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YeongHo Choi, Yu Jin Lee, Sang Do Shin, Kyoung Jun Song, KyungWon Lee, Eui Jung Lee, Yu Jin Kim, Ki Ok Ahn, Ki Jeong Hong, Young Sun Ro
BACKGROUND: Timely transfer and percutaneous coronary intervention (PCI) with or without thrombolysis are recommended by the American Heart Association (AHA) to care for ST-segment elevation myocardial infarction (STEMI) patients who present first to a non-PCI-capable hospital. This study was to evaluate the impact on in-hospital mortality of the compliance with guidelines regarding to the time of PCI for patients with STEMI who were transferred to a capable PCI hospital. METHODS: We used the CArdioVAscular disease Surveillance data from November 2007 to December 2012 for this study...
September 16, 2016: American Journal of Emergency Medicine
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
Michelle Ma Kip, Lotte Mg Steuten, Hendrik Koffijberg, Maarten J IJzerman, Ron Kusters
Early health technology assessment can provide insight in the potential cost-effectiveness of new tests to guide further development decisions. This can increase their potential benefit but often requires evidence which is lacking in early test development stages. Then, expert elicitation may be used to generate evidence on the impact of tests on patient management. This is illustrated in a case study on a new triple biomarker test (copeptin, heart-type fatty acid binding protein, and high-sensitivity troponin [HsTn]) at hospital admission...
October 19, 2016: Journal of Evaluation in Clinical Practice
Jackson J Liang, Eric R Fenstad, Christopher D Janish, Lawrence J Sinak
Left ventricular non-compaction cardiomyopathy is a rare congenital cardiomyopathy, which usually presents early in life but may also manifest into adulthood. We present the case of an elderly woman with left ventricular non-compaction cardiomyopathy, which was discovered incidentally following an ST-elevation myocardial infarction.
October 18, 2016: Acute Cardiac Care
Cemil Zencir, Mahmut Akpek, Sevil Onay, Mithat Selvi
Coronary artery bypass grafting (CABG) surgery maintains an important role in the treatment of coronary artery disease. The huge saphenous vein graft aneurysm (HSVGA) is rare and occurs as a late complication after CABG. Here, we reported a case of HSVGA presenting as non-ST elevation myocardial infarction.
September 2016: Indian Heart Journal
Jiri Parenica, Jiri Jarkovsky, Jan Malaska, Alexandre Mebazaa, Jana Gottwaldova, Katerina Helanova, Jiri Litzman, Milan Dastych, Josef Tomandl, Jindrich Spinar, Ludmila Dostalova, Petr Lokaj, Marie Tomandlova, Monika Goldergova Pavkova, Pavel Sevcik, Matthieu Legrand
INTRODUCTION: Cardiogenic shock (CS) patients are at a high risk of developing infectious complications; however, their early detection is difficult, mainly due to a frequently occurring non-infectious inflammatory response, which accompanies an extensive myocardial infarction or a post-cardiac arrest syndrome. The goal of our prospective study was to describe infectious complications in CS and the immune/inflammatory response based on a serial measurement of several blood-based inflammatory biomarkers...
September 29, 2016: Shock
Idan Roifman, Nilesh R Ghugre, Tasnim Vira, Mohammad I Zia, Anna Zavodni, Mihaela Pop, Kim A Connelly, Graham A Wright
BACKGROUND: Infarct heterogeneity, as assessed by determination of the peri-infarct zone (PIZ) by cardiac magnetic resonance imaging, has been shown to be an independent predictor for the development of cardiac arrhythmias and mortality post myocardial infarction (MI). The temporal evolution of the PIZ post MI is currently unknown. Thus, the main objective of our study was to describe the temporal evolution of the PIZ over a 6 month time period in contemporarily managed ST elevation myocardial infarction (STEMI) patients...
October 14, 2016: BMC Cardiovascular Disorders
Alfonso Jurado-Román, Pilar Agudo-Quílez, Belén Rubio-Alonso, Javier Molina, Belén Díaz, Julio García-Tejada, Roberto Martín, Rocío Tello
BACKGROUND: There are few data on the prognostic significance of the wall motion score index compared with left ventricle ejection fraction after an acute myocardial infarction. Our objective was to compare them after the hyperacute phase. METHODS: Transthoracic echocardiograms were performed in 352 consecutive patients with myocardial infarction, after the first 48 hours of admission and before hospital discharge (median 56.3 hours (48.2-83.1)). We evaluated the ability of the wall motion score index and left ventricular ejection fraction to predict the combined endpoint (mortality and rehospitalization for heart failure) as a primary objective and the independent events of the combined endpoint as a secondary objective...
October 13, 2016: European Heart Journal. Acute Cardiovascular Care
Vivian W Y Lee, Franco W Cheng, Adrian Y Choi, Sam T Fong, Cheuk Man Yu, Bryan P Yan
BACKGROUND: Percutaneous coronary intervention (PCI) is one of the most performed interventions for ischemic heart diseases. In Hong Kong, the total number of patient discharges and deaths for ischemic heart diseases in 2009 was 33,363, including 4,360 deaths. There are over 5,000 cases of PCI yearly. This study aimed to compare clinical, economic and humanistic outcomes among patients receiving drug-eluting stent (DES) or bare metal stent (BMS) in Hong Kong. METHODS: Patients who received stent implantation between 15(th) September, 2009 and 11(th) October, 2010 in Prince of Wales Hospital, Hong Kong, were recruited and followed for 18 months...
October 14, 2016: Journal of Medical Economics
Alberto Dominguez-Rodriguez, Pedro Abreu-Gonzalez, Jose M de la Torre-Hernandez, Julia Gonzalez-Gonzalez, Tamara Garcia-Camarero, Luciano Consuegra-Sanchez, Maria Del Mar Garcia-Saiz, Ana Aldea-Perona, Tirso Virgos-Aller, Agueda Azpeitia, Russel J Reiter
The MARIA randomized trial evaluated the efficacy and safety of melatonin for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). This was a prespecified interim analysis. A total of 146 patients presenting with STEMI within 6 hours of chest pain onset were randomized to receive intravenous and intracoronary melatonin (n=73) or placebo (n=73) during primary pecutaneous coronary intervention (PPCI). Primary endpoint was myocardial infarct size as assessed by magnetic resonance imaging (MRI) at 6±2 days...
October 13, 2016: Journal of Pineal Research
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
Giovanni Teruzzi, Giuseppe Calligaris, Paolo Ravagnani, Daniela Trabattoni, Luca Grancini, Giovanni Monizzi, Alessandro Lualdi, Antonio L Bartorelli
Spontaneous coronary artery dissection (SCAD) accounts approximately for 0.2% of cases of acute coronary syndrome. It is defined "spontaneous" in absence of any coronary wall damage. This disease affects primarily young women in good health, with no risk factors for coronary artery disease, especially during the postpartum period. Since the clinical presentation varies widely from no symptoms to typical angina and sudden cardiac death, SCAD incidence is underestimated.A 40-year-old woman, in the 8th week after delivery, was admitted to our emergency department because of acute chest pain, and a diagnosis of inferior and posterior non-ST-elevation myocardial infarction was made...
October 2016: Giornale Italiano di Cardiologia
Kyyak Hryhoriy
INTRODUCTION: type 2 diabetes mellitus is one of the most important medical and social problems in the world. Patients with diabetes are prone to coronary artery disease, in particular acute coronary syndrome, with atypical clinical signs and susceptibility to tachycardia. Elevated heart rate is an important factor of premature mortality in all patients with acute coronary syndrome. The aim of the investigation was to reveal the heart rate peculiarities in unstable angina and non-ST elevation myocardial infarction patients suffering from diabetes mellitus type 2 for more effective treatment of these patients...
2016: Wiadomości Lekarskie: Organ Polskiego Towarzystwa Lekarskiego
Jarosław Karwowski, Lech Poloński, Marek Gierlotka, Andrzej Ciszewski, Michał Hawranek, Maciej Bęćkowski, Mariusz Gąsior, Ilona Kowalik, Hanna Szwed
BACKGROUND: Prevalence and impact of total coronary occlusion of an Infarct-Related Artery (IRA) on outcomes in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) remain unclear. AIM: We evaluated the clinical significance of total coronary occlusion in NSTEMI patients. METHODS: A total of 2767 patients with NSTEMI enrolled in the Polish Registry of Acute Coronary Syndromes who underwent percutaneous coronary interventions were analyzed...
October 7, 2016: Kardiologia Polska
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
José P S Henriques, Loes P Hoebers, Truls Råmunddal, Peep Laanmets, Erlend Eriksen, Matthijs Bax, Dan Ioanes, Maarten J Suttorp, Bradley H Strauss, Emanuele Barbato, Robin Nijveldt, Albert C van Rossum, Koen M Marques, Joëlle Elias, Ivo M van Dongen, Bimmer E P M Claessen, Jan G Tijssen, René J van der Schaaf
BACKGROUND: In 10% to 15% of patients with ST-segment elevation myocardial infarction (STEMI), concurrent coronary chronic total occlusion (CTO) in a non-infarct-related artery is present and is associated with increased morbidity and mortality. OBJECTIVES: The EXPLORE (Evaluating Xience and Left Ventricular Function in Percutaneous Coronary Intervention on Occlusions After ST-Elevation Myocardial Infarction) trial evaluated whether patients with STEMI and concurrent CTO in a non-infarct-related artery benefit from additional percutaneous coronary intervention (PCI) of CTO shortly after primary PCI...
October 11, 2016: Journal of the American College of Cardiology
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
Magnus T Jensen, Marta Pereira, Carla Araujo, Anti Malmivaara, Jean Ferrieres, Irene R Degano, Inge Kirchberger, Dimitrios Farmakis, Pascal Garel, Marina Torre, Jaume Marrugat, Ana Azevedo
AIMS: The purpose of this study was to investigate the relationship between heart rate at admission and in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: Consecutive ACS patients admitted in 2008-2010 across 58 hospitals in six participant countries of the European Hospital Benchmarking by Outcomes in ACS Processes (EURHOBOP) project (Finland, France, Germany, Greece, Portugal and Spain)...
September 30, 2016: European Heart Journal. Acute Cardiovascular Care
O Nallet, N Ketata, N Ferrier, X Marcaggi
Acute chest pain is a common reason of consultation in the emergency department. The difficulty lies in discriminating patients with acute coronary syndrome or other life-threatening conditions from those non-cardiovascular, non-life-threatening chest pain. Only 15 to 25 % of patients with acute chest pain actually have acute coronary syndrome. Algorithms using high sensitivity troponin at admission and a second assessment 1 or 3hours later are validated to "rule in" or "rule out" the diagnosis of non ST-elevation myocardial infarction...
September 29, 2016: Annales de Cardiologie et D'angéiologie
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
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