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Ulrike Flierl, Florian Zauner, Jan-Thorben Sieweke, Christine Berliner, L Christian Napp, Jochen Tillmanns, Johann Bauersachs, Andreas Schäfer
Prasugrel, a potent thienopyridine, achieves stronger inhibition of platelet activation than clopidogrel. However, onset of inhibition is significantly delayed in patients with acute ST-elevation myocardial infarction (STEMI), as haemodynamic instability and morphine application seem to exhibit significant influence. Since rapid onset of effect was demonstrated in non-STEMI patients when prasugrel was administered only after percutaneous coronary intervention (PCI) without increasing cardiovascular event rates we assessed the efficacy of prasugrel loading immediately after PCI for STEMI instead of pre-loading before revascularisation...
October 13, 2016: Thrombosis and Haemostasis
A I Macfarlane, D Rudd, E Knight, L A G Marshman, E P Guazzo, D S Anderson
: Prior studies have suggested that elevated serum Troponin-I (TnI) levels immediately after non-cardiac surgical procedures (8-40%) represent subclinical cardiac stress which independently predicts increased 30-day mortality. Routine post-operative TnI monitoring has therefore been suggested as a standard of care. However, no prior studies have focussed on elective degenerative spine surgery, whilst few have measured pre-op TnI. Further, prolonged prone positioning could represent an additional, independent, cardiac stress...
October 1, 2016: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Tsuyoshi Nishiguchi, Atsushi Tanaka, Akira Taruya, Hiroki Emori, Yuichi Ozaki, Makoto Orii, Yasutsugu Shiono, Kunihiro Shimamura, Takeyoshi Kameyama, Takashi Yamano, Tomoyuki Yamaguchi, Yoshiki Matsuo, Yasushi Ino, Takashi Kubo, Takeshi Hozumi, Yasushi Hayashi, Takashi Akasaka
OBJECTIVE: Early clinical presentation of ST-segment-elevation myocardial infarction (STEMI) and non-ST-segment-elevation myocardial infarction affects patient management. Although local inflammatory activities are involved in the onset of MI, little is known about their impact on early clinical presentation. This study aimed to investigate whether local inflammatory activities affect early clinical presentation. APPROACH AND RESULTS: This study comprised 94 and 17 patients with MI (STEMI, 69; non-STEMI, 25) and stable angina pectoris, respectively...
September 29, 2016: Arteriosclerosis, Thrombosis, and Vascular Biology
Levent Cerit
No abstract text is available yet for this article.
August 2016: Arquivos Brasileiros de Cardiologia
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
Jianhua Wu, Chris P Gale, Marlous Hall, Tatendashe B Dondo, Elizabeth Metcalfe, Ged Oliver, Phil D Batin, Harry Hemingway, Adam Timmis, Robert M West
AIMS: Early and accurate diagnosis of acute myocardial infarction is central to successful treatment and improved outcomes. We aimed to investigate the impact of the initial hospital diagnosis on mortality for patients with acute myocardial infarction. METHODS AND RESULTS: Cohort study using data from the Myocardial Ischaemia National Audit Project of patients discharged with a final diagnosis of ST-elevation myocardial infarction (STEMI, n=221,635) and non-STEMI (NSTEMI, n=342,777) between 1 April 2004 and 31 March 2013 in all acute hospitals (n = 243) in England and Wales...
August 29, 2016: European Heart Journal. Acute Cardiovascular Care
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
Maria Dorobantu, Stefan Bogdan
With the ageing of the general population, clinicians are facing with increased frequency the challenge of administering parenteral anti-coagulation therapy in the elderly, the main indications being venous thromboembolism (VTE), acute coronary syndromes (ACS), atrial fibrillation and bridging therapy. Assessing the risk/benefit ratio is always difficult in this category of patients, because of the higher risk for hemorrhagic events, although in most cases the benefit outweighs the risk, especially in the setting of VTE...
November 1, 2016: International Journal of Cardiology
Jacob A Doll, Anne S Hellkamp, Abhinav Goyal, Nadia R Sutton, Eric D Peterson, Tracy Y Wang
Importance: Patients with dual Medicare-Medicaid eligibility have a higher burden of chronic disease conditions and increased health care utilization compared with patients with Medicare coverage alone, but the treatment patterns and outcomes of dual-eligible patients with myocardial infarction (MI) are unknown. Objective: To examine the association of dual-eligible status with clinical outcomes and adherence to medication regimens (hereinafter "medication adherence") among older adults after MI...
August 17, 2016: JAMA Cardiology
Jorge A Belardi, Mariano Albertal
During the pre-procedural (medication) phase, the use of bivalirudin monotherapy is associated with the lowest rate of bleeding in patients with Non-ST elevation myocardial infarction (Non-STEMI) undergoing an early invasive strategy. Monotherapy with either bivalirudin or unfractionated heparin (UFH) appear interchangeable in this setting. The use of GPI upstream with either drug should be discouraged due to an increased risk of bleeding and net adverse events. The use of low dose aspirin plus potent P2Y12 inhibitors followed by a transradial approach with implantation of drug-eluting coronary stents with fluorinated polymers represents an strategy that may help limit perioperative ischemic and hemorrhagic complications in these individuals...
August 2016: Catheterization and Cardiovascular Interventions
Truls Råmunddal, Loes P Hoebers, José P S Henriques, Christian Dworeck, Oskar Angerås, Jacob Odenstedt, Dan Ioanes, Göran Olivecrona, Jan Harnek, Ulf Jensen, Mikael Aasa, Per Albertsson, Hans Wedel, Elmir Omerovic
OBJECTIVES: The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on long-term mortality in a large prospective cohort. BACKGROUND: CTO is present in many patients with coronary artery disease and is difficult to treat with percutaneous coronary intervention. METHODS: The study population consisted of all consecutive patients who underwent coronary angiography in Sweden between January 1, 2005 and January 1, 2012, who were registered in SCAAR (Swedish Coronary Angiography and Angioplasty Registry)...
August 8, 2016: JACC. Cardiovascular Interventions
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
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
Fatih Sinan Ertaş, Lale Tokgözoğlu
OBJECTIVE: To evaluate the acute phase (pre- and in-hospital) antithrombotic management patterns (AMPs) and in-hospital outcomes for patients hospitalized with an acute coronary syndrome (ACS). METHODS: In total, 1034 patients [514 patients with ST-segment elevation myocardial infarction (STEMI) and 520 with unstable angina/non-STEMI (UA/NSTEMI)] hospitalized for ACS within 24 h of symptom onset were included in this multicenter prospective registry study conducted at 34 hospitals across Turkey...
June 29, 2016: Anatolian Journal of Cardiology
Mehmet N Akkus, Adil Ormam, Sabri Seyis, Çagdas Baran, Aysegül Görür, Mehmet N Bilen
PURPOSE: The purpose of this study was to determine whether the plasma levels of soluble extracellular matrix metalloproteinase inducer (EMMPRIN) differed among the patients with ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and stable coronary artery disease (CAD) and the healthy controls, and to identify the factors associated with the differences in plasma levels of this this protein among patients in these groups. METHODS: Plasma EMMPRIN levels were compared among four age- and sex-matched groups of patients with STEMI, NSTEMI and stable CAD and healthy controls (n=44 per group), then logistic regression and correlation analyses were conducted for the whole acute myocardial infarction (AMI) patients group...
2016: Clinical and Investigative Medicine. Médecine Clinique et Experimentale
Mahdia Buargub, Zohra Omar Elmokhtar
Acute kidney injury (AKI) is associated with adverse short-and long-term outcomes. The aim of this study was to evaluate the incidence of AKI and the short-term mortality in patients admitted with acute coronary syndrome (ACS) to a single coronary care unit (CCU) in Tripoli, Libya. We retrospectively studied the medical records of ACS patients admitted to the CCU of a referral cardiology center, during the period from January 1, 2014, to December 31, 2014. AKI was defined according to the AKI network criteria...
July 2016: Saudi Journal of Kidney Diseases and Transplantation
Juan Sanchis, Eduardo Núñez, José Antonio Barrabés, Francisco Marín, Luciano Consuegra-Sánchez, Silvia Ventura, Ernesto Valero, Mercè Roqué, Antoni Bayés-Genís, Bruno García Del Blanco, Irene Dégano, Julio Núñez
BACKGROUND: Comorbid elderly patients with non-ST-elevation myocardial infarction (non-STEMI) are underrepresented in randomized trials and undergo fewer cardiac catheterizations according to registries. Our aim was to compare the conservative and invasive strategies in these patients. METHODS: Randomized multicenter study, including 106 patients (January 2012-March 2014) with non-STEMI, over 70years and with comorbidities defined by at least two of the following: peripheral artery disease, cerebral vascular disease, dementia, chronic pulmonary disease, chronic renal failure or anemia...
July 13, 2016: European Journal of Internal Medicine
Shadi Yaghi, Markeith Pilot, Christopher Song, Christina A Blum, Aleksandra Yakhkind, Brian Silver, Karen L Furie, Mitchell S V Elkind, Dean Sherzai, Ayesha Z Sherzai
BACKGROUND: Prior studies show an increased risk of ischemic stroke (IS) after myocardial infarction; however, there is limited evidence on long-term risk and whether it is directly related to cardiac injury. We hypothesized that the risk of IS after acute coronary syndrome is significantly higher if there is evidence of cardiac injury, such as ST-segment elevation myocardial infarction (STEMI) or non-STEMI, than when there is no evidence of cardiac injury, such as in unstable angina...
July 2016: Journal of the American Heart Association
Ender Coskunpinar, Huseyin Altug Cakmak, Ali Kemal Kalkan, Necip Ozan Tiryakioglu, Mehmet Erturk, Zeki Ongen
Recent studies have reported circulating microRNAs (miRNAs) as novel biomarkers for cardiovascular diseases including acute myocardial infarction, heart failure, diabetes mellitus, stroke, and acute pulmonary embolism. The aims of this study were 1) to compare the plasma expression levels of miRNAs in patients with acute coronary syndrome (ACS) and control subjects and in ST-elevation myocardial infarction (STEMI) and non-STEMI 2) to evaluate miRNAs potential to be used as novel diagnostic biomarkers for ACS...
October 10, 2016: Gene
Héctor Bueno, Pieter de Graeff, Isabelle Richard-Lordereau, Joseph Emmerich, Keith Aa Fox, Carola P Friedman, Christophe Gaudin, Amany El-Gazayerly, Samantha Goldman, Melanie Hemmrich, Robert A Henderson, Anders Himmelmann, Alar Irs, Neville Jackson, Stefan K James, Hugo A Katus, Andrea Laslop, Ian Laws, Roxana Mehran, Seleen Ong, Krishna Prasad, Marco Roffi, Giuseppe Mc Rosano, Martin Rose, Peter R Sinnaeve, Wendy Gattis Stough, Kristian Thygesen, Frans Van de Werf, Claire Varin, Freek Wa Verheugt, Maria de Los Angeles Alonso García
Regulatory authorities interpret the results of randomized controlled trials according to published principles. The European Medicines Agency (EMA) is planning a revision of the 2000 and 2003 guidance documents on clinical investigation of new medicinal products for the treatment of acute coronary syndrome (ACS) to achieve consistency with current knowledge in the field. This manuscript summarizes the key output from a collaborative workshop, organized by the Cardiovascular Round Table and the European Affairs Committee of the European Society of Cardiology, involving clinicians, academic researchers, trialists, European and US regulators, and pharmaceutical industry researchers...
June 29, 2016: European Heart Journal. Acute Cardiovascular Care
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