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acute coronary syndrome with ST segment elevation

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https://www.readbyqxmd.com/read/28529261/clinical-implications-of-electrocardiograms-for-patients-with-type-a-acute-aortic-dissection
#1
Masami Kosuge, Kazuo Kimura, Keiji Uchida, Munetaka Masuda, Kouichi Tamura
Type A acute aortic dissection (AAD) is a serious cardiovascular emergency requiring urgent surgery. Timely accurate diagnosis is essential, but often challenging, because of the wide spectrum of clinical presentations. In patients with type A AAD, chest pain is the most common symptom; furthermore, ischemic ST-T changes such as ST-segment elevation or depression or negative T waves are frequently observed on presentation ECG. These clinical presentations of type A AAD are difficult to differentiate from those of acute coronary syndrome (ACS), which could lead to delayed diagnosis and treatment of type A AAD or misdiagnosis of ACS followed by inappropriate treatment...
May 19, 2017: Circulation Journal: Official Journal of the Japanese Circulation Society
https://www.readbyqxmd.com/read/28526546/acute-coronary-syndromes-in-the-very-elderly-short-term-prognostic-performance-of-the-syntax-score
#2
Laurent Faroux, Sophie Tassan-Mangina, Benoit Herce, Pierre Nazeyrollas, Karine Bauley, Damien Metz
Acute coronary syndromes (ACS) frequently occur in elderly subjects. The high mortality associated with ACS in this population justifies the identification of factors related to poor prognosis. We aimed to evaluate the short-term prognostic performance of the SYNTAX score in a population of patients aged 85years or more presenting ACS and undergoing coronary angiography. Secondary objectives were to identify factors related to length of stay and potential markers of in-hospital death. We performed a retrospective, single-centre prognostic study including patients aged 85years or more who underwent coronary angiography for ACS over a 4year period...
May 12, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28516369/management-of-elderly-patients-with-a%C3%A2-non-st-segment-elevation-acute-coronary-syndrome
#3
REVIEW
M E Gimbel, J M Ten Berg
Elderly patients with an acute coronary syndrome are underrepresented in randomised controlled trials. Neither the European Society of Cardiology nor the American Heart Association/American College of Cardiology acute coronary syndrome guidelines provide specific recommendations for elderly patients. However, elderly patients are at higher thrombotic and bleeding risk compared with younger patients leading to difficulties in choosing the optimal treatment. In this review, we discuss the uncertainties we encounter in treating elderly patients with non-ST-elevation acute coronary syndrome and suggest treatment options based on the existing literature...
May 17, 2017: Netherlands Heart Journal
https://www.readbyqxmd.com/read/28515099/temporal-biomarker-profiling-reveals-longitudinal-changes-in-risk-of-death-or-myocardial-infarction-in-non-st-segment-elevation-acute-coronary-syndrome
#4
Mark Chan, Megan L Neely, Matthew T Roe, Shaun G Goodman, David Erlinge, Jan H Cornel, Kenneth J Winters, Joseph A Jakubowski, Chunmei Zhou, Keith A A Fox, Paul W Armstrong, Harvey D White, Dorairaj Prabhakaran, E Magnus Ohman, Kurt Huber
BACKGROUND: There are conflicting data on whether changes in N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high-sensitivity C-reactive protein (hs-CRP) concentrations between time points (delta NT-proBNP and hs-CRP) are associated with a change in prognosis. METHODS: We measured NT-proBNP and hs-CRP at 3 time points in 1665 patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Cox proportional hazards was applied to the delta between temporal measurements to determine the continuous association with cardiovascular events...
May 17, 2017: Clinical Chemistry
https://www.readbyqxmd.com/read/28514396/-long-term-results-of-different-approaches-to-revascularization-in-non-st-segment-elevation-acute-coronary-syndrome-and-multiple-coronary-atherosclerosis
#5
V I Ganyukov, R S Tarasov, Yu N Neverova, N A Kochergin, O L Barbarash, L S Barbarash
AIM: To assess the long-term results of different approaches to treating patients with non-ST-segment elevation acute coronary syndrome (NSTE ACS) and multivessel coronary artery disease (MVCAD). SUBJECTS AND METHODS: A total of 150 patients with NSTE ACS, in whom coronary angiography revealed MVCAD, were examined. The patients were divided into 3 groups according to the selected treatment policy: 1) percutaneous coronary intervention (PCI) (n=91 (60.6%)); 2) coronary artery bypass grafting (CABG) (n=40 (26...
2017: Terapevticheskiĭ Arkhiv
https://www.readbyqxmd.com/read/28509893/spontaneous-coronary-artery-dissection-insights-from-histology-and-optical-coherence-tomography
#6
Sandeep K Krishnan, Alex Zhu, Brent Larson, Timothy D Henry, Suhail Dohad
Spontaneous coronary artery dissection (SCAD) is a well-known but infrequent cause of acute coronary syndrome (ACS), and often goes unrecognized. Although management of SCAD is, at times, controversial, when a patient presents with ACS, percutaneous coronary intervention (PCI) is frequently necessary. We present a patient with ST-segment elevation myocardial infarction (STEMI) with SCAD that illustrates two important points: use of intracoronary optical coherence tomography to guide PCI, and histologic assessment to provide a unique insight into the etiology of SCAD...
2017: Reviews in Cardiovascular Medicine
https://www.readbyqxmd.com/read/28490313/radial-vs-femoral-approach-in-acute-coronary-syndromes-a-comprehensive-meta-analysis-of-randomized-trials
#7
Matteo Nardin, Monica Verdoia, Lucia Barbieri, Alon Schaffer, Harry Suryapranata, Giuseppe De Luca
BACKGROUND: Substantial improvements have been achieved with percutaneous coronary intervention (PCI) for the treatment of acute coronary syndromes (ACS). Nevertheless, bleeding still affects outcomes. The radial approach for PCI has shown important benefits on access site complications, but is still not achieving universal consensus as first choice in acute settings. Therefore, we performed a comprehensive meta-analysis of randomized trials comparing radial vs femoral approach in PCI for ACS...
May 4, 2017: Current Vascular Pharmacology
https://www.readbyqxmd.com/read/28487035/radial-versus-femoral-access-for-the-treatment-of-left%C3%A2-main-lesion-in-the-era-of-second-generation-drug-eluting-stents
#8
Sebastiano Gili, Fabrizio D'Ascenzo, Roberto Di Summa, Federico Conrotto, Enrico Cerrato, Alaide Chieffo, Giacomo Boccuzzi, Antonio Montefusco, Fabrizio Ugo, Pierluigi Omedé, Hiroyoshi Kawamoto, Francesco Tomassini, Marco Pavani, Ferdinando Varbella, Roberto Garbo, Maurizio D'Amico, Giuseppe Biondi Zoccai, Claudio Moretti, Javier Escaned, Antonio Colombo, Fiorenzo Gaita
Transradial access (TRA) is often avoided in favor of the transfemoral access (TFA) during percutaneous coronary interventions of the unprotected left main coronary artery (ULM), due to technical and safety concerns. The aim of this study was to compare the performance of TRA and TFA in the treatment of ULM with second-generation drug-eluting stents. Consecutive patients who underwent percutaneous coronary intervention on ULM with second-generation drug-eluting stents were retrospectively enrolled in the multicenter Failure in Left Main Study With 2nd Generation Stents (FAILS 2) registry...
April 12, 2017: American Journal of Cardiology
https://www.readbyqxmd.com/read/28483589/takotsubo-cardiomyopathy-after-microwave-ablation-for-metastatic-liver-lesions
#9
Mostafa Afennas, Hans Bonnier, Danny Schoors
Takotsubo cardiomyopathy (TCMP) is characterized by transient and reversible left ventricular regional wall motion abnormalities triggered by acute and intense emotional or physical stress. We present a case of a 79 year old woman with a hypertensive crisis after microwave ablation (MWA) for metastatic liver lesions. Initial evaluation suggested an acute coronary syndrome with an ST segment elevation and with elevated serum troponin T. No associated chest pain or dyspnea was present. Further evaluation with ECG, echocardiography, coronarography with left ventricle angiogram and MRI was consistent with an apical ballooning syndrome...
April 29, 2017: Cardiovascular Revascularization Medicine: Including Molecular Interventions
https://www.readbyqxmd.com/read/28476519/the-underutilisation-of-dual-antiplatelet-therapy-in-acute-coronary-syndrome
#10
Malcolm Anastasius, Jerrett K Lau, Karice Hyun, Mario D'Souza, Anushka Patel, Jamie Rankin, Darren Walters, Craig Juergens, Bernadette Aliprandi-Costa, Andrew T Yan, Shaun G Goodman, Derek Chew, David Brieger
BACKGROUND: Despite guideline recommendation of dual antiplatelet therapy (DAPT) in treating ACS, DAPT is underutilized. Our objective was to determine independent predictors of DAPT non-prescription in ACS and describe pattern of DAPT prescription over time. METHODS: Patients presenting to 41 Australian hospitals with an ACS diagnosis between 2009 and 2016 were stratified according to discharge prescription with DAPT and single antiplatelet therapy (SAPT) or no antiplatelet therapy...
April 25, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28475171/relationship-between-infarct-artery-location-acute-total-coronary-occlusion-and-mortality-in-stemi-and-nstemi-patients
#11
Jarosław Karwowski, Marek Gierlotka, Mariusz Gąsior, Lech Poloński, Jan Ciszewski, Maciej Bęćkowski, Ilona Kowalik, Hanna Szwed
INTRODUCTION    Prevalence and impact of total coronary occlusion of an infarct-related artery (IRA) on outcome could be different between patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). OBJECTIVES    We evaluated the impact of IRA occlusion on outcome of myocardial infarction, according to the presence or absence of ST-segment elevation and the culprit lesion location. PATIENTS AND METHODS    We analyzed 4581 STEMI patients and 2717 NSTEMI patients enrolled in the Polish Registry of Acute Coronary Syndromes who underwent PCI...
May 5, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28464182/why-is-reverse-takotsubo-reverse
#12
Daniela Rosu, Sameh Askandar, Rami N Khouzam
OBJECTIVES: Takotsubo cardiomyopathy (TTC) is an acute cardiac syndrome simulating myocardial infarction that is characterized by transient wall motion abnormalities in the absence of coronary artery obstruction. Reverse TTC (rTTC) is a recently described variant of TTC. This review defines and compares both forms of TTC, stating their resemblances and differences. METHODS: We conducted a search of the MEDLINE database. Forty-one cases of rTTC met our eligibility criteria and were summarized in a synthesis of the demographic features, clinical characteristics, and laboratory studies...
May 2017: Southern Medical Journal
https://www.readbyqxmd.com/read/28462421/comparative-effectiveness-of-routine-invasive-coronary-angiography-for-managing-unstable-angina
#13
Sara Vogrin, Richard Harper, Elizabeth Paratz, Andrew MacIsaac, Jodie Burchell, Belinda Smith, Anthony Scott, Jongsay Yong, Vijaya Sundararajan
Background: Non-ST-segment elevation acute coronary syndromes include unstable angina and non-ST-segment elevation myocardial infarction. Most randomized controlled trials of routine versus selective invasive coronary angiography have high rates of crossover from control to intervention groups and do not include subgroup analysis for unstable angina. Consequently, no clear, specific recommendations exist regarding the use of angiography in unstable angina. Objective: To assess the effect of angiography on mortality in unstable angina, incorporating the results of additional cardiac procedures and events...
May 2, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/28457177/high-sensitivity-cardiac-troponin-assays-from-improved-analytical-performance-to-enhanced-risk-stratification
#14
Marek Kozinski, Magdalena Krintus, Jacek Kubica, Grazyna Sypniewska
Implementation of cardiac troponin (cTn) assays has revolutionized the diagnosis, risk stratification, triage and management of patients with suspected myocardial infarction (MI). The Universal Definition of MI brought about a shift in the diagnostics of MI, from an approach primarily based on electrocardiography (ECG) to one primarily based on biomarkers. Currently, detection of a rise and/or fall in concentration or activity of myocardial necrosis biomarkers, preferentially cTns, with at least one value above the 99th percentile upper reference limit (URL), is the essential component for the diagnosis of MI...
May 2017: Critical Reviews in Clinical Laboratory Sciences
https://www.readbyqxmd.com/read/28455489/st-segment-elevation-myocardial-infarction-with-acute-stent-thrombosis-presenting-as-intractable-hiccups-an-unusual-case
#15
Fan Zhang, Nosakhare Douglas Tongo, Victoria Hastings, Parisa Kanzali, Ziqiang Zhu, Hal Chadow, Shahrokh E Rafii
BACKGROUND Acute coronary syndrome (ACS) can present with atypical chest pain or symptoms not attributed to heart disease, such as indigestion. Hiccups, a benign and self-limited condition, can become persistent or intractable with overlooked underlying etiology. There are various causes of protracted hiccups, including metabolic abnormalities, psychogenic disorders, malignancy, central nervous system pathology, medications, pulmonary disorders, or gastrointestinal etiologies. It is rarely attributed to cardiac disease...
April 29, 2017: American Journal of Case Reports
https://www.readbyqxmd.com/read/28450654/left-circumflexus-coronary-artery-total-occlusion-with-clinical-presentation-as-nstemi-and-acute-pulmonary-oedema
#16
Budi Yuli Setianto, Nahar Taufiq, Heri Hernawan
Current guidelines for the management of patients with acute coronary syndromes (ACSs) focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI) or non-ST-elevation acute myocardial infarction (NSTEMI)/unstable angina (UA). Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the 'sine qua non' for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx) occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram...
January 2017: Acta Medica Indonesiana
https://www.readbyqxmd.com/read/28437675/whole-blood-sequencing-reveals-circulating-microrna-associations-with-high-risk-traits-in-non-st-segment-elevation-acute-coronary-syndrome
#17
Alice Wang, Lydia Coulter Kwee, Elizabeth Grass, Megan L Neely, Simon G Gregory, Keith A A Fox, Paul W Armstrong, Harvey D White, E Magnus Ohman, Matthew T Roe, Svati H Shah, Mark Y Chan
BACKGROUND AND AIMS: Although circulating microRNA (miRNAs) have emerged as biomarkers predicting mortality in acute coronary syndrome (ACS), more data are needed to understand these mechanisms. Mapping miRNAs to high-risk traits may identify miRNAs involved in pathways conferring risk for poor outcome in ACS. We aim to investigate the relationship between circulating miRNAs and high-risk traits in non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Whole-genome miRNA sequencing was performed on RNA extracted from whole blood of 199 patients with NSTE-ACS...
March 30, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28435280/high-adherence-to-therapy-and-low-cardiac-mortality-and-morbidity-in-patients-after-acute-coronary-syndrome-systematically-managed-by-office-based-cardiologists-in-germany-1-year-outcomes-of-the-proacor-study
#18
Franz Goss, Johannes Brachmann, Christian W Hamm, Winfried Haerer, Nicolaus Reifart, Benny Levenson
We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy...
2017: Vascular Health and Risk Management
https://www.readbyqxmd.com/read/28427574/acute-noncardiovascular-illness-in-the-cardiac-intensive-care-unit
#19
Eric M Holland, Travis J Moss
BACKGROUND: Fifty years after the inception of the cardiac intensive care unit (CICU), noncardiovascular illnesses have become more prevalent and may contribute to morbidity and mortality. OBJECTIVES: The authors performed multivariate statistical analyses to determine the association of acute noncardiovascular illnesses with outcomes, including length of stay (LOS), mortality, and hospital readmission. METHODS: We studied 1,042 admissions between October 12, 2013 and November 28, 2014 to the CICU at the University of Virginia Health System, a tertiary-care academic medical center...
April 25, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28425755/thrombus-aspiration-in-acute-coronary-syndromes-prevalence-procedural-success-change-in-serial-troponin-t-levels-and-clinical-outcomes-in-a-contemporary-swiss-cohort
#20
Soheila Aghlmandi, Nadine Schärer, Dik Heg, Lorenz Räber, Marcel Zwahlen, Baris Gencer, David Nanchen, David Carballo, Sebastian Carballo, Peter Jüni, Arnold von Eckardstein, Ulf Landmesser, Nicolas Rodondi, François Mach, Stephan Windecker, Christian M Matter, Thomas F Lüscher, Roland Klingenberg
BACKGROUND: Randomised controlled trials have provided conflicting results regarding procedural and clinical outcomes of thrombus aspiration combined with percutaneous coronary intervention, when compared with primary percutaneous coronary intervention alone in patients with acute coronary syndromes. METHODS: Acute coronary syndrome patients referred for coronary angiography to four Swiss university hospitals between 2009 and 2012 were enrolled in the SPUM-ACS cohort...
April 1, 2017: European Heart Journal. Acute Cardiovascular Care
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