Acute ST Elevation MI
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Recent papers in Acute ST Elevation MI
Pathophysiology of ST-elevation myocardial infarction (STEMI) involves sudden and total occlusion of an epicardial coronary artery, making immediate restoration of blood flow by primary percutaneous intervention (PCI) as the most logical... more
Pathophysiology of ST-elevation myocardial infarction (STEMI) involves sudden and total occlusion of an
epicardial coronary artery, making immediate restoration of blood flow by primary percutaneous intervention
(PCI) as the most logical choice of therapy. Several studies have already established primary PCI as the default
strategy for any patient with acute STEMI but its benefits are highly time dependent and wane as time passes.
Hence, current guidelines recommend it up to 12 hours from symptom onset to maximize its impact. With certain
riders (e.g., hemodynamic and electrical instability), patients can be taken for primary PCI up to 24 hours. Due to
various reasons, a significant number of patients seek medical help beyond this limit of 24 hours and a lack of
clear-cut recommendations to manage this subset of stable patients complicates the issue. A number of trials
and metanalyses have tried to find out whether revascularization helps these patients but got mixed results. This
review article summarizes the available evidence and attempts to find out concordance among discordant results
while sketching the best possible strategy to manage these patients. A separate section has been dedicated to
different imaging modalities for viability assessment with respect to same subset of patients
epicardial coronary artery, making immediate restoration of blood flow by primary percutaneous intervention
(PCI) as the most logical choice of therapy. Several studies have already established primary PCI as the default
strategy for any patient with acute STEMI but its benefits are highly time dependent and wane as time passes.
Hence, current guidelines recommend it up to 12 hours from symptom onset to maximize its impact. With certain
riders (e.g., hemodynamic and electrical instability), patients can be taken for primary PCI up to 24 hours. Due to
various reasons, a significant number of patients seek medical help beyond this limit of 24 hours and a lack of
clear-cut recommendations to manage this subset of stable patients complicates the issue. A number of trials
and metanalyses have tried to find out whether revascularization helps these patients but got mixed results. This
review article summarizes the available evidence and attempts to find out concordance among discordant results
while sketching the best possible strategy to manage these patients. A separate section has been dedicated to
different imaging modalities for viability assessment with respect to same subset of patients
Objective: To study the effect of timing of thrombolytic therapy, cardiac risk factors and site of infarction on S.T. resolution post thrombolysis in STEMI patients. Methods: This was a descriptive hospital based study conducted at the... more
Objective: To study the effect of timing of thrombolytic therapy, cardiac risk factors and site of infarction on S.T. resolution post thrombolysis in STEMI patients.
Methods: This was a descriptive hospital based study conducted at the Hayatabad Medical Complex Peshawar. The duration of our study was 5 months from February 2015 to June 2015. Diagnosis of STEMI in symptomatic patients was based on the ECG recognized. Definition of Myocardial Infarction. Time from onset of chest pain to presentation of patients in emergency was noted through history of patients along with time of streptokinase. ECG recordings of patients were taken upon presentation in Emergency. Serial ECG monitoring was done after administration of Streptokinase (SK). ST resolution was observed in the lead with the maximum ST elevation. Data were presented as frequencies and percentages, chi square test was applied.
Results: Among 83 patients with STEMI 50.6% were males and 49.4% were females with the age group range of 30-83 years. Fifty nine patients (71.08%) with STEMI underwent thrombolysis within 12 hours of onset of chest pain while 24 patients (28.92%), underwent thrombolysis after 12 hours of onset of chest pain. Out of the 59 patients who received thrombolytic therapy before 12 hours, 43 (72.88%) completely resolved, while those who received thrombolytic therapy after 12 hours none of them completely resolved as per ECG findings. By applying chi-square test it gives us value of 36.470, and p-value <0.001. In our study 28 patients were diabetic and out of these six (21.43%) completely resolved as per ECG post thrombolysis, 9 (32.14%) partially resolved and 13 (46.43%) failed to resolve. On the other hand, in non-diabetics out of 55, 37 (67.27%) completely resolved, 12 (21.82%) partially resolved and 6 (10.91%) failed to resolve. Among 61 hypertensive, 26 (42.62%) had complete resolution and in 22 who were non-hypertensive, 17 (77.27%) had complete resolution on ECG. Hyperlipidemia and site of infarction didn’t have statistically significant effect on the resolution of ECG post thrombolysis in STEMI patients.
Conclusion: Patients with diabetes, hypertension and those who receive thrombolysis after 12 hours of onset of chest pain respond poorly to thrombolytic therapy as per ECG findings whereas hyperlipidemia and site of infarction don’t affect the response of STEMI patients to thrombolysis.
Methods: This was a descriptive hospital based study conducted at the Hayatabad Medical Complex Peshawar. The duration of our study was 5 months from February 2015 to June 2015. Diagnosis of STEMI in symptomatic patients was based on the ECG recognized. Definition of Myocardial Infarction. Time from onset of chest pain to presentation of patients in emergency was noted through history of patients along with time of streptokinase. ECG recordings of patients were taken upon presentation in Emergency. Serial ECG monitoring was done after administration of Streptokinase (SK). ST resolution was observed in the lead with the maximum ST elevation. Data were presented as frequencies and percentages, chi square test was applied.
Results: Among 83 patients with STEMI 50.6% were males and 49.4% were females with the age group range of 30-83 years. Fifty nine patients (71.08%) with STEMI underwent thrombolysis within 12 hours of onset of chest pain while 24 patients (28.92%), underwent thrombolysis after 12 hours of onset of chest pain. Out of the 59 patients who received thrombolytic therapy before 12 hours, 43 (72.88%) completely resolved, while those who received thrombolytic therapy after 12 hours none of them completely resolved as per ECG findings. By applying chi-square test it gives us value of 36.470, and p-value <0.001. In our study 28 patients were diabetic and out of these six (21.43%) completely resolved as per ECG post thrombolysis, 9 (32.14%) partially resolved and 13 (46.43%) failed to resolve. On the other hand, in non-diabetics out of 55, 37 (67.27%) completely resolved, 12 (21.82%) partially resolved and 6 (10.91%) failed to resolve. Among 61 hypertensive, 26 (42.62%) had complete resolution and in 22 who were non-hypertensive, 17 (77.27%) had complete resolution on ECG. Hyperlipidemia and site of infarction didn’t have statistically significant effect on the resolution of ECG post thrombolysis in STEMI patients.
Conclusion: Patients with diabetes, hypertension and those who receive thrombolysis after 12 hours of onset of chest pain respond poorly to thrombolytic therapy as per ECG findings whereas hyperlipidemia and site of infarction don’t affect the response of STEMI patients to thrombolysis.
Kounis syndrome (KS) is an acute coronary vasospasm after exposure to an allergen due to mast cell degranulation and existing mediators. Various drugs, conditions, and environmental exposures can cause KS. We presented 2 cases, 1 of... more
Kounis syndrome (KS) is an acute coronary vasospasm
after exposure to an allergen due to mast cell degranulation and
existing mediators. Various drugs, conditions, and environmental
exposures can cause KS. We presented 2 cases, 1 of
whom had taken an antiflu drug (containing paracetamol,
pseudoephedrine, and dextromethorphan). His electrocardiogram
(ECG) showed inferior ST elevations (2 mm) with
normal cardiac biomarkers. His cardiac magnetic resonance
imaging showed hypokinesis and myocardial hibernation on
apical septum and on the left ventricle. The second patient took
a pill of naproxen sodium. The ECG showed 1-mm ST
elevation in leads DII, V5, andV6. His troponin was markedly
elevated. These cases showed that there seems to be no
correlation with ECG and troponin levels in KS. In addition,
for patients in whom KS type 1 is expected without troponin
elevation, noninvasive cardiac magnetic resonance imaging
study seems to be appropriate for the diagnosis of KS.
after exposure to an allergen due to mast cell degranulation and
existing mediators. Various drugs, conditions, and environmental
exposures can cause KS. We presented 2 cases, 1 of
whom had taken an antiflu drug (containing paracetamol,
pseudoephedrine, and dextromethorphan). His electrocardiogram
(ECG) showed inferior ST elevations (2 mm) with
normal cardiac biomarkers. His cardiac magnetic resonance
imaging showed hypokinesis and myocardial hibernation on
apical septum and on the left ventricle. The second patient took
a pill of naproxen sodium. The ECG showed 1-mm ST
elevation in leads DII, V5, andV6. His troponin was markedly
elevated. These cases showed that there seems to be no
correlation with ECG and troponin levels in KS. In addition,
for patients in whom KS type 1 is expected without troponin
elevation, noninvasive cardiac magnetic resonance imaging
study seems to be appropriate for the diagnosis of KS.
Background: Primary percutaneous intervention (PCI) is the choice of reperfusion therapy and is significantly superior to thrombolysis in acute ST-elevation myocardial infarction (MI). Objectives: We did design this study to evaluate... more
Background: Primary percutaneous intervention (PCI) is the choice of reperfusion therapy and is significantly superior to thrombolysis in acute ST-elevation myocardial infarction (MI).
Objectives: We did design this study to evaluate the successful rate, early complication and late follow-up of the patients with acute myocardial infarction who referred to Razavi Hospital.
Patients and Methods: In this study, 68 consecutive patients who were admitted by diagnosis of acute coronary myocardial infarction and ST-elevation change in ECG underwent primary PCI by a single high volume operator from March, 2008 to March, 2011. The successful rate, incidence of in Hospital’s main adverse cardiac effects (MACE) and main adverse non-cardiac effects (MANE) and also their impact on one- year cardiac mortality and morbidity were estimated.
Results: The successful rate of primary PCI in this study was estimated to be 100%. MACE occurred in 4 patients (5.8%) (2 deaths and 2 myocardial infarctions) and MANE occurred in 8 patients (11.8%) (7 cases with major or minor bleeding and one with contrast nephropathy). In one- year follow-up of patients who included in the study, surveillance rate was 91.2 % (62 of 68), 13 patients had persistent cardiac symptoms (19.1%), 3 of them were admitted to the hospital with coronary syndromes (4.4%) and just one patients underwent target vessel revascularization (1.5%). 3 patients had to do CABG in the first year (4.4%). Studying the long term MACE and stent type (drug eluting stents vs. bare metal stents) revealed: death; 1 (3.6%) vs. 6 (11.5%), persistent cardiac symp; 3 (10.7) vs. 11 (21.2%), hospitalization; no patient vs. 4 (7.7%) and no TVR in drug eluting stents (DES) group vs. 1 (1.9%) in bare metal stents (BMS) group.
Conclusions: This study confirms that Primary PCI revascularization is the best treatment for the acute ST elevation MI with brilliant acute result and one- year high survival and acceptable cardiac and non-cardiac complications. Studying the effects of using DES and BMS on long term cardiac mortality, morbidity and need to target vessels revascularization (TVR) shows that performing the PCI in the golden time is very important and type of stent is not much important. By reducing the expenses of this procedure through using BMS, we can give this chance to more patients.
Objectives: We did design this study to evaluate the successful rate, early complication and late follow-up of the patients with acute myocardial infarction who referred to Razavi Hospital.
Patients and Methods: In this study, 68 consecutive patients who were admitted by diagnosis of acute coronary myocardial infarction and ST-elevation change in ECG underwent primary PCI by a single high volume operator from March, 2008 to March, 2011. The successful rate, incidence of in Hospital’s main adverse cardiac effects (MACE) and main adverse non-cardiac effects (MANE) and also their impact on one- year cardiac mortality and morbidity were estimated.
Results: The successful rate of primary PCI in this study was estimated to be 100%. MACE occurred in 4 patients (5.8%) (2 deaths and 2 myocardial infarctions) and MANE occurred in 8 patients (11.8%) (7 cases with major or minor bleeding and one with contrast nephropathy). In one- year follow-up of patients who included in the study, surveillance rate was 91.2 % (62 of 68), 13 patients had persistent cardiac symptoms (19.1%), 3 of them were admitted to the hospital with coronary syndromes (4.4%) and just one patients underwent target vessel revascularization (1.5%). 3 patients had to do CABG in the first year (4.4%). Studying the long term MACE and stent type (drug eluting stents vs. bare metal stents) revealed: death; 1 (3.6%) vs. 6 (11.5%), persistent cardiac symp; 3 (10.7) vs. 11 (21.2%), hospitalization; no patient vs. 4 (7.7%) and no TVR in drug eluting stents (DES) group vs. 1 (1.9%) in bare metal stents (BMS) group.
Conclusions: This study confirms that Primary PCI revascularization is the best treatment for the acute ST elevation MI with brilliant acute result and one- year high survival and acceptable cardiac and non-cardiac complications. Studying the effects of using DES and BMS on long term cardiac mortality, morbidity and need to target vessels revascularization (TVR) shows that performing the PCI in the golden time is very important and type of stent is not much important. By reducing the expenses of this procedure through using BMS, we can give this chance to more patients.