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https://www.readbyqxmd.com/read/29151401/evaluation-of-a-primary-care-paramedic-stemi-bypass-guideline
#1
Jonathan L Kwong, Garry Ross, Linda Turner, Chris Olynyk, Sheldon Cheskes, Adam Thurston, P Richard Verbeek
OBJECTIVE: Limited evidence supports primary care paramedic (PCP) direct transport of ST-segment elevation myocardial infarction (STEMI) patients for percutaneous coronary intervention (PCI). The goal of this study was to evaluate an urban-based PCP STEMI bypass guideline. METHODS: We reviewed consecutive Toronto Paramedic Services call reports between April 7, 2015, and May 31, 2016, regarding STEMI patients identified by PCPs. The primary outcome was patient assignment (stable versus unstable) according to guideline criteria...
November 20, 2017: CJEM
https://www.readbyqxmd.com/read/29150157/all-cause-mortality-following-an-acute-coronary-syndrome-12-year-follow-up-of-the-comprehensive-2002-new-zealand-acute-coronary-syndrome-audit
#2
Chris J Ellis, Greg D Gamble, Michael J A Williams, Phil Matsis, John M Elliott, Gerry Devlin, Stewart Mann, John K French, Harvey D White
BACKGROUND: To describe the long-term mortality of a complete national cohort of acute coronary syndrome (ACS) patients enrolled in 2002, to compare this with a national age, sex and Māori ethnicity matched population, and to assess the influence of baseline factors on the 12-year mortality. METHODS: We reviewed 721 patients with a discharge diagnosis of an ACS who were enrolled in the first New Zealand ACS audit group cohort over 14days in May 2002. We matched the cohort to the national mortality database using each patient's unique national identity number...
November 7, 2017: Heart, Lung & Circulation
https://www.readbyqxmd.com/read/29138292/impact-of-regionalization-of-st-elevation-myocardial-infarction-care-on-treatment-times-and-outcomes-for-emergency-medical-services-transported-patients-presenting-to-hospitals-with-percutaneous-coronary-intervention-mission-lifeline-accelerator-2
#3
James G Jollis, Hussein R Al-Khalidi, Mayme L Roettig, Peter B Berger, Claire C Corbett, Shannon Doerfler, Christopher B Fordyce, Timothy D Henry, Lori Hollowell, Zainab Magdon-Ismail, Ajar Kochar, James J McCarthy, Lisa Monk, Peter K O'Brien, Thomas D Rea, Jay Shavadia, Jacqueline Tamis-Holland, B Hadley Wilson, Khaled M Ziada, Christopher B Granger
Background: Regional variations in reperfusion times and mortality in patients with ST-segment elevation myocardial infarction (STEMI) are influenced by differences in coordinating care between emergency medical services (EMS) and hospitals. Building on the Accelerator-1 Project, we hypothesized that time to reperfusion could be further reduced with enhanced regional efforts. Methods: Between April 2015 and March 2017, we worked with 12 metropolitan regions across the United States with 132 PCI-capable hospitals and 946 EMS agencies...
November 14, 2017: Circulation
https://www.readbyqxmd.com/read/29126894/developments-in-pre-hospital-patient-transport-in-st-elevation-myocardial-infarction
#4
Maria Inês da Costa Silveira, Maria João Monteiro Sousa, Patrícia Fernandes Dias de Madureira Rodrigues, Bruno Miguel Fernandes Brochado, Raquel Bachen Guimarães Santos, Maria Ana Meixa Alves Burbach Trêpa, André Miguel Coimbra Luz, João Antonio Brum da Silveira, Aníbal António Braga de Albuquerque, Henrique José Cyrne de Castro Machado Carvalho, Severo Barreiro Torres
INTRODUCTION: ST-elevation myocardial infarction (STEMI) is a medical emergency that benefits from rapid access to specialized care. The objective of this study was to describe developments in patient transport via the pre-hospital emergency medical system (EMS) and its impact on clinical outcomes. METHODS: We retrospectively studied STEMI patients who underwent primary percutaneous coronary intervention between January 2008 and July 2015. Patients were divided according to type of admission...
November 7, 2017: Portuguese Journal of Cardiology: An Official Journal of the Portuguese Society of Cardiology
https://www.readbyqxmd.com/read/29119223/-acute-myocardial-infarction-in-patients-with-st-segment-elevation-myocardial-infarction-esc-guidelines-2017
#5
REVIEW
H Thiele, S Desch, S de Waha
This article gives an update on the management of acute ST-segment elevation myocardial infarction (STEMI) according to the recently released European Society of Cardiology guidelines 2017 and the modifications are compared to the previous STEMI guidelines from 2012. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with a clear preference for the radial artery, use of drug-eluting stents over bare metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration...
November 8, 2017: Herz
https://www.readbyqxmd.com/read/29102582/variation-in-the-adoption-of-transradial%C3%A2-access-for-st-segment-elevation-myocardial-infarction-insights-from-the-ncdr-cathpci-registry
#6
Javier A Valle, Lisa A Kaltenbach, Steven M Bradley, Robert W Yeh, Sunil V Rao, Hitinder S Gurm, Ehrin J Armstrong, John C Messenger, Stephen W Waldo
OBJECTIVES: The study sought to define patient, operator, and institutional factors associated with transradial access (TRA) in ST-segment elevation myocardial infarction (STEMI) percutaneous coronary intervention (PCI), the variation in use across operators and institutions, and the relationship with mortality and bleeding. BACKGROUND: TRA for PCI in STEMI is underutilized. Factors associated with TRA are not well described, nor is there variation across operators and institutions or their relationship with outcomes...
October 25, 2017: JACC. Cardiovascular Interventions
https://www.readbyqxmd.com/read/29102289/in-hospital-mortality-analysis-of-japanese-patients-with-acute-coronary-syndrome-using-the-tokyo-ccu-network-database-applicability-of-the-grace-risk-score
#7
Kota Komiyama, Masato Nakamura, Kengo Tanabe, Hiroki Niikura, Hajime Fujimoto, Keiko Oikawa, Hiroyuki Daida, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama
BACKGROUND: The GRACE risk score was developed to predict in-hospital mortality for acute coronary syndrome (ACS) using multinational registries, but did not include Japanese data. Therefore, GRACE risk scores are not extensively used in Japan. The present study aimed to evaluate the relationship between the GRACE risk score and in-hospital mortality among Japanese patients with ACS using the Tokyo CCU (cardiovascular care unit) Network Database. METHODS AND RESULTS: A total of 9460 patients with ACS hospitalized at 67 Tokyo CCUs between January 2011 and December 2013 were retrospectively reviewed and GRACE risk scores were calculated...
October 25, 2017: Journal of Cardiology
https://www.readbyqxmd.com/read/29074504/derivation-and-validation-of-the-crest-model-for-very-early-prediction-of-circulatory-etiology-death-in-patients-without-stemi-after-cardiac-arrest
#8
Karen E Bascom, John Dziodzio, Samip Vasaiwala, Michael Mooney, Nainesh Patel, John McPherson, Paul McMullan, Barbara Unger, Niklas Nielsen, Hans Friberg, Richard R Riker, Karl B Kern, Christine W Duarte, David B Seder
Background -No practical tool quantitates the risk of circulatory-etiology death (CED) immediately after successful cardiopulmonary resuscitation in patients without ST-elevation myocardial infarction (STEMI). We developed and validated a prediction model to rapidly determine that risk and facilitate triage to individualized treatment pathways. Methods -Using the International Cardiac Arrest Registry (INTCAR), an 87-question data set representing 44 centers in America and Europe, patients were classified as having had CED or a combined endpoint of neurological-etiology death or survival...
October 26, 2017: Circulation
https://www.readbyqxmd.com/read/29071332/effect-of-chewing-vs-swallowing-ticagrelor-on-platelet-inhibition-in-patients-with-st-segment-elevation-myocardial-infarction-a-randomized-clinical-trial
#9
Elad Asher, Shir Tal, Israel Mazin, Arsalan Abu-Much, Avi Sabbag, Moshe Katz, Ehud Regev, Fernando Chernomordik, Victor Guetta, Amit Segev, Dan Elian, Israel Barbash, Paul Fefer, Michael Narodistky, Roy Beigel, Shlomi Matetzky
Importance: Dual anti-platelet therapy represents standard care for treating patients with ST-segment elevation myocardial infarction (STEMI). Ticagrelor is a direct-acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation. Objective: To evaluate whether chewing a loading dose (LD) of ticagrelor, 180 mg, vs traditional oral administration of an equal dose enhances platelet inhibition at 30 minutes and 1 hour after LD administration in patients with STEMI...
October 25, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29067927/observational-study-comparing-pharmacoinvasive-strategy-with-primary-percutaneous-coronary-intervention-in-patients-presenting-with-st-elevation-myocardial-infarction-to-a-tertiary-care-centre-in-india
#10
A G Alex, A Lahiri, T Geevar, O K George
OBJECTIVE: The objective was to study whether the incidence of composite end points (mortality, cardiogenic shock and re-myocardial infarction [re-MI]) in pharmacoinvasive strategy was noninferior to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). METHODS: This was an observational study which included 138 patients. The study included patients admitted with a diagnosis of STEMI within 24 h of symptom onset, who underwent primary PCI or pharmacoinvasive therapy in a single center over a 9-month period...
October 23, 2017: Journal of Postgraduate Medicine
https://www.readbyqxmd.com/read/29066448/impact-of-regional-systems-of-care-on-disparities-in-care-among-female-and-black-patients-presenting-with-st-segment-elevation-myocardial-infarction
#11
Tomoya T Hinohara, Hussein R Al-Khalidi, Christopher B Fordyce, Xiangqiong Gu, Matthew W Sherwood, Mayme L Roettig, Claire C Corbett, Lisa Monk, Jacqueline E Tamis-Holland, Peter B Berger, J E B Burchenal, B Hadley Wilson, James G Jollis, Christopher B Granger
BACKGROUND: The American Heart Association Mission: Lifeline STEMI (ST-segment-elevation myocardial infarction) Systems Accelerator program, conducted in 16 regions across the United States to improve key care processes, resulted in more patients being treated within national guideline goals (time from first medical contact to device: <90 minutes for direct presenters to hospitals capable of performing percutaneous coronary intervention; <120 minutes for transfers). We examined whether the effort reduced reperfusion disparities in the proportions of female versus male and black versus white patients...
October 24, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29066079/diagnosis-of-aortic-dissection-presenting-as-st-elevation-myocardial-infarction-using-point-of-care-ultrasound
#12
Jordan Chenkin
BACKGROUND: Aortic dissections can present with a broad spectrum of signs and symptoms, making them difficult to diagnose in the emergency department (ED). Aortic dissections can cause occlusion of the coronary arteries, mimicking an acute ST-elevation myocardial infarction (STEMI). Emergency point-of-care ultrasound (POCUS) may be a useful diagnostic tool to help differentiate aortic dissection from a primary myocardial infarction. CASE REPORT: A 69-year-old man with no medical history presented to our ED complaining of chest pain...
October 20, 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29054840/contemporary-risk-stratification-after-myocardial-infarction-in-the-community-performance-of-scores-and-incremental-value-of-soluble-suppression-of-tumorigenicity-2
#13
Yariv Gerber, Susan A Weston, Maurice Enriquez-Sarano, Allan S Jaffe, Sheila M Manemann, Ruoxiang Jiang, Véronique L Roger
BACKGROUND: Current American Heart Association/American College of Cardiology guidelines recommend the GRACE (Global Registry of Acute Coronary Events) and TIMI (Thrombolysis in Myocardial Infarction) scores to assess myocardial infarction (MI) prognosis. Changes in the epidemiological characteristics of MI and the availability of new biomarkers warrant an assessment of the performance of these scores in contemporary practice. We assessed the following: (1) the performance of GRACE and TIMI to predict 1-year mortality in a cohort of patients stratified by ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) and (2) the incremental discriminatory power of soluble suppression of tumorigenicity-2, a myocardial fibrosis biomarker...
October 20, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29054179/the-impact-of-systems-of-care-on-pharmacoinvasive-management-with-streptokinase-the-subgroup-analysis-of-the-tn-stemi-programme
#14
Deep Chandh Raja, Vijayakumar Subban, Suma M Victor, George Joseph, Viji Samuel Thomson, Kumaresan Kannan, Justin Paul Gnanaraj, Ganesh Veerasekar, Jose G Thenpally, Nandhini Livingston, Brahmajee K Nallamothu, Thomas Alexander, Ajit S Mullasari
OBJECTIVES: We evaluated the impact of implementation of the TN-STEMI programme on various characteristics of the pharmacoinvasive group by comparing clinical as well as angiographic outcomes between the pre- and post-implementation groups. METHODS: The TN-STEMI programme involved 2420 patients of which 423 patients had undergone a pharmacoinvasive strategy of reperfusion. Of these, 407 patients had a comprehensive blinded core-lab evaluation of their angiograms post-lysis and clinical evaluation of various parameters including time-delays and adverse cardio- and cerebro-vascular events at 1year...
September 2017: Indian Heart Journal
https://www.readbyqxmd.com/read/29021273/improvement-in-care-and-outcomes-for-emergency-medical-service-transported-patients-with-st-elevation-myocardial-infarction-stemi-with-and-without-prehospital-cardiac-arrest-a-mission-lifeline-stemi-accelerator-study
#15
Kristian Kragholm, Di Lu, Karen Chiswell, Hussein R Al-Khalidi, Mayme L Roettig, Matthew Roe, James Jollis, Christopher B Granger
BACKGROUND: Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non-PCI hospitals to go to a PCI center. METHODS AND RESULTS: We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI-capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014...
October 11, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/29020314/improved-outcomes-in-patients-with-st-elevation-myocardial-infarction-during-the-last-20%C3%A2-years-are-related-to-implementation-of-evidence-based-treatments-experiences-from-the-swedeheart-registry-1995-2014
#16
Karolina Szummer, Lars Wallentin, Lars Lindhagen, Joakim Alfredsson, David Erlinge, Claes Held, Stefan James, Thomas Kellerth, Bertil Lindahl, Annica Ravn-Fischer, Erik Rydberg, Troels Yndigegn, Tomas Jernberg
Aims: Impact of changes of treatments on outcomes in ST-elevation myocardial infarction (STEMI) patients in real-life health care has not been documented. Methods and results: All STEMI cases (n = 105.674) registered in the nation-wide SWEDEHEART registry between 1995 and 2014 were included and followed for fatal and non-fatal outcomes for up to 20 years. Most changes in treatment and outcomes occurred from 1994 to 2008. Evidence-based treatments increased: reperfusion from 66...
November 1, 2017: European Heart Journal
https://www.readbyqxmd.com/read/28993605/a-case-of-diffuse-alveolar-hemorrhage-as-a-possible-complication-of-bivalirudin-therapy
#17
Htun Latt, Sammy Aung, Kyaw Kyaw, Thein Tun Aung, Chanwit Roongsritong
BACKGROUND Diffuse alveolar hemorrhage (DAH) is a rare but potentially fatal complication of anticoagulant or antiplatelet therapy. Bivalirudin is a specific and reversible direct thrombin inhibitor (DTI). CASE REPORT We report a case of severe DAH, possibly related to bivalirudin use, in a 61-year-old patient undergoing coronary intervention. The patient had presented with an out-of-hospital cardiac arrest due to acute ST elevation myocardial infarction (STEMI). During the coronary intervention, shortly after receiving bivalirudin, the patient started having frank bleeding from the endotracheal tube and developed hemodynamic compromise...
October 10, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28974830/experience-and-outcomes-of-primary-percutaneous-coronary-intervention-for-patients-with-st-segment-elevation-myocardial-infarction-of-tertiary-care-center-in-bosnia-and-herzegovina
#18
Elmir Jahic
BACKGROUND: Primary percutaneous coronary intervention (PCI) is an emergent percutaneous catheter intervention in the setting of ST-segment elevations myocardial infarction (STEMI), without previous fibrinolytic treatment. AIM: To evaluate the feasibility and outcomes of primary percutaneous coronary interventions for STEMI in regional tertiary care cardiac centre in Bosnia and Herzegovina. METHODS: Between January 2014 and December 2016, consecutive 549 STEMI patients who underwent primary PCI were prospectively enrolled in a primary PCI registry...
June 2017: Medical Archives
https://www.readbyqxmd.com/read/28971637/an-intervention-to-reduce-the-time-interval-between-hospital-entry-and-emergency-coronary-angiography-in-patients-with-st-elevation-myocardial-infarction
#19
Basheer Karkabi, Ronen Jaffe, David A Halon, Amnon Merdler, Nader Khader, Ronen Rubinshtein, Jacob Goldstein, Barak Zafrir, Keren Zissman, Nissan Ben-Dov, Michael Gabrielly, Alex Fuks, Avinoam Shiran, Salim Adawi, Yaron Hellman, Johny Shahla, Salim Halabi, Moshe Y Flugelman, Shai Cohen, Irina Bergman, Sameer Kassem, Chen Shapira
BACKGROUND: Outcomes of patients with acute ST-elevation myocardial infarction (STEMI) are strongly correlated to the time interval from hospital entry to primary percutaneous coronary intervention (PPCI). Current guidelines recommend a door to balloon time of < 90 minutes. OBJECTIVES: To reduce the time from hospital admission to PPCI and to increase the proportion of patients treated within 90 minutes. METHODS: In March 2013 the authors launched a seven-component intervention program:  Direct patient evacuation by out-of-hospital emergency medical services to the coronary intensive care unit or catheterization laboratory Education program for the emergency department staff Dissemination of information regarding the urgency of the PPCI decision Activation of the catheterization team by a single phone call Reimbursement for transportation costs to on-call staff who use their own cars Improvement in the quality of medical records Investigation of failed cases and feedback...
September 2017: Israel Medical Association Journal: IMAJ
https://www.readbyqxmd.com/read/28965096/effect-of-weekend-admission-on-process-of-care-and-clinical-outcomes-for-the-management-of-acute-coronary-syndromes-a-retrospective-analysis-of-three-uk-centres
#20
Glen P Martin, Tim Kinnaird, Matthew Sperrin, Richard Anderson, Amr Gamal, Avais Jabbar, Chun Shing Kwok, Diane Barker, Grant Heatlie, Azfar G Zaman, Mamas A Mamas
OBJECTIVES: The effect of weekend versus weekday admission following acute coronary syndrome (ACS) on process of care and mortality remains controversial. This study aimed to investigate the 'weekend-effect' on outcomes using a multicentre dataset of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction/unstable angina (NSTEMI/UA). DESIGN: This retrospective observational study used propensity score (PS) stratification to adjust estimates of weekend effect for observed confounding...
September 29, 2017: BMJ Open
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