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STEMI guidelines

Afsin Emre Kayipmaz, Orcun Ciftci, Cemil Kavalci, Emir Karacaglar, Haldun Muderrisoglu
BACKGROUND: This study aimed to explore the ST segment elevation myocardial infarction (STEMI) management practices of emergency medicine specialists working in various healthcare institutions of seven different geographical regions of Turkey, and to examine the characteristics of STEMI presentation and patient admissions in these regions. METHODS: We included 225 emergency medicine specialists working in all geographical regions of Turkey. We e-mailed them a 20-item questionnaire comprising questions related to their STEMI management practices and characteristics of STEMI presentation and patient admissions...
2016: PloS One
Ajay Yadlapati, Mark Gajjar, Daniel R Schimmel, Mark J Ricciardi, James D Flaherty
ST-elevation myocardial infarction (STEMI), which constitutes nearly 25-40 % of current acute myocardial infarction (AMI) cases, is a medical emergency that requires prompt recognition and treatment. Since the 2013 STEMI practice guidelines, a wealth of additional data that may further advance optimal STEMI practices has emerged. These data highlight the importance of improving patient treatment and transport algorithms for STEMI from non-primary percutaneous coronary intervention (PCI) centers. In addition, a focus on the reduction of total pain-to-balloon (P2B) times rather than simply door-to-balloon (D2B) times may further improve outcomes after primary PCI for STEMI...
October 6, 2016: Internal and Emergency Medicine
Michael C Kontos, Tracy Y Wang, Anita Y Chen, Eric R Bates, Harold L Dauerman, Timothy D Henry, Steven V Manoukian, Matthew T Roe, Robert Suter, Laine Thomas, William J French
BACKGROUND: Hospital mortality is an important quality measure for acute myocardial infarction care. There is a concern that despite risk adjustment, percutaneous coronary intervention hospitals accepting a greater volume of high-risk ST elevation myocardial infarction (STEMI) transfer patients may have their reported mortality rates adversely affected. METHODS: The STEMI patients in the National Cardiovascular Data RegistryAcute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines from April 2011 to December 2013 were included...
October 2016: American Heart Journal
H-C Mochmann
Witnessed collapse, bystander resuscitation and the use of automated external defibillators for defibrillatable arrhythmias, are recognized as strong predictors for a good prognosis after cardiac arrest. In addition, patient care after return of spontaneous circulation (ROSC), i.e. postresuscitation care, has been identified as an important factor for survival. It is necessary to differentiate between measures for treating the underlying cause of the cardiac arrest and measures for limiting reperfusion injury after global hypoxia and ischemia...
September 21, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Amit N Vora, Tracy Y Wang, Anne S Hellkamp, Laine Thomas, Timothy D Henry, Abhinav Goyal, Matthew T Roe
BACKGROUND: Among older patients with acute myocardial infarction (MI), it remains uncertain whether there is a time-dependent difference in the risk of recurrent mortality and nonfatal cardiovascular and cerebrovascular events for those with ST-segment-elevation MI (STEMI) compared with those with non-ST-segment-elevation MI. METHODS AND RESULTS: Older patients ≥65 years with acute MI and significant coronary artery disease identified with coronary angiography from the ACTION Registry-GWTG (Get With the Guidelines) were linked to Medicare claims data from 2007 to 2010...
September 2016: Circulation. Cardiovascular Quality and Outcomes
N S Vos, G Amoroso, M J Grundeken, A J J Ijsselmuiden, R J M van Geuns, R Spaargaren, J G P Tijssen, K T Koch
AIM: The aim of this study was to achieve useful insights into pre-hospital management and procedural performance for ST-elevation myocardial infarction (STEMI) in the Netherlands by extrapolating patient characteristics, and procedural and clinical outcomes of the Dutch patient cohort from the APPOSITION-III trial. METHODS: This is a retrospective analysis from the APPOSITION-III trial with respect to the geographical borders of STEMI management. The APPOSITION-III trial was a European registry for the use of the STENTYS self-expandable stent in STEMI patients undergoing primary percutaneous coronary intervention (PPCI)...
August 31, 2016: Netherlands Heart Journal
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
T Viergutz, J Grüttner, T Walter, C Weiss, B Haaff, G Pollach, C Madler, T Luiz
BACKGROUND: In the current guidelines for the treatment of patients with ST-segment elevation myocardial infarction (STEMI), the European Society of Cardiology (ESC) recommends preclinical fibrinolysis as a reperfusion therapy if, due to long transportation times, no cardiac catheterisation is available within 90-120 min. However, there is little remaining in-depth expertise in this method because fibrinolysis is presently only rarely indicated. METHODS: In a rural area in southwestern Germany, where an emergency primary percutaneous coronary intervention was not routinely available within 90-120 min, 156 STEMI patients underwent fibrinolysis with the plasminogen activator reteplase, performed by trained emergency physicians...
September 2016: Der Anaesthesist
Yu-Chen Wang, Ying-Ying Huang, Ping-Hang Lo, Kuan-Cheng Chang, Chu-Huang Chen, Ming-Fong Chen
BACKGROUND: To investigate the age-dependent impact of the superfast door-to-balloon (D2B) times of ≤60min as recommended by the new ESC Guideline for patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) on mid-term survival rates based on a single center registry dataset. PATIENTS AND METHODS: This study enrolled consecutive STEMI patients who underwent PPCI from Jan 1, 2009 through Sep 30, 2013...
November 1, 2016: International Journal of Cardiology
James G Jollis, Hussein R Al-Khalidi, Mayme L Roettig, Peter B Berger, Claire C Corbett, Harold L Dauerman, Christopher B Fordyce, Kathleen Fox, J Lee Garvey, Tammy Gregory, Timothy D Henry, Ivan C Rokos, Matthew W Sherwood, Robert E Suter, B Hadley Wilson, Christopher B Granger
BACKGROUND: Up to 50% of patients fail to meet ST-segment-elevation myocardial infarction (STEMI) guideline goals recommending a first medical contact-to-device time of <90 minutes for patients directly presenting to percutaneous coronary intervention-capable hospitals and <120 minutes for transferred patients. We sought to increase the proportion of patients treated within guideline goals by organizing coordinated regional reperfusion plans. METHODS: We established leadership teams, coordinated protocols, and provided regular feedback for 484 hospitals and 1253 emergency medical services (EMS) agencies in 16 regions across the United States...
August 2, 2016: Circulation
Hyun-Min Na, Goo-Yeong Cho, Joo Myung Lee, Myung-Jin Cha, Yeonyee E Yoon, Seung-Pyo Lee, Hyung-Kwan Kim, Yong-Jin Kim, Dae-Won Sohn
BACKGROUND: We sought to assess echocardiographic predictors of left ventricular (LV) adverse remodeling after successfully reperfused acute ST elevation myocardial infarction (STEMI). LV remodeling is commonly found in STEMI patients and it may suggest adverse outcome in acute myocardial infarction. We sought to identify whether 2D strain and torsion be independent parameters for prediction of LV adverse remodeling. METHODS: We investigated 208 patients with low-risk STEMI patients who had follow up echocardiography at 6 or more months...
June 2016: Journal of Cardiovascular Ultrasound
Florian Blachutzik, Stephan Achenbach, Monique Troebs, Jens Roether, Holger Nef, Christian Hamm, Christian Schlundt
Current guidelines recommend invasive coronary angiography and interventional revascularization in ST-elevation and Non-ST-elevation myocardial infarction (STEMI and NSTEMI). The aim of this study was to analyze culprit lesions and percutaneous coronary intervention (PCI) success in patients with previous coronary artery bypass grafting (CABG). We analyzed the data of 121 consecutive patients in whom coronary angiography was performed in the setting of STEMI or NSTEMI and who had previous CABG. Coronary angiograms were reviewed, and clinical data were evaluated...
August 15, 2016: American Journal of Cardiology
Roman Pfister, Samuel Lee, Kathrin Kuhr, Frank Baer, Wolfgang Fehske, Hans-Wilhelm Hoepp, Stephan Baldus, Guido Michels
AIMS: The impact of type of first medical contact (FMC) in the setting of a guideline conform metropolitan ST-elevation myocardial infarction (STEMI) network providing obligatory primary percutaneous coronary intervention (PCI) is unclear. METHODS AND RESULTS: 3,312 patients were prospectively included between 2006 and 2012 into a registry accompanying the "Cologne Infarction Model" STEMI network, with 68.4% primarily presenting to emergency medical service (EMS), 17...
2016: PloS One
Padmaa Venkatason, Yong Z Zubairi, Imran Hafidz, Wan Azman Wan, Ahmad S Zuhdi
BACKGROUND: The administration of evidence-based pharmacotherapy and timely primary percutaneous coronary intervention have been shown to improve outcome in ST elevation myocardial infarction (STEMI). However, implementation remains a challenge due to the limitations in facilities, expertise and funding. OBJECTIVES: To investigate adherence to guideline-based management and mortality of STEMI patients in Malaysia. DESIGN: Retrospective analysis...
May 2016: Annals of Saudi Medicine
Matias B Yudi, Nicholas Jones, Dharsh Fernando, David J Clark, Jay Ramchand, Elizabeth Jones, Robynne Dakis, Douglas Johnson, Robert Chan, Amirul Islam, Omar Farouque, Mark Horrigan
Guidelines mandate urgent revascularization in patients presenting with ST-elevation myocardial infarction (STEMI) irrespective of age. Whether this strategy is optimal in patients aged ≥85 years remains uncertain. We aimed to assess the clinical characteristics and outcomes of patients aged ≥85 years with STEMI stratified by their management strategy. We analyzed baseline clinical characteristics of 101 consecutive patients aged ≥85 years who presented with STEMI to a tertiary Australian hospital...
July 1, 2016: American Journal of Cardiology
Najmeh Alyasin
Clopidogrel as a potent antiplatelet agent is administered in patients with ST elevation myocardial infarction (STEMI). The efficacy and safety of 2 clopidogrel loading regimen (300 mg vs 600 mg) in STEMI patients undergoing a primary percutaneous coronary intervention is still under investigation. The purpose of this article is to highlight current knowledge and guidelines regarding clopidogrel loading dose and also time of administration in STEMI setting and before primary percutaneous coronary intervention...
June 2016: Journal of Vascular Nursing: Official Publication of the Society for Peripheral Vascular Nursing
Carsten Stengaard, Jacob T Sørensen, Martin B Rasmussen, Hanne M Søndergaard, Karen K Dodt, Troels Niemann, Lars Frost, Tage Jensen, Troels M Hansen, Ingunn Skogstad Riddervold, Claus-Henrik Rasmussen, Mathias Giebner, Jens Aarøe, Michael Maeng, Evald H Christiansen, Steen D Kristensen, Hans E Bøtker, Christian J Terkelsen
BACKGROUND: The 2015 European Society of Cardiology non-ST-elevation myocardial infarction (NSTEMI) guidelines recommend angiography within 24 h in high-risk patients with NSTEMI. An organized STEMI-like approach with pre-hospital or immediate in-hospital triage for acute coronary angiography (CAG) may be of therapeutic benefit but it remains unknown whether the patients can be properly diagnosed in the pre-hospital setting. We aim to evaluate whether it is feasible to diagnose patients with NSTEMI in the pre-hospital phase or immediately upon admission...
May 6, 2016: European Heart Journal. Acute Cardiovascular Care
Apurva Patel, Roosha Parikh, Kanhaiya L Poddar, Stephen G Ellis, E Murat Tuzcu, Samir R Kapadia
BACKGROUND: Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤90min for favorable survival impact after STEMI. Efforts to achieve these targets may result in unnecessary emergent angiography for inappropriate activations. OBJECTIVE: Evaluate the frequency, trend and factors which are significantly associated with inappropriate for intervention cardiac catheterization laboratory (CCL) activation. METHODS: We analyzed 1764 consecutive emergent CCL activation for possible ST segment elevation myocardial infarction (STEMI) between 7/2005 and 8/2013...
June 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Céline Rousseaux, Pierre Mols, Peter R Sinnaeve, Carl Convens, Philippe Dubois, Pascal Vranckx, Sofie Gevaert, Patrick Coussement, Ahmed Se Ramadan, Christophe Beauloye, Marc Renard, Patrick Evrard, Jean-François Argacha, Herbert De Raedt, Kristien Wouters, Marc J Claeys
OBJECTIVES: Emergency medical services play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates the effect of emergency medical services use on adherence to reperfusion therapy guidelines in Belgian STEMI patients and on in-hospital mortality. METHODS: The mode of admission with against without emergency medical services was associated with baseline risk profile, reperfusion modalities and in-hospital mortality in 5692 consecutive STEMI patients from 2012 to 2014...
September 2016: European Heart Journal. Acute Cardiovascular Care
Veena Nanjappa, Gopi Aniyathodiyil, R Keshava
BACKGROUND: Gender disparity, with respect to women receiving less medical therapy, undergoing fewer invasive procedures, and experiencing worse outcome than men, has been noted in various observational and randomized trials, though guidelines on acute coronary syndrome (ACS) are gender-neutral. Indian data with focus on women with ACS are lacking. AIM: This study was undertaken to give us an insight on the clinical presentation, risk factors, and in-hospital outcome of ACS in women and at 30 days...
March 2016: Indian Heart Journal
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