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Prehospital STEMI

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https://www.readbyqxmd.com/read/28679686/long-term-mortality-and-prehospital-tirofiban-treatment-in-patients-with-st-elevation-myocardial-infarction
#1
Enrico Fabris, Sinem Kilic, Dirk A A M Schellings, Jurrien M Ten Berg, Mark W Kennedy, K Gerts van Houwelingen, Evangelos Giannitsis, Evelien Kolkman, Jan Paul Ottervanger, Christian Hamm, Arnoud W J Van't Hof
OBJECTIVE: We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels. METHODS: A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo...
July 5, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28627230/relationship-between-community-hospital-versus-pre-hospital-location-of-randomisation-and-clinical-outcomes-in-st-elevation-myocardial-infarction-patients-insights-from-the-stream-study
#2
Robert C Welsh, Patrick Goldstein, Peter Sinnaeve, Miodrag C Ostojic, Yinggan Zheng, Thierry Danays, Cynthia M Westerhout, Frans Van de Werf, Paul W Armstrong
AIMS: The STREAM study randomly assigned ST-elevation myocardial infarction (STEMI) patients to receive a pharmacoinvasive versus primary percutaneous coronary intervention reperfusion strategy. We assessed whether there was an association between outcomes based on randomisation at a community hospital versus a prehospital location. METHODS/RESULTS: Community hospital patients (358/1866 (19.2%)) were compared to prehospital patients and their outcomes categorised into pharmacoinvasive according to their treatment assignment...
June 1, 2017: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/28598044/a-study-of-prehospital-delay-patterns-in-acute-myocardial-infarction-in-an-urban-tertiary-care-institute-in-mumbai
#3
Ashar Khan, Milind Phadke, Yash Y Lokhandwala, Pratap J Nathani
OBJECTIVE: There is now increasing awareness about the need for early diagnosis in patients presenting with chest pain. Pre-hospital delay remains a major hurdle in the institution of early reperfusion therapy, which is crucial in salvaging 'at-risk' myocardium and reducing adverse cardiovascular events following ST elevation myocardial infarction (STEMI). This study aims to determine the incidence and the determinants of delayed presentation STEMI and the potential impact of such delay on adverse cardiovascular outcomes...
May 2017: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/28540982/gender-differences-in-factors-related-to-prehospital-delay-in-patients-with-st-segment-elevation-myocardial-infarction
#4
Hee Sook Kim, Kun Sei Lee, Sang Jun Eun, Si Wan Choi, Dae Hyeok Kim, Tae Ho Park, Kyeong Ho Yun, Dong Heon Yang, Seok Jae Hwang, Ki Soo Park, Rock Bum Kim
PURPOSE: The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS: A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset...
July 2017: Yonsei Medical Journal
https://www.readbyqxmd.com/read/28489635/trends-in-sex-differences-in-clinical-characteristics-treatment-strategies-and-mortality-in-patients-with-st-elevation-myocardial-infarction-in-poland-from-2005-to-2011
#5
Lukasz Zandecki, Marcin Sadowski, Marianna Janion, Marek Gierlotka, Mariusz Gasior, Lech Polonski
INTRODUCTION: During the last decade, there has been an increased awareness of sex differences in the clinical characteristics, management, and mortality in myocardial infarction. Many previous studies have found that women with ST-elevation myocardial infarction (STEMI) have a poorer baseline risk profile, are less intensively treated, and have worse outcomes. OBJECTIVE: To evaluate whether sex disparities in STEMI have changed in recent years. METHODS: This is a retrospective analysis of data on 111 148 STEMI patients enrolled in the Polish Registry of Acute Coronary Syndromes between 2005 and 2011...
August 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/28367010/prehospital-delay-and-time-to-reperfusion-therapy-in-st-elevation-myocardial-infarction
#6
Linsha George, Lakshmi Ramamoorthy, Santhosh Satheesh, Rama Prakasha Saya, D K S Subrahmanyam
BACKGROUND: Despite efforts aimed at reducing the prehospital delay and treatment delay, a considerable proportion of patients with ST elevation myocardial infarction (STEMI) present late and receive the reperfusion therapy after unacceptably long time periods. This study aimed at finding out the patients' decision delay, prehospital delay, door-to-electrocardiography (ECG), door-to-needle, and door-to-primary percutaneous coronary intervention (PCI) times and their determinants among STEMI patients...
April 2017: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/28296638/complete-versus-incomplete-angiography-prior-to-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction
#7
Kevin Stiver, Xu Gao, Satya Shreenivas, Konstantinos Boudoulas, Ernie Mazzaferri, Nader Makki, Scott M Lilly
OBJECTIVES: Shorter reperfusion times in ST-elevation myocardial infarction (STEMI) are associated with improved survival. Prehospital strategies have been developed to minimize door-to-balloon (DTB) time, but few strategies within the catheterization laboratory itself have been evaluated. Incomplete angiography (IA) prior to percutaneous coronary intervention (PCI) is undertaken in clinical practice as a means to further reduce DTB time. We sought to determine whether or not those with STEMI who underwent IA prior to PCI had different preprocedural characteristics or post-PCI outcomes...
August 2017: Journal of Invasive Cardiology
https://www.readbyqxmd.com/read/28127213/components-and-determinants-of-therapeutic-delay-in-patients-with-acute-st-elevation-myocardial-infarction-a-tertiary-care-hospital-based-study
#8
Jahangir Rashid Beig, Nisar A Tramboo, Kuldeep Kumar, Irfan Yaqoob, Imran Hafeez, Fayaz A Rather, Tariq R Shah, Hilal A Rather
BACKGROUND: Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state. METHODS: This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient's decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated...
January 2017: Journal of the Saudi Heart Association
https://www.readbyqxmd.com/read/28024553/sustained-performance-of-a-physicianless-system-of-automated-prehospital-stemi-diagnosis-and-catheterization-laboratory-activation
#9
Brian J Potter, Alexis Matteau, Samer Mansour, Charbel Naim, Mounir Riahi, Richard Essiambre, Martine Montigny, Isabelle Sareault, François Gobeil
BACKGROUND: Treatment times for primary percutaneous coronary intervention frequently exceed the recommended maximum delay. Automated "physicianless" systems of prehospital cardiac catheterization laboratory (CCL) activation show promise, but have been met with resistance over concerns regarding the potential for false positive and inappropriate activations (IAs). METHODS: From 2010 to 2015, first responders performed electrocardiograms (ECGs) in the field for all patients with a complaint of chest pain or dyspnea...
January 2017: Canadian Journal of Cardiology
https://www.readbyqxmd.com/read/27939226/effectiveness-of-a-prehospital-wireless-12-lead-electrocardiogram-and-cardiac-catheterization-laboratory-activation-for-st-elevation-myocardial-infarction
#10
Alain Tanguay, Eric Brassard, Johann Lebon, François Bégin, Denise Hébert, Jean-Michel Paradis
The aim of the study was to determine the prevalence of false-positive and inappropriate cardiac catheterization laboratory (CCL) activation in patients suspected with ST-elevation myocardial infarction (STEMI) diverted to a percutaneous coronary intervention (PCI) facility after paramedics wireless 12-lead electrocardiogram transmission to an emergency physician at an online medical control center. This retrospective study collected data from medical records of patients with suspected STEMI from 2006 to 2014...
February 15, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/27930573/management-of-st-segment-elevation-myocardial-infarction-in-predominantly-rural-central-china-a-retrospective-observational-study
#11
MULTICENTER STUDY
You Zhang, Shuyan Yang, Xinyun Liu, Muwei Li, Weidong Zhang, Haiyan Yang, Dayi Hu, Chuanyu Gao, Guangcai Duan
The degree of adherence to current guidelines for clinical management of ST-segment elevation myocardial infarction (STEMI) is known in developed countries and large Chinese cities, but in predominantly rural areas information is lacking. We assessed the application of early reperfusion therapy for STEMI in secondary and tertiary hospitals in Henan province in central China.Data were retrospectively collected from 5 secondary and 4 tertiary hospitals in Henan concerning STEMI patients treated from January 2011 to January 2012, including management strategy, delay time, and inhospital mortality...
December 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27894465/is-denial-a-maladaptive-coping-mechanism-which-prolongs-pre-hospital-delay-in-patients-with-st-segment-elevation-myocardial-infarction
#12
X Y Fang, L Albarqouni, A F von Eisenhart Rothe, S Hoschar, J Ronel, K-H Ladwig
OBJECTIVE: During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. METHODS: This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside...
December 2016: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/27887720/prehospital-electrocardiographic-acuteness-score-of-ischemia-is-inversely-associated-with-neurohormonal-activation-in-stemi-patients-with-severe-ischemia
#13
Yama Fakhri, Mikkel Malby Schoos, Maria Sejersten, Mads Ersbøll, Nana Valeur, Lars Køber, Christian Hassager, Galen S Wagner, Jens Kastrup, Peter Clemmensen
BACKGROUND: Elevated levels of N-terminal pro brain natriuretic peptide (NT-proBNP) are associated with adverse cardiovascular outcome after ST elevation myocardial infarction (STEMI). We hypothesized that decreasing acuteness-score (based on the electrocardiographic score by Anderson-Wilkins acuteness score of myocardial ischemia) is associated with increasing NT-proBNP levels and the impact of decreasing acuteness-score on NT-proBNP levels is substantial in STEMI patients with severe ischemia...
January 2017: Journal of Electrocardiology
https://www.readbyqxmd.com/read/27885888/cangrelor-in-combination-with-ticagrelor-provides-consistent-and-potent-p2y12-inhibition-during-and-after-primary-percutaneous-coronary-intervention-in-real-world-patients-with-st-segment-elevation-myocardial-infarction
#14
Moman A Mohammad, Pontus Andell, Sasha Koul, Stefan James, Fredrik Scherstén, Matthias Götberg, David Erlinge
Patients pretreated with ticagrelor with less than 1 hour from percutaneous coronary intervention (PCI) or receiving ticagrelor in cath lab were prospectively included and received cangrelor. Cangrelor was infused for 2 hours and platelet function was assessed as P2Y12 reactivity units (PRU) with the VerifyNow P2Y12 function assay before start of infusion, 15 min after the start of infusion, and 30 min after the end of infusion. A total of n = 32 patients with an average age of 68 (±13) years with n = 22 (69%) males were included...
June 2017: Platelets
https://www.readbyqxmd.com/read/27858506/causes-of-prehospital-misinterpretations-of-st-elevation-myocardial-infarction
#15
Nichole Bosson, Stephen Sanko, Ronald E Stickney, James Niemann, William J French, James G Jollis, Michael C Kontos, Tyson G Taylor, Peter W Macfarlane, Richard Tadeo, William Koenig, Marc Eckstein
OBJECTIVES: To determine the causes of software misinterpretation of ST elevation myocardial infarction (STEMI) compared to clinically identified STEMI to identify opportunities to improve prehospital STEMI identification. METHODS: We compared ECGs acquired from July 2011 through June 2012 using the LIFEPAK 15 on adult patients transported by the Los Angeles Fire Department. Cases included patients ≥18 years who received a prehospital ECG. Software interpretation of the ECG (STEMI or not) was compared with data in the regional EMS registry to classify the interpretation as true positive (TP), true negative (TN), false positive (FP), or false negative (FN)...
May 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27818120/efficacy-and-safety-of-prehospital-administration-of-unfractionated-heparin-enoxaparin-or-bivalirudin-in-patients-undergoing-primary-percutaneous-coronary-intervention-for-st-segment-elevation-myocardial-infarction-insights-from-the-orbi-registry
#16
COMPARATIVE STUDY
Vincent Auffret, Guillaume Leurent, Dominique Boulmier, Marc Bedossa, Amer Zabalawi, Jean-Philippe Hacot, Isabelle Coudert, Emmanuelle Filippi, Philippe Castellant, Antoine Rialan, Gilles Rouault, Philippe Druelles, Bertrand Boulanger, Josiane Treuil, Bertrand Avez, Marielle Le Guellec, Martine Gilard, Hervé Le Breton
BACKGROUND: Despite numerous studies in recent years, the best anticoagulant option for primary percutaneous coronary intervention (PCI) remains a matter of debate. AIMS: To compare in-hospital outcomes after prehospital administration of low-dose unfractionated heparin (UFH)±glycoprotein IIb/IIIa inhibitors (GPIs), enoxaparin±GPIs, or bivalirudin in patients undergoing primary PCI for ST-segment elevation myocardial infarction (STEMI). METHODS: A total of 1720 patients (median age 62...
December 2016: Archives of Cardiovascular Diseases
https://www.readbyqxmd.com/read/27814743/prehospital-fibrinolysis-versus-primary-percutaneous-coronary-intervention-in-st-elevation-myocardial-infarction-a-systematic-review-and-meta-analysis-of-randomized-controlled-trials
#17
Vincent Roule, Pierre Ardouin, Katrien Blanchart, Adrien Lemaitre, Julien Wain-Hobson, Damien Legallois, Joachim Alexandre, Rémi Sabatier, Paul Milliez, Farzin Beygui
BACKGROUND: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI), but its benefit over prehospital fibrinolysis (FL) is not clear. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials in which outcomes of patients with STEMI managed with FL early in the prehospital setting versus PPCI were compared. RESULTS: Compared with PPCI, FL was consistently associated with similar rates of short-term (30-90 days) death (relative risk [RR] 0...
November 5, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27580835/characteristics-treatment-and-in-hospital-outcomes-of-patients-with-stemi-in-a-metropolitan-area-of-a-developing-country-an-initial-report-of-the-extended-jakarta-acute-coronary-syndrome-registry
#18
Surya Dharma, Hananto Andriantoro, Ismi Purnawan, Iwan Dakota, Faris Basalamah, Beny Hartono, Ronaly Rasmin, Herawati Isnanijah, Muhammad Yamin, Ika Prasetya Wijaya, Vireza Pratama, Tjatur Bagus Gunarto, Yahya Berkahanto Juwana, Frits R W Suling, A M Onny Witjaksono, Hengkie F Lasanudin, Kurniawan Iskandarsyah, Hardja Priatna, Pradana Tedjasukmana, Uki Wahyumandradi, Adrianus Kosasih, Imelda A Budhiarti, Wisnoe Pribadi, Jeffrey Wirianta, Utojo Lubiantoro, Rini Pramesti, Diah Retno Widowati, Sissy Kartini Aminda, M Abas Basalamah, Sunil V Rao
OBJECTIVE: We studied the characteristics of patients with ST segment elevation myocardial infarction (STEMI) after expansion of a STEMI registry as part of the STEMI network programme in a metropolitan city and the surrounding area covering ∼26 million inhabitants. DESIGN: Retrospective cohort study. SETTING: Emergency department of 56 health centres. PARTICIPANTS: 3015 patients with acute coronary syndrome, of which 1024 patients had STEMI...
August 31, 2016: BMJ Open
https://www.readbyqxmd.com/read/27512532/utilizations-and-perceptions-of-emergency-medical-services-by-patients-with-st-segments-elevation-acute-myocardial-infarction-in-abu-dhabi-a-multicenter-study
#19
Edward Lance Callachan, Alawi A Alsheikh-Ali, Satish Chandrasekhar Nair, Stevan Bruijns, Lee A Wallis
BACKGROUND: Data on the use of emergency medical services (EMS) by patients with cardiac conditions in the Gulf region are scarce, and prior studies have suggested underutilization. Patient perception and knowledge of EMS care is critical to proper utilization of such services. OBJECTIVES: To estimate utilization, knowledge, and perceptions of EMS among patients with ST-elevation myocardial infarction (STEMI) in the Emirate of Abu Dhabi. METHODS: We conducted a multicenter prospective study of consecutive patients admitted with STEMI in four government-operated hospitals in Abu Dhabi...
April 2016: Heart Views: the Official Journal of the Gulf Heart Association
https://www.readbyqxmd.com/read/27503306/-preclinical-fibrinolysis-in-patients-with-st-segment-elevation-myocardial-infarction-in-a-rural-region
#20
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
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