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Review STEMI

Samir B Pancholy, Gaurav Patel, Sukrut P Nanavaty, Maitri S Pancholy
Cardiogenic shock (CS) following ST-elevation myocardial infarction (STEMI) is a devastating complication and continues to have a high mortality rate. Coronary revascularization with percutaneous coronary intervention (PCI) is the cornerstone in the management of CS; however, PCI-related access-site bleeding has been observed to be more prevalent in CS patients. Historically, PCI by transfemoral access (TFA) has been the preferred approach over transradial access (TRA) in CS patients due to weak radial pulse, operators' inexperience with TRA, and the use of TFA for concomitant mechanical cardiovascular support...
October 11, 2016: Minerva Cardioangiologica
Julian Ck Tay, Liou Wei Lun, Zhong Liang, Terrance Sj Chua, Swee Han Lim, Aaron Sl Wong, Marcus Eh Ong, Kay Woon Ho
INTRODUCTION: Door-to-balloon (DTB) time is critical to ST elevation myocardial infarction (STEMI) patients' survival. Although DTB time is reduced with direct cardiovascular laboratory (CVL) activation by emergency physicians, concerns regarding false-positive activation remain. We evaluate false-positive rates before and after direct CVL activation and factors associated with false-positive activations. MATERIALS AND METHODS: This is a retrospective single centre study of all emergency CVL activation 3 years before and after introduction of direct activation in July 2007...
August 2016: Annals of the Academy of Medicine, Singapore
Michael G Millin, Angela C Comer, Jose V Nable, Peter V Johnston, Benjamin J Lawner, Nathan Woltman, Matthew J Levy, Kevin G Seaman, Jon Mark Hirshon
INTRODUCTION: The American Heart Association recommends that post-arrest patients with evidence of ST elevation myocardial infarction (STEMI) on electrocardiogram (ECG) be emergently taken to the catheterization lab for percutaneous coronary intervention (PCI). However, recommendations regarding the utility of emergent PCI for patients without ST elevation are less specific. This review examined the literature on the utility of PCI in post-arrest patients without ST elevation compared to patients with STEMI...
September 15, 2016: Resuscitation
John Gale, Andrew Coburn, Karen Pearson, Zachariah Croll, George Shaler
BACKGROUND: The development of measures to monitor and evaluate the performance and quality of emergency medical services (EMS) systems has been a focus of attention for many years. The Medicare Rural Hospital Flexibility Program (Flex Program), established by Congress in 1997, provides grants to states to implement initiatives to strengthen rural healthcare delivery systems, including better integration of EMS into those systems of care. OBJECTIVE: Building on national efforts to develop EMS performance measures, we sought to identify measures relevant to the rural communities and hospitals supported by the Flex Program...
September 16, 2016: Prehospital Emergency Care
Ashleigh Dind, Usaid Allahwala, Kaleab N Asrress, Sanjit S Jolly, Ravinay Bhindi
Recent advances have caused a major shift in the way ST-elevation myocardial infarctions are managed. This review explores the pharmacological and interventional techniques that have evidence for improving outcomes and the landmark trials that have sparked change. The new P2Y12 inhibitors, ticagrelor and prasugrel, have been shown to be superior to clopidogrel in STEMI patients undergoing primary percutaneous coronary intervention. Concurrently, many technical aspects of percutaneous coronary intervention have been further clarified by trial data, with bare-metal stents, routine thrombus aspiration and femoral access showing evidence of inferiority...
August 22, 2016: Heart, Lung & Circulation
Giuseppe Tarantini, Gianpiero D'Amico, Sorin J Brener, Paola Tellaroli, Marco Basile, Alessandro Schiavo, Marco Mojoli, Chiara Fraccaro, Alfredo Marchese, Giuseppe Musumeci, Gregg W Stone
OBJECTIVES: The authors conducted a systematic pairwise and network meta-analysis to assess optimal treatment strategies in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MV-CAD) undergoing primary percutaneous coronary intervention (PCI). BACKGROUND: Patients with STEMI and MV-CAD have a worse prognosis than those with single-vessel CAD. The optimal revascularization strategy for these patients is uncertain...
September 12, 2016: JACC. Cardiovascular Interventions
Christopher E D Saunderson, Amrit Chowdhary, Richard A Brogan, Phillip D Batin, Christopher P Gale
Mild hypothermia has been shown to improve neurological outcome and reduce mortality following out of hospital cardiac arrest. In animal models the application of hypothermia with induced coronary occlusion has demonstrated a reduction in infarct size. Consequently, hypothermia has been proposed as a treatment, in addition to Primary Percutaneous Coronary Intervention (PPCI) for ST segment elevation myocardial infarction (STEMI). However, there is incomplete understanding of the mechanism and magnitude of the protective effect of hypothermia on the myocardium, and limited outcome data...
November 15, 2016: International Journal of Cardiology
Abdel Rahman A Al Emam, Ahmed Almomani, Syed A Gilani, Wissam I Khalife
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. It occurs predominantly among younger females, typically in the absence of atherosclerotic coronary artery disease. Presentations vary greatly and this condition can be fatal. Given its rarity, there are no management guidelines. We present six patients with SCAD with different presentations and treatment approaches as examples in our literature review. Two patients presented with ST elevation myocardial infarction (STEMI), two with non-STEMI (NSTEMI), and two with cardiac arrest...
September 2016: International Journal of Angiology: Official Publication of the International College of Angiology, Inc
Alka B Patel, Hude Quan, Robert C Welsh, Jessica Deckert-Sookram, Wayne Tymchak, Sunil Sookram, Ian Surdhar, Padma Kaul
BACKGROUND: Health care administrative databases are useful for assessing the population-level burden of disease and examining issues related to access, costs and quality of care. In these databases, the diagnoses and procedures are coded with the use of the World Health Organization International Classification of Diseases (ICD). We examined the validity of 2 ICD-10 coding definitions for categorizing patients with acute myocardial infarction (MI) as having ST-elevation MI (STEMI) or non-ST-elevation MI (non-STEMI)...
October 2015: CMAJ Open
Sanjiv Gupta, Madan Mohan Gupta
Percutaneous coronary intervention (PCI) is effective in opening the infarct related artery and restoring thrombolysis in myocardial infarction flow 3 (TIMI-flow 3) in large majority of ST-elevation myocardial infarction (STEMI). However there remain a small but significant proportion of patients, who continue to manifest diminished myocardial reperfusion despite successful opening of the obstructed epicardial artery. This phenomenon is called no-reflow. Clinically it manifests with recurrence of chest pain and dyspnea and may progress to cardiogenic shock, cardiac arrest, serious arrhythmias and acute heart failure...
July 2016: Indian Heart Journal
Satyavan Sharma, Nikhil Raut, Anil Potdar
AIM: Spontaneous coronary artery dissection (SCAD) is a less recognized cause of ST elevation myocardial infarction (STEMI) in clinical practice. The aim of this communication is to describe a case series in South Asian population and highlight on the long-term clinical outcomes on conservative management. METHODS: A retrospective analysis of data of five patients (6 instances) of SCAD managed in a tertiary care center during January 1994 to June 2015 was done. Clinical, angiographic, therapeutic, and follow-up data till end of June 2015 are analyzed...
July 2016: Indian Heart Journal
Mohammed Albrahim, Amjad M Ahmed, Abdulrahman Alwakeel, Faisal Hijji, Mouaz H Al-Mallah
BACKGROUND: Early treatment of ST elevation myocardial infarction (STEMI) is essential to improve survival of these patients. However, not all patients present early enough to receive optimal treatment especially in third world countries. Social factors affecting early vs. late treatment have not been studied, particularly in the Middle East. Thus, the aim of this study was to determine the social factors associated with delayed presentation of STEMI patients. METHODS: All patients with STEMI presenting to King Abdulaziz Cardiac Center (KACC) between October 2013 and July 2014 were approached...
2016: Qatar Medical Journal
Giuseppe Andò, Italo Porto, Gilles Montalescot, Leonardo Bolognese, Carlo Trani, Giuseppe Oreto, Robert A Harrington, Deepak L Bhatt
BACKGROUND: Consistent evidence of benefit exists for radial access (RA) in ST-elevation acute myocardial infarction (STEMI). Patients with non ST-elevation acute coronary syndrome (NSTE-ACS) have a more varied ischemic and bleeding profile. No randomized trial of vascular access ever focused on NSTE-ACS and landmark studies did not provide conclusive results in this heterogeneous subset of patients. METHODS: We assessed in a meta-analysis whether RA is associated with improved outcomes in NSTE-ACS patients...
November 1, 2016: International Journal of Cardiology
Rong Li, Xiao-Ming Li, Jun-Rong Chen
PURPOSE: The purpose of this study is to evaluate the therapeutic efficacy and safety of stem cells for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). MATERIALS AND METHODS: We performed a systematic review and meta-analysis of relevant published clinical studies. A computerized search was conducted for randomized controlled trials of stem cell therapy for STEMI. RESULTS: Twenty-eight randomized controlled trials with a total of 1,938 STEMI patients were included in the present meta-analysis...
2016: Therapeutics and Clinical Risk Management
Coşkun Usta, Nur Tükel Turgut, Aslı Bedel
Platelet aggregation is a crucial feature in coronary artery thrombus formation and is a major causative factor in both acute coronary syndromes (ACS) and reocclusion after percutaneous coronary interventions (PCI). The glycoprotein (GP) IIb/IIIa (αIIbβ3) integrin receptor is the pivotal mediator of platelet aggregation. In late 1990s, the introduction of GP IIb/IIIa inhibitors (GPI) was associated with a reduction of ischemic complication, and a clear clinical benefit in PCI during ACS, for both non ST-elevation (NSTE) and ST-segment elevation myocardial infarction (STEMI)...
November 1, 2016: International Journal of Cardiology
Mohamed Shokr, Ahmed Rashed, Kusum Lata, Ashok Kondur
Drug induced myocardial infarction is a known entity with different forms of steroids linked to coronary artery disease (CAD) either through promoting its traditional risk factors, inducing coronary spasm, or by other unidentified mechanisms. Dexamethasone is known to promote an atherogenic and hypercoagulable state. We report a case of a 75-year-old woman who had ST elevation myocardial infarction (STEMI) associated with dexamethasone use just 4 days following an angiogram showing minor luminal irregularities...
2016: Case Reports in Cardiology
Chee Yoong Foo, Daniel D Reidpath, Nathorn Chaiyakunapruk
BACKGROUND: Acute myocardial infarction (AMI) is a medical emergency in which sudden occlusion of coronary artery(ies) results in ischemia and necrosis of the cardiac tissues. Reperfusion therapies that aim at reopening the occluded artery remain the mainstay of treatment for AMI. Primary percutaneous coronary intervention (PCI), which enables the restoration of blood flow by reopening the occluded artery(ies) via a catheter with an inflatable balloon, is currently the preferred treatment for AMI with ST segment elevation (STEMI)...
2016: Systematic Reviews
Benjamin I Shepple, William A Thistlethwaite, Christopher L Schumann, Kwame O Akosah, Robert C Schutt, Ellen C Keeley
As part of a quality improvement project, we performed a process analysis to evaluate how patients presenting with type 1 non-ST elevation myocardial infarction (STEMI) are diagnosed and managed early after the diagnosis has been made. We performed a retrospective chart review and collected detailed information regarding the timing of the first 12-lead electrocardiogram, troponin order entry and first positive troponin result, administration of anticoagulation and antiplatelet medications, and referral for coronary angiography to identify areas of treatment variability and delay...
September 2016: Critical Pathways in Cardiology
Michael P Thomas, Eric R Bates
Primary PCI is the dominant reperfusion strategy for patients with ST-elevation myocardial infarction and continues to evolve. The purpose of this review is to summarize recent reports that focused on the relationship of door-to-balloon time with mortality, radial versus femoral artery access, aspiration thrombectomy, culprit versus multivessel primary PCI, drug-eluting stents, and anticoagulation and antiplatelet therapies.
June 27, 2016: Trends in Cardiovascular Medicine
K A Mol, B M Rahel, J G Meeder, B C A M van Casteren, P A Doevendans, M J M Cramer
Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement...
October 15, 2016: International Journal of Cardiology
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