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Samantha Noll, Heidi Alvey, Namita Jayaprakash, Aniruddha Paranjpe, Joseph Miller, Michele L Moyer, Richard Nowak
INTRODUCTION: Current AHA/ACC guidelines on the management of ST-elevation myocardial infarction (STEMI) suggest that an ECG is indicated within 10minutes of arrival for patients arriving to the Emergency Department (ED) with symptoms concerning for STEMI. In response, there has been a creep towards performing ECGs more frequently in triage. The objectives of this study were to quantify the number of triage ECGs performed at our institution, assess the proportion of ECGs performed within current hospital guidelines, and evaluate the rate of STEMI detection in triage ECGs...
February 3, 2018: American Journal of Emergency Medicine
Alain Tanguay, Johann Lebon, Lorraine Lau, Denise Hébert, François Bégin
OBJECTIVE: Repeated or serial 12-lead electrocardiograms (ECGs) in the prehospital setting may improve management of patients with subtle ST-segment elevation (STE) or with a ST-segment elevation myocardial infarction (STEMI) that evolves over time. However, there is a minimal amount of scientific evidence available to support the clinical utility of this method. Our objective was to evaluate the use of serial 12-lead ECGs to detect STEMI in patients during transport in a Canadian emergency medical services (EMS) jurisdiction...
January 16, 2018: Prehospital Emergency Care
Edwin C Ho, Sheldon Cheskes, Paul Angaran, Laurie J Morrison, Theresa Aves, Cathy Zhan, Dennis T Ko, Paul Dorian
BACKGROUND: Clinical practice guidelines recommend implantable cardioverter defibrillators (ICDs) for the secondary prevention of sudden death after a cardiac arrest not from a reversible cause, but "real world" implantation rates are not well described. METHODS: Adults with out of hospital cardiac arrest attended by Emergency Medical Services are captured in the Toronto Regional RescuNET database. We analyzed those who survived to hospital discharge and collected data on age, sex, initial rhythm, ST-elevation myocardial infarction (STEMI) on presenting electrocardiogram (ECG), in-hospital revascularization, neurologic status (Modified Rankin Scale [MRS]) at discharge, and admission hospital type...
October 2017: Canadian Journal of Cardiology
Melanie Dechamps, Diego Castanares-Zapatero, Patrick Vanden Berghe, Philippe Meert, Alessandro Manara
In the Emergency Department, chest pain triage systems are based on either clinical features or ECG recording. In this prospective, single-center, observational study, we aimed to compare the diagnostic performance of these triage systems in distinguishing acute coronary syndromes (ACS) from diseases of mild severity. Patients were sorted into the triage systems based on collected data at admission and on a systematic 12-lead ECG performed at triage. The final diagnosis was determined after a 30-day follow-up...
December 2017: Internal and Emergency Medicine
Seifollah Abdi, Omid Rafizadeh, Mohammadmehdi Peighambari, Hoseinali Basiri, Hooman Bakhshandeh
BACKGROUND: The no-reflow phenomenon is an uncommon and critical occurrence which myocardial reperfusion does not restore to its optimal level. Several predisposing factors of the no-reflow phenomenon have been identified. However, at present we know little about clinical predictors of no-reflow after percutaneous coronary intervention (PCI). OBJECTIVES: In this study, we evaluated clinical predictors of no-reflow phenomenon after PCI in patients with acute STEMI, to plan a better treatment of these patients...
May 2015: Research in Cardiovascular Medicine
Ingo Eitel, Thomas Stiermaier, Karl P Rommel, Georg Fuernau, Marcus Sandri, Norman Mangner, Axel Linke, Sandra Erbs, Phillip Lurz, Enno Boudriot, Meinhard Mende, Steffen Desch, Gerhard Schuler, Holger Thiele
AIMS: Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control...
November 21, 2015: European Heart Journal
Turgay Celik, Sevket Balta, Cengiz Ozturk, Mehmet Gungor Kaya, Mustafa Aparci, Osman A Yildirim, Mustafa Demir, Murat Unlu, Sait Demirkol, Selim Kilic, Atila Iyisoy
No-reflow is of prognostic value in ST-segment elevation myocardial infarction (STEMI) but has not been extensively investigated in young patients. Young patients with STEMI admitted within 12 hours from symptom onset and treated by primary percutaneous coronary intervention (pPCI) were recruited. Patients were classified into 2 groups based on postintervention thrombolysis in myocardial infarction (TIMI) flow grade; no-reflow: TIMI flow grade 0, 1 or 2 (group 1; n = 27; 21 men, mean age: 42 ± 4 years); and angiographic success: TIMI flow grade 3 (group 2; n = 118; 110 men, mean age: 43 ± 4 years)...
August 2016: Angiology
Aloysia A M van Oeffelen, Saskia Rittersma, Ilonca Vaartjes, Karien Stronks, Michiel L Bots, Charles Agyemang
BACKGROUND: Previously, ethnic inequalities in prognosis after a first acute myocardial infarction were observed in the Netherlands. This might be due to differences in revascularisation rate between ethnic minority groups and ethnic Dutch. Therefore, we investigated inequalities in revascularisation rate after occurrence of an ST-elevation myocardial infarction (STEMI) between first generation ethnic minority groups (henceforth, migrants) and ethnic Dutch. METHODS: All STEMI events between 2006 and 2011 were identified in a subset of the Achmea Health Database, which records medical care to persons insured at the Achmea health insurance company, a major health insurance company in the central part of the Netherlands...
2015: PloS One
Ismail Bolat, Ozgur Akgul, Huseyin Altug Cakmak, Hamdi Pusuroglu, Umut Somuncu, Sinem Ozbey, Vesile Ornek, Mehmet Erturk, Mehmet Gul
BACKGROUND: Mean platelet volume to platelet count (MPV/Plt) ratio has been demonstrated to be a good indicator of long-term mortality in patients with non-ST-segment elevation myocardial infarction (NSTEMI). However, the prognostic value of MPV/Plt in ST-elevation myocardial infarction (STEMI) is not reported. AIM: To determine whether the MPV/Plt ratio on admission has any predictive value for major adverse cardiac events including short- and long-term mortality in STEMI...
2016: Kardiologia Polska
Jacek Gacoń, Anna Kabłak-Ziembicka, Ewa Stępień, Francisco J Enguita, Izabela Karch, Bogusław Derlaga, Krzysztof Żmudka, Tadeusz Przewłocki
BACKGROUND: Coronary artery occlusion does not always manifest with ST-elevation, and some patients can have patent coronary vessel. AIM: We evaluated circulating microRNA (miRNA) profiles to discriminate subjects with infarct-related artery (IRA) occlusion. METHODS AND RESULTS: Patients (n = 43) with uncomplicated acute coronary syndrome and positive troponins were classified with respect to patent vs. occluded IRA or ST-elevation vs. non-ST elevation MI (STEMI vs...
2016: Kardiologia Polska
Sradha Kotwal, Isuru Ranasinghe, David Brieger, Philip Clayton, Alan Cass, Martin Gallagher
BACKGROUND: Acute myocardial infarction (AMI) has poorer outcomes in disadvantaged populations such as those in regional and remote locations. We compared long-term outcomes associated with presentation to regional or remote hospitals among AMI patients. METHODS AND RESULTS: Administrative claims data from New South Wales (27% regional and remote residents) was used to identify patients >18 years admitted to any NSW hospital with a principal diagnosis of AMI (ICD10 codes: I21·0-I21·4) between 01/07/2004 and 30/06/2008...
February 2016: Heart, Lung & Circulation
Leili Pourafkari, Nader D Nader, Navid Heydari, Arezou Tajlil, Samad Ghaffari
OBJECTIVE: This study aimed to determine the association of a prominent Q wave in lead (-)aVR with clinical, echocardiographic and angiographic findings in anterior ST elevation myocardial infarction (STEMI) and to evaluate the role of this finding in short-term and long-term outcomes. METHODS: During a one-year period, 150 patients with first time anterior STEMI were screened and 121 patients with no other cardiopulmonary and renal comorbid diagnoses were included in the study...
September 2015: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Kazuo Kimura, Koichi Nakao, Yoshisato Shibata, Takahito Sone, Tadateru Takayama, Shigeru Fukuzawa, Yasuharu Nakama, Haruo Hirayama, Naoya Matsumoto, Masami Kosuge, Takafumi Hiro, Hajime Sakuma, Masaharu Ishihara, Masanori Asakura, Chikuma Hamada, Akira Kaneko, Toshiaki Yokoi, Atsushi Hirayama
BACKGROUND: In patients with ST-elevation acute myocardial infarction (STEMI), reperfusion therapy limits infarct size, but can directly evoke myocardial reperfusion injury. Activation of the Na(+)/H(+) exchanger (NHE) plays an important role in reperfusion injury. TY-51924, a novel NHE inhibitor, significantly reduced infarct size in animal studies and was well tolerated in early-phase clinical trials. This study aim was to evaluate the efficacy and safety of TY-51924 in patients with STEMI...
April 2016: Journal of Cardiology
Ravinder Singh Rao, Robert L Shapiro, John M Lasala
We report a case of an 87-year-old female who underwent percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction while she was being worked up for transcatheter aortic valve procedure. Hemodynamic compromise occurred during the PCI, which could only be mitigated by doing a balloon aortic valvuloplasty and Impella™ insertion. This case report will help in preparedness for any untoward events in patients with aortic stenosis and undergoing percutaneous coronary intervention.
April 2016: Catheterization and Cardiovascular Interventions
Peng Jiecheng, Wang Ai-Ling
BACKGROUND: The coronary no-reflow (NR) phenomenon, which is associated with poor clinical outcomes, is usually referred to as a post-percutaneous coronary intervention (PCI) state. NR can occur in different stages of the PCI procedure, not only including the post-stenting stage, but from balloon pre-dilation to pre-stenting. The clinical significance of NR in the different stages of the PCI procedure is unclear. The purpose of the current study was to analyze the clinical and angiographic characteristics, the prognosis for NR patients in the aforementioned two stages and to determine the predictors of NR in the early stage...
May 2016: Perfusion
Sudhakar George, Patrick A Calvert
PURPOSE OF REVIEW: The purpose of this review is to highlight important and interesting advances in the field of ischaemic heart disease that have occurred over the last 18 months. It is focused on research that is likely to lead to changes in clinical practice. RECENT FINDINGS: There is new evidence on appropriate pharmacotherapy during angioplasty in both stable and unstable patients. The use of pressure wire assessment has been shown to improve patient outcome...
November 2015: Current Opinion in Cardiology
António Gaspar, Miguel Álvares Pereira, Pedro Azevedo, André Lourenço, Jorge Marques, Adelino Leite-Moreira
BACKGROUND: ST-elevation myocardial infarction (STEMI) accounts for nearly one third of acute coronary syndromes. Despite improved STEMI patient care, mortality remains high, contributing significantly to the ischemic heart disease burden. This may partly be related to ischemia-reperfusion injury (IRI). Remote ischemic conditioning (RIC), through short cycles of ischemia-reperfusion applied to a limb, has been shown to reduce IRI in various clinical settings. Our primary hypothesis is that RIC will reduce adverse events related to STEMI when applied as adjunctive therapy to primary percutaneous coronary intervention (PCI)...
September 8, 2015: Trials
Ju Yeon Heo, Ki Jeong Hong, Sang Do Shin, Kyoung Jun Song, Young Sun Ro
STUDY OBJECTIVE: Rapid access to reperfusion is important in ST-segment elevation myocardial infarction (STEMI). The goal of this study is to assess the association of the educational level of patients with STEMI and prehospital and inhospital delay before reperfusion. METHODS: We used a nationwide database of 31 emergency departments for cardiovascular disease surveillance operated by the Korean Centers for Disease Control and Prevention. ST-segment elevation myocardial infarction cases registered from November 2007 to December 2012 were enrolled...
December 2015: American Journal of Emergency Medicine
Homa Waziri, Erik Jørgensen, Henning Kelbæk, Emil L Fosbøl, Frantz Pedersen, Ulrik M Mogensen, Thomas A Gerds, Lars Køber, Kristian Wachtell
AIMS: Due to the limitations of 12-lead ECG, occlusions of the left circumflex artery (LCX) are more likely to present as non-ST-elevation acute coronary syndrome (NSTEACS) compared with other coronary arteries. We aimed to study mortality in patients with LCX lesions and to assess the importance of coronary artery dominance on triage of these patients. METHODS AND RESULTS: From the Eastern Danish Heart Registry, 3,632 NSTEACS and 3,907 ST-elevation myocardial infarction (STEMI) consecutive, single-vessel disease patients were included...
July 20, 2016: EuroIntervention
Thomas Engstrøm, Henning Kelbæk, Steffen Helqvist, Dan Eik Høfsten, Lene Kløvgaard, Lene Holmvang, Erik Jørgensen, Frants Pedersen, Kari Saunamäki, Peter Clemmensen, Ole De Backer, Jan Ravkilde, Hans-Henrik Tilsted, Anton Boel Villadsen, Jens Aarøe, Svend Eggert Jensen, Bent Raungaard, Lars Køber
BACKGROUND: Patients with acute ST-segment elevation myocardial infarction (STEMI) and multivessel coronary disease have a worse prognosis compared with individuals with single-vessel disease. We aimed to study the clinical outcome of patients with STEMI treated with fractional flow reserve (FFR)-guided complete revascularisation versus treatment of the infarct-related artery only. METHODS: We undertook an open-label, randomised controlled trial at two university hospitals in Denmark...
August 15, 2015: Lancet
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