimorada da área de captura flutuante de dois passos. As taxas de mortalidade por IAM foram comparadas entre municípios com e sem cobertura de serviços de RC e entre baixo e alto acesso espacial a estes serviços, ambos utilizando o teste de Wilcoxon. Resultados: Observou-se que 8,02% (32/399) dos municípios tinham acesso a ambos os tipos de reperfusão, 24,56% (98/399) acesso apenas à intervenção coronariana percutânea primária, e 12,03% (48/399) acesso apenas à reperfusão química. Municípios com acesso aos serviços de RC apresentaram menor taxa de mortalidade (mediana=74,67) comparado com aqueles sem cobertura deste serviço (mediana=102,83) (p<0,001). Houve diferença significativa entre municípios com baixo (mediana=68,30) e alto acesso espacial aos serviços de RC (mediana=80,02) (p=0,007). Conclusão: O aumento do acesso espacial aos serviços de RC é crucial para a sobrevivência dos pacientes infartados.
Background
Left ventricular thrombus (LVT) formation is a serious complication of acute myocardial infarction (AMI) requiring complicated management strategies and collaboration among cardiologists, cardiovascular surgeons, and neurosurgeons.
Case Summary
We present the case of an 83-year-old female patient with AMI. Emergency coronary angiography revealed subtotal occlusion of the proximal left anterior descending artery, and the patient was successfully treated with a drug-eluting stent. The following day, she suddenly developed loss of consciousness, global aphasia, and right hemiplegia. Brain magnetic resonance imaging revealed acute ischaemic cerebral infarction caused by multiple mobile LVT, as demonstrated by echocardiography. After a heart-brain team discussion, we decided to perform percutaneous mechanical thrombectomy. Successful recanalization was achieved with mechanical thrombectomy two hours after presentation, which resulted in significant neurological recovery. Immediately after the thrombectomy, she was transferred to a cardiovascular surgery center for surgical removal of multiple LV apical thrombi. Two weeks after the operation, the patient was discharged with the recovery of LV systolic function.
Discussion
Although AMI complicated by acute stroke caused by LVT remains a clinical challenge, a multidisciplinary approach is critically important for optimal care. Based on an urgent team discussion, we decided to perform endovascular thrombectomy for ischaemic stroke, followed by surgical removal of the LVT, requiring patient transportation to the cardiovascular surgery center. Given that the heart and brain team-based approach remains confined to large, specialised centers, it might be beneficial to establish a community-based integrated heart-brain team that can address the growing needs of complex patients.
Purpose
This study aims to conduct a comprehensive cost-effectiveness comparison between novel oral anticoagulants (NOACs) and warfarin in Chinese patients with left ventricular thrombosis (LVT). By incorporating the impact of volume-based procurement (VBP) policy for pharmaceuticals in China, this analysis intends to provide crucial insights for informed healthcare decision-making.
Patients and Methods
A Markov model was employed to simulate the disease progression of LVT over a 54-week time horizon, using weekly cycles and six mutually exclusive health states. The model incorporated transition probabilities between health states calculated based on clinical trial data and literature sources. Various cost and utility parameters were also included. Additionally, a series of sensitivity analyses were conducted to address parameter variations and associated uncertainties.
Results
The study finding suggest that from the perspective of Chinese healthcare, the majority of brand-name drug (BND) NOACs generally lack cost-effectiveness when compared to warfarin. However, when considered the VBP policy, NOACs, particularly rivaroxaban, prove to be more cost-effective than warfarin. Rivaroxaban provided an additional 0.0304 quality-adjusted life years (QALYs) per patient and reduced overall medical costs by 9095.73 CNY, resulting in an incremental cost-effectiveness ratio (ICER) of −298,786.20 CNY/QALY. Sensitivity analysis indicated a 78.4% probability of any NOACs being more cost-effective compared to warfarin. However, specifically considering NOACs under the VBP policy, the likelihood of them being more cost-effective approached 90%.
Conclusion
Taking into account Chinese pharmaceutical procurement policies, the findings highlight the superior efficacy of NOACs, especially rivaroxaban, in enhancing both the quality of life and economic benefits for Chinese LVT patients. NOACs present a more cost-effective treatment option, improving patient quality of life and healthcare cost efficiency compared to warfarin.
Evidence on comparative effectiveness and safety of prasugrel and ticagrelor post-percutaneous transluminal coronary angioplasty is scarce in Indian population. In a 1:1 propensity score-matched cohort with 71 individuals in each group, the incidence of a composite of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or coronary revascularization was not significantly different in prasugrel and ticagrelor group (7.04% vs 9.86%; absolute difference, 2.8%; HR, 0.65; 95% CI, 0.21–2.1; p = 0.49). There was no significant difference in bleeding (5.63% vs 9.86%; absolute difference, −4.20%; 95% CI, −13.0%–4.5%) and dyspnea (7.04% vs 12.7%; absolute difference, −5.60%; 95% CI, −15.4%–4.1%).
Background and objective
Macrophages play a crucial and dichotomous role cardiac repair following myocardial ischemia-reperfusion, as they can both facilitate tissue healing and contribute to injury. This duality is intricately linked to environmental factors, and the identification of macrophage subtypes within the context of myocardial ischemia-reperfusion injury (MIRI) may offer insights for the development of more precise intervention strategies.
Methods
Specific marker genes were used to identify macrophage subtypes in GSE227088 (mouse single-cell RNA sequencing dataset). Genome Set Enrichment Analysis (GSEA) was further employed to validate the identified LAM subtypes. Trajectory analysis and single-cell regulatory network inference were executed using the R packages Monocle2 and SCENIC, respectively. The conservation of LAM was verified using human ischemic cardiomyopathy heart failure samples from the GSE145154 (human single-cell RNA sequencing dataset). Fluorescent homologous double-labeling experiments were performed to determine the spatial localization of LAM-tagged gene expression in the MIRI mouse model.
Results
In this study, single-cell RNA sequencing (scRNA-seq) was employed to investigate the cellular landscape in ischemia-reperfusion injury (IRI). Macrophage subtypes, including a novel Lipid-Associated Macrophage (LAM) subtype characterized by high expression of Spp1, Trem2, and other genes, were identified. Enrichment and Progeny pathway analyses highlighted the distinctive functional role of the SPP1+ LAM subtype, particularly in lipid metabolism and the regulation of the MAPK pathway. Pseudotime analysis revealed the dynamic differentiation of macrophage subtypes during IRI, with the activation of pro-inflammatory pathways in specific clusters. Transcription factor analysis using SCENIC identified key regulators associated with macrophage differentiation. Furthermore, validation in human samples confirmed the presence of SPP1+ LAM. Co-staining experiments provided definitive evidence of LAM marker expression in the infarct zone. These findings shed light on the role of LAM in IRI and its potential as a therapeutic target.
Conclusion
In conclusion, the study identifies SPP1+ LAM macrophages in ischemia-reperfusion injury and highlights their potential in cardiac remodeling.
Background and objective
Left ventricular thrombus (LVT) formation in patients with acute myocardial infarction (AMI) or cardiomyopathies is not uncommon. The optimal oral anticoagulation therapy for resolving LVT has been under intense debate. Vitamin K antagonists (VKAs) remain the anticoagulant of choice for this condition, according to practice guidelines. Evidence supporting the use of direct oral anticoagulants (DOACs) in the management of LVT continues to grow. We performed a systematic review and meta-analysis to compare the efficacy and safety of DOACs versus VKAs.
Methods
A comprehensive literature search was carried out in PubMed, Cochrane Library, Web of Science, Embase, and Scopus databases in July 2023. The efficacy outcomes of this study were thrombus resolution, ischemic stroke, systemic embolism, stroke/systemic embolism, all-cause mortality, and adverse cardiovascular events. The safety outcomes were any bleeding, major bleeding, and intracranial hemorrhage. A total of twenty-seven eligible studies were included in the meta-analysis. Data were analyzed utilizing Stata software version 15.1.
Results
There was no significant difference between DOACs and VKAs with regard to LVT resolution (RR = 1.00, 95% CI 0.95–1.05, P = 0.99). In the overall analysis, DOACs significantly reduced the risk of stroke (RR = 0.74, 95% CI 0.57–0.96, P = 0.021), all-cause mortality (RR = 0.70, 95% CI 0.57–0.86, P = 0.001), any bleeding (RR = 0.75, 95% CI 0.61–0.92, P = 0.006) and major bleeding (RR = 0.67, 95% CI 0.52–0.85, P = 0.001) when compared to VKAs. Meanwhile, in the sub-analysis examining randomized controlled trials (RCTs), the aforementioned outcomes no longer differed significantly between the DOACs and VKAs groups. The incidences of systemic embolism (RR = 0.81, 95% CI 0.54–1.22, P = 0.32), stroke/systemic embolism (RR = 0.85, 95% CI 0.72–1.00, P = 0.056), intracranial hemorrhage (RR = 0.59, 95% CI 0.23–1.54, P = 0.28), and adverse cardiovascular events (RR = 0.99, 95% CI 0.63–1.56, P = 0.92) were comparable between the DOACs and VKAs groups. A subgroup analysis showed that patients treated with rivaroxaban had a significantly lower risk of stroke (RR = 0.24, 95% CI 0.08–0.72, P = 0.011) than those in the VKAs group.
Conclusion
With non-inferior efficacy and superior safety, DOACs are promising therapeutic alternatives to VKAs in the treatment of LVT. Further robust investigations are warranted to confirm our findings.
BACKGROUND
Venoarterial (VA) extracorporeal membrane oxygenation (ECMO), an effective short-term circulatory support method for refractory cardiogenic shock, is widely applied. However, retrospective analyses have shown that VA-ECMO-assisted cases were associated with a relatively high mortality rate of approximately 60%. Embolization in important organs caused by complications of left ventricular thrombosis (LVT) during VA-ECMO is also an important reason. Although the incidence of LVT during VA-ECMO is not high, the consequences of embolization are disastrous.
CASE SUMMARY
A 37-year-old female patient was admitted to hospital because of fever for 4 d and palpitations for 3 d. After excluding the diagnosis of coronary heart disease, we established a diagnosis of “clinically explosive myocarditis”. The patient still had unstable hemodynamics after drug treatment supported by VA-ECMO, with heparin for anticoagulation. On day 4 of ECMO support, a left ventricular thrombus attached to the papillary muscle root of the mitral valve was found by transthoracic echocardiography. Left ventricular decompression was performed and ECMO was successfully removed, but the patient eventually died of multiple cerebral embolism.
CONCLUSION
LVT with high mobility during VA-ECMO may cause embolism in important organs. Therefore, a "wait and see" strategy should be avoided.
Background
Clinical outcome of ischemic cardiogenic shock (CS) requiring extracorporeal membrane oxygenation is highly variable, necessitating appropriate assessment of prognosis. However, a systemic predictive model estimating the mortality of refractory ischemic CS is lacking. The PRECISE (Prediction of In‐Hospital Mortality for Patients With Refractory Ischemic Cardiogenic Shock Requiring Veno‐Arterial Extracorporeal Membrane Oxygenation Support) score was developed to predict the prognosis of refractory ischemic CS due to acute myocardial infarction.
Methods and Results
Data were obtained from the multicenter CS registry RESCUE (Retrospective and Prospective Observational Study to Investigate Clinical Outcomes and Efficacy of Left Ventricular Assist Device for Korean Patients With Cardiogenic Shock) that consists of 322 patients with acute myocardial infarction complicated by refractory ischemic CS requiring extracorporeal membrane oxygenation support. Fifteen parameters were selected to assess in‐hospital mortality. The developed model was validated internally and externally using an independent external cohort (n=138). Among 322 patients, 138 (42.9%) survived postdischarge. Fifteen predictors were included for model development: age, diastolic blood pressure, hypertension, chronic kidney disease, peak lactic acid, serum creatinine, lowest left ventricular ejection fraction, vasoactive inotropic score, shock to extracorporeal membrane oxygenation insertion time, extracorporeal cardiopulmonary resuscitation, use of intra‐aortic balloon pump, continuous renal replacement therapy, mechanical ventilator, successful coronary revascularization, and staged percutaneous coronary intervention. The PRECISE score yielded a high area under the receiver‐operating characteristic curve (0.894 [95% CI, 0.860–0.927]). External validation and calibration resulted in competent sensitivity (area under the receiver‐operating characteristic curve, 0.895 [95% CI, 0.853–0.930]).
Conclusions
The PRECISE score demonstrated high predictive performance and directly translates into the expected in‐hospital mortality rate. The PRECISE score may be used to support clinical decision‐making in ischemic CS ( www.theprecisescore.com ).
Registration
URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02985008.
BACKGROUND
Presently, there is no established standard anti-blood clot therapy for patients facing acute myocardial infarction (AMI) complicated by left ventricular thrombus (LVT). While vitamin K antagonists are the preferred choice for oral blood thinning, determining the best course of blood-thinning medication remains challenging. It is unclear if non-vitamin K antagonist oral blood thinners have different effectiveness in treating LVT. This study significantly contributes to the medical community.
CASE SUMMARY
The blood-thinning treatment of a patient with AMI and LVT was analyzed. Triple blood-thinning therapy included daily enteric-coated aspirin tablets at 0.1 g, daily clopidogrel hydrogen sulfate at 75 mg, and dabigatran etexilate at 110 mg twice daily. After 15 d, the patient’s LVT did not decrease but instead increased. Clinical pharmacists comprehensively analyzed the cases from the perspective of the patient’s disease status and drug interaction. The drug regimen was reformulated for the patient, replacing dabigatran etexilate with warfarin, and was administered for six months. The clinical pharmacist provided the patient with professional and standardized pharmaceutical services. The patient’s condition was discharged after meeting the international normalized ratio value (2-3) criteria. The patient fully complied with the follow-up, and the time in the therapeutic range was 78.57%, with no serious adverse effects during pharmaceutical monitoring.
CONCLUSION
Warfarin proves to be an effective drug for patients with AMI complicated by LVT, and its blood-thinning course lasts for six months.
Myocardial infarction with non-obstructive coronary arteries (MINOCA) includes coronary embolism, dissection, spasm and microvascular dysfunction, as well as plaque rupture or erosion (causing <50% stenosis). In the most recent studies, events that can be classified as MINOCA account for approximately 6–8% of all diagnoses of acute myocardial infarction (AMI). Clinical suspect may suggest the need for additional diagnostic procedures beyond the usual coronary angiography, such as cardiac imaging or provocative tests. Cardiac magnetic resonance (CMR) is essential for both validating the diagnosis and ruling out other conditions with a comparable clinical presentation. The prognosis is not as good as previously believed; rather, it is marked by morbidity and mortality rates comparable to those of other types of AMI. Identification of the underlying causes of MINOCA is recommended by current guidelines and consensus documents in order to optimize treatment, enhance prognosis, and encourage prevention of recurrent myocardial infarction. In this narrative review, we have outlined the various causes of MINOCA and their specific therapies in an attempt to identify a personalized approach to its treatment.
Background:
Concomitant coronavirus 2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) are associated with increased adverse in-hospital outcomes.
Objectives:
This study aimded to evaluate the angiographic, procedural, laboratory, and prognostic differences in COVID-19-positive and negative patients with STEMI undergoing primary percutaneous coronary intervention (PCI).
Methods:
A single-center, retrospective, observational study was conducted between November 2020 and August 2022 in a tertiary-level hospital. According to their status, patients were divided into two groups (COVID-19 positive and negative). All patients were admitted due to confirmed STEMI and treated with primary PCI. In-hospital and angiographic outcomes were compared between the two groups. Two-sided p-values < 0.05 were accepted as statistically significant.
Results:
Of the 494 STEMI patients enrolled in this study, 42 were identified as having a positive dagnosis for COVID-19 (8.5%), while 452 were negative. The patients who tested positive for COVID-19 had a longer total ischemic time than did those who tested negative for COVID-19 (p=0.006). Moreover, these patients presented an increase in stent thrombosis (7.1% vs. 1.7%, p=0.002), length of hospitalization (4 days vs. 3 days, p= 0.018), cardiogenic shock (14.2% vs. 5.5 %, p= 0.023), and in-hospital total and cardiac mortality (p<0.001 and p=0.032, respectively).
Conclusions:
Patients with STEMI with concomitant COVID-19 infections were associated with increased major adverse cardiac events. Further studies are needed to understand the exact mechanisms of adverse outcomes in these patients.
Aortic dissection with concurrent ST-elevation myocardial infarction (STEMI) is rarely reported. As the proportion of myocardial infarction is higher in the emergency setting compared to aortic dissection, the diagnosis of aortic dissection may be overlooked, and it can be potentially fatal. By using bedside available information, detailed history taking, and multimodality imaging in the emergency setting, it is possible to avoid a mistaken diagnosis. Here, we present a case of aortic aneurysm presenting with anterior STEMI. A 79-year-old woman was admitted to our emergency department with decreased consciousness. Shortly before the patient went unconscious, she had a short episode of dyspnea. Her ECG showed marked ST elevation in the anterior leads. However, her chest radiograph revealed mediastinal widening and a prominent aortic knob. Due to suspicion of aortic dissection from the chest radiograph and loss of consciousness, which may be a sign of malperfusion syndrome of aortic dissection, bedside handheld echocardiography was then performed. It revealed hypokinesis of anterior and anteroseptal walls, pericardial effusion, and dilated aortic root to ascending aorta with severe aortic regurgitation. The presence intimal flap can not be clearly excluded. Based on her imaging and clinical findings, aortic dissection was suspected and thrombolysis was postponed. The patient proceeded to undergo triple-rule-out computed tomography, from which the finding of ascending aortic aneurysm was noted, along with multiple stenosis of LAD (moderate-to-severe) and LCx (moderate), and there was no presence of false lumen. Acute aortic dissection should be considered a differential diagnosis in patients presenting with symptoms suggesting acute coronary syndrome. A suspected case of acute aortic dissection should necessitate further imaging studies. Therefore, multimodality imaging plays a vital role in the emergency setting, as it may avoid fatal consequences of misdiagnosis and mistreatment.
Background
Ventricular septal rupture (VSR) is a rare but grave complication of acute myocardial infarction (AMI). It is a mechanical complication of myocardial infarction where patients may present either in a compensated state or in cardiogenic shock. The aim of the study is to determine the in-hospital mortality. The study also aims to identify the predictors of outcomes (in-hospital mortality, vasoactive inotrope score (VIS), duration of ICU stay and mechanical ventilation in the postoperative period) and compare the clinical and surgical parameters between survivors and non-survivors.
Methods
This is a retrospective study. The data of 90 patients was collected from the medical records and the data comprising of 13 patients who underwent VSR closure by single patch technique, or septal occluder, and those who expired before receiving the treatment, was excluded. The data of 77 patients diagnosed with post-AMI VSR and who underwent surgical closure of VSR by double patch technique was included in this study. Clinical findings and echocardiography parameters were recorded from the perioperative period. The statistical software used was SPSS version 27. The primary outcome was determining the in-hospital mortality. The secondary outcome was identifying the clinical parameters that are significantly more in the non-survivors, and the factors predicting the in-hopsital mortality and morbidity (increased duration of ICU stay, and of mechanical ventilation, postoperative requirement of high doses of vasopressors and inotropes). Subgroup analysis was done to identify the relation of various clinical parameters with the postoperative complications. The factors predicting the in-hospital mortality were illustrated by a forest plot.
Results
The mean age of the patients was 60.35 (±9.9) years, 56 (72.7%) were males, and 21 (27.3%) were females. Requirement of mechanical ventilation preoperatively (OR 3.92 [CI 2.91-6.96]), cardiogenic shock at presentation (OR 4 [CI 2.33 – 6.85]), requirement of IABP (OR 2.05 [CI 1.38-3.94]), were predictors of mortality. The apical location of VSR had been favorable for survival. The EUROScore II at presentation correlated with the postoperative VIS (level of significance [LS] 0.0011, R 0.36. The in-hospital mortality in this study was 33.76%.
Conclusion
The in-hospital mortality of VSR is 33.76%. Cardiogenic shock at presentation, non-apical site of VSR, preoperative requirement of mechanical ventilation, high VIS preoperatively, perioperative utilization of IABP, prolonged CPB time, postoperative duration of mechanical ventilation, and high postoperative VIS were the factors associated with increased odds of in-hospital mortality.
Background: Inferior wall ST-segment elevation myocardial infarction (STEMI) is a severe condition with high mortality. Rapid treatment with primary percutaneous coronary intervention (PPCI) is preferred. Pulse pressure (PP) is a known risk factor for both cardiovascular disease and may be a valuable predictor of outcomes in these patients. Objective: The study aims to evaluate the relationship between PP and long-term prognosis, mortality, and major cardiovascular events after inferior STEMI in cases who underwent PPCI. Methods: This cross-sectional study included subjects with a confirmed diagnosis of inferior STEMI who underwent PPCI. Patient data were gathered from hospital records and analyzed for the relationship between PP and MACE during hospitalization and one-year follow-up. Statistical analysis was performed using SPSS. Result: This cross-sectional study of 320 cases found that DM, DBP, and Cr patients had a higher incidence of MACEs (P-value<0.05). Subjects with higher LVEF and SBP had fewer MACEs (P-value<0.05). Cases with a PP of ≤50 had a higher mortality and heart failure incidence during hospitalization than those with a PP >50 (P-value<0.05). However, the two groups had no significant difference in one-year MACE rates. Conclusion: The study found that increasing DBP, Cr, and DM and decreasing LVEF and SBP impacted MACE incidence. PP ≤ 50 had more heart failure incidence and mortality during hospitalization in patients with inferior STEMI.
Background
This study evaluated the effectiveness of the smartphone-based WeChat platform in reducing the ischemia time of ST-segment elevation myocardial infarction (STEMI).
Methods
A total of 198 STEMI patients who underwent primary percutaneous coronary intervention (PCI) from January 2022 to August 2022 in our hospital were enrolled in this retrospective cohort study. Patients were divided into two groups according to whether their electrocardiograms (ECGs) were posted on the WeChat platform. The two groups were compared for the following: diagnosis time of first ECG, time from first medical contact (FMC) to catheterization laboratory (CL) activity, bypass emergency department (ED) or critical care unit (CCU), time of door to wire, time of door to balloon, time of FMC to wire, heart failure during hospitalization, cardiogenic shock during hospitalization, malignant arrhythmia during hospitalization, death during hospitalization, total hospital cost, and length of stay.
Results
The diagnosis time for the first ECG was 10.05± 3.30 mins in the control group and 2.50 ± 0.82 mins in the WeChat group (p < 0.05). The time from FMC to CL activity was significantly shorter in the WeChat group compared to the control group (p < 0.05). None of the control group patients bypassed the ED, compared to 80 (80%) of patients in the WeChat group (p < 0.05). The time from door to wire was 60.22 ± 12.73 mins in the WeChat group and 92.56 ± 20.23 mins in the control group (p < 0.05). The time of FMC to wire was also significantly shorter in the WeChat group than in the control group (p < 0.05). The WeChat group had a significantly lower rate of heart failure during hospitalization than the control group (p < 0.05). However, the two groups showed no significant differences for cardiogenic shock during hospitalization, malignant arrhythmia during hospitalization, death during hospitalization, total hospital cost, and length of stay.
Conclusions
The smartphone-based WeChat platform demonstrated high efficacy and accessibility in reducing the ischemia time for STEMI patients. Our results indicate that social media platforms such as WeChat could be a useful approach for improving the prognosis of cardiovascular disease.
A panel of 10 experts in obesity from various Latin American countries held a Zoom meeting intending to reach a consensus on the use of anti‐obesity medicines and make updated recommendations suitable for the Latin American population based on the available evidence. A questionnaire with 16 questions was developed using the Patient, Intervention, Comparison, Outcome (Result) methodology, which was iterated according to the modified Delphi methodology, and a consensus was reached with 80% or higher agreement. Failure to reach a consensus led to a second round of analysis with a rephrased question and the same rules for agreement. The recommendations were drafted based on the guidelines of the American College of Cardiology Foundation/American Heart Association Task Force on Practice. This panel of experts recommends drug therapy in patients with a body mass index of ≥30 or ≥27 kg/m ² plus at least one comorbidity, when lifestyle changes are not enough to achieve the weight loss objective; alternatively, lifestyle changes could be maintained while considering individual parameters. Algorithms for the use of long‐term medications are suggested based on drugs that increase or decrease body weight, results, contraindications, and medications that are not recommended. The authors concluded that anti‐obesity treatments should be individualized and multidisciplinary.
Cardiovascular disorder is the leading cause death in the world, one of them are acute myocardial infarction (AMI) which associated with hypertension and cardiac remodeling. ISO may cause inflammation, enhance the production of oxidative stress while decrease the antioxidant defensive system, myocardium impairment, calcium overload, enhanced cyclic adenosine monophosphate level, intracellular acidosis, and altered membrane permeability. Vernonia amygdalina (VA) is a medicinal plant with antioxidant and anti-inflammatory properties. This study investigated the potential cardioprotective effect of VA on ISO-induced cardiac toxicity in rats. Male Wistar rats were randomly divided into six groups: ISO (ISO), quercetin 100 mg/kg plus ISO (ISO+QR), VA ethanol extract 100, 300, 500 mg/kg plus ISO (ISO+VA100, ISO+VA300 and ISO+VA500). ISO was administered subcutaneously (85 mg/kg) on days 15 while quercetin and VA extract and was given orally for 14 days. At the end of the experiment, the blood was taken from the heart were analyzed for markers of cardiac, oxidative stress and inflammation. The ISO group exhibited significant (p<0.05) elevation of cardiac biomarkers such as lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), troponin-T, and BNP as well as increased oxidative stress markers such as malondialdehyde (MDA) and reduced antioxidant enzyme superoxide dismutase (SOD), catalase (CAT), and Glutathione peroxidases (GPx). Additionally, the ISO group had elevated levels of pro-inflammatory cytokines interleukin-1 (IL-1), interleukin-6 (IL-6), Highly sensitive c reactive protein (HsCRP) and tumor necrosis factor-alpha (TNF-α). Treatment with VA extract significantly (p<0.001) reduced these parameters in the VA+ISO group compared to the ISO group. These findings suggest that VA has a potential protective effect against ISO-induced cardiotoxicity by reducing oxidative stress, apoptosis, and inflammation. (The graphiccal abstract can be seen in the Fig. 1).
ResearchGate has not been able to resolve any references for this publication.