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Stemi care

M Martínez-García, J Vargas-Barrón, F Bañuelos-Téllez, H González-Pacheco, C Fresno, E Hernández-Lemus, M A Martínez-Ríos, M Vallejo
OBJECTIVE: ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN: Retrospective data analysis. METHODS: STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence)...
March 13, 2018: Public Health
Pin Pin Pek, Huili Zheng, Andrew Fu Wah Ho, Win Wah, Huay Cheem Tan, Ling Li Foo, Marcus Eng Hock Ong
BACKGROUND: With an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study was to compare epidemiology, treatments and outcomes between young and elderly STEMI patients. Our secondary aim was to determine the cut-off age when the benefits of primary percutaneous coronary intervention (PCI) were less pronounced. METHODS: Data were collected by the Singapore Myocardial Infarction Registry...
March 15, 2018: Emergency Medicine Journal: EMJ
Rajkumar Doshi, Jay Shah, Varun Jauhar, Dean Decter, Rajiv Jauhar, Perwaiz Meraj
BACKGROUND: The aim of this study was to analyze the indications for using bare metal stents (BMSs) in hospitalizations with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS: The study cohorts were identified from the National Inpatient Sample database from 2010-2014 using appropriate, International Classification of Diseases, 9th Revision, Clinical Modification, diagnostic and procedural codes. RESULTS: A total of 123,487 hospitalizations were identified for this study...
March 12, 2018: Heart & Lung: the Journal of Critical Care
Abdulla Shehab, Khalid F AlHabib, Akshaya Srikanth Bhagavathul, Ahmad Hersi, Hussam Alfaleh, Mostafa Q Alshamiri, Anhar Ullah, Khadim Sulaiman, Wael Almahmeed, Jassim Al Suwaidi, Alwai A Alsheikh-Ali, Haitham Amin, Mohammed Al Jarallah, Amar M Salam
BACKGROUND: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIM: To examine the clinical presentation, patient management, quality of care, risk factors and in-hospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries...
March 14, 2018: Current Vascular Pharmacology
Jasveen J Kandhai-Ragunath, Carine J M Doggen, Liefke C van der Heijden, Marlies M Kok, Paolo Zocca, Bjorn de Wagenaar, Cees Doelman, Harald T Jørstad, Ron J G Peters, Clemens von Birgelen
Knowledge about the changes in endothelial function after ST-elevation myocardial infarction (STEMI) is of substantial interest, but serial data are scarce. The aim of the present study was to noninvasively evaluate whether endothelial function, as assessed shortly after primary percutaneous coronary intervention (PPCI) for STEMI, may improve until 12-month follow-up. This prospective observational cohort study was performed in patients in the RESPONSE randomized trial who participated in a substudy and underwent noninvasive assessment of endothelial function at 1 (baseline), 6, and 12-month follow-up after treatment of a STEMI by PPCI...
March 14, 2018: Heart and Vessels
Chetan P Huded, Michael Johnson, Kathleen Kravitz, Venu Menon, Mouin Abdallah, Travis C Gullett, Scott Hantz, Stephen G Ellis, Seth R Podolsky, Stephen W Meldon, Damon M Kralovic, Deborah Brosovich, Elizabeth Smith, Samir R Kapadia, Umesh N Khot
BACKGROUND: Women with STEMI receive suboptimal care and have worse outcomes than men. Whether strategies to reduce STEMI care variability impact disparities in the care and outcomes of women with STEMI is unknown. OBJECTIVES: We assessed the care and outcomes of men vs. women with STEMI before and after implementation of a comprehensive STEMI protocol. METHODS: On 7/15/14 we implemented: (1) emergency department catheterization lab activation, (2) STEMI Safe Handoff Checklist, (3) immediate transfer to an immediately available catheterization lab, and (4) radial first approach to percutaneous coronary intervention (PCI)...
March 7, 2018: Journal of the American College of Cardiology
Leonardo De Luca, Mauro Pennacchi, Giuseppe Musumeci, Fabrizio D'Ascenzo, Pamela Gallo, Stefano Rigattieri, Antonino Granatelli, Sergio Berti, Michele Massimo Gulizia, Stefano De Servi, Leonardo Bolognese
BACKGROUND: Few data exist on temporal evolution of antithrombotic agent use in patients with acute coronary syndromes (ACS) undergoing percutaneous coronary intervention (PCI) in Italy. We sought to compare data from the most recent prospective, multicenter, nationwide registries conducted in Italy, namely EYESHOT and SCOPE. METHODS: EYESHOT enrolled 2585 consecutive ACS patients, both ST-segment elevation myocardial infarction (STEMI) and non-ST elevation ACS (NSTE-ACS), admitted to 203 Italian coronary care units over a 3-week period (2-22 Dec 2013 and 27 Jan-16 Feb 2014)...
February 2018: Giornale Italiano di Cardiologia
Jacob A Udell, Gregg C Fonarow, Thomas M Maddox, Christopher P Cannon, W Frank Peacock, Warren K Laskey, Maria V Grau-Sepulveda, Eric E Smith, Adrian F Hernandez, Eric D Peterson, Deepak L Bhatt
BACKGROUND: Sex-based differences in acute coronary syndrome (ACS) mortality may attenuate with age due to better symptom recognition and prompt care. Hypothesis Age is a modifier of temporal trends in sex-based differences in ACS care. METHODS: Among 104,817 eligible patients with ACS enrolled in the AHA GWTG-CAD registry between 2003-2008, care and in-hospital mortality were evaluated stratified by sex and age (<65 years and ≥65 years). Temporal trends within sex and age groups were assessed for two care processes: the percentage of patients with ST-elevation MI (STEMI) presenting to PCI capable hospitals with a door-to-balloon time ≤ 90 minutes (DTB90) and the proportion of eligible patients with ACS treated with aspirin within 24 hours of presentation...
March 9, 2018: Clinical Cardiology
António Gaspar, André P Lourenço, Miguel Álvares Pereira, Pedro Azevedo, Roberto Roncon-Albuquerque, Jorge Marques, Adelino F Leite-Moreira
To test whether remote ischaemic conditioning (RIC) as adjuvant to standard of care (SOC) would prevent progression towards heart failure (HF) after ST-elevation myocardial infarction (STEMI). Single-centre parallel 1:1 randomized trial (computerized block-randomization, concealed allocation) to assess superiority of RIC (3 cycles of intermittent 5 min lower limb ischaemia) over SOC in consecutive STEMI patients (NCT02313961, clinical From 258 patients randomized to RIC or SOC, 9 and 4% were excluded because of unconfirmed diagnosis and previously unrecognized exclusion criteria, respectively...
March 7, 2018: Basic Research in Cardiology
Stéphane Manzo-Silberman, Francis Couturaud, Sandrine Charpentier, Vincent Auffret, Carlos El Khoury, Hervé Le Breton, Loïc Belle, Stéphanie Marlière, Marianne Zeller, Yves Cottin, Nicolas Danchin, Tabassome Simon, François Schiele, Martine Gilard
BACKGROUND: Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population. METHODS AND RESULTS: We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility...
February 13, 2018: International Journal of Cardiology
Matthew S Schoenfeld, Ibrahim Kassas, Binita Shah
Early revascularization is the gold standard for management of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock (CS). The use of transradial artery access (TRA) in percutaneous coronary intervention (PCI) has increased in recent years and has emerged as a safe and effective approach to PCI in high-risk patients, with advantages in reduced major bleeding events, other peri-procedural complications, and all-cause mortality when compared with transfemoral artery access (TFA). Multiple randomized clinical trials have demonstrated these advantages of TRA vs...
February 24, 2018: Current Treatment Options in Cardiovascular Medicine
Giovanni Veronesi, Antonella Zambon, John F Beltrame, Francesco Gianfagna, Giovanni Corrao, Marco M Ferrario
Background: Hospital-based registries provide a key contribution in assessing the quality of care in acute myocardial infarction (MI) patients, although some concern on selection bias of included cases has recently arisen. We investigated the feasibility of a retrospective, population-based registry of MIs in monitoring the quality of care. Methods: We identified all the hospitalizations with a diagnosis of acute MI among 35-79 years old residents in the Varese province, Northern Italy, in 2007-2008...
February 21, 2018: International Journal for Quality in Health Care
Glenn N Levine, Xuming Dai, Timothy D Henry, Marcella Calfon Press, Ali E Denktas, Ross F Garberich, Alice K Jacobs, Brian E Jaski, Prashant Kaul, Michael C Kontos, George A Stouffer, Sidney C Smith
Importance: In-hospital ST-segment elevation myocardial infarction (STEMI) is a unique clinical entity with epidemiology, incidence, and outcomes distinct from that of out-of-hospital STEMI and has only within the past 10 years begun to receive increased attention and research. Patients with in-hospital STEMI are older, have more comorbidities, and more frequently have coagulopathies and contraindications for anticoagulation and fibrinolytic therapy. A standardized clinical definition of in-hospital STEMI is lacking...
February 21, 2018: JAMA Cardiology
Iain Findlay, Tamsin Morris, Ruiqi Zhang, Colin McCowan, Sarah Shield, Brian Forbes, Alex McConnachie, Kenneth Mangion, Colin Berry
Aims: To implement secondary care electronic record linkage for patients hospitalised with suspected or known acute coronary syndrome (ACS) in a complex regional healthcare system and evaluate this e-Registry in terms of patterns of service delivery and 1-year outcomes. Methods and Results: Existing electronic hospital records were linked to create episodes of care using (1) a patient administration system, (2) invasive cardiovascular procedure referrals and (3) a catheter laboratory record...
February 16, 2018: European Heart Journal. Quality of Care & Clinical Outcomes
James Xu, Leia Hee, Andrew Hopkins, Craig P Juergens, Sidney Lo, John K French, Christian J Mussap
BACKGROUND: Immediate cardiac catheterisation (CC) is recommended in ST-elevation myocardial infarction (STEMI) following sudden cardiac arrest (SCA). Guidelines advise urgent CC for SCA patients without-STEMI, at clinician discretion. We examined the clinical and angiographic factors predicting mortality in SCA patients having CC. METHODS: Consecutive SCA patients having CC at Liverpool Hospital, Sydney (January 2011-September 2015) were retrospectively analysed...
February 8, 2018: Heart, Lung & Circulation
Sheeren Khaled, Rajaa Matahen
BACKGROUND: Acute coronary syndrome (ACS) remains a leading cause of death in the United States. Numerous studies have shown that the degree of LV systolic dysfunction is a major if not the most important determinant of long-term outcome in ACS. OBJECTIVES: To identify the most important risk factors and other clinical predictors which might have impact on left ventricular ejection fraction in patients with ACS. RESULTS: The total patients (299) admitted to our center from July, 2015 till December, 2015; with established diagnosis of ACS were classified in to two groups: Group I: 193 patients with impaired LVEF <40% (64...
January 2018: Indian Heart Journal
Sameer Mehta, Christopher Granger, Cindy Lee Grines, Alice Jacobs, Timothy D Henry, Ivan Rokos, Alexandra Lansky, Andreas Baumbach, Roberto Botelho, Alexandra Ferre, Isaac Yepes, Roopa Salwan, Jamshed Dalal, Jitendra Makkar, Neeraj Bhalla, Sundeep Mishra, Vinod Vijan, Shirish Hiremath
Our previous research found seven specific factors that cause system delays in ST-elevation Myocardial infarction management in developing countries. These delays, in conjunction with a lack of organized STEMI systems of care, result in inefficient processes to treat AMI in developing countries. In our present opinion paper, we have specifically explored the three most pertinent causes that afflict the seven specific factors responsible for system delays. In doing so, we incorporated a unique strategy of global STEMI expertise...
January 2018: Indian Heart Journal
Priyadarshani Galappatthy, Vipula R Bataduwaarachchi, Priyanga Ranasinghe, Gamini K S Galappatthy, Maheshi Wijayabandara, Dinuka S Warapitiya, Mythily Sivapathasundaram, Thilini Wickramarathna, Upul Senarath, Sathasivam Sridharan, Chandrika N Wijeyaratne, Ruvan Ekanayaka
BACKGROUND: Ischaemic heart disease is the leading cause of in-hospital mortality in Sri Lanka. Acute Coronary Syndrome Sri Lanka Audit Project (ACSSLAP) is the first national clinical-audit project that evaluated patient characteristics, clinical outcomes and care provided by state-sector hospitals. METHODS: ACSSLAP prospectively evaluated acute care, in-hospital care and discharge plans provided by all state-sector hospitals managing patients with ACS. Data were collected from 30 consecutive patients from each hospital during 2-4 weeks window...
February 16, 2018: Heart: Official Journal of the British Cardiac Society
Jay S Shavadia, William French, Anne S Hellkamp, Laine Thomas, Eric R Bates, Steven V Manoukian, Michael C Kontos, Robert Suter, Timothy D Henry, Harold L Dauerman, Matthew T Roe
BACKGROUND: Assessing hospital-related network-level primary percutaneous coronary intervention (PCI) performance for ST-segment elevation myocardial infarction (STEMI) is challenging due to differential time-to-treatment metrics based on location of diagnostic electrocardiogram (ECG) for STEMI. METHODS: STEMI patients undergoing primary PCI at 588 PCI-capable hospitals in AHA Mission: Lifeline (2008-2013) were categorized by initial STEMI identification location: PCI-capable hospitals (Group 1); pre-hospital setting (Group 2); and non-PCI-capable hospitals (Group 3)...
March 2018: American Heart Journal
Ivan Olier, Alex Sirker, David J R Hildick-Smith, Tim Kinnaird, Peter Ludman, Mark A de Belder, Andreas Baumbach, Jonathan Byrne, Muhammad Rashid, Nick Curzen, Mamas A Mamas
OBJECTIVES: Prasugrel and ticagrelor both reduce ischaemic endpoints in high-risk acute coronary syndromes, compared with clopidogrel. However, comparative outcomes of these two newer drugs in the context of primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) remains unclear. We sought to examine this question using the British Cardiovascular Interventional Society national database in patients undergoing primary PCI for STEMI. METHODS: Data from January 2007 to December 2014 were used to compare use of P2Y12 antiplatelet drugs in primary PCI in >89 000 patients...
February 2, 2018: Heart: Official Journal of the British Cardiac Society
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