Prosthetic valve thrombosis.

BACKGROUND: We conducted a retrospective, single center study to evaluate the clinical characteristics and outcomes of all consecutive patients with prosthetic valve thrombosis (PVT) over a 10 year period. METHODS: Data from 85 episodes of PVT in 80 patients treated over a 10-year period between 2001 and 2011 were analyzed. The diagnosis of PVT was confirmed by echocardiography and/or fluoroscopy. PVT was considered obstructive if there was an increased pressure gradient on the echo study or reduced or fixed leaflet mobility on fluoroscopy. The primary treatment approaches included: redo surgery or thrombolysis for obstructive PVT and the intensification of anticoagulation in nonobstructive PVT. RESULTS: The mean age was 49.4 ± 13.1 years (range: 13-79) and 40% were male. Thrombosed valves included 53 mitral, 22 aortic, six tricuspid, and both mitral and aortic position in nine patients. Subtherapeutic INR (less than 2.5) was observed in 58 patients (68.2%). Ten patients died before any definite therapeutic strategy in obstructive PVT. In ten patients, episodes were considered nonobstructive. Sixteen patients received fibrinolysis (streptokinase) that was successful in nine patients (56.2%). Intracranial hemorrhage occurred in three (18.7%) patients, and there were four deaths in this group. In the surgical group, 49 patients underwent operation as first line therapy and seven patients after failed thrombolysis. One brain hemorrhage and three (5.3%) deaths occurred during or after surgery. Total complications were significantly less frequent in the surgery group compared with those in the thrombolytic group (14.2% vs. 68.7%, p-value < 0.001). Higher NYHA functional class and lower systolic blood pressure were associated with in-hospital mortality. CONCLUSION: Thrombolysis is less effective and has more complications compared to surgery in treatment of obstructive PVT. Compromised hemodynamic status during presentation of these patients denotes higher in-hospital mortality.

First-degree atrioventricular block in acute anterior myocardial infarction.

BACKGROUND: There is paucity of data regarding the prognostic implications of first-degree atrioventricular block in patients with acute anterior myocardial infarction as a distinct group. The aim of this study was to elucidate the association of prolonged PR interval with hospital clinical outcomes in patients with treated with thrombolysis. METHODS: Three hundred consecutive patients with a first acute anterior ST-segment elevation myocardial infarction undergoing thrombolysis between October 2017 and March 2018, were retrospectively enrolled in this study. They were divided into two groups based on PR interval on admission: PR interval ≤200 ms, and PR interval > 200 ms. Hospital mortality and complications were compared between the 2 groups. RESULTS: Of the 300 patients, 26 (8.66%) had first-degree atrioventricular block on initial presentation. Overall, hospital death occurred in 20 (6.66%) patients. Patients with PR interval > 200 ms had a higher hospital mortality rate (26.9%) than those without (4.7%, p < 0.001). In multivariate Cox regression analysis, only left ventricular systolic function and PR interval were independent predictors of hospital mortality (odds ratio = 1.031; 95% confidence interval: 1.008-1.056, p = 0.009 for PR interval). CONCLUSION: In patients with a first acute anterior ST-segment elevation myocardial infarction treated with thrombolysis, first-degree atrioventricular block was associated with increased hospital mortality and a worse prognosis.

Association Between Off-hour Presentations and In-hospital Mortality for Patients with Acute ST-Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.

OBJECTIVES: This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital mortality in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. METHODS: We analysed in-hospital the mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between the two groups. RESULTS: One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p = 0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p = 0.58). Multivariate logistic regression analysis showed that off-hours presentation was not associated with in-hospital mortality. [odds ratio (OR) 0.74; 95% CI, 0.21-2.61, p = 0.64]. CONCLUSION: Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with PPCI. Larger studies are warranted in order to determine the prognostic role of off-hour presentation in patients with STEMI undergoing PPCI.

Electrocardiographic left ventricular hypertrophy is not associated with increased in-hospital adverse events in patients with first Non-ST segment elevation myocardial infarction: A single center study.

BACKGROUND: There is conflicting data about prognostic implication of electrocardiographic (ECG) left ventricular hypertrophy (LVH) in patients with first non- ST-segment elevation myocardial infarction (NSTEMI). We aimed to examine the association of left ventricular hypertrophy (LVH) on admission electrocardiogram with adverse outcomes in patients with NSTEMI. METHODS: In the present study, 460 patients (77.5% males with mean age of 65.44±13.15 years) with first NSTEMI were evaluated. ECG left ventricular hypertrophy (LVH) was diagnosed based on Sokolow-Lyon voltage criteria. Baseline laboratory and clinical results, angiographic data, as well as in- hospital adverse events were compared between the patients with and without LVH. RESULTS: Electrocardiographic LVH was observed in 74 (16.1%) patients. Patients with LVH had higher admission systolic blood pressure (132.91±21.08 vs 125.80±21.78; P=0.01) and higher peak troponin (6.42±1.03 vs 4.41±0.28; P=0.004), but less likely to undergo coronary angiography (54.1% vs 66.8%; P=0.03) .Patients with electrocardiographic LVH had similar in-hospital mortality (5.4% vs 3.6%, P=0.5) and heart failure/ pulmonary edema (2.7% vs 2.07%, P=0.6) compared to patients without LVH. CONCLUSION: The present study showed that among the patients with first NSTEMI, electrocardiographic LVH was not associated with increased in-hospital adverse events.

ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention.

BACKGROUND: The early identification of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) with high risk features is particularly important. Acute inferior STEMI may be associated with ST-segment depression in the left precordial leads (V4-V6). This study assessed prognostic value of ST-segment depression in these left precordial leads during the admission of patients with acute inferior STEMI treated with primary percutaneous coronary intervention. METHODS: This retrospective study enrolled 1,374 patients with acute inferior STEMI who underwent primary percutaneous coronary angioplasty between March 2011 and June 2014. The patients were divided into two groups: one group (n = 687) with left precordial ST-segment depression and the other (n = 687) without such ST-segment changes. RESULTS: The patients with left precordial ST-segment depression were older and had higher incidence of hypertension, diabetes mellitus, and higher levels of troponin. In-hospital mortality was higher in patients with left precordial ST-segment depression. Advanced coronary artery disease was more observed in these patients. CONCLUSION: In patients with acute inferior STEMI treated with primary coronary intervention, left precordial ST-segment depression during admission of ECG is associated with more advanced coronary artery disease, and worse in-hospital clinical outcomes.