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https://www.readbyqxmd.com/read/27847262/the-angelmed-guardian-system-is-there-a-role-for-implantable-devices-to-detect-coronary-artery-occlusion
#1
Toby Rogers, Arie Steinvil, Rebecca Torguson, Ron Waksman
The AngelMed Guardian System is an implantable device similar to a single chamber pacemaker that continuously monitors the intracardiac electrogram for evidence of ST segment shift indicating acute coronary artery occlusion. The system aims to reduce time to presentation by alerting patients to present to a medical facility whether symptoms are present or not. In March 2016, the US Food and Drug Administration (FDA) assembled a meeting of the Circulatory System Devices Panel to review the results of the AngelMed for Early Recognition and Treatment of STEMI (ALERTS) pivotal trial and the accompanying premarket approval (PMA) application for regulatory approval of the AngelMed Guardian System in the US...
October 8, 2016: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/27762311/temporal-shifts-in-clinical-presentation-and-underlying-mechanisms-of-atherosclerotic-disease
#2
REVIEW
Gerard Pasterkamp, Hester M den Ruijter, Peter Libby
The concept of the 'vulnerable plaque' originated from pathological observations in patients who died from acute coronary syndrome. This recognition spawned a generation of research that led to greater understanding of how complicated atherosclerotic plaques form and precipitate thrombotic events. In current practice, an increasing number of patients who survive their first event present with non-ST-segment elevation myocardial infarction (NSTEMI) rather than myocardial infarction (MI) with ST-segment elevation (STEMI)...
October 20, 2016: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/27714584/contemporary-management-of-st-segment-elevation-myocardial-infarction
#3
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
https://www.readbyqxmd.com/read/27543469/spontaneous-coronary-artery-dissection-case-series-and-review-of-literature
#4
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
https://www.readbyqxmd.com/read/27147636/mode-of-admission-and-its-effect-on-adherence-to-reperfusion-therapy-guidelines-in-belgian-stemi-patients
#5
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
https://www.readbyqxmd.com/read/26961064/thrombus-aspiration-in-acute-myocardial-infarction
#6
REVIEW
Karim D Mahmoud, Felix Zijlstra
The success of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) is often hampered by incomplete microvascular myocardial reperfusion owing to distal embolization of thrombus resulting in microvascular obstruction. To address this problem, thrombus aspiration devices have been developed that can be used to evacuate coronary thrombus either manually or mechanically. Thrombus aspiration has the potential to reduce the local thrombus load, minimize the need for balloon predilatation, facilitate direct stenting, prevent distal embolization, and ultimately improve myocardial reperfusion...
July 2016: Nature Reviews. Cardiology
https://www.readbyqxmd.com/read/26910240/the-incidence-and-significance-of-acute-kidney-injury-following-emergent-contrast-administration-in-patients-with-stemi-and-stroke
#7
Michael Robert Marchick, Brandon Russell Allen, Emily Cassin Weeks, Jonathan Jacob Shuster, Marie-Carmelle Elie
The authors have investigated the incidence of acute kidney injury (AKI) and short-term mortality following an activated STEMI and stroke alert at a tertiary referral and academic center. A single center, retrospective chart review of STEMI and stroke activation patients from January 2010 to March 2012. Data was collected and reviewed from an institutional database following IRB-approval. Inclusion criteria were STEMI patients taken for cardiac catheterization, excluding patients receiving hemodialysis due to end-stage renal disease (ESRD)...
September 2016: Internal and Emergency Medicine
https://www.readbyqxmd.com/read/26864325/the-recognition-of-stemi-by-paramedics-and-the-effect-of-computer-interpretation-respect-a-randomised-crossover-feasibility-study
#8
Richard Pilbery, M Dawn Teare, Steve Goodacre, Francis Morris
BACKGROUND: The appropriate management of patients with ST-segment elevation myocardial infarction (STEMI) depends on accurate interpretation of the 12-lead ECG by paramedics. Computer interpretation messages on ECGs are often provided, but the effect they exert on paramedics' decision-making is not known. The objective of this study was to assess the feasibility of using an online assessment tool, and collect pilot data, for a definitive trial to determine the effect of computer interpretation messages on paramedics' diagnosis of STEMI...
July 2016: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/26843199/in-vivo-assessment-of-myocardial-viability-after-acute-myocardial-infarction-a-head-to-head-comparison-of-the-perfusable-tissue-index-by-pet-and-delayed-contrast-enhanced-cmr
#9
Stefan A J Timmer, Paul F A Teunissen, Ibrahim Danad, Lourens F H J Robbers, Pieter G H M Raijmakers, Robin Nijveldt, Albert C van Rossum, Adriaan A Lammertsma, Niels van Royen, Paul Knaapen
BACKGROUND: Early recognition of viable myocardium after acute myocardial infarction (AMI) is of clinical relevance, since affected segments have the potential of functional recovery. Delayed contrast-enhanced magnetic resonance imaging (DCE-CMR) has been validated extensively for the detection of viable myocardium. An alternative parameter for detecting viability is the perfusable tissue index (PTI), derived using [(15)O]H2O positron emission tomography (PET), which is inversely related to the extent of myocardial scar (non-perfusable tissue)...
February 2, 2016: Journal of Nuclear Cardiology: Official Publication of the American Society of Nuclear Cardiology
https://www.readbyqxmd.com/read/26603617/thrombus-aspiration-in-st-segment-elevation-myocardial-infarction
#10
R A Meneguz-Moreno, R A Costa, A A, J Ribamar Costa, A Abizaid
Primary percutaneous coronary intervention (PCI) has become the treatment of choice in patients with ST-segment elevation myocardial infarction (STEMI) throughout the last years. A significant number of studies have demonstrated a morbidity and mortality benefit over thrombolysis, which has been attributed to better coronary perfusion in patients undergoing primary PCI. Even though it usually achieves normal flow in the affected epicardial vessel, myocardial reperfusion is not fully restored in a significant percentage of patients...
December 2015: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/26560436/precordial-junctional-st-segment-depression-with-tall-symmetric-t-waves-signifying-proximal-lad-occlusion-case-reports-of-stemi-equivalence
#11
Ruben W de Winter, Rob Adams, Niels J W Verouden, Robbert J de Winter
Timely reperfusion therapy by means of primary percutaneous coronary intervention (PCI) is the preferred treatment for patients with ST-segment elevation myocardial infarction. A significant number of patients with large acute myocardial infarction, caused by occlusion of an epicardial coronary artery, do not show ST-elevation on the electrocardiogram. Other ECG abnormalities may be present, the so called STEMI-equivalents. One such STEMI equivalent, junctional ST-segment depression followed by tall symmetrical T-waves in the precordial leads, often in combination with slight ST-elevation in lead AVR, has been associated with proximal occlusion of the left anterior descending coronary artery...
January 2016: Journal of Electrocardiology
https://www.readbyqxmd.com/read/26286904/finding-traction-for-mechanical-circulatory-support-during-coronary-interventions
#12
EDITORIAL
Garrick C Stewart
No abstract text is available yet for this article.
September 29, 2015: Circulation
https://www.readbyqxmd.com/read/26275407/high-risk-percutaneous-coronary-intervention-in-a-patient-with-a-single-coronary-artery-presenting-as-stemi-and-cardiogenic-shock
#13
Murad Abdelsalam, Mrinalini Krishnan, Sandeep Banga, William B Bachinsky
Cardiogenic shock due to ST elevation myocardial infarction in a patient with a single coronary artery involving the sole vessel is a rare presentation. This can be clinically and angiographically challenging. Proper recognition of the topography of diseased vessels and a systematic guarded approach can lead to procedural success. We report a case of an 81-year-old woman who presented with chest pain followed by a near syncope associated with an acute myocardial infarction. Coronary angiography revealed a single proximally occluded right coronary artery and an anomalous left main coronary artery (originating from the proximal right coronary artery) and occluded distal left circumflex artery...
2015: BMJ Case Reports
https://www.readbyqxmd.com/read/26154447/setting-up-an-efficient-therapeutic-hypothermia-team-in-conscious-st-elevation-myocardial-infarction-patients-a-uk-heart-attack-center-experience
#14
Shahed Islam, James Hampton-Till, Shah MohdNazri, Noel Watson, Ellie Gudde, Tom Gudde, Paul A Kelly, Kare H Tang, John R Davies, Thomas R Keeble
Patients presenting with ST elevation myocardial infarction (STEMI) are routinely treated with percutaneous coronary intervention to restore blood flow in the occluded artery to reduce infarct size (IS). However, there is evidence to suggest that the restoration of blood flow can cause further damage to the myocardium through reperfusion injury (RI). Recent research in this area has focused on minimizing damage to the myocardium caused by RI. Therapeutic hypothermia (TH) has been shown to be beneficial in animal models of coronary artery occlusion in reducing IS caused by RI if instituted early in an ischemic myocardium...
December 2015: Therapeutic Hypothermia and Temperature Management
https://www.readbyqxmd.com/read/25890944/the-recognition-of-stemi-by-paramedics-and-the-effect-of-computer-interpretation-respect-a-cluster-randomised-crossover-pilot-study
#15
Richard Pilbery, Dawn Teare, Steve Goodacre, Francis Morris
BACKGROUND: Timely diagnosis and appropriate management of patients with ST-segment elevation myocardial infarction (STEMI) depends on accurate interpretation of the 12-lead ECG by paramedics. Computer interpretation messages on ECGs are often provided, but the effect they exert on paramedics' decision making is not known. The objective of this pilot study was to assess the feasibility of a trial using an online assessment tool, to determine the effect of computer interpretation messages on paramedics' diagnosis of STEMI...
May 2015: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/25818495/baseline-q-waves-and-time-from-symptom-onset-to-st-segment-elevation-myocardial-infarction-insights-from-plato-on-the-influence-of-sex
#16
RANDOMIZED CONTROLLED TRIAL
Naji Kholaif, Yinggan Zheng, Pushpa Jagasia, Anders Himmelmann, Stefan K James, Philippe Gabriel Steg, Robert F Storey, Cynthia M Westerhout, Paul W Armstrong
BACKGROUND: The prognostic value of time from symptom onset to reperfusion may be enhanced by the identification of Q waves on the presenting electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated whether the relative prognostic utility of these 2 metrics was altered by sex. METHODS: Q waves in the distribution of the ST-segment elevation on the baseline ECG were evaluated by a blinded core laboratory in 2838 STEMI patients (2163 men and 675 women) from the PLATelet inhibition and patient Outcomes (PLATO) trial who underwent percutaneous coronary intervention (PCI) within 12 hours of symptom onset...
August 2015: American Journal of Medicine
https://www.readbyqxmd.com/read/25804008/is-it-time-to-stop-chilling-induced-therapeutic-hypothermia-doesn-t-appear-to-have-the-prehospital-effect-we-thought-it-did
#17
Bryan E Bledsoe
The evidence is quite clear that ITH in the prehospital setting is of dubious benefit. But what is the harm in continuing the practice? Well, prehospital ITH most likely takes away from more beneficial therapies such as high-quality CPR, rapid defibrillation, recognition of ST-segment elevation myocardial infarction (STEMI), and similar essential treatments. Several studies have shown prehospital ITH, in many cases, delays hospital transport. When the initial studies of ITH were released, I was immediately on the ITH bandwagon...
February 2015: EMS World
https://www.readbyqxmd.com/read/25765553/closing-the-mortality-gap-after-a-myocardial-infarction-in-people-with-and-without-chronic-obstructive-pulmonary-disease
#18
COMPARATIVE STUDY
Kieran J Rothnie, Liam Smeeth, Emily Herrett, Neil Pearce, Harry Hemingway, Jadwiga Wedzicha, Adam Timmis, Jennifer K Quint
OBJECTIVE: Patients with chronic obstructive pulmonary disease (COPD) have increased mortality following myocardial infarction (MI) compared with patients without COPD. We investigated the extent to which differences in recognition and management after MI could explain the mortality difference. METHODS: 300 161 patients with a first MI between 2003 and 2013 were identified in the UK Myocardial Ischaemia National Audit Project database. Logistic regression was used to compare mortality in hospital and at 180 days postdischarge between patients with and without COPD...
July 2015: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/25689221/characteristics-of-statewide-protocols-for-emergency-medical-services-in-the-united-states
#19
Douglas F Kupas, Ellen Schenk, J Matthew Sholl, Richard Kamin
OBJECTIVE: We sought to categorize and characterize the utilization of statewide emergency medical services (EMS) protocols as well as state recognition of specialty receiving facilities for trauma and time-sensitive conditions in the United States. METHODS: A survey of all state EMS offices was conducted to determine which states use mandatory or model statewide EMS protocols and to characterize these protocols based on the process for authorizing such protocols...
April 2015: Prehospital Emergency Care
https://www.readbyqxmd.com/read/25543899/recent-advances-in-optimal-adjunctive-antithrombotic-therapy-in-stemi-patients-undergoing-primary-angioplasty-an-overview
#20
REVIEW
Giuseppe De Luca, Harry Suryapranata
There has been a considerable effort to improve adjunctive antithrombotic therapies to reperfusion strategies in the treatment of ST-segment elevation Myocardial Infarction (STEMI). Therefore, the aim of this article is to provide a critical and updated overview of recent advances on adjunctive antithrombotic therapies in patients undergoing primary angioplasty for STEMI. Due to very low costs, early Unfractionated Heparin (UFH) plus additional periprocedural administration should still be regarded as the gold standard in antithrombotic therapy, whereas subsequent subcutaneous administration of Low Molecular Weight Heparins (LMWHs) or fondaparinux should be considered, especially in patients at higher risk of thromboembolic complications...
2015: Current Vascular Pharmacology
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