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Xu J, Wang Z, Ai Y, Wen Y. Serum circRNA (Circ)_0051386 assists in the diagnosis of acute ST-segment elevation myocardial infarction and prediction of the occurrence of major adverse cardiovascular events after percutaneous coronary intervention. Acta Cardiol 2024; 79:215-223. [PMID: 38456718 DOI: 10.1080/00015385.2024.2324218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND This study aimed to uncover the diagnostic value of circRNA (Circ)_0051386 in acute ST-segment elevation myocardial infarction (STEMI) and its predictive value for the occurrence of adverse major adverse cardiovascular events (MACEs). METHODS This study included 166 patients with STEMI and 83 health donors. The expression levels of serum Circ_0051386 in these participants were quantified using real-time quantitative polymerase chain reaction (RT-qPCR). Additionally, the incidence of MACEs during a 6-month follow-up period after percutaneous coronary intervention (PCI) was collected in the STEMI patient cohort. RESULTS Before and after propensity score matching (PSM), Circ_0051386 all had higher expression levels in the patients with STEMI than the normal subjects (all p < .001)and robust diagnosis values for the STEMI (AUC = 0.766, 0.779). Kaplan-Meier curves showed the high expression Circ_0051386 group had a higher occurrence rate of MACEs during a 6-month follow-up after PCI in patients with STEMI and this phenomenon was confirmed by internal validation (all p < .05). In addition, the multivariate COX regression showed gensini score (HR = 1.020, 95% CI = 1.002 - 1.038, p = .028) and Circ_0051386 (HR = 2.468, 95% CI =1.548-3.935, p < .001)were independent risk factors of the occurrence of MACEs in patients with STEMI after PCI. Pearson analysis presented that Circ_0051386 was positively correlated with gensini scores (r = 0.33), IL-1β (r = 0.55)and TNF-α(r = 0.41). CONCLUSION Our study indicated that Circ_0051386 is a biomarker of the diagnostic for STEMI and the predictor of the MACEs in STEMI patients after PCI. Its potential role in STEMI may be the regulation of inflammation in the vascular endothelial.
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Affiliation(s)
- Jinlin Xu
- Emergency Department, Xiantao First People's Hospital, Xiantao, China
| | - Zhiwei Wang
- Emergency Department, Xiantao First People's Hospital, Xiantao, China
| | - Yu Ai
- Emergency Department, Xiantao First People's Hospital, Xiantao, China
| | - Ye Wen
- Emergency Department, Xianning Central Hospital, The First Affiliated Hospital of Hubei University of Science and Technology, Xianning, China
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2
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Özlek B, Dere Ö, Köseoğlu FD. Diagnostic Dilemma: Acute Mesenteric Ischemia may Mimic Acute ST-Segment Elevation Myocardial Infarction. Balkan Med J 2024; 41:149-150. [PMID: 38146601 PMCID: PMC10913115 DOI: 10.4274/balkanmedj.galenos.2023.2023-10-81] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/22/2023] [Indexed: 12/27/2023] Open
Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Türkiye
| | - Özcan Dere
- Department of General Surgery, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Türkiye
| | - Fatoş Dilan Köseoğlu
- Department of Internal Medicine, Bakırçay University Faculty of Medicine, İzmir, Türkiye
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Tofighi S, Poorhosseini H, Jenab Y, Alidoosti M, Sadeghian M, Mehrani M, Tabrizi Z, Hashemi P. Comparison of machine-learning models for the prediction of 1-year adverse outcomes of patients undergoing primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Clin Cardiol 2024; 47:e24157. [PMID: 37721426 PMCID: PMC10765993 DOI: 10.1002/clc.24157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 08/18/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Acute ST-elevation myocardial infarction (STEMI) is a leading cause of mortality and morbidity worldwide, and primary percutaneous coronary intervention (PCI) is the preferred treatment option. HYPOTHESIS Machine learning (ML) models have the potential to predict adverse clinical outcomes in STEMI patients treated with primary PCI. However, the comparative performance of different ML models for this purpose is unclear. METHODS This study used a retrospective registry-based design to recruit consecutive hospitalized patients diagnosed with acute STEMI and treated with primary PCI from 2011 to 2019, at Tehran Heart Center, Tehran, Iran. Four ML models, namely Gradient Boosting Machine (GBM), Distributed Random Forest (DRF), Logistic Regression (LR), and Deep Learning (DL), were used to predict major adverse cardiovascular events (MACE) during 1-year follow-up. RESULTS A total of 4514 patients (3498 men and 1016 women) were enrolled, with MACE occurring in 610 (13.5%) subjects during follow-up. The mean age of the population was 62.1 years, and the MACE group was significantly older than the non-MACE group (66.2 vs. 61.5 years, p < .001). The learning process utilized 70% (n = 3160) of the total population, and the remaining 30% (n = 1354) served as the testing data set. DRF and GBM models demonstrated the best performance in predicting MACE, with an area under the curve of 0.92 and 0.91, respectively. CONCLUSION ML-based models, such as DRF and GBM, can effectively identify high-risk STEMI patients for adverse events during follow-up. These models can be useful for personalized treatment strategies, ultimately improving clinical outcomes and reducing the burden of disease.
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Affiliation(s)
- Saeed Tofighi
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Hamidreza Poorhosseini
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Yaser Jenab
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Mohammad Alidoosti
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Mohammad Sadeghian
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Mehdi Mehrani
- Tehran Heart Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Zhale Tabrizi
- Department of RadiologyIran University of Medical SciencesTehranIran
| | - Parisa Hashemi
- School of MedicineShahid Beheshti University of Medical SciencesTehranIran
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Kanabar K, Vyas P, Karwa A, Sheth M, Jain S. Hepatic artery branch perforation with hemoperitomeum: A rare complication of pericardiocentesis. J Invasive Cardiol 2024; 36. [PMID: 38224302 DOI: 10.25270/jic/23.00127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
A 58-year-old male patient presented with anterior myocardial infarction after 36 hours of symptom onset.
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Affiliation(s)
- Kewel Kanabar
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad-380016, India.
| | - Pooja Vyas
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad-380016, India
| | - Akash Karwa
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad-380016, India
| | - Megha Sheth
- Department of Radiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad-380016, India
| | - Sharad Jain
- Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Centre, Ahmedabad-380016, India
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Mathur R, Lakhawat V, Kesarwani V, Sarda P, Baroopal A. Study of mechanical complications in patients with acute ST-segment elevated myocardial infarction. Indian Heart J 2024; 76:60-62. [PMID: 38301960 PMCID: PMC10943558 DOI: 10.1016/j.ihj.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 08/20/2023] [Accepted: 01/29/2024] [Indexed: 02/03/2024] Open
Abstract
This prospective observational study aimed to determine the proportion of mechanical complications in patients with acute STEMI and assess the associated outcomes. The study was conducted between June'21 and May'22, including 1307 patients. Mechanical complications were evaluated using 2D-Echo. Among the STEMI patients, 17 individuals (1.3 %) experienced mechanical complications. The most prevalent complication was FWR (n = 9), followed by VSR(n = 7) and PMR (n = 1). However, despite their low incidence, mechanical complications carry a significant mortality burden. Mortality rates were higher in older age and female patients.
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Affiliation(s)
- Rohit Mathur
- Department of Cardiology, Dr SN Medical College, Jodhpur, Rajasthan, India
| | - Vivek Lakhawat
- Department of Cardiology, Dr SN Medical College, Jodhpur, Rajasthan, India.
| | - Viplov Kesarwani
- Department of Cardiology, Dr SN Medical College, Jodhpur, Rajasthan, India
| | - Pawan Sarda
- Department of Cardiology, Dr SN Medical College, Jodhpur, Rajasthan, India
| | - Anil Baroopal
- Department of Cardiology, Dr SN Medical College, Jodhpur, Rajasthan, India
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Kumar S, Griffith N, Walter D, Swett M, Raman V, Vargas JD, Deb B, Chou J, Arafat A, Srichai MB. Characterization of Myocardial Injury With High-Sensitivity Troponin. Tex Heart Inst J 2023; 50:e238108. [PMID: 38115713 PMCID: PMC10751476 DOI: 10.14503/thij-23-8108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND High-sensitivity troponin I, cardiac form (hs-cTnI) accelerates the assessment of acute coronary syndrome. Little has been documented about its performance, how it relates to different types of myocardial injury, and its impact on morbidity and mortality. This study sought to expand understanding of hs-cTnI by characterizing types of myocardial injury, the impact of comorbidities, and 30-day outcomes. METHODS The study retrospectively evaluated 1,975 patients with hs-cTnI levels obtained in the emergency department or inpatient setting from June to September 2020. Troponin was considered elevated if it was higher than the 99th percentile for either sex. Charts were reviewed to determine the presence of myocardial injury. Troponin elevation was adjusted for demographics, comorbidities, and kidney dysfunction. Thirty-day mortality and readmission rates were calculated. RESULTS Of 1,975 patients, 468 (24%) had elevated hs-cTnI, and 330 (17%) had at least 1 type of myocardial injury, type 2 myocardial infarction being the most frequent. Sensitivity and specificity using the 99th percentile as a cutoff were 99% and 92%, respectively. The average maximum hs-cTnI level was significantly higher for type 1 myocardial infarction (P < .001). Being male, Black, non-Hispanic, and a hospital inpatient were all associated with higher initial and peak hs-cTnI levels (P < .001). Elevated hs-cTnI level, age, heart disease, kidney dysfunction, and inpatient status were predictive of 30-day mortality on multivariate analysis. CONCLUSION Elevated hs-cTnI levels in emergency department and inpatient settings occurs most commonly because of type 2 myocardial infarction. Maximum hs-cTnI level is associated with the patient's particular type of myocardial injury, certain demographics, and cardiovascular comorbidities, and it may be a predictor of 30-day outcomes.
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Affiliation(s)
- Sant Kumar
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Nayrana Griffith
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Dylan Walter
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Michael Swett
- Department of Internal Medicine, MedStar Georgetown University Hospital, Washington, DC
| | - Venkatesh Raman
- Department of Cardiology, US Department of Veterans Affair Medical Center, Washington, DC
| | - Jose D. Vargas
- Department of Cardiology, US Department of Veterans Affair Medical Center, Washington, DC
| | - Brototo Deb
- Department of Internal Medicine, MedStar Washington Hospital Center, Washington, DC
| | - Jiling Chou
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Ayah Arafat
- MedStar Health Research Institute, Hyattsville, Maryland
| | - Monvadi B. Srichai
- Department of Cardiology, MedStar Georgetown University Hospital, Washington, DC
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Carter AJ, Raffoul J, Lane L, LeSage L, Langenhorst S, Smolin M, Dempsey M, Hughes D, Gleason M, Weiss S, Anderson WD. Facility-based approach for the management of acute ST segment elevation myocardial infarction with cardiogenic shock in a rural medical centre: the Durango model. Open Heart 2023; 10:e002299. [PMID: 38065583 PMCID: PMC10711864 DOI: 10.1136/openhrt-2023-002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Cardiogenic shock (CS) complicates 5%-15% of cases of acute myocardial infarction (AMI) with inpatient mortality greater than 40%. The implementation of standardised protocols may improve clinical outcomes in patients with AMI-CS. METHODS AND ANALYSIS The Durango model is a prospective single-centre registry designed to enable early identification of patients with STEMI-CS to facilitate primary reperfusion therapy with a shock team management algorithm in a rural level II heart attack centre. This prospective registry includes all patients >18 years of age presenting with STEMI with or without CS beginning on 1 February 2023. The primary outcome measures are adherence to model-based documentation of SCAI shock Classification prehospital and in the ED with appropriate STEMI shock alert for AMI and stages C, D, E shock; use of mechanical circulatory support Pre-PCI and door to support time <90 min. ETHICS AND DISSEMINATION This study was approved by the Institutional Review Board with a waiver of informed consent. The findings will be submitted for publication in a peer-review open access journal on completion of the study. CONCLUSIONS The Durango model will demonstrate that the implementation of a STEMI shock team can be feasible in a rural medical centre through comprehensive education of a diverse group providers with different levels of experience, continuous model/device proficiency training and performance feedback.
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Affiliation(s)
| | - Jad Raffoul
- Cardiology, Mercy Regional Medical Center, Durango, Colorado, USA
| | - Linden Lane
- Cardiology, Mercy Regional Medical Center, Durango, Colorado, USA
| | - Leah LeSage
- Cardiology, Mercy Regional Medical Center, Durango, Colorado, USA
| | | | - Matthew Smolin
- Cardiology, Mercy Regional Medical Center, Durango, Colorado, USA
| | - Michael Dempsey
- Critical Care, Mercy Regional Medical Center, Durango, Colorado, USA
| | - David Hughes
- Emergency Department, Mercy Regional Medical Center, Durango, Colorado, USA
| | - Michael Gleason
- Emergency Department, Mercy Regional Medical Center, Durango, Colorado, USA
| | - Steven Weiss
- Critical Care, Mercy Regional Medical Center, Durango, Colorado, USA
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Yao H, Cottin Y, Chagué F, Maza M, Bichat F, Zeller M, Putot A. Diagnostic and prognostic impact of new pathophysiology-based categorization of type 1 and type 2 myocardial infarction: data from the French RICO survey. Am Heart J 2023; 266:86-97. [PMID: 37703947 DOI: 10.1016/j.ahj.2023.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/03/2023] [Accepted: 09/06/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND A new classification of type 1 and 2 myocardial infarction (MI) derived from the fourth universal definition of MI (UDMI) has been recently proposed, based on pathophysiology of coronary artery disease (CAD). We assessed the impact of this new MI categorization on epidemiology and outcomes, considering type 1 MI (T1MI) and type 2 MI (T2MI), with and without CAD. METHODS Retrospective study including all consecutive patients hospitalized for an acute MI in a multicenter database (RICO). MI was defined according to current UDMI. Rates and outcomes of T1MI and T2MI were addressed according to the new classification. RESULTS Among the 4,573 patients included in our study, 3,710 patients (81.1%) were initially diagnosed with T1M1 and 863 (18.9%) with T2MI. After reclassification, 96 T2MI patients were moved into the T1MI category. Out of the remaining 767 patients with T2MI, 567 underwent coronary angiography, and were adjudicated as type 2A MI (68.6%) with obstructive CAD, and type 2B MI (31.4%) without obstructive CAD. When compared with T1MI and T2BMI, T2AMI patients had worse in-hospital outcomes, including severe heart failure (P < .001), atrial fibrillation or flutter (P < .001) and severe bleeding (P < .001). Kaplan-Meier 1-year survival curves showed higher all-cause and CV causes mortality in T2AMI patients compared to T1MI and T2BMI (P < .001). In multivariate Cox regression analysis, type of MI was independent predictor of death. CONCLUSION Our large observational multicenter study shows major disparities in mortality according to type of MI and support the relevance of the new MI classification to improve risk classification, taking into account CAD in T2MI. Our findings may help identifying specific phenotypes and considering personalized diagnostic and management strategies.
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Affiliation(s)
- Hermann Yao
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France; PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France; Abidjan Heart Institute, Côte d'Ivoire.
| | - Yves Cottin
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Frédéric Chagué
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Maud Maza
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Florence Bichat
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France
| | - Marianne Zeller
- Cardiology department, University Hospital Center Dijon Bourgogne, Dijon, France; PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France
| | - Alain Putot
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, Dijon, France
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9
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Puymirat E, Soulat G, Fayol A, Mousseaux E, Montalescot G, Cayla G, Steg PG, Berard L, Rousseau A, Drouet É, Simon T, Danchin N. Rationale and design of the direct oral anticoagulants for prevention of left ventricular thrombus after anterior acute myocardial infarction (APERITIF) trial. Am Heart J 2023; 266:98-105. [PMID: 37716448 DOI: 10.1016/j.ahj.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND Anterior acute myocardial infarction (AMI) is associated with an increased risk of left ventricular (LV) thrombus formation. We hypothesized that adding low-dose oral rivaroxaban to the usual antiplatelet regimen would reduce the risk of LV thrombus in patients with large AMI. STUDY DESIGN APERITIF is an investigator-initiated, multicenter randomized open-label, blinded end-point (PROBE) trial, nested in the ongoing "FRENCHIE" registry, a French multicenter prospective observational study, in which all consecutive patients admitted within 48 hours of symptom onset in a cardiac Intensive Care Unit (ICU) for AMI are included (NCT04050956). Among them, patients with anterior ST-elevation-myocardial infarction (STEMI) or very high-risk non- ST-elevation-myocardial infarction (NSTEMI) patients with involvement of the left anterior descending artery are randomized into 2 groups: Dual Antiplatelet Therapy (DAPT) alone or DAPT plus rivaroxaban 2.5mg twice daily for 4 weeks, started as soon as possible after completion of the initial percutaneous coronary intervention/angiography procedure. The primary endpoint is the presence of LV thrombus at 1 month, as detected by contrast enhanced CMR (CE-CMR). Secondary endpoints include LV thrombus dimension (greatest diameter), the rate of major bleedings and major cardiovascular events at 1 month. Based on estimated event rates, a sample size of 560 patients is needed to show superiority of DAPT plus rivaroxaban therapy versus DAPT alone, with 80% power. CONCLUSION The APERITIF trial will determine whether, in patients with large AMIs, the use of rivaroxaban 2.5mg twice daily in addition to DAPT reduces LV thrombus formation, compared with DAPT alone. CLINICALTRIALS gov Identifier: NCT05077683.
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Affiliation(s)
- Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France; PARCC (Paris-Cardiovascular Research Center), INSERM 970, Paris, France; French Alliance for Cardiovascular Trials (FACT), Paris, France.
| | - Gilles Soulat
- PARCC (Paris-Cardiovascular Research Center), INSERM 970, Paris, France; Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Antoine Fayol
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France; PARCC (Paris-Cardiovascular Research Center), INSERM 970, Paris, France
| | - Elie Mousseaux
- PARCC (Paris-Cardiovascular Research Center), INSERM 970, Paris, France; Department of Radiology, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, Institut de Cardiologie (APHP), INSERM UMRS 1166, Hôpital Pitié-Salpêtrière, Paris, France
| | | | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials (FACT), Paris, France; Université Paris-Cité, INSERM Unité-1148, and Hôpital Bichat, AP-HP, Paris, France
| | - Laurence Berard
- French Alliance for Cardiovascular Trials (FACT), Paris, France; Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST), AP-HP, Hôpital Saint Antoine, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France
| | - Alexandra Rousseau
- French Alliance for Cardiovascular Trials (FACT), Paris, France; Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST), AP-HP, Hôpital Saint Antoine, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France
| | - Élodie Drouet
- French Alliance for Cardiovascular Trials (FACT), Paris, France; Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST), AP-HP, Hôpital Saint Antoine, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France
| | - Tabassome Simon
- French Alliance for Cardiovascular Trials (FACT), Paris, France; Department of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST), AP-HP, Hôpital Saint Antoine, Université Pierre et Marie Curie (UPMC-Paris 06), Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France; French Alliance for Cardiovascular Trials (FACT), Paris, France
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Bergman I, Boyle D, Braver O, Gelikas S, Wexler Y, Omelchenko A, Assali A, Nussinovitch U. Ischemic Postconditioning Confers No Benefit to Left Ventricular Systolic Function: A Meta-Analysis of Cardiac Magnetic Resonance Imaging Results. Am J Cardiol 2023; 208:126-133. [PMID: 37837795 DOI: 10.1016/j.amjcard.2023.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 09/05/2023] [Accepted: 09/09/2023] [Indexed: 10/16/2023]
Abstract
Ischemic postconditioning (IPoC) is a technique suggested to reduce reperfusion injury in patients suffering acute ST-elevation myocardial infarction (STEMI), although its use is highly controversial. This meta-analysis aimed to evaluate the effect of IPoC with percutaneous coronary intervention in patients with acute STEMI, as measured by follow-up left ventricular ejection fraction (LVEF) on cardiac magnetic resonance imaging. The investigators searched PubMed, Embase, and Web of Science for all randomized controlled trials published during the last 2 decades. After the removal of duplicates, 2,021 articles from online databases had been identified using relevant search criteria. The included randomized controlled trials had studied patients with acute STEMI and Thrombolysis in Myocardial Infarction flow 0 to 1 at presentation and had measured follow-up LVEF using cardiac magnetic resonance imaging. Overall, 11 studies (n = 1,339 patients) qualified for inclusion. In each study, the control group did not differ significantly from the experimental group. The pooled data from included studies were analyzed using standardized mean difference between IPoC and control groups, and the 95% confidence interval for LVEF; the results were visualized using a forest plot. Bivariate regression analyses and 1-way analyses of LVEF coefficient ratios were done to isolate for various clinical and procedural parameters. An analysis of pooled data of the IPoC (n = 674) and control (n = 665) groups showed that IPoC did not significantly impact follow-up LVEF (using standardized mean difference 0.10, 95% confidence interval 0.00 to 0.21). Further analysis showed that IPoC did not improve follow-up LVEF when isolating for relevant clinical and procedural parameters. In conclusion, the use of IPoC as an adjunctive therapy to percutaneous coronary intervention seemingly provides no benefit to left ventricular systolic function, as quantified with cardiac magnetic resonance imaging, in patients with acute STEMI with Thrombolysis in Myocardial Infarction flow 0 to 1.
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Affiliation(s)
- Idan Bergman
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rabin Medical Center, Petach Tikva, Israel
| | | | - Omri Braver
- Department of Cardiology, Barzilai Medical Center, Ashkelon, Israel
| | - Shaul Gelikas
- The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Yehuda Wexler
- Rappaport Faculty of Medicine and Research Institute, Technion - Israel Institute of Technology, Haifa, Israel
| | - Alexander Omelchenko
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Abid Assali
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
| | - Udi Nussinovitch
- Heart Institute at the Edith Wolfson Medical Center, Holon, Israel.
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11
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Tsangaris A, Raveendran G, Hiremath G. Transcatheter closure of a large post-myocardial infarction ventricular septal defect using the GORE cardioform ASD Occluder. J Invasive Cardiol 2023; 35. [PMID: 37992329 DOI: 10.25270/jic/23.00181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
A 49-year-old man presented late with an anterior wall myocardial infarction (MI) status post-primary coronary intervention of the left anterior descending artery that resulted in no reflow of the vessel. The patient was transferred to our institution in cardiogenic shock.
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Affiliation(s)
- Adamantios Tsangaris
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Ganesh Raveendran
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Gurumurthy Hiremath
- Division of Cardiology, Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
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12
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Reindl M, Lechner I, Holzknecht M, Tiller C, Fink P, Oberhollenzer F, Mayr A, Troger F, Pamminger M, Henninger B, Theurl M, Klug G, Brenner C, Bauer A, Metzler B, Reinstadler SJ. Improved detection of echocardiographically occult left ventricular thrombi following ST-elevation myocardial infarction. Eur Heart J Acute Cardiovasc Care 2023; 12:703-710. [PMID: 37348047 DOI: 10.1093/ehjacc/zuad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/11/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023]
Abstract
AIM The aim of this study was to investigate predictors of transthoracic echocardiography (TTE)-occult left ventricular (LV) thrombi (LVT) and to propose a clinical model for improved detection of TTE-occult LVT post-ST-elevation myocardial infarction (STEMI). Patients with acute STEMI are at significant risk for developing LVT. However, this complication often (up to 65%) remains undetected by using TTE, referred to as TTE-occult LVT. METHODS AND RESULTS In total, 870 STEMI patients underwent TTE and cardiac magnetic resonance (CMR), the reference method for LVT detection, 3 days after infarction. Clinical (body mass index, peak cardiac troponin T) and echocardiographic [ejection fraction, apical wall motion scores (AWMSs)] predictors were analysed. Primary endpoint was the presence of TTE-occult LVT identified by CMR imaging. From the overall cohort, 37 patients (4%) showed an LVT by CMR. Of these thrombi, 25 (68%) were not identified by TTE. Transthoracic echocardiography-occult thrombi did not significantly differ in volume (1.4 vs. 2.74 cm3), diameter (19.0 vs. 23.3 mm), and number of fragments or shape compared with TTE-apparent LVT (all P > 0.05). For predicting these TTE-occult LVT, the 16-segment AWMS (AWMS16Seg) showed highest validity {area under the curve: 0.91 [95% confidence interval (CI): 0.89-0.93]; P < 0.001}, with an association independent of ejection fraction and 17-segment AWMS (AWMS17Seg) [odds ratio: 1.68 (95% CI: 1.43-1.97); P < 0.001] and clinical (body mass index, peak troponin) and angiographic (culprit lesion, post-interventional thrombolysis in myocardial infarction flow) associates of TTE-occult LVT (all P < 0.05). Dichotomization at AWMS16Seg ≥ 8 (n = 260, 30%) allowed for a detection of all TTE-occult LVT (sensitivity: 100%), with a corresponding specificity of 77%. CONCLUSION After acute STEMI, AWMS16Seg served as a simple and very robust predictor of TTE-occult LVT. An AWMS16Seg-based algorithm to identify patients for additional CMR imaging offers great potential to optimize detection of TTE-occult LVT following STEMI.
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Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Fritz Oberhollenzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Felix Troger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Mathias Pamminger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Benjamin Henninger
- University Clinic of Radiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Markus Theurl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christoph Brenner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria
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13
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McCarthy CP, Murphy SP, Amponsah DK, Rambarat PK, Lin C, Liu Y, Mohebi R, Levin A, Raghavan A, Miksenas H, Rogers C, Wasfy JH, Blankstein R, Ghoshhajra B, Hedgire S, Januzzi JL. Coronary Computed Tomographic Angiography With Fractional Flow Reserve in Patients With Type 2 Myocardial Infarction. J Am Coll Cardiol 2023; 82:1676-1687. [PMID: 37777947 DOI: 10.1016/j.jacc.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/24/2023] [Accepted: 08/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Type 2 myocardial infarction (T2MI) related to a supply/demand imbalance of coronary blood flow is common and associated with poor prognosis. Coronary artery disease (CAD) may predispose some individuals to T2MI and contribute to its high rate of recurrent cardiovascular events. Little is known about the presence and extent of CAD in this population. OBJECTIVES The goal of this study was to evaluate the presence and characteristics of CAD among patients with T2MI. METHODS In this prospective study, consecutive eligible individuals with Fourth Universal Definition of Myocardial Infarction criteria for T2MI were enrolled. Participants underwent coronary computed tomography angiography (CTA), fractional flow reserve derived with coronary CTA (FFRCT), and plaque volume analyses. RESULTS Among 50 participants, 25 (50%) were female, and the mean age was 68.0 ± 11.4 years. Atherosclerotic risk factors were common. Coronary CTA revealed coronary plaque in 46 participants (92%). A moderate or greater stenosis (≥50%) was identified in 42% of participants, and obstructive disease (≥50% left main stenosis or ≥70% stenosis in any other epicardial coronary artery) was present in 26%. Prevalence of obstructive CAD did not differ according to T2MI cause (P = 0.54). A hemodynamically significant focal stenosis identified by FFRCT was present in 13 participants (26%). Among participants with a stenosis ≥50% (n = 21), FFRCT excluded lesion-specific hemodynamically significant stenosis in 8 cases (38%). CONCLUSIONS Among individuals with adjudicated T2MI, CAD was prevalent, but the majority of patients had nonobstructive CAD. Mediators of ischemia are likely multifactorial in this population. (Defining the Prevalence and Characteristics of Coronary Artery Disease Among Patients with Type 2 Myocardial Infarction using CT-FFR [DEFINE TYPE 2 MI]; NCT04864119).
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Affiliation(s)
- Cian P McCarthy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA. https://twitter.com/CianPMcCarthy
| | - Sean P Murphy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Daniel K Amponsah
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Paula K Rambarat
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Claire Lin
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Yuxi Liu
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Reza Mohebi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Allison Levin
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Avanthi Raghavan
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Hannah Miksenas
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jason H Wasfy
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ron Blankstein
- Department of Medicine (Cardiovascular Division) and Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sandeep Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James L Januzzi
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA; Baim Institute for Clinical Research, Boston, Massachusetts, USA.
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14
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Mehta S, Mehran R, Hassan S, Kaur J, Sule A, Arsene C, Krishnamoorthy G, Szklo M. Prevalence and Outcomes of Patients With Acute Ischemic Stroke and Concomitant Non-ST-Elevation Myocardial Infarction (Results from the National Inpatient Sample 2016 to 2019). Am J Cardiol 2023; 205:346-353. [PMID: 37639760 DOI: 10.1016/j.amjcard.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/31/2023] [Accepted: 08/05/2023] [Indexed: 08/31/2023]
Abstract
Acute myocardial infarction (MI) may concomitantly occur with acute ischemic stroke. The incidence and outcomes of acute non-ST-elevation MI (NSTEMI) in acute ischemic stroke are not well studied. We examined hospitalized patients with acute ischemic stroke and a concomitant NSTEMI diagnosis who were included in the National Inpatient Sample 2016 to 2019. Acute ischemic stroke and NSTEMI were defined by using the International Classification of Diseases, Tenth Revision codes. Patients with ST-elevation MI were excluded. The outcomes were expressed as percentages. A multivariable logistic regression analysis was used to examine the association of concomitant acute ischemic stroke and NSTEMI with the primary outcome of mortality and the secondary outcomes. A subgroup analysis of patients with NSTEMI with acute ischemic stroke that underwent percutaneous coronary intervention (PCI) (angiography and angioplasty) was also performed. Of the total hospitalized patients with acute ischemic stroke (n = 1,726,265), 1.60% (n = 27,630) patients (mean age 73.5 years, 52.2% women, 67% White race) had NSTEMI diagnosed during the hospitalization. Of these, 14.1% (n = 3,890) died in the NSTEMI group and 3.4% (n = 57,670) died in the non-NSTEMI group. The most common outcomes in the NSTEMI group were Acute kidney injury 31.8%, Intracranial hemorrhage 6.6%, and sepsis 6.13%. NSTEMI in acute ischemic stroke was associated with mortality (odds ratio [OR] 3.60, 95% confidence interval [CI] 3.29 to 3.93, p ≤0.001), ICH (OR 1.46, 95% CI 1.30 to 1.63, p <0.001), and having any of the secondary outcomes (OR 2.73, 95% CI 2.57 to 2.90, p <0.001). PCI was performed in 9.14% of patients with acute ischemic stroke with NSTEMI. PCI was associated with having any of the secondary outcomes (OR 0.83, 95% CI 0.7 to 1.02, p = 0.8), mortality (OR 0.35, 95% CI 0.23 to 0.54, p <0.001), and ICH (OR 0.42, 95% CI 0.25 to 0.7, p = 0.01). In conclusion, NSTEMI in acute ischemic stroke is associated with increased mortality and other adverse events. PCI in the subgroup of patients with NSTEMI was not associated with increased mortality or intracranial bleeding.
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Affiliation(s)
- Shivani Mehta
- Department of Internal Medicine, Trinity Health Oakland/Wayne state University, Pontiac, Michigan.
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Shahzad Hassan
- Department of Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Jasmeet Kaur
- Fox Chase Cancer Center, Temple University Hospital, Philadelphia, Pennsylvania
| | - Anupam Sule
- Department of Internal Medicine, Trinity Health Oakland/Wayne state University, Pontiac, Michigan
| | - Camelia Arsene
- Department of Internal Medicine, Trinity Health Oakland/Wayne state University, Pontiac, Michigan
| | - Geetha Krishnamoorthy
- Department of Internal Medicine, Trinity Health Oakland/Wayne state University, Pontiac, Michigan
| | - Moyses Szklo
- Department of Epidemiology, the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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15
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Ueyama H, Leshnower BG, Inci E, Keeling WB, Tully A, Guyton RA, Xie JX, Gleason PT, Byku I, Devireddy C, Hanzel GS, Block PC, Lederman RJ, Greenbaum AB, Babaliaros VC. Hybrid Closure of Postinfarction Apical Ventricular Septal Defect Using Septal Occluder Device and Right Ventricular Free Wall: The Apical BASSINET Concept. Circ Cardiovasc Interv 2023; 16:e013243. [PMID: 37732604 PMCID: PMC10592084 DOI: 10.1161/circinterventions.123.013243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/28/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Postinfarction ventricular septal defect (VSD) is a catastrophic complication of myocardial infarction. Surgical repair still has poor outcomes. This report describes clinical outcomes after a novel hybrid transcatheter/surgical repair in patients with apical VSD. METHODS Seven patients with postmyocardial infarction apical VSD underwent hybrid transcatheter repair via subxiphoid surgical access. A transcatheter occluder (Amplatzer Septal Occluder) with a trailing premounted suture was deployed through the right ventricular wall and through the ventricular septum into the left ventricular apex. The trailing suture was used to connect an anchor external to the right ventricular wall. Tension on the suture then collapses the right ventricular free wall against the septum and left ventricular occluder, thereby obliterating the VSD. Outcomes were compared with 9 patients who underwent surgical repair using either patch or primary suture closure. RESULTS All patients had significant left-to-right shunt (Qp:Qs 2.5:1; interquartile range [IQR, 2.1-2.6] hybrid repair versus 2.0:1 [IQR, 2.0-2.5] surgical repair), and elevated right ventricular systolic pressure (62 [IQR, 46-71] versus 49 [IQR, 43-54] mm Hg, respectively). All had severely depressed stroke volume index (22 versus 21 mL/m2) with ≈45% in each group requiring mechanical support preprocedurally. The procedure was done 15 (IQR, 10-50) versus 24 (IQR, 10-134) days postmyocardial infarction, respectively. Both groups of patients underwent repair with technical success and without intraprocedural death. One patient in the hybrid group and 4 in the surgical group developed multiorgan failure. The hybrid group had a higher survival at discharge (86% versus 56%) and at 30 days (71% versus 56%), but similar at 1 year (57% versus 56%). During follow-up, 1 patient in each group required reintervention for residual VSD (hybrid: 9 months versus surgical: 5 days). CONCLUSIONS Early intervention with a hybrid transcatheter/surgical repair may be a viable alternative to traditional surgery for postinfarction apical VSD.
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Affiliation(s)
- Hiroki Ueyama
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Bradley G. Leshnower
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Errol Inci
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - W. Brent Keeling
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andy Tully
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert A. Guyton
- Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Joe X. Xie
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Patrick T. Gleason
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Isida Byku
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Chandan Devireddy
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - George S. Hanzel
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Peter C. Block
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Robert J. Lederman
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Adam B. Greenbaum
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
| | - Vasilis C. Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University Hospital Midtown, Atlanta, Georgia, USA
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16
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Li J, Sun JH, Li XJ, Liu Y, Yu MY, Li DM, Ma YX, Luo HY, Yang YJ. [Impact of COVID-19 on primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction in Beijing]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:977-983. [PMID: 37709715 DOI: 10.3760/cma.j.cn112148-20230104-00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Objective: To investigate the impact of COVID-19 on treatment of patients with acute ST segment elevation myocardial infarction(STEMI) undergoing primary percutaneous coronary intervention(PPCI). Methods: This was a multicenter retrospective study. STEMI patients undergoing PPCI from January 1, 2019 to December 31, 2021 were selected, based on the data of Xinnaolvsetongdao App. Clinical data and treatment time indicators, including symptom to first medical contact (S-FMC), symptom to door (StoD), first medical contact to ECG (FMC-ECG), first medical contact to guide wire (FMC-W), door to balloon (DtoB) and total ischemic time in 2019, 2020 and 2021 were compared. STEMI patients aged<60 years were sub-grouped as the young and middle-aged group, and STEMI patients aged≥60 years were sub-grouped as the elderly group. Results: A total of 7 435 (3 305 in 2019, 1 796 in 2020 and 2 334 in 2021) STEMI patients aged (59.6±12.6) years undergoing PPCI were included in this analysis. There were 5 990 males. For STEMI patients with PPCI in 2019, 2020 and 2021, FMC-ECG was 3 (1, 5) min, 3(1, 7) min and 4 (1, 7) min. FMC-W was 73 (56, 87) min, 78 (62, 95) min and 77 (62, 87) min. DtoB was 73 (56, 85) min, 78 (62, 95) min and 77 (62, 86) min. Total ischemic time was 189 (130, 273) min, 196 (138, 295) min and 209 (143, 276) min. FMC-ECG, FMC-W, DtoB and total ischemic time were longer in 2020 and 2021 than in 2019 (all P<0.05). The proportions of patients with FMC-ECG≤10 min (88.4% (1 588/1 796) vs. 92.7% (3 064/3 305), P<0.05), FMC-W≤120 min (87.9% (1 579/1796) vs. 91.7% (3 030/3 305), P<0.05) and DtoB≤90 min (72.3% (1 298/1 796) vs. 80.8% (2 672/3 305), P<0.05) were lower in 2020 than in 2019, whereas no differences were observed in the proportions of patients with FMC-ECG≤10 min (91.3% (2 131/2 334) vs. 92.7% (3 064/3 305), P=0.054), FMC-W≤120 min (92.0% (2 148/2 334) vs. 91.7% (3 030/3 305), P=0.635) and DtoB≤90 min (80.0% (1 867/2 334) vs. 80.8% (2 672/3 305), P=0.424) in 2021 compared with 2019. In the subgroup analysis, the proportions of patients with FMC-ECG≤10 min, FMC-W≤120 min and DtoB≤90 min were lower in the elderly group than in young and middle-aged group in 2019 (all P<0.05). The proportions of patients with FMC-W≤120 min and DtoB≤90 min were lower in the elderly group than in young and middle-aged group in 2021(all P<0.05). No differences were observed in the proportions of patients with FMC-ECG≤10 min, FMC-W≤120 min and DtoB≤90 min between the two group in 2020 (all P>0.05). Conclusions: Affected by the COVID-19, there is a reduction in the number of PPCI cases and treatment delays in STEMI patients, especially in the elderly. After adjusting the treatment strategy and widely applying the Xinnaolvsetongdao APP, the above indicators are significantly improved in 2021 as compared with 2020.
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Affiliation(s)
- J Li
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - J H Sun
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - X J Li
- Quality Control and Improvement Center of Cardiovascular Intervention in Beijing, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - Y Liu
- Department of Science and Education, Beijing Municipal Health Commission, Beijing 100053, China
| | - M Y Yu
- Quality Control and Improvement Center of Cardiovascular Intervention in Beijing, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
| | - D M Li
- Beijing Anlong Maide Medical Technology Co., Ltd,Beijing 100085, China
| | - Y X Ma
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - H Y Luo
- Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
| | - Y J Yang
- Quality Control and Improvement Center of Cardiovascular Intervention in Beijing, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100037, China
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17
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Khaloo P, Ledesma PA, Nahlawi A, Galvin J, Ptaszek LM, Ruskin JN. Outcomes of Patients With Takotsubo Syndrome Compared With Type 1 and Type 2 Myocardial Infarction. J Am Heart Assoc 2023; 12:e030114. [PMID: 37681546 PMCID: PMC10547303 DOI: 10.1161/jaha.123.030114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Abstract
Background Takotsubo syndrome (TS) and myocardial infarction (MI) share similar clinical and laboratory characteristics but have important differences in causes, demographics, management, and outcomes. Methods and Results In this observational study, the National Inpatient Sample and National Readmission Database were used to identify patients admitted with TS, type 1 MI, or type 2 MI in the United States between October 1, 2017, and December 31, 2019. We compared patients hospitalized with TS, type 1 MI, and type 2 MI with respect to key features and outcomes. Over the 27-month study period, 2 035 055 patients with type 1 MI, 639 075 patients with type 2 MI, and 43 335 patients with TS were identified. Cardiac arrest, ventricular fibrillation, and ventricular tachycardia were more prevalent in type 1 MI (4.02%, 3.2%, and 7.2%, respectively) compared with both type 2 MI (2.8%, 0.8%, and 5.4% respectively) and TS (2.7%, 1.8%, and 5.3%, respectively). Risk of mortality was lower in TS compared with both type 1 MI (3.3% versus 7.9%; adjusted odds ratio [OR], 0.3; P<0.001) and type 2 MI (3.3% versus 8.2%; adjusted OR, 0.3; P<0.001). Mortality rate (OR, 1.2; P<0.001) and cardiac-cause 30-day readmission rate (adjusted OR, 1.7; P<0.001) were higher in type 1 MI than in type 2 MI. Conclusions Patients with type 1 MI had the highest rates of in-hospital mortality and cardiac-cause 30-day readmission. Risk of all-cause 30-day readmission was highest in patients with type 2 MI. The risk of ventricular arrhythmias in patients with TS is lower than in patients with type 1 MI but higher than in patients with type 2 MI.
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Affiliation(s)
- Pegah Khaloo
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Pablo A. Ledesma
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Acile Nahlawi
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Jennifer Galvin
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Leon M. Ptaszek
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
| | - Jeremy N. Ruskin
- Cardiac Arrhythmia Service, Massachusetts General HospitalHarvard Medical SchoolBostonMA
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18
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Londhe C, Agrawal A, Pednekar S, Pandey D, Khan MF. Swallowing Dysfunction after Acute Stroke: The Incidence, Predictors and Outcome. J Assoc Physicians India 2023; 71:11-12. [PMID: 37651239 DOI: 10.59556/japi.71.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
INTRODUCTION Swallowing dysfunction is common after acute stroke. It increases the risk of aspiration pneumonia and affects nutrition. In this study, we aimed to determine the incidence of dysphagia after a single episode of acute stroke in conscious patients and the factors predisposing the patient to dysphagia. We also assessed the course of dysphagia over a period of 8 weeks after stroke. MATERIALS AND METHODS It was a prospective observational study. We included patients of acute stroke (ischemic, hemorrhagic, lacunar, anterior, as well as posterior circulation) with Glasgow Coma Scale (GCS) of ≥12; within 48 hours of onset. Patients were screened for dysphagia by the Gugging Swallowing Screen (GUSS) screening tool; then assessed in detail using by Mann Assessment of Swallowing Ability (MASA) scoring scale. Patients with dysphagia were reassessed at 7 days and at 8 weeks after stroke for the presence and severity of dysphagia. RESULTS We included 150 patients. The incidence of dysphagia at day 1, day 7, and 8 weeks was 42, 24, and 9%, respectively. The proportion of patients with moderate and severe dysphagia also decreased during a follow-up period of 8 weeks from 18 to 3% and from 20 to 6%, respectively. The incidence of dysphagia was significantly greater in moderately severe stroke [National Institutes of Health Stroke Scale (NIHSS 5-14)] than in mild stroke (NIHSS 1-4). It was also more common in total anterior circulation infarct (TACI) than partial anterior circulation or lacunar infarct (LacI) and in posterior circulation strokes than the strokes involving anterior circulation. Patients with dysphagia had longer hospital stays (7.29 ± 3.4 days vs 3.62 ± 1.5 days, p = 0.001) and higher mean modified Rankin score at discharge (3.45 vs 2.17, p = 0.001). CONCLUSION Swallowing dysfunction should be checked in all cases of strokes, including unilateral hemispheric strokes and in fully conscious patients. Swallowing improves with time, but the patient may require feeding assistance in an acute setting. Dysphagia is more common in strokes with higher NIHSS, involving more brain parenchyma and posterior circulation strokes.
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Affiliation(s)
| | | | - Sangeeta Pednekar
- Professor, Department of Medicine, Lokmanya Tilak Municipal Medical College and General Hospital (LTMGH), Mumbai, Maharashtra, India
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19
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Dayem KA, Younis O, Zarif B, Attia S, AbdelSalam A. Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients - DACAMI (a randomized controlled clinical trial). Int J Cardiol 2023; 379:9-14. [PMID: 36889650 DOI: 10.1016/j.ijcard.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. METHODS In this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide - NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. RESULTS From October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: -3.28-19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: -19.37 to -3.56, p-value 0.029). CONCLUSIONS Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further. This trial is locally registered at the National Heart Institute, Cairo - Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 - June 16th,2022.
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Affiliation(s)
- Khairy Abdel Dayem
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
| | - Omar Younis
- Cardiology, National Heart Institute, 5 Ibn Al Nafees Square, Al Kit Kat, Giza 3755204, Egypt.
| | - Bassem Zarif
- Cardiology, National Heart Institute, 5 Ibn Al Nafees Square, Al Kit Kat, Giza 3755204, Egypt
| | - Sameh Attia
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
| | - Ahmed AbdelSalam
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
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20
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Taggart C, Monterrubio-Gómez K, Roos A, Boeddinghaus J, Kimenai DM, Kadesjo E, Bularga A, Wereski R, Ferry A, Lowry M, Anand A, Lee KK, Doudesis D, Manolopoulou I, Nestelberger T, Koechlin L, Lopez-Ayala P, Mueller C, Mills NL, Vallejos CA, Chapman AR. Improving Risk Stratification for Patients With Type 2 Myocardial Infarction. J Am Coll Cardiol 2023; 81:156-168. [PMID: 36631210 PMCID: PMC9841577 DOI: 10.1016/j.jacc.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/28/2022] [Accepted: 10/14/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Despite poor cardiovascular outcomes, there are no dedicated, validated risk stratification tools to guide investigation or treatment in type 2 myocardial infarction. OBJECTIVES The goal of this study was to derive and validate a risk stratification tool for the prediction of death or future myocardial infarction in patients with type 2 myocardial infarction. METHODS The T2-risk score was developed in a prospective multicenter cohort of consecutive patients with type 2 myocardial infarction. Cox proportional hazards models were constructed for the primary outcome of myocardial infarction or death at 1 year using variables selected a priori based on clinical importance. Discrimination was assessed by area under the receiving-operating characteristic curve (AUC). Calibration was investigated graphically. The tool was validated in a single-center cohort of consecutive patients and in a multicenter cohort study from sites across Europe. RESULTS There were 1,121, 250, and 253 patients in the derivation, single-center, and multicenter validation cohorts, with the primary outcome occurring in 27% (297 of 1,121), 26% (66 of 250), and 14% (35 of 253) of patients, respectively. The T2-risk score incorporating age, ischemic heart disease, heart failure, diabetes mellitus, myocardial ischemia on electrocardiogram, heart rate, anemia, estimated glomerular filtration rate, and maximal cardiac troponin concentration had good discrimination (AUC: 0.76; 95% CI: 0.73-0.79) for the primary outcome and was well calibrated. Discrimination was similar in the consecutive patient (AUC: 0.83; 95% CI: 0.77-0.88) and multicenter (AUC: 0.74; 95% CI: 0.64-0.83) cohorts. T2-risk provided improved discrimination over the Global Registry of Acute Coronary Events 2.0 risk score in all cohorts. CONCLUSIONS The T2-risk score performed well in different health care settings and could help clinicians to prognosticate, as well as target investigation and preventative therapies more effectively. (High-Sensitivity Troponin in the Evaluation of Patients With Suspected Acute Coronary Syndrome [High-STEACS]; NCT01852123).
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Affiliation(s)
- Caelan Taggart
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Karla Monterrubio-Gómez
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Andreas Roos
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Department of Emergency and Reparative Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Jasper Boeddinghaus
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Erik Kadesjo
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institute, Stockholm, Sweden; Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anda Bularga
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Amy Ferry
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Matthew Lowry
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Atul Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Kuan Ken Lee
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Dimitrios Doudesis
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ioanna Manolopoulou
- Department of Statistical Sciences, University College London, London, United Kingdom
| | - Thomas Nestelberger
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Luca Koechlin
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Pedro Lopez-Ayala
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Christian Mueller
- Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, Basel, Switzerland
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom; Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Catalina A Vallejos
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom; The Alan Turing Institute, London, United Kingdom
| | - Andrew R Chapman
- BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom.
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21
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Gaggini M, Michelucci E, Ndreu R, Rocchiccioli S, Chatzianagnostou K, Berti S, Vassalle C. Lipidomic Analysis to Assess the Correlation between Ceramides, Stress Hyperglycemia, and HbA1c in Acute Myocardial Infarction. Molecules 2023; 28:molecules28020716. [PMID: 36677773 PMCID: PMC9862855 DOI: 10.3390/molecules28020716] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/13/2023]
Abstract
Ceramides have been associated with cardiometabolic disease (e.g., acute myocardial infarction (AMI) and type 2 diabetes (T2D)) and adverse outcomes. Acute admission hyperglycemia (AH) is a transient glucose alteration in response to stress. As glycated hemoglobin (HbA1c) reflects the glycemia over a longer period of time, its use may be helpful in distinguishing between the AH and hyperglycemia associated with T2D in the AMI setting. The aim was to assess the correlation of ceramides with both AH (defined as an admission glucose level ≥140 mg/dL in the absence of T2D) and HbA1c-T2D and other demographic, clinical, and inflammatory-related biomarkers in AMI. High-performance liquid chromatography-tandem mass spectrometry was used to identify nine ceramide species, and their three ratios, in 140 AMI patients (FTGM coronary unit, Massa, Italy). The ceramides did not correlate with stress hyperglycemia, but specific species were elevated in T2D-AMI. Moreover, some ceramides were associated with other cardiometabolic risk factors. Ceramides assessment may be helpful in better understanding the pathogenic molecular mechanisms underlying myocardial acute events and cardiometabolic risk, as a basis for the future evaluation of their role as prognostic predictors and therapeutic targets in T2D-AMI patients.
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Affiliation(s)
- Melania Gaggini
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Elena Michelucci
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
- Institute of Chemistry of Organometallic Compounds, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Rudina Ndreu
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124 Pisa, Italy
| | | | - Sergio Berti
- Fondazione CNR-Regione Toscana G Monasterio, 54100 Massa, Italy
| | - Cristina Vassalle
- Fondazione CNR-Regione Toscana G Monasterio, 56124 Pisa, Italy
- Correspondence:
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22
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Pica S, Crimi G, Castelvecchio S, Pazzanese V, Palmisano A, Lombardi M, Tondi L, Esposito A, Ameri P, Canale C, Cappelletti A, Alberti LP, Tavano D, Camporotondo R, Costantino I, Campodonico J, Pontone G, Villani A, Gallone GP, Montone RA, Niccoli G, Gargiulo P, Punzo B, Vicenzi M, Carugo S, Menicanti L, Ambrosio G, Camici PG. Cardiac magnetic resonance predictors of left ventricular remodelling following acute ST elevation myocardial infarction: The VavirimS study. Int J Cardiol 2023; 370:8-17. [PMID: 36351542 DOI: 10.1016/j.ijcard.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 10/30/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Left ventricular (LV) remodelling (REM) ensuing after ST-elevation myocardial infarction (STEMI), has typically been studied by echocardiography, which has limitations, or cardiac magnetic resonance (CMR) in early phase that may overestimate infarct size (IS) due to tissue edema and stunning. This prospective, multicenter study investigated LV-REM performing CMR in the subacute phase, and 6 months after STEMI. METHODS AND RESULTS patients with first STEMI undergoing successful primary angioplasty were consecutively enrolled. CMR was done at 30-days and 6-months. Primary endpoint was prevalence at 6 months of LV-REM [≥12% increase in LV end-diastolic volume index (LV-REMEDV)]; LV-REM by end-systolic volume index increase ≥12% (LV-REMESV) was also calculated. Of 325 patients enrolled, 193 with a full set of research-quality CMR images were analyzed. LV-REMEDV and LV-REMESV were present in 36/193 (19%) and 34/193 (18%) patients, respectively. At follow up, LV ejection fraction (EF) improved in patients with or without LV-REMEDV, whilst it decreased in those with LV-REMESV (p < 0.001 for interaction). Considering predictors of LV-REM, IS in the highest tertile was clearly separated from the two lower tertiles. In LV-REMEDV, the highest tertile was associated with significantly higher LV-EDV, LV-ESV, and lower EF. CONCLUSIONS In a contemporary cohort of STEMI patients studied by CMR, prevalence of LV-REMEDV was lower than previously reported. Importantly, our data indicate that LV-REMEDV might not be "adverse" per se, but rather "compensatory", being associated with LV-EF improvement at follow-up. Conversely, LV-REMESV might be an "adverse" phenomenon associated with decreased LV-EF, driven by IS.
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Affiliation(s)
- Silvia Pica
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Gabriele Crimi
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | - Anna Palmisano
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Lara Tondi
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Antonio Esposito
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy; Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Pietro Ameri
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Claudia Canale
- Cardio-Thoraco-Vascular Department, IRCCS Policlinico San Martino and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | | | | | - Rita Camporotondo
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Coronary Care Unit Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Jenness Campodonico
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluca Pontone
- Centro Cardiologico Monzino IRCCS and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | | | | | - Rocco A Montone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giampaolo Niccoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Medicine, University of Parma, Parma, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | | | - Marco Vicenzi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Carugo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Cardiovascular Disease Unit, Internal Medicine Department and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology, University of Perugia School of Medicine, Perugia, Italy
| | - Paolo G Camici
- Vita Salute University and IRCCS San Raffaele Hospital, Milano, Italy.
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Bularga A, Mills NL, Chapman AR. Response by Bularga et al to Letter Regarding Article, "Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study". Circulation 2022; 146:e258-e259. [PMID: 36343102 DOI: 10.1161/circulationaha.122.061692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Anda Bularga
- British Heart Foundation Centre for Cardiovascular Science (A.B., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Nicholas L Mills
- British Heart Foundation Centre for Cardiovascular Science (A.B., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Usher Institute (N.L.M.), University of Edinburgh, United Kingdom
| | - Andrew R Chapman
- British Heart Foundation Centre for Cardiovascular Science (A.B., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
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Gao Q, Bie F, Hu Y, Chen Y, Yang B. Characteristics and mechanism of reciprocal ST-segment depression in acute ST segment elevation myocardial infarction: Reciprocal ST-segment depression and ST segment elevation myocardial infarction. Medicine (Baltimore) 2022; 101:e31238. [PMID: 36343047 PMCID: PMC9646491 DOI: 10.1097/md.0000000000031238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
At present, the mechanism of reciprocal ST-segment depression (RSTD) is unclear. ST-segment changes may be caused by the potential difference between the positive and negative electrodes, although this requires further investigation. The characteristics of RSTD and their relationship with ST-segment elevation in acute ST segment elevation myocardial infarction (STEMI) patients were analyzed. We replaced the negative electrode of the precordial leads of an inferior wall myocardial infarction patient and observed the changes in the ST-segment of the precordial leads. A total of 85 patients were included, of which 75 were patients with RSTD. All 45 patients with inferior myocardial infarction had limb lead RSTD, and 37 had anterior lead ST-segment depression. All ST-segment changes in STEMI can be explained by the proposed mechanism, and the value of ST segment depression in limb leads can be calculated by the value of ST segment elevation. In summary, the mechanism of RSTD in acute myocardial infarction may be that the action potential (AP) of the negative electrode of the lead weakens or disappears and the AP of the positive electrode may not be completely offset, resulting in ST-segment depression. Animal experimental studies are needed for further confirmation. When the negative electrode of the precordial lead is changed in acute inferior wall myocardial infarction patient, the ST-segment of the precordial lead changes accordingly. All the changes are consistent with our analysis.
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Affiliation(s)
- Qijun Gao
- Department of Cardiology, First People's Hospital of Jingmen, Jingmen, Hubei Province, P.R. China
| | - Fangfang Bie
- Department of Cardiology, First People's Hospital of Jingmen, Jingmen, Hubei Province, P.R. China
| | - Yingfu Hu
- Department of Cardiology, First People's Hospital of Jingmen, Jingmen, Hubei Province, P.R. China
| | - Yafeng Chen
- Department of Cardiology, First People's Hospital of Jingmen, Jingmen, Hubei Province, P.R. China
| | - Bo Yang
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, P.R. China
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Gao W, Zhong X, Ma Y, Huang D, Wang R, Zhao S, Yang S, Qian J, Ge J. A randomized multicenter trial to evaluate early invasive strategy for patients with acute ST-segment elevation myocardial infarction presenting 24-48 hours from symptom onset: Protocol of the RESCUE-MI study. Am Heart J 2022; 251:54-60. [PMID: 35525262 DOI: 10.1016/j.ahj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For ST-segment elevation myocardial infarction (STEMI) patients presenting 24 to 48 hours from symptom onset, whether early invasive strategy should be performed still remains controversial. METHODS This is a prospective, open-label, multicenter, investigator initiated, randomized controlled trial (NCT04962178) to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset. A total of 366 patients will be included from 10 hospitals in mainland China. They will be randomly (1:1) divided into 2 groups: the early invasive strategy group (primary percutaneous coronary intervention, PPCI) and conservative strategy group (optimal medical therapy with primary PCI not performed). All patients will be followed for 1 month. The primary end point is myocardial infarction size on cardiac magnetic resonance (CMR). The secondary end points are as follows: (1) major adverse cardiovascular events (MACE), which is defined as a composite of cardiac death, recurrent myocardial infarction, ischemic driven target vessel revascularization and stroke; (2) other CMR end points, including microvascular obstruction, intramyocardial hemorrhage, myocardial area at risk, left ventricular ejection fraction, left ventricular end diastolic volume and left ventricular end systolic volume. DISCUSSION This study is designed to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset and will add more evidence for clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04962178. Registered on July 14, 2021.
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Affiliation(s)
- Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xin Zhong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuanji Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ruochen Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
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26
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Santucci A, Cavallini C. [Diagnostic, therapeutic and prognostic aspects of type 2 myocardial infarction]. G Ital Cardiol (Rome) 2022; 23:523-532. [PMID: 35771018 DOI: 10.1714/3831.38170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Type 2 myocardial infarction is the ischemic necrosis of cardiomyocytes due to oxygen supply/demand imbalance. The most common causes are surgery, sepsis, arrhythmias, hypo/hypertension. Patients with type 2 myocardial infarction, a disease that accounts for about 25% of total myocardial infarctions, have more comorbidities and are older than patients with type 1 myocardial infarction. Coronary angiography is not mandatory, but it may be useful for the differential diagnosis with acute coronary syndrome. The prognosis in these patients is severe and burdened by high non-cardiovascular and cardiovascular mortality. Treatment is poorly codified and involves the management of trigger events and/or treatment of the underlying coronary artery disease, which is often present; revascularization has an uncertain benefit. Ongoing studies will provide insight on this complex disease.
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Affiliation(s)
- Andrea Santucci
- S.C. Cardiologia, Ospedale S. Maria della Misericordia, Perugia
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27
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Abstract
Background Prior studies have reported disparities by race in the management of acute myocardial infarction (MI), with many studies having limited covariates or now dated. We examined racial and ethnic differences in the management of MI, specifically non–ST‐segment‐elevation MI (NSTEMI), in a large, socially diverse cohort of insured patients. We hypothesized that the racial and ethnic disparities in the receipt of coronary angiography or percutaneous coronary intervention would persist in contemporary data. Methods and Results We identified individuals presenting with incident, type I NSTEMI from 2017 to 2019 captured by a health claims database. Race and ethnicity were categorized by the database as Asian, Black, Hispanic, or White. Covariates included demographics (age, sex, race, and ethnicity); Elixhauser variables, including cardiovascular risk factors and other comorbid conditions; and social factors of estimated annual household income and educational attainment. We examined rates of coronary angiography and percutaneous coronary intervention by race and ethnicity and income categories and in multivariable‐adjusted models. We identified 87 094 individuals (age 73.8±11.6 years; 55.6% male; 2.6% Asian, 13.4% Black, 11.2% Hispanic, 72.7% White) with incident NSTEMI events from 2017 to 2019. Individuals of Black race were less likely to undergo coronary angiography (odds ratio [OR], 0.93; [95% CI, 0.89–0.98]) and percutaneous coronary intervention (OR, 0.86; [95% CI, 0.81–0.90]) than those of White race. Hispanic individuals were less likely (OR, 0.88; [95% CI, 0.84–0.93]) to undergo coronary angiography and percutaneous coronary intervention (OR, 0.85; [95% CI, 0.81–0.89]) than those of White race. Higher annual household income attenuated differences in the receipt of coronary angiography across all racial and ethnic groups. Conclusions We identified significant racial and ethnic differences in the management of individuals presenting with NSTEMI that were marginally attenuated by higher household income. Our findings suggest continued evidence of health inequities in contemporary NSTEMI treatment.
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Affiliation(s)
- Tarryn Tertulien
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Stephen T. Broughton
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
- Division of CardiologyUPMC Heart and Vascular Institute, University of PittsburghPittsburghPennsylvania
| | - Gretchen Swabe
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
| | - Utibe R. Essien
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
- Center for Health Equity Research and PromotionVA Pittsburgh Healthcare SystemPittsburghPennsylvania
| | - Jared W. Magnani
- Department of MedicineUniversity of Pittsburgh Medical CenterPittsburghPennsylvania
- Division of CardiologyUPMC Heart and Vascular Institute, University of PittsburghPittsburghPennsylvania
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28
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Smilowitz NR, Shah B, Lorin J, Berger JS. Patterns and outcomes of invasive management of type 2 myocardial infarction in the United States. Coron Artery Dis 2022; 33:269-276. [PMID: 35044332 PMCID: PMC9064880 DOI: 10.1097/mca.0000000000001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Type 2 myocardial infarction (MI) occurs due to a mismatch in myocardial oxygen supply and demand without unstable coronary artery disease. We sought to identify patterns, predictors and outcomes of invasive management of type 2 MI in the USA. METHODS Adults aged ≥18 years hospitalized with type 2 MI were identified in a cross-sectional study from the 2018 National Inpatient Sample. Invasive management was defined as invasive coronary angiography or revascularization. Patient, hospital and geographic characteristics associated with invasive management were identified by multivariable logistic regression. Propensity-matched cohorts were generated to evaluate associations between invasive vs. conservative management and mortality. RESULTS We identified 268 850 admissions with type 2 MI in 2018. Type 2 MI patients had a high burden of comorbidities and were commonly admitted with diagnoses of circulatory (39.7%), infectious (23.1%) or respiratory (10.8%) illness. Only 11.2% of type 2 MI were managed invasively, of which 17.9% underwent coronary revascularization. Odds of invasive management were higher with commercial insurance [adjusted OR (aOR) 1.39; 95% confidence interval (CI), 1.27-1.52] and lower with Medicaid (aOR 0.86; 95% CI, 0.76-0.96) vs. Medicare. Significant heterogeneity in invasive management of type 2 MI was observed by geographic region (range 7.2-13.8%), independent of patient and hospital factors. Invasive management was associated with lower in-hospital mortality than conservative management overall (3.9 vs. 9.1%; P < 0.001) and in propensity-matched analyses (OR, 0.70; 95% CI, 0.59-0.84). CONCLUSION Invasive management of type 2 MI varies by insurance status and geography, highlighting uncertainty regarding optimal management and potential disparities in clinical care.
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Affiliation(s)
- Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System
| | - Binita Shah
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System
| | - Jeffrey Lorin
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Cardiology Section, Department of Medicine, Veterans Affairs New York Harbor Health Care System
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine
- Department of Surgery, New York University School of Medicine, New York, USA
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29
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Klingenberg R, Stähli BE, Heg D, Denegri A, Manka R, Kapos I, von Eckardstein A, Carballo D, Hamm CW, Vietheer J, Rolf A, Landmesser U, Mach F, Moccetti T, Jung C, Kelm M, Münzel T, Pedrazzini G, Räber L, Windecker S, Matter CM, Ruschitzka F, Lüscher TF. Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS) - A phase II, randomized, double-blind, multi-center, placebo-controlled trial. Am Heart J 2022; 247:33-41. [PMID: 35092722 DOI: 10.1016/j.ahj.2022.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Activation of inflammatory pathways during acute myocardial infarction contributes to infarct size and left ventricular (LV) remodeling. The present prospective randomized clinical trial was designed to test the efficacy and safety of broad-spectrum anti-inflammatory therapy with a mammalian target of rapamycin (mTOR) inhibitor to reduce infarct size. DESIGN Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS, clinicaltrials.gov NCT01529554) is a phase II randomized, double-blind, multi-center, placebo-controlled trial on the effects of a 5-day course of oral everolimus on infarct size, LV remodeling, and inflammation in patients with acute ST-elevation myocardial infarction (STEMI). Within 5 days of successful primary percutaneous coronary intervention (pPCI), patients are randomly assigned to everolimus (first 3 days: 7.5 mg every day; days 4 and 5: 5.0 mg every day) or placebo, respectively. The primary efficacy outcome is the change from baseline (defined as 12 hours to 5 days after pPCI) to 30-day follow-up in myocardial infarct size as measured by cardiac magnetic resonance imaging (CMRI). Secondary endpoints comprise corresponding changes in cardiac and inflammatory biomarkers as well as microvascular obstruction and LV volumes assessed by CMRI. Clinical events, laboratory parameters, and blood cell counts are reported as safety endpoints at 30 days. CONCLUSION The CLEVER-ACS trial tests the hypothesis whether mTOR inhibition using everolimus at the time of an acute STEMI affects LV infarct size following successful pPCI.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, Social and Preventive Medicine, University of Bern, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ioannis Kapos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | | | - David Carballo
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Julia Vietheer
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Charité - University Medicine, , Berlin, Germany
| | - François Mach
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Christian Jung
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Thomas Münzel
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland; Imperial College, National Heart and Lung Institute and Royal Brompton and Harefield Hospitals, Heart Division London, U.K..
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30
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Bularga A, Hung J, Daghem M, Stewart S, Taggart C, Wereski R, Singh T, Meah MN, Fujisawa T, Ferry AV, Chiong J, Jenkins WS, Strachan FE, Semple S, van Beek EJ, Williams M, Dey D, Tuck C, Baker AH, Newby DE, Dweck MR, Mills NL, Chapman AR. Coronary Artery and Cardiac Disease in Patients With Type 2 Myocardial Infarction: A Prospective Cohort Study. Circulation 2022; 145:1188-1200. [PMID: 35341327 PMCID: PMC9010024 DOI: 10.1161/circulationaha.121.058542] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/25/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND Type 2 myocardial infarction is caused by myocardial oxygen supply-demand imbalance, and its diagnosis is increasingly common with the advent of high-sensitivity cardiac troponin assays. Although this diagnosis is associated with poor outcomes, widespread uncertainty and confusion remain among clinicians as to how to investigate and manage this heterogeneous group of patients with type 2 myocardial infarction. METHODS In a prospective cohort study, 8064 consecutive patients with increased cardiac troponin concentrations were screened to identify patients with type 2 myocardial infarction. We excluded patients with frailty or renal or hepatic failure. All study participants underwent coronary (invasive or computed tomography angiography) and cardiac (magnetic resonance or echocardiography) imaging, and the underlying causes of infarction were independently adjudicated. The primary outcome was the prevalence of coronary artery disease. RESULTS In 100 patients with a provisional diagnosis of type 2 myocardial infarction (median age, 65 years [interquartile range, 55-74 years]; 43% women), coronary and cardiac imaging reclassified the diagnosis in 7 patients: type 1 or 4b myocardial infarction in 5 and acute myocardial injury in 2 patients. In those with type 2 myocardial infarction, median cardiac troponin I concentrations were 195 ng/L (interquartile range, 62-760 ng/L) at presentation and 1165 ng/L (interquartile range, 277-3782 ng/L) on repeat testing. The prevalence of coronary artery disease was 68% (63 of 93), which was obstructive in 30% (28 of 93). Infarct-pattern late gadolinium enhancement or regional wall motion abnormalities were observed in 42% (39 of 93), and left ventricular systolic dysfunction was seen in 34% (32 of 93). Only 10 patients had both normal coronary and normal cardiac imaging. Coronary artery disease and left ventricular systolic dysfunction were previously unrecognized in 60% (38 of 63) and 84% (27 of 32), respectively, with only 33% (21 of 63) and 19% (6 of 32) on evidence-based treatments. CONCLUSIONS Systematic coronary and cardiac imaging of patients with type 2 myocardial infarction identified coronary artery disease in two-thirds and left ventricular systolic dysfunction in one-third of patients. Unrecognized and untreated coronary or cardiac disease is seen in most patients with type 2 myocardial infarction, presenting opportunities for initiation of evidence-based treatments with major potential to improve clinical outcomes. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03338504.
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Affiliation(s)
- Anda Bularga
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - John Hung
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marwa Daghem
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Stacey Stewart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Caelan Taggart
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Ryan Wereski
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Trisha Singh
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Mohammed N. Meah
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Takeshi Fujisawa
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Amy V. Ferry
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Justin Chiong
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - William S. Jenkins
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Fiona E. Strachan
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Scott Semple
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Edwin J.R. van Beek
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Michelle Williams
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
- Edinburgh Imaging (S.S., E.J.R.v.B., M.W.), University of Edinburgh, United Kingdom
| | - Damini Dey
- Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, CA (D.D.)
| | - Chris Tuck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Andrew H. Baker
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - David E. Newby
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | - Marc R. Dweck
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
| | | | - Andrew R. Chapman
- BHF Centre for Cardiovascular Science (A.B., J.H., M.D., S.S., C.T., R.W., T.S., M.N.M., T.F., A.V.F., J.C., W.S.J., F.E.S., M.W., C.T., A.H.B., D.E.N., M.R.D., N.L.M., A.R.C.), University of Edinburgh, United Kingdom
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Visser PCJ, Vink MA, Patterson MS, Yazdanbakhsh A, Arlan F, Kuipers RS. Cardiac arrest resulting from an unidentified foreign object, later identified as a balloon cover, within the left anterior descending coronary artery. BMJ Case Rep 2022; 15:e244786. [PMID: 35428662 PMCID: PMC9013957 DOI: 10.1136/bcr-2021-244786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/04/2022] Open
Abstract
A 31-year-old man with a history of hypertrophic cardiomyopathy and alcohol septal ablation one week before was presented after an out of hospital cardiac arrest in the setting of an anterior wall ST-elevation myocardial infarction. Immediate coronary angiography showed an unidentified foreign object within the left anterior descending coronary artery (LAD), later identified as the cover of a balloon that had been unintentionally inserted and abandoned within the LAD during the alcohol septum ablation one week earlier. Intracoronary imaging confirmed the presence of endothelial damage and thrombus formation within the LAD explaining acute myocardial infarction. The patient was treated by surgical retrieval of the balloon cover, extended septal myectomy and coronary artery bypass grafting (CABG) of the LAD. This case is both an example of unintentional neglect of unexpected objects, and the importance of multimodality imaging and multidisciplinary teamwork to get to a correct diagnosis and treatment.
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Affiliation(s)
| | - Maarten A Vink
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Mark S Patterson
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Aria Yazdanbakhsh
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, Noord-Holland, Netherlands
| | - Fatih Arlan
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, Utrecht, Netherlands
| | - Remko S Kuipers
- Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
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32
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Chapman AR, Lindahl B, Mills NL, Mueller C. Blood and imaging biomarkers in type 2 myocardial infarction. Eur Heart J Acute Cardiovasc Care 2022; 11:269-271. [PMID: 35018435 PMCID: PMC8929983 DOI: 10.1093/ehjacc/zuab130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Indexed: 01/11/2023]
Affiliation(s)
- Andrew R Chapman
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
| | - Bertil Lindahl
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, Chancellors Building, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Christian Mueller
- Department of Cardiology, University Hospital, Basel, Basel, Switzerland
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33
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Arrivi A, Borghetti V. Acute Left Ventricle Free-Wall Rupture Post Primary PCI: In Vivo Imaging. J Invasive Cardiol 2022; 34:E253-E254. [PMID: 35235533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 69-year-old male was referred to our cath lab for primary percutaneous coronary intervention due to acute anterior ST-segment elevation myocardial infarction. Left coronary angiography revealed acute occlusion of the proximal left anterior descending artery. After several additional diagnostic procedures and implantation of a drug-eluting stent, an abrupt clinical deterioration manifested with sudden hypotension. There was evidence of cardiac tamponade, and the constant supply of blood from the pericardium along with the development of cardiogenic shock state led us to suspect cardiac laceration. This imaging series illustrates a heart team operating in vivo on a rare acute myocardial infarction mechanical complication, which occurred soon after primary percutaneous coronary intervention.
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Affiliation(s)
- Alessio Arrivi
- Santa Maria University Hospital, Via Tristano di Joannuccio 1, 05100, Terni, Italy.
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34
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Franchina AG, Tomasello SD, Azzarelli SA, Scardaci F, Argentino V, Amico F. [Staged rotational atherectomy in a patient with acute ST-elevation myocardial infarction: a case report and review of the literature]. G Ital Cardiol (Rome) 2022; 23:128-132. [PMID: 35343517 DOI: 10.1714/3735.37215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Rotational atherectomy represents an option to improve the treatment of calcified/undilatable coronary stenoses, but its use in ST-elevation myocardial infarction (STEMI) is controversial. We report the case of a patient with an occlusive and calcified coronary stenosis and its management not previously described. A 67-year-old man with STEMI was referred to our cath-lab. Coronary angiography showed a complex calcified and thrombotic occlusion of the right coronary artery. Vessel patency was obtained with balloon dilation, achieving clinical stability. The patient started dual antiplatelet therapy and was scheduled for a staged procedure using rotational atherectomy ("Rota-staged PCI"), performed 6 days later reaching optimal angiographic and clinical results. Our purpose was to manage this STEMI patient with an occluded and heavily calcified coronary artery in two times: a primary coronary angioplasty to quickly reopen the artery and an early staged PCI using rotational atherectomy to optimize the intervention (coronary dilation and stent deployment) minimizing the risk of stent underexpansion or acute complications.
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Affiliation(s)
- Antonio Gabriele Franchina
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania - Formazione Specialistica in Cardiologia, Università degli Studi, Catania
| | - Salvatore Davide Tomasello
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania
| | - Salvatore Adriano Azzarelli
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania
| | - Francesco Scardaci
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania
| | - Vincenzo Argentino
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania
| | - Francesco Amico
- Unità di Cardiologia Interventistica ed Emodinamica, Divisione di Cardiologia, Azienda Ospedaliera per le Emergenze Cannizzaro, Catania
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Hung J, Roos A, Kadesjö E, McAllister DA, Kimenai DM, Shah ASV, Anand A, Strachan FE, Fox KAA, Mills NL, Chapman AR, Holzmann MJ. Performance of the GRACE 2.0 score in patients with type 1 and type 2 myocardial infarction. Eur Heart J 2021; 42:2552-2561. [PMID: 32516805 PMCID: PMC8266602 DOI: 10.1093/eurheartj/ehaa375] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/17/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
AIMS The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. METHODS AND RESULTS In two cohorts of consecutive patients with suspected acute coronary syndrome from 10 hospitals in Scotland (n = 48 282) and a tertiary care hospital in Sweden (n = 22 589), we calculated the GRACE 2.0 score to estimate death at 1 year. Discrimination was evaluated by the area under the receiver operating curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong's test. Type 1 myocardial infarction was diagnosed in 4981 (10%) and 1080 (5%) patients in Scotland and Sweden, respectively. At 1 year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE 2.0 score of 0.83 [95% confidence interval (CI) 0.82-0.85] and 0.85 (95% CI 0.81-0.89). Type 2 myocardial infarction occurred in 1121 (2%) and 247 (1%) patients in Scotland and Sweden, respectively, with 258 (23%) and 57 (23%) deaths at 1 year. The AUC was 0.73 (95% CI 0.70-0.77) and 0.73 (95% CI 0.66-0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P < 0.001 and P = 0.008, respectively). CONCLUSION The GRACE 2.0 score provided good discrimination for all-cause death at 1 year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. TRIAL REGISTRATION ClinicalTrials.gov number, NCT01852123.
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Affiliation(s)
- John Hung
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - Andreas Roos
- Department of Medicine, Karolinska Institute, 171 77 Solna, Stockholm, Sweden
- Functional Area of Emergency Medicine, Karolinska University Hospital, 141 57 Huddinge, Stockholm, Sweden
| | - Erik Kadesjö
- Department of Medicine, Karolinska Institute, 171 77 Solna, Stockholm, Sweden
- Functional Area of Emergency Medicine, Karolinska University Hospital, 141 57 Huddinge, Stockholm, Sweden
| | - David A McAllister
- Institute of Health and Wellbeing, University of Glasgow, G12 8QQ Glasgow, UK
| | - Dorien M Kimenai
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
- Usher Institute, University of Edinburgh, EH8 9AG Edinburgh, UK
- CARIM School for Cardiovascular Diseases, Maastricht University, 6229 ER Maastricht, the Netherlands
- Central Diagnostic Laboratory, Maastricht University Medical Center, 6229 ER Maastricht, the Netherlands
| | - Anoop S V Shah
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
- Usher Institute, University of Edinburgh, EH8 9AG Edinburgh, UK
| | - Atul Anand
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - Fiona E Strachan
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - Keith A A Fox
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - Nicholas L Mills
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
- Usher Institute, University of Edinburgh, EH8 9AG Edinburgh, UK
| | - Andrew R Chapman
- BHF Centre for Cardiovascular Science, University of Edinburgh, 49 Little France Crescent, EH16 4SB Edinburgh, UK
| | - Martin J Holzmann
- Department of Medicine, Karolinska Institute, 171 77 Solna, Stockholm, Sweden
- Functional Area of Emergency Medicine, Karolinska University Hospital, 141 57 Huddinge, Stockholm, Sweden
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36
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Long A, Talreja A, Baran D, Talreja D. Percutaneous Closure of a Large Postinfarct Ventricular Septal Defect With an Atrial Septal Defect Closure Device in a High Surgical Risk Patient. J Invasive Cardiol 2021; 33:E485-E486. [PMID: 34089311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We report here the transcatheter closure of a large and complex post-myocardial infarction ventricular septal defect (VSD) involving the papillary muscle, measuring 38 mm in its greatest extent, too large to utilize a VSD occluder device (the largest VSD occluder is 24 mm). This necessitated the novel, off-label use of an atrial septal defect occluder instead.
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Affiliation(s)
- Ashleigh Long
- Sentara Heart Hospital, 600 Gresham Drive, Norfolk, VA 23507.
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37
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Fairley SL. Acute Inferior ST-Elevation Myocardial Infarction Caused by Occlusion of a Giant Coronary Artery Aneurysm. J Invasive Cardiol 2021; 33:E401-E402. [PMID: 33932287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An approach to the treatment of a giant aneurysm of the proximal right coronary artery with thrombotic occlusion is described.
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Affiliation(s)
- Sarah L Fairley
- Cardiology Department, Wellington Hospital, Riddiford St, Wellington, New Zealand.
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38
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Wang A, Xu J, Chen Z. Cognition and progress of de Winter electrocardiogram pattern. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2021; 46:421-425. [PMID: 33967090 PMCID: PMC10930315 DOI: 10.11817/j.issn.1672-7347.2021.190588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Indexed: 11/03/2022]
Abstract
The de Winter electrocardiogram pattern is an acute ST-segment elevation myocardial infarction equivalent, however this specific electrocardiogram change is easily ignored by clinicians. The de Winter electrocardiogram pattern in patients with acute chest pain mostly indicates sub-complete or complete occlusion of the left anterior descending or the diagonal branch. Patients with acute chest pain and such electrocardiographic finding should undergo emergency coronary angiography immediately to determine the coronary condition, and reperfusion therapy should be performed as soon as possible to reduce the incidence of adverse cardiovascular events.
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Affiliation(s)
- Aihua Wang
- Department of Critical Care Medicine, Chongqing Yongchuan District People's Hospital, Chongqing 402160.
| | - Jing Xu
- Department of Color Ultra Room, Mianyang Central Hospital, Mianyang Sichuan 621000
| | - Zijun Chen
- Department of Cardiology, Yongchuan Hospital of Chongqing Medical University, Chongqing 402160, China.
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Kamizono Y, Ikeda D. Acute Posterior-inferior Myocardial Infarction Caused by Total Occlusion Distal to the Apex of the Hyperdominant Left Anterior Descending Artery. Intern Med 2020; 59:3183-3186. [PMID: 32759596 PMCID: PMC7807107 DOI: 10.2169/internalmedicine.5425-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 77-year-old woman was admitted to our hospital with severe ongoing chest pain. Electrocardiography showed ST-segment elevation in the inferior leads and tall R waves in leads V1-2. Posterior-inferior myocardial infarction was diagnosed. Emergent coronary angiography (CAG) revealed the wrap-around left anterior descending artery (LAD) with total occlusion distal to the cardiac apex. She underwent percutaneous coronary intervention (PCI). Despite difficulty navigating the long and tortuous LAD, we successfully performed reperfusion of the wrap-around LAD. CAG post-PCI showed the posterior descending artery arising from the LAD, described as hyperdominant LAD.
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Affiliation(s)
- Yusuke Kamizono
- Department of Internal Medicine, Gyokusuikai Hospital, Japan
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40
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Cure E, Cumhur Cure M. Comment on "The relationship between atherogenic index of plasma and no‑reflow in patients with acute ST‑segment elevation myocardial infarction who underwent primary percutaneous coronary intervention". Int J Cardiovasc Imaging 2020; 36:797-798. [PMID: 32067176 DOI: 10.1007/s10554-020-01781-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 01/29/2020] [Indexed: 02/07/2023]
Abstract
We read with great pleasure the interesting study evaluating "The relationship between atherogenic index of plasma (AIP) and no-reflow in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention" by Süleymanoğlu M et al. The most important problem in the study was that they miscalculated their patients' AIP values. As a result of this miscalculation, all patients seemed to be at high cardiac risk. When calculating AIP, the unit of both triglyceride (TG) and high-density lipoprotein (HDL) levels should be taken in mmol. In calculating the AIP value, Süleymanoğlu et al. used the units as mg/dl and found the median values as 0.50 (patients with noreflow, high cardiac risk) and 0.39 (patients without noreflow, high cardiac risk), respectively. When we calculate the estimated AIP by converting units to mmol, it is 0.15 (patients with noreflow, intermediate cardiac risk) and 0.03 (patients with noreflow, low cardiac risk), respectively. Interestingly, their patients' cholesterol levels such as total cholesterol, TG, low-density lipoprotein, and HDL were very lower than those of healthy individuals in their country. We believe that the authors should explain this situation.
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Affiliation(s)
- Erkan Cure
- Department of Internal Medicine, Ota&Jinemed Hospital, Muradiye Mahallesi Nuzhetiye Cad, Deryadil Sokagi No:1, Besiktas, 34357, Istanbul, Turkey.
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41
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Shen WF. [Improving the quality of clinical care for acute ST-segment elevation myocardial infarction through increasing the guideline adherence]. Zhonghua Xin Xue Guan Bing Za Zhi 2019; 47:762-765. [PMID: 31648458 DOI: 10.3760/cma.j.issn.0253-3758.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- W F Shen
- Department of Cardiology, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
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Akçay M, Meriç M, Gedikli Ö, Yüksel S, Şahin M. Acute anterior myocardial infarction in the 36th week of pregnancy: A successful stepwise treatment approach. Turk Kardiyol Dern Ars 2018; 46:702-705. [PMID: 30516528 DOI: 10.5543/tkda.2017.79092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Acute myocardial infarction (AMI) is associated with a high incidence of maternal and fetal complications when it develops during pregnancy or the early postpartum period. The pathophysiology involves various factors, including alterations in the vascular wall and hypercoagulability as a result of the hormonal and hemodynamic effects of pregnancy. It frequently occurs due to the development of a thrombus following a ruptured plaque. In addition, coronary artery dissection constitutes a significant cause of AMI in pregnancy. In the literature, the therapeutic approach covers a wide spectrum, ranging from conservative follow-up to percutaneous coronary intervention, urgent bypass surgery, and occasionally, thrombolytic therapy. The success rate is often low; however, maternal and fetal complications are seen more frequently during invasive interventions and bypass surgeries because of the structural changes in the coronary intima and media wall. Presently described is the case of a woman in the 36th week of pregnancy who presented with AMI. The occlusion could not be detected during the primary percutaneous intervention, and thrombolytic treatment and a stepwise percutaneous intervention were performed with a successful result.
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Affiliation(s)
- Murat Akçay
- Department of Cardiology, Ondokuz Mayıs University Faculty of Medicine, Samsun, Turkey.
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43
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Affiliation(s)
- Andy S. C. Yong
- Faculty of Medicine and Health SciencesMacquarie UniversitySydneyAustralia
| | - William F. Fearon
- Division of Cardiovascular Medicine and Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCA
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Gaglia MA. Warfarin Prophylaxis for Anterior Infarction: Another Black Mark for Triple Therapy. Cardiovasc Revasc Med 2017; 18:557-558. [PMID: 29246274 DOI: 10.1016/j.carrev.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Michael A Gaglia
- University of New Mexico School of Medicine, Department of Cardiology, Albuquerque, NM.
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45
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Guo RY, Wu YF, Zhao W, Li SS, Li M, Du X, Li X, Xie GQ, Gao RL. [Impact of the time from symptoms onset to thrombolysis on in-hospital major adverse cardiovascular event rate in patients with acute ST-segment elevation myocardial infarction]. Zhonghua Xin Xue Guan Bing Za Zhi 2016; 44:128-132. [PMID: 26926505 DOI: 10.3760/cma.j.issn.0253-3758.2016.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the impact of thrombolytic therapy time delay on in-hospital major adverse cardiac event rate in patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS This survey was performed in 101 level 2 hospitals from 15 provinces or autonomous region in China. Patients admitted to these hospitals with acute STEMI during November 2011 to November 2014 and received thrombolytic therapy were eligible for this study. Multivariate logistic regression modeling was used to estimate the rate of in-hospital major adverse cardiac events (re-infarction, stroke and all-cause mortality) in patients with different thrombolytic time delay. RESULTS A total of 3 719 STEMI patients received thrombolytic therapy, 88%(3 270 cases) of them were treated within 12 hours. After controlling for the impact of confounding factors, such as a variety of risk factors, past disease histories, the severity of STEMI, medication, interventions, etc, MACE rates significantly increased along with the thrombolysis time delay, no matter thrombolysis succeeded or not (trend test P<0.05). In group of successful thrombolysis, multivariate adjusted rate of MACE for 0-5.9 hours, 6.0-11.9 hours and ≥12.0 hours were 3.2%, 3.9% and 7.8%; in group of unsuccessful thrombolysis, it was 11.6%, 14.1% and 25.2% respectively (trend test P<0.05). The multivariate adjusted rates of re-infarction in group of successful thrombolysis as well as in group of unsuccessful thrombolysis significantly increased in proportion to thrombolysis time delay ≥ 12.0 h (trend test P<0.05). In group of successful thrombolysis, multivariate adjusted rate of re-infarction for 0-5.9 hours, 6.0-11.9 hours and ≥12.0 hours were 1.9%, 1.5% and 6.8%; in group of unsuccessful thrombolysis, it was 3.9%, 3.1% and 13.6%, respectively. Within the same time delay group, MACE and re-infarction rates were significantly lower in successful thrombolysis group than in unsuccessful thrombolysis group (all P<0.05). CONCLUSION Thrombolytic therapy should be conducted within 6 hours after the attack. Both re-infarction or MACE rates are significantly increased in patients with more than 12 hours thrombolysis time delay.
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Affiliation(s)
- R Y Guo
- School of Public Health, Peking University Health Science Centre, Beijing 100191, China
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Abu-Assi E, Raposeiras-Roubin S, González-Juanatey JR. Coronary Artery Dominance as a Prognostic Factor: In Anterior Myocardial Infarctions as Well? Response. Rev Esp Cardiol (Engl Ed) 2016; 69:86. [PMID: 26603827 DOI: 10.1016/j.rec.2015.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Emad Abu-Assi
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain.
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, Spain
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Núñez Gil IJ, Feltes G, Fernández-Ortiz A. Coronary Artery Dominance as a Prognostic Factor: In Anterior Myocardial Infarctions as Well? Rev Esp Cardiol (Engl Ed) 2016; 69:86. [PMID: 26564449 DOI: 10.1016/j.rec.2015.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/07/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Iván J Núñez Gil
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain.
| | - Gisela Feltes
- Servicio de Cardiología, Hospital Clínico San Carlos, Madrid, Spain
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Zukela T, Zhou Q, Wang H, Zhou X, Li Y, Zhang Y, Li J, Zhang J, Xing Q, Tang B. [Relationship between new-onset atrial fibrillation and sympathetic neural remodeling in a canine acute myocardial infarction model]. Zhonghua Xin Xue Guan Bing Za Zhi 2015; 43:975-981. [PMID: 26888810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To establish the canine model of new-onset atrial fibrillation (AF) after acute myocardial infarction (AMI), and explore the relationship between new-onset AF and sympathetic neural remodeling in this model. METHODS Twenty four adult mongrel dogs were randomly divided into 4 groups by applying random number table. Group A (n=6): ligate the left circumflex artery (LCX). Group B (n=6): ligate the LCX and right atrial anterior artery and right atrial middle artery. Group C (n=6): ligate left anterior descending artery.Group D (n=6): sham operation.Sequential electrophysiology study was performed in all dogs to determine the AF induction rate, AF duration, effective refractory period (ERP), the density of tyrosine hydroxylase (TH) and norepinephrine transporter (NET) before AMI or sham operation, and at 30 min, 2 hours and 4 hours after AMI or sham operation. RESULTS (1) The highest AF induction rate of right atrium and left auricle was 96.7%(58/60) and 95.0%(57/60) in group B, 81.7%(49/60) and 38.3%(23/60) in group A, 28.3%(17/60) and 35.0%(21/60) in group C, 20.0%(12/60) and 33.3%(20/60) in group D. (2) At 4 hours after AMI, AF duration was significantly prolonged in group B(193.50±54.67) s, compared with group A(53.83±9.37) s, group C(45.00±19.50) s, and group D(16.67±4.50) s (all P<0.05). (3) In group B, the ERP of AF was prolonged at 30 minutes after AMI and shortened at 2 hours and 4 hours after AMI compared with baseline level(all P<0.05). (4) The TH density of left atrium ((3 485±694) µm2/mm2) and left auricle((2 645±454) µm2/mm2) in group A and the TH density of left atrium ((7 873±1159) µm2/mm2) and left auricle((3 070±605) µm2/mm2) in group B were significantly higher than those in group C ((1 474±475) µm2/mm2, (1 177±277) µm2/mm2) and group D ((678±206) µm2/mm2, (489±125) µm2/mm2) (all P<0.05), and the TH density of right atrium and right auricle in group B were higher than group A (all P<0.05). The NET density of left atrium((476±75) µm2/mm2) and left auricle ((414±52) µm2/mm2) in group A and the NET density of left atrium((527±81) µm2/mm2) and left auricle((429±85) µm2/mm2) in group B were lower than that in group C ((1 044±105) µm2/mm2, (867±67) µm2/mm2) and group D ((1 438±60) µm2/mm2, (1 027±119) µm2/mm2) (all P<0.05). CONCLUSIONS Ligating the LCX, right atrial anterior artery and right atrial middle artery at the same time can significantly increase the success rate in establishing the canine model of new-onset atrial fibrillation after acute myocardial infarction and can also increase the AF duration.Cardiac sympathetic remodeling after acute myocardial infarction is associated with induction and duration of AF.
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Affiliation(s)
- Tuerhong Zukela
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China
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Redondo-Diéguez A. Comments on the Long-term Prognosis of Patients With Non-ST-segment Elevation Acute Myocardial Infarction and Coronary Arteries Without Significant Stenosis. Response. Rev Esp Cardiol (Engl Ed) 2015; 68:821-822. [PMID: 26162673 DOI: 10.1016/j.rec.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 04/21/2015] [Indexed: 06/04/2023]
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50
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Hu X, Qiao S, Qiu H, Ye S, Feng L, Song L. [Association between ABO blood group and acute myocardial infarction]. Zhonghua Xin Xue Guan Bing Za Zhi 2015; 43:785-787. [PMID: 26652818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore the association between the ABO blood group and the risk of myocardial infarction in Chinese people. METHODS We retrospectively recruited 1 988 consecutive patients with acute myocardial infarction (AMI) and 1 856 non-coronary artery disease (non-CAD) subjects who hospitalized in our hospital between January 2013 and December 2013. The clinical features and ABO blood group were analyzed. RESULTS Blood group distribution was A (27.1%, 539/1 988), B (34.4%, 684/1 988), AB (10.8%, 215/1 988), O (27.7%, 551/1 988) in patients with AMI and A (26.7%, 496/1 856), B(32.2%, 598/1 856), AB(10.8%, 200/1 856), O (30.4%, 564/1 856) in non-CAD group. The single factor analysis showed that blood group O tended to be more common in the non-CAD group than in AMI group (P = 0.06). After adjustment for common cardiovascular risk factors such as age, gender, hypertension, diabetes, smoking and serum cholesterol level, the A, B, and AB blood groups were associated with increased risk of AMI compared with O blood group, and the difference was significant with A blood group (OR = 1.229, 95% CI 1.019-1.482, P = 0.031) and B blood groups (OR = 1.214, 95% CI 1.017-1.449, P = 0.032). In addition, non-O blood group remained significantly associated with the increased risk of AMI than O blood group after logistic regression analysis (OR = 1.223, 95% CI 1.048-1.426, P = 0.01). CONCLUSION Our results suggest that non-O blood group is associated with the increased risk of AMI.
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Affiliation(s)
- Xiaoying Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China;
| | - Hong Qiu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Shaodong Ye
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Lei Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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