Indian Journal of Basic and Applied Medical Research; December 2013: Vol.-3, Issue-1 , 80-87 Original article : Effect of acute myocardial infarction on serum zinc level * DR. PRAVIN P. SHEKOKAR 1, DR. MRS. S. D. KAUNDINYA2 1Assistant Professor, Department of Physiology, Government Medical College, Akola, Collector Office Road, Akola. Pin 444001 (Maharashtra), India 2Professor & Head of Dept, Department of Physiology, Grant Government Medical College And Sir J.J. Hospital, Mumbai-8, India *Corrersponding author : Email: [email protected] Abstract: Introduction: Myocardial infarction is a common presentation of coronary artery disease. The diagnosis of acute myocardial infarction (AMI) is of vital importance from the management and prognosis point of view. Objective: The purpose of this study was to investigate serum zinc level in acute myocardial infarction patients and to correlate it with biochemical parameter SGOT. Methods: In the present study 30 patients suffering from acute myocardial ...
Background: Chronic kidney disease (CKD) is a strong risk factor for cardiovascular events, and there are consistence evidences about worse short- and long-term outcomes in CKD patients with acute myocardial infarction. The aim of this study was to evaluate the effects and safety of triple antiplatelet therapy (aspirin plus clopidogrel plus cilostazol) in CKD patients with ST-elevation myocardial infarction (STEMI) compared with dual antiplatelet therapy (aspirin plus clopidogrel).. Methods and results: Among over 21,000 patients in Korean Acute Myocardial Infarction Registry (KAMIR) data, 5,138 STEMI patients who underwent successful primary percutaneous coronary intervention with drug-eluting stents were enrolled in this study. They were divided by estimated creatinine clearance (eCrCl); ≥ 60 ml/min (n=3,445; dual = 2169, triple = 1276) and , 60 ml/min (n=1693; dual = 1120, triple = 573). Various major adverse cardiac events including major bleeding at 12 months were evaluated. The triple ...
TY - JOUR. T1 - Comparison of delay times between Symptom onset of an acute ST-elevation myocardial infarction and hospital arrival in men and women ,65 years versus ≥65 years of age. T2 - Findings from the multicenter Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. AU - Ladwig, Karl-Heinz. AU - Fang, Xiaoyan. AU - Wolf, Kathrin. AU - Hoschar, Sophia. AU - Albarqouni, Loai. AU - Ronel, Joram. AU - Meinertz, Thomas. AU - Spieler, Derek. AU - Laugwitz, Karl-Ludwig. AU - Schunkert, Heribert. N1 - Copyright © 2017 Elsevier Inc. All rights reserved.. PY - 2017/12/15. Y1 - 2017/12/15. N2 - Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (,65 ...
TY - JOUR. T1 - Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. AU - MRUSMI Investigators. AU - Mathias, Wilson. AU - Tsutsui, Jeane M.. AU - Tavares, Bruno G.. AU - Fava, Agostina M.. AU - Aguiar, Miguel O.D.. AU - Borges, Bruno C.. AU - Oliveira, Mucio T.. AU - Soeiro, Alexandre. AU - Nicolau, Jose C.. AU - Ribeiro, Henrique B.. AU - Chiang, Hsu Po. AU - Sbano, João C.N.. AU - Morad, Abdulrahman. AU - Goldsweig, Andrew. AU - Rochitte, Carlos E.. AU - Lopes, Bernardo B.C.. AU - Ramirez, José A.F.. AU - Kalil Filho, Roberto. AU - Porter, Thomas R.. PY - 2019/6/11. Y1 - 2019/6/11. N2 - Background: Preclinical studies have demonstrated that high mechanical index (MI)impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis)can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). Objectives: This study tested the clinical ...
I read the article by Yang JH,et al with great interest, in which the authors compared 1-year prognostic impacts of angiotensin receptor blockers (ARBs) with angiotensin converting enzyme inhibitors (ACEIs) in patients with ST segment elevation myocardial infarction (STEMI) with preserved left ventricular systolic function who underwent primary percutaneous coronary intervention (PCI) [1]. I believe it would be appreciated if authors discuss the long-term survival benefit of ARBs before concluding that ARBs are as beneficial as ACEIs in STEMI patients with preserved left ventricular systolic function after PCI.. Although ARBs could be an alternative to ACEIs, a recent observational study using inverse probability of treatment weighting and propensity score matching methods revealed that patients treated with ACEIs had significantly lower long-term mortality compared with those treated with ARBs from 2 to 5 years after acute myocardial infarction [2]. This study also demonstrated that crude ...
According to data from randomized, controlled trials, primary percutaneous coronary intervention (PCI) is the treatment of choice for ST-segment elevation myocardial infarction (MI). In these trials, 1 life was saved and 2 other life-threatening complications, including stroke and reinfarction, were prevented for every 50 patients with ST-segment elevation MI treated with primary PCI rather than thrombolytic therapy. Only 1 major bleeding episode occurred.. How can these superior results be realized outside the context of randomized trials? We anticipate 4 obstacles to instituting primary PCI as the universal treatment of ST-segment elevation MI: 1) lack of timely availability, 2) technical expertise of center and operator, 3) the need to address patient subgroups that are not studied in randomized trials, and 4) comparisons of primary PCI to newer pharmacologic regimens.. We propose 3 strategies to increase the availability of this procedure: 1) perform primary PCI in qualified community ...
List of Tables. Table 1: Clinical subtypes of Indication. Table 2: Risk Factors. Table 3: Prevalence cases (%) Region wise. Table 4: Sources used for forecasting the data. Table 5: Myocardial Infarction Global Epidemiology, (2013-2023). Table 6: Prevalent Cases of Myocardial Infarction (Ages =XX Years), US (2013-2023). Table 7: Prevalent Cases of Myocardial Infarction By Sex (Males & Females), US (2013-2023). Table 8: Prevalent Cases By Myocardial Infarction Sub-population, US (2013-2023). Table 9: Prevalent Cases of Myocardial Infarction (Ages =XX Years), United Kingdom (2013-2023). Table 10: Prevalent Cases of Myocardial Infarction By Sex (Males & Females), United Kingdom (2013-2023). Table 11: Prevalent Cases By Myocardial Infarction Sub-population, United Kingdom (2013-2023). Table 12: Prevalent Cases of Myocardial Infarction (Ages =XX Years), Germany (2013-2023). Table 13: Prevalent Cases of Myocardial Infarction By Sex (Males & Females), Germany (2013-2023). Table 14: Prevalent Cases By ...
Aims. The TRA·CER trial compared vorapaxar, a novel platelet protease-activated receptor (PAR)-1 antagonist, with placebo in 12 944 patients with high-risk non-ST-segment elevation acute coronary syndromes (NSTE ACS). In this analysis, we explored the effect of vorapaxar on myocardial infarction (MI).. Methods and results. A blinded, independent central endpoint adjudication committee prospectively defined and classified MI according to the universal MI definition, including peak cardiac marker value (creatine kinase-MB [CK-MB] and/or troponin). Because the trial failed to meet its primary endpoint, these analyses are considered exploratory. During a median follow-up of 502 days, 1580 MIs occurred in 1319 patients. The majority (n = 1025, 64.9%) were type 1 (spontaneous) MI, followed by type 4a [percutaneous coronary intervention (PCI)-related] MI (n = 352; 22.3%). Compared with placebo, vorapaxar reduced the hazard of a first MI of any type by 12% [hazard ratio (HR), 0.88; 95% confidence ...
Since indium-111 platelet scintigraphy for the detection of left ventricular thrombosis often shows considerable non-specific blood pool activity a subtraction method using simultaneous technetium-99m blood pool scintigraphy was undertaken in 11 subjects with well documented remote myocardial infarction, who served as positive or negative controls, and in 18 consecutive patients with acute myocardial infarction. The results were compared with those of cross sectional echocardiography. Thirteen patients had transmural myocardial infarction and the calculated count per pixel in the left ventricle of the subtracted indium-111 platelet scintigram was (mean (SD)) 0.28(0.35), but five patients with subendocardial myocardial infarction had a mean count of 0.04(0.06). In seven patients with transmural myocardial infarction (two anterior and five inferior) left ventricular thrombosis was detected by indium-111 platelet scintigraphy but in only one of these by cross sectional echocardiography. None of the ...
TY - JOUR. T1 - Longitudinal trends in the severity of acute myocardial infarction. T2 - A population study in Olmsted County, Minnesota. AU - Hellermann, Jens P.. AU - Reeder, Guy S.. AU - Jacobsen, Steven J.. AU - Weston, Susan A.. AU - Killian, Jill M.. AU - Roger, Véronique L.. PY - 2002/8/1. Y1 - 2002/8/1. N2 - The mechanisms of the decline in coronary heart disease mortality are not fully elucidated. In particular, little is known about the trends in severity of myocardial infarction, which may have contributed to the mortality decline. This study examines indicators of myocardial infarction severity including Killip class, electrocardiogram descriptors, and peak creatine kinase values in a population-based, myocardial infarction incidence cohort to test the hypothesis that the severity of myocardial infarction declined over time. Between 1983 and 1994, 1,295 incident cases of myocardial infarction (mean age, 67 (standard deviation, 6) years; 43% women) occurred in Olmsted County, ...
Introduction: ST Segment Elevation Myocardial Infarction (STEMI) is largely due to plaque rupture (60-70% of cases) and plaque erosion (30-40%). Coronary inflammation plays a pivotal role in rupture, but the pathophysiology of erosion is unknown. Autopsy studies have shown that inflammatory infiltrates are much less abundant in erosion compared to rupture. We explored the hypothesis that differences in intracoronary cytokines can be demonstrated in vivo in the early phase of STEMI in patients undergoing primary percutaneous coronary intervention (PPCI).. Methods: We recruited 40 STEMI patients undergoing PPCI with in less than 6 hours of chest pain in a single-centre observational study. Blood samples were taken from the infarct-related artery using thrombus aspiration. Culprit plaques were imaged using optical coherence tomography (OCT) before PCI and classified by two blinded observers. The expression profiles of 102 cytokines were measured using an array, and comparisons of the two ...
Emerging evidence indicate that progenitor stem cells derived from bone marrow can be used to improve cardiac function in acute myocardial infarction patients. There is a great potential for stem cell therapy, using a variety of cell precursors to contribute to new blood vessel formation and muscle preservation in the myocardial infarct zone. The administration of cells via an infusion through the infarct related artery appears to be feasible and result in a clinical effect in some studies. Across the globe AMI is the leading cause of morbidity and mortality. This cannot be prevented by optimal standard therapies i.e. balloon or stent dilation of the infarct vessels.. The study is a double blind, placebo controlled, randomized, multicenter trial. Male or female patients between 18-75 years with first incidence of Acute Myocardial Infarction(AMI) and LVEF less than or equal to 40% are included in the study. Patients who have undergone successful percutaneous intervention (PCI) within ≤ 24 hours ...
TY - JOUR. T1 - Comparison of Six-Month Outcomes for Primary Percutaneous Revascularization for Acute Myocardial Infarction With Drug-Eluting Versus Bare Metal Stents (from the APEX-AMI Study). AU - Patel, Manesh R.. AU - Pfisterer, Matthias E.. AU - Betriu, Amadeo. AU - Widmisky, Petr. AU - Holmes, David R.. AU - ONeill, William W.. AU - Stebbins, Amanda. AU - Van de Werf, Frans. AU - Armstrong, Paul W.. AU - Granger, Christopher B.. PY - 2009/1/15. Y1 - 2009/1/15. N2 - We evaluated the use and outcomes of drug-eluting stents (DESs) and bare metal stents (BMSs) in a large primary percutaneous coronary intervention (PCI) acute ST-elevation myocardial infarction (MI) trial. Recently concerns have been raised with "off-label" use of DESs for short- and long-term clinical outcomes. Limited randomized data exist evaluating DESs versus BMSs in ST-elevation MI. Patients (n = 5,745) in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial were categorized by stent type used. ...
RRH: Rural and Remote Health. Published article number: 2013 - Thrombolysis for acute ST elevation myocardial infarction: a pilot study comparing results from GP led small rural health emergency departments with results from a physician led sub-regional emergency department
Objectives. This study was designed to reassess the prediction of recurrent nonfatal myocardial infarction in patients recovering from acute myocardial infarction after thrombolysis.. Background. Recurrent nonfatal myocardial infarction is a strong and independent predictor of subsequent mortality. Current knowledge of risk factors for nonfatal reinfarction is still largely based on data gathered before the advent of thrombolysis. Thus, this prospective study was planned to identify harbingers of nonfatal reinfarction in the postinfarction patients of the multicenter Gruppo Italiano per lo Studio della Sopravvivenza nellInfarto Miocardico (GISSI-2) trial.. Methods. Predictors of nonfatal reinfarction at 6 months were analyzed by multivariate technique (Cox model) in 8,907 GISSI-2 survivors of myocardial infarction with clinical follow-up, relying on a set of prespecified variables reflecting residual ischemia, left ventricular failure or dysfunction, complex ventricular arrhythmias, comorbidity ...
1. Aronson D, Nassar M, Goldberg T, Kapeliovich M, Hammerman H, Azzam ZS. The impact of body mass index on clinical outcomes after acute myocardial infarction. Int J Cardiol. 2010;145:476-480. doi: 10.1016/j.ijcard.2009.12.029 20096942. 2. Kang WY, Jeong MH, Ahn YK, Kim JH, Chae SC, Kim YJ, et al. Obesity paradox in Korean patients undergoing primary percutaneous coronary intervention in ST-segment elevation myocardial infarction. J Cardiol. 2010;55:84-91. doi: 10.1016/j.jjcc.2009.10.004 20122553. 3. Kragelund C, Hassager C, Hildebrandt P, Torp-Pedersen C, Kober L. Impact of obesity on long-term prognosis following acute myocardial infarction. Int J Cardiol. 2005;98:123-131. 15676176. 4. Lazzeri C, Valente S, Chiostri M, Attana P, Picariello C, Sorini Dini C, et al. Impact of age on the prognostic value of body mass index in ST-elevation myocardial infarction. Nutr Metab Cardiovasc Dis. 2013;23:205-211. doi: 10.1016/j.numecd.2012.05.013 22901842. 5. OBrien EC, Fosbol EL, Peng SA, Alexander KP, ...
|p|The 12-lead surface electrocardiogram adjacent QTc dispersion, which is the maximum difference of corrected QT interval between two adjacent leads, is a simple method to determine regional variation in repolarization and refractoriness. The aim of this study is to evaluate adjacent QTc dispersion as a marker of susceptibility to ventricular arrhythmias after myocardial infarction. A total of 135 consecutive patients with acute myocardial infarction were enrolled in the study. Adjacent QTc, measured by lens magnifier, was calculated on the first, second and third days after acute myocardial infarction. On the second day after acute myocardial infarction, adjacent QTc dispersion was significantly greater in patients with ventricular arrhythmias (P < 0.001). Adjacent QTc dispersion on the first and fifth day after acute myocardial infarction was not associated with development of ventricular arrhythmias. On the second day after acute myocardial infarction, adjacent QTc dispersion is
No beneficial effect of intravenous enalaprilat followed by oral enalapril on mortality when administered within 24 hours post myocardial infarction. It is important to note in this study that follow-up was for 6 months only, possibly missing a late benefit due to ACE inhibitor therapy. The benefit of ACE inhibition appears most prominent for patients with anterior myocardial infarctions. This was a "non-selective" post myocardial infarction study without heart failure or left ventricular dysfunction on entry criterion. In ISIS-4 and GISSI-3, mortality improved by 0.46% and 0.8%, respectively, with risk reductions of 9% and 11%. In view of the risk of hypotension (20% in ISIS-4, compared with placebo 10%), very early ACE inhibition may benefit a highly selected subset of patients.. ...
Objective - The cause of increased post-AMI (acute myocardial infarction) mortality associated with depression remains poorly elucidated. The objective of this study was to examine the extent to which self-reported cardiac functional status accounted for depression-mortality associations following AMI.. Methods - Using a prospective cohort design (n = 1941), the authors obtained self-reported measures of depression and developed profiles of the patients pre-hospitalization cardiac risks, co-morbid conditions and drugs and revascularization procedures during or following index AMI hospitalization. To create these profiles, the patients self-reports were retrospectively linked to no less than 12 years worth of previous hospitalization data. Mortality rates 2 years after acute MI were examined with and without sequential risk adjustment for age, sex, income, cardiovascular risk, co-morbid conditions, selected process-of-care factors and self-reported cardiac functional status.. Results - ...
Whereas thrombus aspiration in patients with ST-elevation myocardial infarction (STEMI) is recommended by current guidelines, there are insufficient data to unequivocally support thrombectomy in patients with non-STEMI (NSTEMI). The Thrombus Aspiration in ThrOmbus containing culpRiT lesions in Non-ST-Elevation Myocardial Infarction (TATORT-NSTEMI) trial is a 400 patient, prospective, controlled, multicenter, randomized, open-label trial. The hypothesis is that under the background of early revascularization, adjunctive thrombectomy in comparison to conventional percutaneous coronary intervention (PCI) alone leads to less microvascular obstruction (MO) assessed by cardiac magnetic resonance imaging (CMR) in patients with NSTEMI. Patients will be randomized in a 1:1 fashion to one of the two treatment arms. The primary endpoint is the extent of MO assessed by CMR. Secondary endpoints include infarct size and myocardial salvage assessed by CMR, enzymatic infarct size as well as angiographic ...
Acute Myocardial infarction (AMI) at a young age (below 45 years) is rare and difficult to predict. We reported a fatal myocardial infarction from advanced atherosclerosis in a healthy young man who had no other major coronary risk factors except mild hypercholesterolemia. Thus, all available systemic risk scores identified him as a low risk candidate for developing a cardiovascular event. Autopsy revealed advanced atherosclerosis in all three major coronary arteries causing acute and old myocardial infarction. Thick epicardial adipose tissue and myocardial bridging of the mid left anterior descending artery were also noted. He frequently used etoricoxib to treat knee and back pain for consecutive five years. Potential mechanisms of sudden death from atherosclerosis, myo- cardial bridging, epicardial adipose tissue and selective COXIB are discussed in more detail below.. ...
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Title:Intracoronary Injection of Glycoprotein IIb/IIIa, Abciximab, as Adjuvant Therapy in Primary Coronary Intervention. VOLUME: 11 ISSUE: 2. Author(s):Andrea Rognoni, Alessadro Lupi, Chiara Cavallino, Roberta Rosso, Alessia Veia, Sara Bacchini and Angelo Sante Bongo. Affiliation:Coronary Care Unit and Catheterization Laboratory, Hospital "Maggiore della Carita", Corso Mazzini 18, 28100 Novara, Italy.. Keywords:STEMI, Acute coronary syndrome, adjuvant therapy, bleeding, GP IIb/IIIa inhibitors, in - stent restenosis, no - reflow phenomenon, percutaneous coronary intervention, platelet, thrombosis.. Abstract:Acute coronary syndromes and, in paticular, ST - segment elevation myocardial infarction are the principle causes or mortality and morbidity in the industrialized countries. The manadgement of acute myocadial infarction is much debated in the literature; primary percutaneous coronary intervention is the treatment of choice. In the recent years there has been an increasing interest in the ...
The objectives are to examine if the excess risk of myocardial infarction from exposure to job strain is due to interaction between high demands and low control and to analyse what role such an interaction has regarding socioeconomic differences in risk of myocardial infarction. The material is a population-based case-referent study having...
Patients with symptoms suggestive of an acute myocardial infarction (MI) and having electrocardiographic evidence of an acute MI manifested by ST elevations (>1 mm in two contiguous leads afterto rule out coronary vasospasm) that is considered to rep
Patients with symptoms suggestive of an acute myocardial infarction (MI) and having electrocardiographic evidence of an acute MI manifested by ST elevations (>1 mm in two contiguous leads afterto rule out coronary vasospasm) that is considered to rep
Background. Acute myocardial infarction is a major cause of death and morbidity worldwide, both in women and in men. Up to the age of 70 the incidence of acute myocardial infarction is higher in men than in women. Although the incidence is lower in young women than in young men, young women are particularly vulnerable due to higher fatality rates. The lower incidence in women compared to men might underestimate womens risk. Women might also be less likely to identify themselves as possible sufferers and to take cardio-protective actions.. The treatment of acute myocardial infarction has changed dramatically the last decades and reperfusion therapy has great impact on myocardial damage. The most critical time of an acute myocardial infarction is the very early phase, as rapid treatment is significantly associated with reduced mortality. Time has therefore become an important issue regarding the patients prognosis. These patients often delay in seeking medical assistance, and this "patient ...
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SUMMARY A seasonal pattern with winter peak in acute myocardial infarction incidence and cardiovascular disease risk factors is observed in studies worldwide. However, several previous studies have methodical limitations and few are performed in cold climate areas. The aim of this thesis is to assess the effect of season and meteorological factors on first-ever myocardial infarction and the seasonal variation in cardiovascular disease risk factors in a subarctic adult population with long-term follow-up, using appropriate methods with adjudicated outcomes and well-defined exposures. The population-based Tromsø Study consists of more than 40,000 individuals living in a subarctic climate in Northern Norway. The cohort members have been examined up to nine times in six repeated health surveys in the years between 1974 and 2008. Data on myocardial infarction and risk factors have been collected throughout follow-up. The thesis consists of three studies. The first study is an analysis of the ...
OBJECTIVE--The SAVE study showed that captopril improves mortality in patients with left ventricular dysfunction after myocardial infarction and that this benefit occurred even in patients with no clinically overt heart failure. On the basis of this, it seems important to identify correctly which patients have left ventricular dysfunction after a myocardial infarction. The objective was to compare various methods of identifying patients with left ventricular dysfunction (left ventricular ejection fraction, LVEF, , or = 40%) after acute myocardial infarction. The methods compared were echocardiography (quantitative and qualitative visual assessment), clinical evaluation (subjective assessment and three clinical score methods), and measurement of plasma concentrations of cardiac natriuretic peptide hormones (atrial and brain natriuretic peptides, ANP and BNP). DESIGN--Cross sectional study of left ventricular function in patients two to eight days after acute myocardial infarction. ...
Background and Objectives: Metabolic syndrome (MetS) is an important risk factor for cardiovascular disease. However, the clinical outcome of acute myocardial infarction (AMI) with MetS has not been well examined. The purpose of this study was to evaluate the clinical outcomes of AMI patients with MetS. Subjects and Methods: We evaluated a total of 6352 AMI patients who had successful percutaneous coronary interventions and could be identified for MetS between 2005 and 2008 at 51 hospitals participating in the Korea Acute Myocardial Infarction Registry. They were divided into 2 groups according to the presence of MetS: the MetS group (n=2493, 39.2%) versus the Non-MetS group (n=3859, 60.8%). In addition, 4049 AMI patients with high levels of low density lipoprotein-cholesterol (LDL-C) (��100 mg/dL) among them, were divided into the MetS group (n=1561, 38.6%) versus the Non-MetS group (n=2488, 61.4%). Results: In the overall population, there was no significant difference in 12-month the ...
The HELP-AMI (Hepacoat for Culprit or Multivessel Stenting for Acute Myocardial Infarction) trial randomized 69 patients in a 3:1 ratio to MV or CVO primary PCI (17). There was a nonsignificant reduction in repeat revascularization with MV primary PCI (17% vs. 35%), but no differences in death or reinfarction rates.. Politi et al. (18) randomized 214 patients to CVO primary PCI, MV primary PCI, or staged PCI. Again, repeat revascularization rates were lower with MV primary PCI, but there were no differences in death or reinfarction rates.. The PRAMI (Preventive Angioplasty in Acute Myocardial Infarction) trial screened 1,922 patients and enrolled 465 patients at 5 sites over 5 years (16). Recruitment was stopped prematurely by the data safety and monitoring board with a mean follow-up of 23 months due to significant differences between groups. The sample size was on the basis of an expected annual MACE rate of 20% for CVO primary PCI and a 30% risk reduction for MV primary PCI at 80% power. ...
TY - JOUR. T1 - Echocardiography in acute myocardial infarction. AU - Corya, Betty C.. AU - Rasmussen, Susan. AU - Knoebel, Suzanne B.. AU - Feigenbaum, Harvey. PY - 1975/7. Y1 - 1975/7. N2 - Sixty-four patients with acute transmural myocardial infarction had daily echocardiograms while in the coronary care unit. Patients with previous infarction were excluded. The electrocardlographic site of infarction was anterior wall in 28, inferior wall in 33 and both anterior and inferior wall in 3 patients. Echocardiograms satisfactory for Interpretation were obtained in 92 percent of cases. Abnormal left ventricular wall motion corresponding to the electrocardiographic site of infarction was seen in the echocardiogram in 84 percent of cases. Exaggerated normal motion in noninfarcted areas was seen in 30 percent. The left ventricular internal dimension correlated with clinical heart failure (P , 0.005) and was increased in 50 percent. Abnormal mitral valve closure, which reflects increased left ...
Chest pain is a symptom of illnesses of different organs (heart, lung, stomach and intestines, muscles, and skeleton) or of psychiatric disorders, all of which require specific treatment. Due to the high mortality and morbidity of coronary disease, in the event of chest pain, a GP will always consider the possibility of an acute myocardial infarction or unstable angina. Moreover, fast treatment - such as thrombolysis, percutaneous coronary intervention, or coronary artery bypass graft - can be life-saving and increase the patients life expectancy and quality of life.1. The annual incidence of acute myocardial infarction for persons aged 30-69 years is estimated by the British Heart Foundation at 0.6% for men and at 0.1% for women.2 In Belgium the figures are comparable: in the 45-75-year-old age group Bartholomeeussen et al3 found a yearly incidence of acute myocardial infarction of 0.55% for men and 0.19% for women. The incidence of severe heart disease in people complaining of chest pain is ...
Background: Myocardial infarction with non-obstructive coronary arteries is a working diagnosis for several heart disorders. Previous studies on anxiety and depression in patients with myocardial infarction with non-obstructive coronary arteries are lacking. Our aim was to investigate the prevalence of anxiety and depression among patients with myocardial infarction with non-obstructive coronary arteries. Methods: We included 99 patients with myocardial infarction with non-obstructive coronary arteries together with age- and sex-matched control groups who completed the Beck Depression Inventory and the Hospital Anxiety and Depression Scale (HADS) 3 months after the acute event. Results: Using the Beck Depression Inventory, we found that the prevalence of depression in patients with myocardial infarction with non-obstructive coronary arteries (35%) was higher than in healthy controls (9%; P =.006) and similar to that of patients with coronary heart disease (30%; P =.954). Using the HADS anxiety ...
Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
In 680 patients with acute myocardial infarction the prognosis during the following 5 years was related to observations made in a standard electrocardiogram (ECG) and 24 precordial chest leads. Patients with a Q-wave infarction (based on a 12-lead standard ECG) had a mortality rate during hospitalization of 10.2% which was much higher than that in patients with a non-Q-wave infarction (1.9%, p less than 0.001). At 5 years follow-up 33.6% of those with a Q-wave infarction had died versus 28.4% of those with a non-Q-wave infarction (p greater than 0.2). Corresponding mortality rate among patients with no previous infarction (n = 587) was 32.1% and 25.2%, respectively (p = 0.17). In patients with anterior infarction and no previous infarction there was no correlation between Q- and R-wave changes in the 24 chest leads 4 days after admission to hospital and 5-year mortality rate. We thus conclude that patients with a Q-wave infarction had a higher in-hospital mortality compared with non-Q-wave ...
Nanog is a potential stem cell marker and is considered a regeneration factor during tissue repair. In the present study, we investigated expression patterns of nanog in the rat heart after acute myocardial infarction by semi-quantitative RT-PCR, immunohistochemistry and Western blot analyses. Our results show that nanog at both mRNA and protein levels is positively expressed in myocardial cells, fibroblasts and small round cells in different myocardial zones at different stages after myocardial infarction, showing a spatio-temporal and dynamic change. After myocardial infarction, the nanog expression in fibroblasts and small round cells in the infarcted zone (IZ) is much stronger than that in the margin zone (MZ) and remote infarcted zone (RIZ). From day 7 after myocardial infarction, the fibroblasts and small cells strongly expressed nanog protein in the IZ, and a few myocardial cells in the MZ and the RIZ and the numbers of nanog-positive fibroblasts and small cells reached the highest peak at 21
title: Clinical impact of thrombus aspiration during primary percutaneous coronary intervention: Results from Korea Acute Myocardial Infarction Registry, doi: 22341434, category: Article
European Society of Cardiology (ESC) Guidelines on the management of acute myocardial infarction in patients with ST-segment elevation have been published and announced during the recent ESC Congress which took place in Barcelona.. The document provides recommendations on topics not covered by the 2012 Guidelines and changes some previous recommendations following new evidence.. For the first time there is a clear definition of when to start the clock for the 90 minute target to treat patients with percutaneous coronary intervention (PCI). The clock should start at the time of ST-segment elevation myocardial infarction (STEMI) diagnosis by electrocardiogram (ECG).. "Until now there was confusion over whether the clock starts when the patient has the first symptoms, when he or she calls the emergency services, when the ambulance arrives on the scene, or when the patient arrives at the hospital," said Task Force Chairperson Prof Stefan James (Sweden). "We dont know if the patient is suffering ...
Coronary flow reserve (CFR) in the non-infarcted myocardium is often impaired following acute myocardial infarction (AMI). However, the clinical significance of CFR in the non-infarcted myocardium is not fully understood. The objective of the present
OBJECTIVES: We sought to directly compare primary stenting with accelerated tissue plasminogen activator (t-PA) in patients presenting with acute ST-elevation myocardial infarction (AMI). BACKGROUND: Thrombolysis remains the standard therapy for AMI.
Background In ST-elevation myocardial infarction, primary percutaneous coronary intervention (PCI) has a superior clinical outcome, but it may increase costs in comparison to thrombolysis. The aim of the study was to compare costs, clinical outcome, and quality-adjusted survival between primary PCI and thrombolysis. Methods Patients with ST-elevation myocardial infarction were randomized to primary PCI with adjunctive enoxaparin and abciximab (n = 101), or to enoxaparin followed by reteplase (n = 104). Data on the use of health care resources, work loss, and health-related quality of life were collected during a 1-year period. Cost-effectiveness was determined by comparing costs and quality-adjusted survival. The joint distribution of incremental costs and quality-adjusted survival was analyzed using a nonparametric bootstrap approach. Results Clinical outcome did not differ significantly between the groups. Compared with the group treated with thrombolysis, the cost of interventions was higher ...
TY - JOUR. T1 - Renal impairment predicts long-term mortality risk after acute myocardial infarction. AU - Smith, Grace L.. AU - Masoudi, Frederick A.. AU - Shlipak, Michael G.. AU - Krumholz, Harlan M.. AU - Parikh, Chirag R.. PY - 2008/1/1. Y1 - 2008/1/1. N2 - Renal function predicts mortality after acute myocardial infarction (AMI), but it is unknown whether the prognostic importance of renal function persists over time. This study examined how the association between renal function and mortality changed in the 10 yr after AMI in a cohort of patients. In 118,753 patients (age ≥65 yr) from the Cooperative Cardiovascular Project, mean Cockcroft-Gault creatinine clearance was 55 ± 24 ml/min and estimated GFR was 57 ± 21 ml/min per 1.73 m2 at baseline. By 10 yr, 68% of patients had died. Compared with normal renal function, even mild renal impairment increased the 10-yr risk for mortality risk by 10%. Severe renal impairment more than doubled the risk for mortality at 1 yr, and this increased ...
We mapped a gene predisposing to myocardial infarction to a locus on chromosome 13q12-13. A four-marker single-nucleotide polymorphism (SNP) haplotype in this locus spanning the gene ALOX5AP encoding 5-lipoxygenase activating protein (FLAP) is associated with a two times greater risk of myocardial infarction in Iceland. This haplotype also confers almost two times greater risk of stroke. Another ALOX5AP haplotype is associated with myocardial infarction in individuals from the UK. Stimulated neutrophils from individuals with myocardial infarction produce more leukotriene B4, a key product in the 5-lipoxygenase pathway, than do neutrophils from controls, and this difference is largely attributed to cells from males who carry the at-risk haplotype. We conclude that variants of ALOX5AP are involved in the pathogenesis of both myocardial infarction and stroke by increasing leukotriene production and inflammation in the arterial wall ...
We performed a fixed stratum, case crossover analysis.15 A case crossover study can be thought of as a type of self matched, case control study: for each individual, exposure data are collected for the "case" day (that is, the day of the myocardial infarction) and a set of "control" days that were not associated with the event of interest. In the fixed stratum design, externally fixed time strata are used as the source of control days, a feature which ensures the validity of standard analytical methods.16 In our study the fixed strata were calendar months, and the control days comprised every other day in the calendar month of the myocardial infarction. Exposure and confounder data were obtained at the hour of the myocardial infarction event for both case and control days; matching case and control data on time of day in this way avoids confounding due to any natural circadian patterns in myocardial infarction risk. Conditional logistic regression was then used to compare exposure data on case ...
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Importance of ST-Segment Monitoring Post- Acute Myocardial Infarction When reviewing a chest pain case that has resulted in a diagnosis of Acute Myocardial Infarction it is important to ascertain if the patients ST-segment was monitored post intervention. The following are the indications for ST-Segment monitoring post-Acute Myocardial Infarction: Evaluating post-MI ischemia Evaluating reocclusion after angioplasty […]. ...
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OBJECTIVES: Early detection of microvascular dysfunction after acute myocardial infarction (AMI) could identify patients at high risk of adverse clinical outcome, who may benefit from adjunctive treatment. Our objective was to compare invasively measured coronary flow reserve (CFR) and hyperaemic microvascular resistance (HMR) for their predictive power of long-term clinical outcome and cardiac magnetic resonance (CMR)-defined microvascular injury (MVI). METHODS: Simultaneous intracoronary Doppler flow velocity and pressure measurements acquired immediately after revascularisation for AMI from five centres were pooled. Clinical follow-up was completed for 176 patients (mean age 60±10 years; 140(80%) male; ST-elevation myocardial infarction (STEMI) 130(74%) and non-ST-segment elevation myocardial infarction 46(26%)) with median follow-up time of 3.2 years. In 110 patients with STEMI, additional CMR was performed. RESULTS: The composite end point of death and hospitalisation for heart failure occurred in
BACKGROUND: Physicians current attitudes and practices toward the management of high cholesterol levels in patients with recent acute myocardial infarction are not well defined. OBJECTIVE: To examine threshold levels of serum cholesterol and other factors that influence physicians decision to prescribe lipid-lowering drugs and initiate dietary therapy in patients with recent acute myocardial infarction. METHODS: Community-wide questionnaire survey of general internists, cardiologists, and family physicians practicing in the Worcester, Mass, metropolitan area. RESULTS: Among the 257 responding physicians, lipid-lowering drug therapy was more likely to be initiated in younger patients at lower total serum and low-density lipoprotein (LDL) cholesterol levels than in older patients (P =.03). Younger physicians were more likely to initiate dietary and lipid-lowering drug therapy at lower total and LDL cholesterol levels than their older counterparts. Younger physicians also considered LDL cholesterol level
Background: Primary percutaneous coronary intervention (PPCI) has been performed traditionally by using femoral approach. Transradial approach has become increasingly popular as it is likely to be less complicating, more comfortable and relatively cost effective having mortality and morbidity benefits. The aim of the study was to compare the in-hospital outcomes of transradial PPCI with that of transfemoral route.. Methods: A total of 80 patients with ST elevation myocardial infarction (STEMI) who underwent PPCI were enrolled in the study. Patients were divided in two groups. Group-I: transradial PPCI; and Group-II: transfemoral PPCI. All patients were followed up during the period of hospital stay and adverse outcomes were observed and compared between the groups.. Results: The result showed that bleeding took place in 2.5% patient of Group-I and 15% patients of Group- II. Vascular complications occurred in 2.5% and 12.5% patients of Group-I and Group-II, respectively. In Group-II, 7.5% ...
Abstract. Background: Little is known about the relation of the dietary intake of n-3 polyunsaturated fatty acids, ie, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) from fatty fish and a-linolenic acid from vegetable oils, with ischemic heart disease among older adults. Objective: We investigated the associations of plasma phospholipid concentrations of DHA, EPA, and a-linolenic acid as biomarkers of intake with the risk of incident fatal ischemic heart disease and incident nonfatal myocardial infarction in older adults. Design: We conducted a case-control study nested in the Cardiovascular Health Study, a cohort study of adults aged = 65 y. Cases experienced incident fatal myocardial infarction and other ischemic heart disease death (n = 54) and incident nonfatal myocardial infarction (n = 125). Matched controls were randomly selected (n = 179). We measured plasma phospholipid concentrations of n-3 polyunsaturated fatty acids in blood samples drawn ˜2 y before the event. Results: ...
Symptoms and pre-hospital delay times in relation to infarct related artery (IRA) in ST-elevation myocardial infarction (STEMI) patients - a survey report from the SymTime study group ...
Younger women hospitalized with an acute myocardial infarction (MI) have a poorer prognosis than men. Whether this is true for patients with acute ST-segment elevation MI (STEMI) and non-STEMI (NSTEMI) is not extensively studied. Using the MarketScan 2004 to 2007 Commercial and Medicare supplemental admission databases, we assessed gender differences in in-hospital mortality according to age in 91,088 patients (35,899 with STEMI, 55,189 with NSTEMI) who were 18 to 89 years old and had acute MI as their primary diagnosis. Patients with STEMI had significantly higher in-hospital mortality than those with NSTEMI (4.35% vs 3.53%, p ,0.0001). Compared to men women were older, had higher co-morbidity scores, and were less likely to undergo revascularization during hospitalization in the STEMI and NSTEMI populations. In patients with STEMI the unadjusted women-to-men odds ratio for in-hospital mortality was 2.29 (95% confidence interval 1.48 to 3.55) for the 18- to 49-year age group, 1.68 (1.28 to ...
Background The TASTE trial did not demonstrate clinical benefit of thrombus aspiration (TA). High-risk patients might benefit from TA. Methods The TASTE trial was a multicenter, randomized, controlled, open-label trial obtaining end points from national registries. Patients (n = 7,244) with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) were randomly assigned 1: 1 to TA and PCI or to PCI alone. We assessed the 1-year clinical effect of TA in a subgroup with potentially large anterior STEMI: mid or proximal left anterior descending coronary artery infarct lesion, thrombolysis in myocardial infarction 0 to 2 flow, and symptom onset to PCI time = 5 hours. In this substudy, patient eligibility criteria corresponded to that of the INFUSE-AMI study. Results In total, 1,826 patients fulfilled inclusion criteria. All-cause mortality at 1 year of patients randomized to TA did not differ from those randomized to PCI only (hazard ratio [HR] 1.05, 95% ...
Objective: SCUBE1 [signal peptide-CUB (complement C1r/C1 s)-EGF (epidermal growth factor)-like domain-containing protein 1] might function as a novel platelet-endothelial adhesion molecule and play pathological roles in cardiovascular biology. Acute myocardial infarction is one of the most common causes of death in modern society. The concept of no reflow (NR) refers to a state of myocardial tissue hypoperfusion in the presence of a patent epicardial coronary artery. The main mechanisms of this phenomenon are thought to be high platelet activity and much thrombus burden. So, we researched the role of SCUBE1 in the pathogenesis of NR ...
Looking for cardiac infarction? Find out information about cardiac infarction. blockage of blood circulation to a localized area or organ of the body resulting in tissue death. Infarctions commonly occur in the spleen spleen, soft,... Explanation of cardiac infarction
Background: In patients with acute myocardial infarction (MI), BMI , 18.5 kg/m2 and a decrease in BMI during follow-up have been associated with poor prognosis. For BMI ≥ 25 kg/m2, an "obesity paradox" has been suggested. Recently, high visit-to-visit BMI variability has also been associated with poor prognosis in patients with coronary artery disease. Aims: To simultaneously evaluate several BMI measurements and study their association with cardiovascular (CV) outcomes in a large cohort of patients with acute myocardial infarction (MI) and left ventricular (LV) systolic dysfunction, heart failure (HF) or both. Methods: The high-risk MI dataset is pooled from four trials: CAPRICORN, EPHESUS, OPTIMAAL and VALIANT. Mean BMI, change from baseline, and variability were assessed during follow-up. The primary outcome was CV death. Cox-proportional hazard models were performed to study the association between the various BMI parameters and outcomes (median follow-up = 1.8 years). Results: A total of ...
After myocardial infarction (MI) 15-20% of the patients experience symptoms of depression. Furthermore, depression has been shown to be a risk factor for the development of myocardial infarction (MI). Inflammatory cytokines like tumor necrosis factor alpha (TNF-α) are a possible underlying mechanisms for this connection. TNF-α is elevated in patients suffering MI and the same holds true for patients with depression. TNF-α can activate two receptors, one of which leads to apoptosis and inflammation (TNF-R1), with the other leading to cellular survival (TNF-R2).We conducted this experiment to uncover if selective TNF-α interference is superior to non-selective TNF-α inhibition in diminishing depression and neuroinflammation after myocardial infarction. Mice underwent either sham surgery or the induction of MI. The MI groups were given either saline solution, Enbrel (a TNF-α blocker), a R1 antagonist or a R2 agonist. We used the effect of Enbrel as a baseline where TNF-α has no influence. ...
BACKGROUND: A previous study has shown an increased prevalence of late gadolinium enhancement cardiovascular magnetic resonance (LGE CMR) detected unrecognized myocardial infarction (UMI) with increasing extent and severity of coronary artery disease. However, the coronary artery disease was evaluated on a patient level assuming normal coronary anatomy. Therefore, the aims of the present study were to investigate the prevalence of UMI identified by LGE CMR imaging in patients with stable angina pectoris and no known previous myocardial infarction; and to investigate whether presence of UMI is associated with stenotic lesions in the coronary artery supplying the segment of the myocardium in which the UMI is located, using coronary angiography to determine the individual coronary anatomy in each patient.. METHODS: In this prospective multicenter study, we included patients with stable angina pectoris and without prior myocardial infarction, scheduled for coronary angiography. A LGE CMR examination ...
Response to comment on: n-3 fatty acids, ventricular arrthmia-related events, and fatal myocardial infarction in postmyocardial infarction patients with diabetes ...
Main / New Prescription / Clopidogrel post mi nice NICE have issued guidance as to the use of antiplatelet agents post myocardial infarction (1). aspirin should be offered to all people after an MI and continue it indefinitely, unless they are aspirin intolerant or have an indication for anticoagulation; aspirin should be offered to people who have had an MI more than Cardiac rehabilitation after an acute myocardial infarction (MI); Lifestyle changes after an MI; Drug therapy; Coronary revascularisation after an MI; Selected .. For patients with aspirin hypersensitivity, clopidogrel monotherapy should be considered as an alternative treatment.. The combination of appetite and clopidogrel is not recommended for certain use for any longer than 12 hours clopidogrel post mi nice the acute phase of myocardial infarction (MI), unless there are other opioids to continue dual antiplatelet medication, and the combination is clopidogrel post mi nice recommended for a shorter duration after an. Does ...
An increasing prevalence of having survived a myocardial infarction increases the importance of medical secondary prevention. Although preventive medication reduces mortality, prescribing and adherence are known to be frequently insufficient. General practitioners are the most important prescriber. However, their perspective on prescribing and medical non-adherence following myocardial infarction has not yet been explored. Thus, the aim of this study was to explore the general practitioners perspective on long-term care after myocardial infarction focussing on medical prevention. In this qualitative interview study we conducted episodic interviews with sixteen general practitioners from rural and urban surgeries in Germany. Framework analysis with focus on general practitioners prescribing and patients non-adherence was performed. Almost all general practitioners reported following guidelines for myocardial infarction aftercare and prescribing the medication that was initiated in the hospital;
BACKGROUND: In a push to treat ST-elevation myocardial infarction (STEMI) patients with primary percutaneous coronary intervention (PCI) within 90 min of door-to-balloon time, emergency cardiac catheterization laboratory activation protocols bypass routine clinical assessments, raising the possibility of more frequent catheterizations in patients with no culprit coronary lesion. OBJECTIVE: To determine the incidence, predictors, and prognosis of false-positive STEMI. METHODS: We followed a prospective cohort of patients diagnosed with STEMI by usual criteria receiving emergency cardiac catheterization with intention of primary PCI between January 2005 and December 2007 at a tertiary care center. False-positive STEMI was defined as absence of a clear culprit lesion on coronary angiography. RESULTS: Of 489 patients who received emergency cardiac catheterization indicated for STEMI, 54 (11.0%, 95% confidence interval [CI] 8.3-13.8) had no culprit lesion on coronary angiography. Independent predictors of
Evaluation of the degree of myocardial injury as a result of myocardial necrosis in the acute phase of ST-segment elevation myocardial infarction (STEMI) may be of clinical importance to guide further revascularisation and add important diagnostic and prognostic information in these patients. Left ventricular ejection fraction (LVEF) measured by echocardiography during initial hospitalisation is a well-established marker of LV global function and predicts short- and long-term morbidity and mortality in patients with acute myocardial infarction. However, the measurement of LVEF presents a number of challenges related to image quality, assumptions of LV geometry and high observer variability. Measurement of myocardial deformation by strain has emerged as a promising tool to evaluate regional and global function. The aim of this thesis in clinical cardiology was to investigate the ability of strain to predict myocardial necrosis, LV function and clinical cardiac outcome in patients with acute ...
Background-This study investigates the hypothesis that morphologic analysis of intracardiac electrograms provides a sensitive approach to detect acute myocardial infarction or myocardial infarction-induced arrhythmia susceptibility. Large proportions of irreversible myocardial injury and fatal ventricular tachyarrhythmias occur in the first hour after coronary occlusion; therefore, early detection of acute myocardial infarction may improve clinical outcomes. Methods and Results-We developed a method that uses the wavelet transform to delineate electrocardiographic signals, and we have devised an index to quantify the ischemia-induced changes in these signals. We recorded body-surface and intracardiac electrograms at baseline and following myocardial infarction in 24 swine. Statistically significant ischemia-induced changes after the initiation of occlusion compared with baseline were detectable within 30 seconds in intracardiac left ventricle (P,0.0016) and right ventricle-coronary sinus ...
References:. 1. Rawles JM, Kenmure AC. Controlled trial of oxygen in uncomplicated myocardial infarction. Br Med J. 1976;1(6018):1121-3. [PMC free article] [PubMed]. 2. Ranchord AM, Argyle R, Beynon R, et al. High-concentration versus titrated oxygen therapy in ST-elevation myocardial infarction: a pilot randomized controlled trial. Am Heart J. 2012;163(2):168-75.[PubMed]. 3. OConnor RE, Bossaert L, Arntz HR, et al. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2010;122:S422-65. [PubMed]. 4. Cabello JB, Burls A, Emparanza JI, et al. Oxygen therapy for acute myocardial infarction. Cochrane Database Syst Rev. 2010;(6):CD007160. [PubMed]. 5. Stub D, Smith K, Bernard S, et al. Air Versus Oxygen in ST-Segment Elevation Myocardial Infarction. Circulation. 2015 [PubMed]. 6. Hofmann R, James SK, Svensson L, et al. Determination of the role of oxygen in suspected acute ...
Extracted from text ... 45 The Valsartan in Acute Myocardial Infarction (VALIANT) study results, announced last week at the American Heart Association Meeting, confirmed the value of using valsartan (Diovan(r)) in early post-MI heart failure or left ventricular dysfunction, while also adding additional pharmacological insights into this acute cardiac condition.1, 2 The VALIANT trial that started in 2000 compared the effects of the angiotensin receptor blocker valsartan, the ACE inhibitor captopril, and the combination of valsartan and captopril, in a population of high-risk patients with clinical or radiological evidence of heart failure, evidence of left ventricular systolic dysfunction, or both, after acute myocardial infarction. ..
Patients with type 2 diabetes are at high risk of fatal and non-fatal myocardial infarction and stroke. There is indirect evidence that agonists of peroxisome proliferator-activated receptor gamma (PPAR gamma) could reduce macrovascular complications. Our aim, therefore, was to ascertain whether pioglitazone reduces macrovascular morbidity and mortality in high-risk patients with type 2 diabetes. We did a prospective, randomised controlled trial in 5238 patients with type 2 diabetes who had evidence of macrovascular disease. We recruited patients from primary-care practices and hospitals. We assigned patients to oral pioglitazone titrated from 15 mg to 45 mg (n=2605) or matching placebo (n=2633), to be taken in addition to their glucose-lowering drugs and other medications. Our primary endpoint was the composite of all-cause mortality, non fatal myocardial infarction (including silent myocardial infarction), stroke, acute coronary syndrome, endovascular or surgical intervention in the coronary ...
The Thrombolysis in Myocardial Infarction (TIMI) Score is used to determine the likelihood of ischemic events or mortality in patients with unstable angina or non-ST-segment elevation myocardial infarction (NSTEMI). Each of the following criteria constitutes one point for TIMI scoring (see Table 1): Age ≥65 years Three or more risk factors ...
Among patients with recent acute myocardial infarction, the implementation of an integrated, multifactorial, and comprehensive cardiac rehabilitation program nonsignificantly reduces major adverse cardiac events over 3 years of follow-up compared with usual care. All individual adverse outcomes were nonsignificantly lower with cardiac rehabilitation; however, myocardial infarction was significantly reduced by this approach. While physical activity and dietary habits were improved at 3 years with cardiac rehabilitation, most risk factors (low-density lipoprotein cholesterol, body mass index, and glycated hemoglobin) were fairly similar between the groups. The rate of smoking discontinuation was slightly greater with cardiac rehabilitation at the extent of follow-up ...
Myocardial infarction complications may occur immediately following a heart attack (in the acute phase), or may need time to develop (a chronic problem). After an infarction, an obvious complication is a second infarction, which may occur in the domain of another atherosclerotic coronary artery, or in the same zone if there are any live cells left in the infarct. A myocardial infarction may compromise the function of the heart as a pump for the circulation, a state called heart failure. There are different types of heart failure; left- or right-sided (or bilateral) heart failure may occur depending on the affected part of the heart, and it is a low-output type of failure. If one of the heart valves is affected, this may cause dysfunction, such as mitral regurgitation in the case of left-sided coronary occlusion that disrupts the blood supply of the papillary muscles. The incidence of heart failure is particularly high in patients with diabetes and requires special management strategies. ...
The results from randomized trials indicate that outcomes are better when patients with ST-segment elevation myocardial infarction (STEMI) who present to non-PCI hospitals are transferred to a PCI facility for primary PCI compared with being given fibrinolytic therapy at the local hospital. Current guidelines recommend the door-to-balloon (D2B) time be ≤90 minutes for patients presenting to a PCI facility and ≤120 minutes for patients transferred from a non-PCI facility. Currently, guidelines recommend that patients with cardiogenic shock, patients who are ineligible for fibrinolytic therapy, and patients who can be treated within 120 minutes be transferred for primary PCI. ...
Evidence over the recent decades indicates that susceptibility to cardiovascular disease (CVD) may be established already prenatally and in early childhood, and that the aetiological processes of the disease involve biological and social influences occurring throughout a persons life span. Numerous studies have shown that small size at birth is associated with increased risk of CVD later in life. This finding is suggested to reflect the influence of poor foetal nutrition on the bodys organ structure, physiology and metabolism. Surprisingly, there is little empirical evidence available to support the proposed causal mechanisms. The aim of this thesis is to study the mechanisms under-lying the inverse association of size at birth with CVD.. Three studies in the thesis are based on Uppsala Birth Cohort Study (UBCoS), a prospective cohort study which includes men and women, who were born at the Uppsala Academic Hospital between 1915 and 1929. Information from birth records, school catalogues, ...
Improving patient survival is the ultimate goal after acute myocardial infarction. Although thrombolytics, aspirin, and beta-blockers have greatly decreased mortality, structural changes such as ventricular dilatation evolving within the myocardium during and after acute myocardial infarction indicate a poor prognosis. The Survival and Ventricular Enlargement trial demonstrated that when administered 3 to 16 days after acute myocardial infarction in selected patients, captopril, the angiotensin-converting enzyme inhibitor, reduces ventricular dilatation, prevents the development of congestive heart failure, and reduces morbidity and mortality. This paper reviews results of that trial and presents guidelines for effective captopril dosage after acute myocardial infarction. ...
Coronary artery disease is the single largest cause of mortality worldwide, with myocardial infarction being the most serious manifestation. Timely and effective myocardial reperfusion using primary PCI in acute ST elevation myocardial infarction (STEMI) has substantially improved clinical outcomes of patients. Following reopening of the blocked artery, reperfusion itself can cause myocardial injury and cell death (myocardial ischaemia/reperfusion injury). Studies in animal MI models and human therapeutic interventions indicate that ischemia/reperfusion injury is responsible for up to 50% of final infarct size. While CD4 T-lymphocytes (T-cells) have been shown to promote myocardial ischemia/reperfusion injury in the mouse model, their role during STEMI in humans is by large unknown. A low number of lymphocytes following myocardial infarction is a negative predictor of survival, and we have previously shown (PLoS One 2012) that CD4 and CD8 T-cells drop by up to 50% in the peripheral blood during ...
SCVS 2018 Abstracts: Statins Reduce Mortality And Failure To Rescue after Myocardial Infarction Following Aortobifemoral Bypass In Aortoiliac Occlusive Disease Patients
A 78-year-old woman was referred to our emergency department due to inferior myocardial infarction. Previous coronary computed tomography angiogram had detected an expanded right coronary artery (RCA) possibly due to aneurysmal changes after Kawasaki disease (Figs. 1A and 1B). Emergent coronary angiogram revealed total occlusion of the proximal RCA, and subsequent percutaneous coronary intervention was performed. Intravascular ultrasound imaging showed a very large caliber of the RCA laden with thrombus. Thrombectomy, thrombolysis, and plain old balloon angioplasty were performed aggressively; however, only TIMI (Thrombolysis In Myocardial Infarction) flow grade 1 was achieved (Fig. 2, Online Videos 1 and 2). Despite the continuation of medical therapy, including aspirin and warfarin, 1.5-year follow-up coronary computed tomography angiogram showed reocclusion of the RCA. Online Videos 1 and 2 show the RCA angiogram before and after the interventional procedures. ...
The presence of no-reflow in patients with acute myocardial infarction has been found to be a predictor of adverse events, with higher incidence of left ventricular (LV) remodelling, congestive heart failure, and death. An initial study by Wu et al. (n. 44; follow-up 16 months) demonstrated that patients with MVO had more cardiovascular events (45% versus 9%, P 0.016) independently of the total infarct size (6). Since then, several studies have succeeded in demonstrating such a correlation. A larger study by Hombach et al. (20) found that infarct size, MVO, LV end-diastolic volume, and EF predicted major adverse cardiac events (MACE), with MVO being the strongest predictor (13.2% more events). Cochet et al (21) showed that MVO and the Global Registry of Acute Coronary Events (GRACE) score were significant predictors of MACE (odds ratio [OR], 8.7; CI, 3.6 to 21.1; P,0.001; OR, 2.8; CI, 1.3 to 6; P,0.01, respectively). Nijveldt et al. (22) examined the relation between angiographic, ...
OBJECTIVE: We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-hospital administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM.. BACKGROUND: DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population.. METHODS: In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested.. RESULTS: A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (≥70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P , 0.01) and ...
Introduction: Although percutaneous coronary intervention is an accepted first-line therapy in acute ST elevation myocardial infarction (STEMI) in general population, few data are available on the short- and long-term outcomes of very old patients (age >90 years). Our aim is to evaluate and compare the short and long-term outcomes after primary percutaneous coronary intervention (PPCI) or medical therapy in nonagenarian patients with STEMI. Methods: We retrospectively identified patients older than 90 years old in our clinic, with acute STEMI who presented within 12 hours after symptoms onset, either underwent PPCI or medically treated. In hospital events and long-term results analyzed subsequently. Results: From January 2005 to December 2014, 73 patients with STEMI either underwent PPCI (PPCI group n = 42) or had only medical treatment (Non-PPCI group n = 31). Mean age was 92.4 ± 3.1 (90-106). Patients were followed 26.5 ± 20.1 months. Recurrent myocardial infarction during hospitalization
There are currently many kinds of drugs for heart failure. Among them, the new drug LCZ696 is recommended by US guidelines as a first-line treatment for chronic heart failure. LCZ696 is better than conventional drugs at reducing cardiac death and hospitalization due to heart failure. Now, researchers from Kumamoto University in Japan have revealed that LCZ696 can prevent cardiac rupture and heart failure following acute myocardial infarction which is one of the causes of chronic heart failure.. In the past, angiotensin converting enzyme inhibitors (ACE inhibitors) or Angiotensin II Receptor Blockers (ARBs) were used in combination with other drugs as the initial therapy for heart failure and acute myocardial infarction. ACE inhibitors and ARBs both inhibit the system responsible for regulating blood pressure, the Renin-Angiotensin-Aldosterone System (RAAS), which causes high blood pressure when it becomes overactive.. ...
Infectious Disease News | Patients with respiratory infections, particularly influenza, have an increased risk for acute myocardial infarction, according to a study published in The New England Journal of Medicine.“Our findings are important because an association between influenza and acute myocardial infarction (MI) reinforces the importance of vaccination,” Jeffrey C. Kwong, MD, a scientist at the Institute
Acute myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Myocardial infarction occurs when myocardial ischemia, a diminished blood supply to the heart, exceeds a critical threshold and overwhelms myocardial cellular repair mechanisms designed to maintain normal operating function and homeostasis. Ischemia at this critical threshold level for an extended period results in irreversible myocardial cell damage or death.. Critical myocardial ischemia can occur as a result of increased myocardial metabolic demand, decreased delivery of oxygen and nutrients to the myocardium via the coronary circulation, or both. An interruption in the supply of myocardial oxygen and nutrients occurs when a thrombus is superimposed on an ulcerated or unstable atherosclerotic plaque and results in coronary occlusion.1 A high-grade (,75%) fixed coronary artery stenosis caused by atherosclerosis or a dynamic stenosis associated with coronary vasospasm can also limit the supply of ...
The general aim of this thesis was to study symptoms, prehospital delay and time trends in long-term survival in men and women with myocardial infarction (MI). The study was based on quantitative and qualitative data collections.. Study I was based on The Northern Sweden MONICA Myocardial Infarction Registry, 1989-2003, including 5072 men and 1470 women with a confirmed MI. Symptoms and prehospital delay were described and trends over time according to sex and age were studied. Typical pain was present in 86% of the men and 81% of the women and typical symptoms were more common among younger persons than older persons. Up to the age of 65 no gender differences were seen in the prehospital delay. In the oldest age group (65-74 years) time to hospital was longer than among the younger group, especially among women.. Study II was based on individual interviews with 20 men with a first confirmed MI, representing the age range 65-80 years, about their experiences during the prehospital phase. The ...
Interview with Juan Jesús Carrero, PhD(Pharm and Med), author of Warfarin, Kidney Dysfunction, and Outcomes Following Acute Myocardial Infarction in Patients With Atrial Fibrillation...
One of the most dramatic interventions in modern medicine is the treatment of acute myocardial infarction. The sustained occlusion that occurs with Q wave infarction can result in extensive damage unless coronary flow is restored early. Dr Vacek discusses the rapid response to acute Q wave infarction, including diagnostic techniques, reperfusion, patient monitoring, and ongoing medical therapy.
BACKGROUND: Although increased attention has been paid to sex and racial differences in the management of myocardial infarction, it is unknown whether these differences have narrowed over time. METHODS: With the use of data from the National Registry of Myocardial Infarction, we examined sex and racial differences in the treatment of patients who were deemed to be "ideal candidates" for particular treatments and in deaths among 598,911 patients hospitalized with myocardial infarction between 1994 and 2002. RESULTS: In the unadjusted analysis, sex and racial differences were observed for rates of reperfusion therapy (for white men, white women, black men, and black women: 86.5, 83.3, 80.4, and 77.8 percent, respectively; P ...
Background: Endoscopy is routinely recommended as a diagnostic procedure in patients presenting with upper gastrointestinal tract bleeding (UGIB). An example being, instances where patients with liver cirrhosis present with UGIB stemming from probable esophageal varices. However, among many contraindication for the procedure, acute ST elevation myocardial infarction is perhaps the most absolute (whose, post-PCI adjuvant pharmaceutical treatment too may result in UGIB). Since comorbidities are common among chronic liver disease patients, instances of such contraindications are becoming common. Objective: This study hopes to assess the efficacy and safety of diagnostic endoscopy v/s non-invasive markers of probable causes of UGIB in patients with a history of liver cirrhosis and acute ST elevation myocardial infarction. Methodology: This retrospective analysis was conducted upon a total of 43 cases presenting with UGIB and a history of liver cirrhosis and acute STEMI to the medical out-patient ...
TY - JOUR. T1 - Cumulative Human Immunodeficiency Viremia, Antiretroviral Therapy, and Incident Myocardial Infarction. AU - Delaney, Joseph A.. AU - Nance, Robin M.. AU - Whitney, Bridget M.. AU - Crane, Heidi M.. AU - Williams-Nguyen, Jessica. AU - Feinstein, Mathew J.. AU - Kaplan, Robert C.. AU - Hanna, David B.. AU - Budoff, Matthew J.. AU - Drozd, Daniel R.. AU - Burkholder, Greer. AU - Mugavero, Michael J.. AU - Mathews, William C.. AU - Moore, Richard D.. AU - Eron, Joseph J.. AU - Hunt, Peter W.. AU - Geng, Elvin. AU - Saag, Michael S.. AU - Kitahata, Mari M.. AU - Heckbert, Susan R.. PY - 2019/1/1. Y1 - 2019/1/1. N2 - Background: People living with HIV are at risk of increased myocardial infarction (MI). Cumulative HIV viral load (VL) has been proposed as a better measure of HIV inflammation than other measures of VL, like baseline VL, but its associations with MI are not known. Methods: The multisite Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort ...
Background: Recent studies have demonstrated an association between venous thromboembolism (VTE) and arterial thrombotic diseases. Objectives: To study the association between incident myocardial infarction (MI) and VTE in a prospective population-based cohort. Methods: Study participants (n = 29 506) were recruited from three surveys of the Tromsø Study (conducted in 1994-1995, 2001-2002, and 2007-2008) and followed up to 2010. All incident MI and VTE events during follow-up were recorded. Cox regression models with age as the time scale and MI as a time-dependent variable were used to calculate hazard ratios (HRs) of VTE adjusted for sex, body mass index, blood pressure, diabetes mellitus, HDL cholesterol, smoking, physical activity, and education level. Results: During a median follow-up of 15.7 years, 1853 participants experienced an MI and 699 experienced a VTE. MI was associated with a 51% increased risk of VTE (HR 1.51; 95% confidence interval [CI] 1.08-2.10) and a 72% increased risk of
Marijuana is the most commonly used psychoactive drug in the USA. A 35-year-old man with a medical history of marijuana abuse is admitted to the hospital due to crushing substernal chest pain. ECG shows evolving ST-segment elevation with a rise in cardiac enzymes, consistent with ST-elevation myocardial infarction. A urine toxicology screen is positive for cannabis and negative for cocaine and other stimulant drugs. An emergent cardiac catheterisation reveals no evidence of coronary artery disease or thrombosis. A diagnosis of coronary vasospasm is strongly considered, and the patient is started on calcium channel blocker, with a resolution of symptoms and ECG changes. Marijuana-induced coronary spasm causing myocardial infarction has rarely been reported. Marijuana is becoming a social norm in adolescents and there remains a misconception that it is harmless and even beneficial. Increasing drug abuse remains a public health concern, necessitating population education by physicians for safer ...
Objective: To determine the relation between serum cholesterol levels and the long-term risk for reinfarction, death from coronary heart disease, and all-cause mortality in persons who recover from myocardial infarction.. ▪ Design: Prospective, longitudinal study.. ▪ Setting: A geographically defined population-based cohort of adults participating in the Framingham Heart Study.. ▪ Patients: Men (n = 260) and women (n =114), 33 to 88 years of age (mean age, 62 years), who had a history of myocardial infarction.. ▪ Measurements: A complete physical examination, including electrocardiographic evaluation, blood pressure measurement, height and weight measurements, determination of smoking habits, and casual determinations of blood glucose and serum cholesterol, was done approximately 1 year after recovery from initial myocardial infarction. Patients were followed after infarction for the occurrence of reinfarction or death (mean follow-up, 10.5 years; range, 0.8 to 31.6 years).. ▪ Main ...
The subjects of the first meeting covered aspects of surgical, endovascular and drug treatment of myocardial infarction, post-infarction patients. Prof. Vera Tseluiko outlined the main provisions of the recommendations of the European Society of Cardiology in 2017 regarding the treatment of myocardial infarction with ST-segment elevation, and Professor Oleg Zharinov reported on the principles of use of dual antiplatelet therapy in the treatment of post-infarct patients in accordance with the European consensus of 2017.. The second session was devoted to the problems of diagnosis and treatment of heart failure. MD D. Ryabenko (NSC "Institute of Cardiology named after N. Strazhesko") highlighted the features of modern diagnosis and treatment of myocarditis, Professor Олег Zharinov told about the principles of managing patients with ischemic cardiomyopathy, and Professor L. Voronkov (NSC "Institute of Cardiology named after N. Strazhesko of the Academy of Medical Sciences of Ukraine") reported ...
Heart disease is the leading cause of death in the United States. Statistics from 1989-90 show more than 780,000 deaths were attributed to heart disease alone. It has been estimated that 40 million of us are suffering from heart disease at any given time. Treatment alone costs $78 billion dollars a year. In this section, we will deal with problems associated with blockage of the coronary arteries that supply blood to the heart muscle itself. There are a number of different terms that refer, for the most part, to the same underlying disease process.. 1. HEART ATTACK = MYOCARDIAL INFARCTION = MI (this describes the complete blockage of a coronary vessel). With total blockage of blood flow the heart muscle will die resulting in a myocardial infarction.. 2. ANGINA: chest pain as a result of the hearts inability to receive adequate blood flow (and oxygen). When the blood flow is COMPLETELY interrupted, myocardial infarction (heart attack) results.. 3. CORONARY ARTERY DISEASE: describes the problem ...
Anterior myocardial infarction. ST elevation myocardial Infarction (STEMI) occlusion of the left anterior descending artery (LAD) EKG Library
ST-segment elevation myocardial infarction (STEMI) is considered a major contributor to global mortality and morbidity. The final necrotic infarct size has been identified as one of the major predictors of the clinical outcome after STEMI. In the recent decades, STEMI management has evolved dramatically, now encompassing dedicated STEMI networks, potent antithrombotic drugs, and rapid achievement of myocardial reperfusion. These therapeutic interventions in the acute phase have resulted in a remarkable decline in cardiac morbidity and mortality. Adjunctive therapies, next to early coronary reperfusion, are considered the major challenge to reduce infarct size and further improve clinical outcome after STEMI and is topic of intensive experimental and clinical research.. The use of beta-adrenergic receptor antagonists (beta-blockers) is mandatory in the subacute phase after acute myocardial infarction (AMI), resulting in a decrease in mortality, life-threatening arrhythmias, reinfarction, and ...