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1.
J Electrocardiol ; 82: 80-82, 2024.
Article in English | MEDLINE | ID: mdl-38056361

ABSTRACT

We report the case of a 73-year-old male admitted for epigastric pain and syncope with increased troponin level and a rare electrocardiogram (a single­lead ST-elevation). Coronary angiography showed multi-vessel coronary artery disease. The patient underwent coronary angioplasty with drug-eluting stenting on left anterior descending coronary artery and drug eluting ballooning on first diagonal ostium. Coronary revascularization was completed with a staged stenting on left circumflex artery and right coronary artery. In rare cases of acute coronary syndrome, even isolated ST single lead anomalies may underlie multivessel coronary disease.


Subject(s)
Acute Coronary Syndrome , Coronary Artery Disease , Male , Humans , Aged , Coronary Artery Disease/complications , Coronary Artery Disease/diagnosis , Coronary Artery Disease/surgery , Acute Coronary Syndrome/diagnosis , Electrocardiography , Coronary Angiography , Myocardial Revascularization
2.
Circ J ; 86(4): 611-619, 2022 03 25.
Article in English | MEDLINE | ID: mdl-34897190

ABSTRACT

BACKGROUND: Two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) can predict the prognosis. This study investigated the clinical significance of a serial 3D-STE can predict the prognosis after onset of STEMI.Methods and Results:This study enrolled 272 patients (mean age, 65 years) with first-time STEMI treated with reperfusion therapy. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Within 1 year, 19 patients who experienced major adverse cardiac events (MACE; cardiac death, heart failure requiring hospitalization) were excluded. Among the 253 patients, 248 were examined with follow-up echocardiography. The patients were followed up for a median of 108 months (interquartile range: 96-129 months). The primary endpoint was the occurrence of a MACE; 45 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 2D-global longitudinal strain (GLS) and 3D-GLS at 1-year indices were significant predictors of MACE. The Kaplan-Meier curve demonstrated that a 3D-GLS of >-13.1 was an independent predictor for MACE (log-rank χ2=165.5, P<0.0001). The deterioration of 3D-GLS at 1 year was a significant prognosticator (log-rank χ2=36.7, P<0.0001). CONCLUSIONS: The deterioration of 3D-GLS measured by STE at 1 year after the onset of STEMI is the strongest predictor of long-term prognosis.


Subject(s)
Echocardiography, Three-Dimensional , ST Elevation Myocardial Infarction , Aged , Echocardiography/methods , Humans , Prognosis , ROC Curve , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Ventricular Function, Left
3.
Circ J ; 86(10): 1499-1508, 2022 09 22.
Article in English | MEDLINE | ID: mdl-35545531

ABSTRACT

BACKGROUND: The role of left atrial (LA) function in the long-term prognosis of ST-elevation acute myocardial infarction (STEMI) is still unclear.Methods and Results: Percutaneous coronary intervention (PCI) was performed in 433 patients with the first episode of STEMI within 12 h of onset. The patients underwent echocardiography 24 h after admission. LA reservoir strain and other echocardiographic parameters were analyzed. Follow up was performed for up to 10 years (mean duration, 91 months). The primary endpoint was major adverse cardiovascular events (MACE): cardiac death or hospitalization due to heart failure (HF). MACE occurred in 90 patients (20%) during the follow-up period. Multivariate Cox hazard analyses showed LA reservoir strain, global longitudinal strain (GLS), age and maximum B-type natriuretic peptide (BNP) were the significant predictors of MACE. Kaplan-Meier curves demonstrated that LA reservoir strain <25.8% was a strong predictor (Log rank, χ2=76.7, P<0.0001). Net reclassification improvement (NRI) demonstrated that adding LA reservoir strain had significant incremental effect on the conventional parameters (NRI and 95% CI: 0.24 [0.11-0.44]) . When combined with GLS >-11.5%, the patients with LA reservoir strain <25.8% were found to be at extremely high risk for MACE (Log rank, χ2=126.3, P<0.0001). CONCLUSIONS: LA reservoir strain immediately after STEMI onset was a significant predictor of poor prognosis in patients, especially when combined with GLS.


Subject(s)
Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Natriuretic Peptide, Brain , Predictive Value of Tests , Prognosis , ST Elevation Myocardial Infarction/diagnostic imaging , Ventricular Function, Left
4.
Circ J ; 85(10): 1735-1743, 2021 09 24.
Article in English | MEDLINE | ID: mdl-34078840

ABSTRACT

BACKGROUND: Three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) is associated with left ventricular (LV) remodeling and 1-year prognosis. This study investigated the clinical significance of 3D-STE in predicting the long-term prognosis of patients with STEMI.Methods and Results:A total of 270 patients (mean age 64.6 years) with first-time STEMI treated with reperfusion therapy were enrolled. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Patients were followed up for a median of 119 months (interquartile range: 96-129 months). The primary endpoint was occurrence of a major adverse cardiac event (MACE: cardiac death, heart failure with hospitalization), and 64 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 3D-STE indices were stronger predictors of MACE compared with those of 2D-STE. Additionally, 3D-global longitudinal strain (GLS) was the strongest predictor for MACE followed by 3D-global circumferential strain (GCS). The Kaplan-Meier curve demonstrated that 3D-GLS >-11.0 was an independent predictor for MACE (log-rank χ2=132.2, P<0.0001). When combined with 3D-GCS >-18.3, patients with higher values of 3D-GLS and 3D-GCS were found to be at extremely high risk for MACE. CONCLUSIONS: Global strain measured by 3D-STE immediately after the onset of STEMI is a clinically significant predictor of 10-year prognosis.


Subject(s)
Echocardiography, Three-Dimensional , ST Elevation Myocardial Infarction , Echocardiography/methods , Humans , Middle Aged , Prognosis , ROC Curve , Reproducibility of Results , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Ventricular Function, Left , Ventricular Remodeling
5.
Int Heart J ; 62(2): 256-263, 2021 Mar 30.
Article in English | MEDLINE | ID: mdl-33678797

ABSTRACT

Radial access is recommended for primary percutaneous coronary intervention (PCI), because it has fewer bleeding complications than trans-femoral PCI. However, even if trans-radial PCI is chosen, patients with ST-elevation myocardial infarction (STEMI) presenting with anemia on admission might have poor clinical outcomes. The aim of this retrospective study was to investigate whether anemia on admission was associated with mid-term clinical outcomes in patients who underwent trans-radial primary PCI. The primary endpoint was a composite of all-cause death, recurrent acute myocardial infarction, and readmission for heart failure. A total of 288 consecutive patients with STEMI who underwent trans-radial primary PCI were divided into an anemia group (n = 79) and a non-anemia group (n = 209). The median follow-up duration was 301 days. The anemia group was significantly older than the non-anemia group (77.3 ± 11.9 versus 64.4 ± 12.7 years, respectively; P < 0.001). There were significantly more females in the anemia group than in the non-anemia group (36.7% versus 14.4%, respectively; P < 0.001). Kaplan-Meier analysis revealed that the composite outcome-free survival was significantly worse in the anemia group than in the non-anemia group (P < 0.001). Multivariate Cox hazard model analysis revealed that hemoglobin levels on admission were significantly associated with the composite outcome (per 1 g/dL increase: hazard ratio 0.76, 95% confidence interval 0.66-0.88, P < 0.001) after controlling for confounding factors. In conclusion, baseline anemia was significantly associated with poor clinical outcomes. Patients with STEMI presenting with anemia should be managed carefully, even if trans-radial primary PCI is chosen.


Subject(s)
Anemia/etiology , Catheterization, Peripheral/methods , Percutaneous Coronary Intervention/methods , Risk Assessment/methods , ST Elevation Myocardial Infarction/surgery , Aged , Anemia/epidemiology , Electrocardiography , Female , Hospital Mortality/trends , Humans , Incidence , Japan/epidemiology , Male , Middle Aged , Radial Artery , Retrospective Studies , Risk Factors , ST Elevation Myocardial Infarction/mortality , Treatment Outcome
6.
Drug Dev Res ; 81(5): 551-556, 2020 08.
Article in English | MEDLINE | ID: mdl-32142170

ABSTRACT

OBJECTIVE: To conduct a randomized double-blind prospective study to investigate effect of different doses of atorvastatin, rosuvastatin, and simvastatin on elderly patients with ST-elevation AMI after PCI. METHODS: One hundred and ninety-two AMI patients over 60 years old who underwent PCI were randomly divided into six groups: the low atorvastatin group, high atorvastatin group; low rosuvastatin group; high rosuvastatin group; low simvastatin group; high simvastatin group. Demographic data and clinical information as well as coronary angiography parameters were recorded. Plasma levels of CK-MB, BNP, ALT, and TnI were measured at 12 hr, 24 hr, and 1 week after PCI. Major cardiovascular events (MACE) were recorded and analyzed using Kaplan-Meier (K-M) curve. RESULTS: No significant differences were observed in angiographic and procedural characteristics. In all high dose groups, all levels of CK-MB, BNP, ALT, and TnI were significantly lower. However, after 1 week of PCI, only CK-MB, BNP, and TnI showed significant difference between high and low dose groups. Patients in high dose groups had significantly lower rates for surgical or percutaneous intervention, recurrence of angina, and rehospitalization. K-M curve analysis also showed cumulative incidence freedom time of overall MACE in high dose groups was significantly longer. No significant differences were found among different drugs with the same doses. CONCLUSION: Patients with higher doses had lower level of CK-MB, BNP, ALT, and TnI and lower occurrence of MACE after PCI.


Subject(s)
Atorvastatin/therapeutic use , Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use , Percutaneous Coronary Intervention , Rosuvastatin Calcium/therapeutic use , ST Elevation Myocardial Infarction/drug therapy , Simvastatin/therapeutic use , Aged , Aged, 80 and over , Alanine Transaminase/blood , Cholesterol/blood , Coronary Angiography , Creatine Kinase, MB Form/blood , Double-Blind Method , Female , Humans , Male , Middle Aged , Natriuretic Peptide, Brain/blood , ST Elevation Myocardial Infarction/blood , ST Elevation Myocardial Infarction/diagnostic imaging , Troponin I/blood
7.
Cardiology ; 139(4): 255-264, 2018.
Article in English | MEDLINE | ID: mdl-29621763

ABSTRACT

OBJECTIVES: To investigate the predictive value of four-dimensional (4D) strain echocardiography for major adverse cardiovascular events (MACE) in ST-elevation acute myocardial infarction (STEMI) patients. METHODS: Consecutive STEMI patients who underwent successful primary coronary interven tion (PCI) were enrolled and followed, with 2D and 4D strain echocardiography performed within 1 week after PCI. RESULTS: Twenty-six first MACE were recorded in 81 patients who finished a ∼3.0 year follow-up. Compared with those without MACE, subjects with MACE were more likely to have anterior MI (73.08 vs. 38.18%, p = 0.003), significantly decreased 2D left ventricular ejection fraction (2DLVEF) and 4DLVEF (all p < 0.05), as well as an overtly compromised 4D strain parameters. The prediction models incorporating infarct location with either 2DLVEF or 4D strain parameters were then developed. Model comparisons revealed that the global area strain (GAS)-based model had the highest discriminative capacity (c statistics = 0.774) and was well calibrated for MACE. Additionally, the clinical utility of the GAS-based prediction model was verified by decision curve analysis showing a consistent positive and larger net benefit compared to the 2DLVEF-based model. CONCLUSIONS: Our data support a superiority of 4D strain echocardiography over conventional 2D echocardiography, especially GAS, for risk stratification in STEMI patients after successful primary PCI.


Subject(s)
Echocardiography, Four-Dimensional , ST Elevation Myocardial Infarction/diagnostic imaging , Aged , China/epidemiology , Female , Humans , Male , Middle Aged , Percutaneous Coronary Intervention , Predictive Value of Tests , Risk Assessment , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/surgery
8.
Heart Vessels ; 33(5): 498-506, 2018 May.
Article in English | MEDLINE | ID: mdl-29159569

ABSTRACT

Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT < 60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT > 120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (< 0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72-6.83, P < 0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06-0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.


Subject(s)
Hospitalization/trends , Percutaneous Coronary Intervention/methods , Registries , ST Elevation Myocardial Infarction/surgery , Time-to-Treatment/trends , Aged , Female , Hospital Mortality/trends , Humans , Japan/epidemiology , Male , Retrospective Studies , Risk Factors , ST Elevation Myocardial Infarction/mortality , Time Factors
9.
Acta Med Indones ; 49(1): 52-56, 2017 Jan.
Article in English | MEDLINE | ID: mdl-28450654

ABSTRACT

Current guidelines for the management of patients with acute coronary syndromes (ACSs) focus on the electrocardiogram to divide patients into ST-elevation acute myocardial infarction (STEMI) or non-ST-elevation acute myocardial infarction (NSTEMI)/unstable angina (UA). Patients with STEMI in the earliest time will receive reperfusion therapy to destruct occlusive thrombus. An ST segment elevation is the 'sine qua non' for diagnosing acute total coronary occlusion causing transmural myocardial infarction. Left circumflex coronary artery (LCx) occlusion is often categorized as NSTEMI because of the absence of significant ST-elevation on the 12 lead standard electrocardiogram. An ST segment elevation is presented in fewer than 50% of patients with LCx total occlusion, such that the reperfusion therapy is delayed. We reported a 77 years old woman whom being diagnosed with NSTEMI because a 12 lead electrocardiogram showed ST segment depression in lead V2-V5. On coronary angiography, we found a total occlusion in the LCx artery as the culprit lession.


Subject(s)
Acute Coronary Syndrome/complications , Non-ST Elevated Myocardial Infarction/diagnosis , Pulmonary Edema/complications , Aged , Coronary Angiography , Coronary Vessels/physiopathology , Electrocardiography, Ambulatory , Female , Humans
10.
Med Intensiva ; 39(8): 477-82, 2015 Nov.
Article in Spanish | MEDLINE | ID: mdl-25798956

ABSTRACT

AIM: To evaluate the usefulness of copeptin as a rapid and reliable marker for discarding non-ST elevation acute myocardial infarction (NSTEMI) in patients attended in an Emergency Care Department due to acute chest pain with a normal or non-diagnostic electrocardiogram and a negative first troponin I result. DESIGN: A prospective observational study was carried out. SETTING: The Emergency Care Department of a university hospital. PATIENTS: The study comprised a total of 97 patients attended in the Emergency Care Department due to chest pain suggestive of acute coronary syndrome with an evolution of under 12h, a non-diagnostic electrocardiogram and a negative first troponin I result. INTERVENTIONS: None. VARIABLES OF INTEREST: Patient demographic data and baseline characteristics, copeptin upon admission, troponin I upon admission and after 6h, and final diagnosis. RESULTS: The final diagnosis was NSTEMI in 14 patients (14.4%) -no significant differences in copeptin concentration being observed between the 2 groups, though a tendency towards higher values was recorded in the NSTEMI group (median: 24.6pmol/l [interquartile range: 42.0] vs. 12.0pmol/l [16.1]; P=.06). The AUC ROC for copeptin upon admission was 0.657 (95%CI: 0.504-0.810), with a negative predictive value of 92% for a cutoff point of 14pmol/l. CONCLUSIONS: Copeptin determination upon admission to the Emergency Care Department in patients with chest pain for ≤12h, suggestive of acute coronary syndrome, with a non-diagnostic electrocardiogram and a negative first troponin I determination does not allow rapid and reliable exclusion of the presence of NSTEMI. Serial troponin I measurements are needed in this respect.


Subject(s)
Chest Pain/etiology , Myocardial Infarction/blood , Non-ST Elevated Myocardial Infarction/blood , Troponin I/blood , Adult , Aged , Aged, 80 and over , Biomarkers , Diagnosis, Differential , Electrocardiography , Emergency Service, Hospital , Female , Hospitals, University , Humans , Male , Middle Aged , Myocardial Infarction/complications , Predictive Value of Tests , Prospective Studies , Risk Factors , Sensitivity and Specificity , Young Adult
11.
Int J Cardiol ; 411: 132272, 2024 Sep 15.
Article in English | MEDLINE | ID: mdl-38880421

ABSTRACT

BACKGROUND: Machine learning clustering of patients with ST-elevation acute myocardial infarction (STEMI) may provide important insights into their risk profile, management and prognosis. METHODS: All adult discharges for STEMI in the National Inpatient Sample (October 2015 to December 2019) were included, excluding patients with prior myocardial infarction. Machine-learning clustering analysis was used to define clusters based on 21 clinical attributes of interest. Main outcomes of the study were cluster-based comparison of risk profile, in-hospital clinical outcomes and utilization of invasive management. Binomial hierarchical multivariable logistic regression with adjusted odds ratios (aOR) and 95% confidence intervals (95% CI) was used to detect the between-cluster differences. RESULTS: Out of overall 470,960 STEMI cases, the machine-learning analysis revealed 4 different clusters with 205,640 (cluster 0: 'behavioural risk cluster'), 146,400 (cluster 1: 'least comorbidity cluster'), 45,100 (cluster 2: 'diabetes with end-organ damage cluster') and 73,820 (cluster 3: 'cardiometabolic cluster') cases. Attributes with the highest importance for clustering were hypertension and diabetes. After multivariable adjustment, patients from 'diabetes with end-organ damage cluster' exhibited the worst mortality, MACCE and ischemic stroke (p < 0.001 for all), as well as the lowest utilization of invasive management (p < 0.001 for all), in comparison to other clusters. Patients from 'behavioural risk cluster' exhibited the best in-hospital prognosis and the highest utilization of invasive management, compared to other clusters (p < 0.001 for all). CONCLUSIONS: Machine learning driven clustering of inpatients with STEMI reveals important population subgroups with distinct prevalence, risk profile, prognosis and management. Data driven approaches may identify high risk phenogroups and warrants further study.


Subject(s)
Machine Learning , ST Elevation Myocardial Infarction , Humans , Male , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/epidemiology , Female , Cluster Analysis , Middle Aged , Aged , Prognosis , Hospital Mortality/trends , Adult , Risk Factors
12.
Front Cardiovasc Med ; 10: 1100187, 2023.
Article in English | MEDLINE | ID: mdl-36873399

ABSTRACT

Background: ST-segment elevation myocardial infarction (STEMI) is a frequent cause of sudden cardiac arrest (SCA) and early percutaneous coronary intervention (PCI) is associated with increased survival. Despite constant improvements in SCA management, survival remains poor. We aimed to assess pre-PCI SCA incidence and related outcomes in patients admitted with STEMI. Methods: This was a prospective cohort study of patients admitted with STEMI in a tertiary university hospital over 11 years. All patients were submitted to emergency coronary angiography. Baseline characteristics, details of the procedure, reperfusion strategies, and adverse outcomes were assessed. The primary outcome was in-hospital mortality. The secondary outcome was 1-year mortality after hospital discharge. Predictors of pre-PCI SCA was also assessed. Results: During the study period 1,493 patients were included; the mean age was 61.1 years (±12), and 65.3% were male. Pre-PCI SCA was present in 133 (8.9%) patients. In-hospital mortality was higher in the pre-PCI SCA group (36.8% vs. 8.8%, p < 0.0001). In multivariate analysis, anterior MI, cardiogenic shock, age, pre-PCI SCA and lower ejection fraction remained significantly associated with in-hospital mortality. When we analyzed the interaction between pre-PCI SCA and cardiogenic shock upon admission there is a further increase in mortality risk when both conditions are present. For predictors of pre-PCI SCA, only younger age and cardiogenic shock remained significantly associated after multivariate analysis. Overall 1-year mortality rates were similar between pre-PCI SCA survivors and non-pre-PCI SCA group. Conclusion: In a cohort of consecutive patients admitted with STEMI, pre-PCI SCA was associated with higher in-hospital mortality, and its association with cardiogenic shock further increases mortality risk. However, long-term mortality among pre-PCI SCA survivors was similar to non-SCA patients. Understanding characteristics associated with pre-PCI SCA may help to prevent and improve the management of STEMI patients.

13.
J Investig Med ; 71(8): 838-844, 2023 12.
Article in English | MEDLINE | ID: mdl-37377036

ABSTRACT

The triglyceride-glucose (TyG) index is a new reliable marker of insulin resistance (IR) and has recently been reported to be associated with renal dysfunction and contrast-induced nephropathy (CIN). Our aim in this study is to investigate the relationship between the TyG index and CIN in non-diabetic non-ST elevation acute myocardial infarction (NSTEMI) patients. The study included 272 non-diabetic patients who applied with NSTEMI and underwent coronary angiography (CAG). Patient data were divided into quartiles according to the TyG index: Q1: TyG < 8.55; Q2: 8.55 ≤ TyG ≤ 8.87; Q3: 8.88 ≤ TyG ≤ 9.29; and Q4: TyG > 9.29. Baseline characteristics, laboratory measurements, angiography data, and the incidence of CIN were compared between the groups. CIN was observed in 18 (6.6%) patients in the study. The incidence of CIN was lowest in the Q1 group and highest in the Q4 group (1 (1.5%) in Q1; 3 (4.4%) in Q2; 5 (7.4%) in Q3; 9 (13.2%) in Q4; p = 0.040). TyG index was found to be an independent risk factor for the development of CIN in multivariate logistic regression analysis (odds ratio = 6.58; confidence interval (CI) = 2.12-20.40; p = 0.001). TyG index value of 9.17 was identified as an effective cut-off point for the prediction of CIN (Area under the curve: 0.712, CI: 0.590-0.834, p = 0.003), and it had a sensitivity of 61% and a specificity of 72%. The results of this study showed that a high TyG index increases the incidence of CIN after CAG in non-diabetic NSTEMI patients and is an independent risk factor for the development of CIN.


Subject(s)
Kidney Diseases , Non-ST Elevated Myocardial Infarction , Humans , Non-ST Elevated Myocardial Infarction/diagnostic imaging , Prospective Studies , Risk Assessment , Triglycerides , Biomarkers , Risk Factors , Kidney Diseases/chemically induced , Kidney Diseases/diagnostic imaging , Glucose , Blood Glucose
14.
J Med Cases ; 13(6): 281-289, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35837083

ABSTRACT

Acute myocardial infarction (AMI) in young patients is very rare, but the incidence has increased over years past at younger ages, likely due to the presence of multiple risk factors. We present the first known case of ST-elevation AMI (STEMI) in a young man. A 22-year-old Japanese man was transferred to our hospital due to suddenly occurred anterior chest pain. An electrocardiogram revealed ST elevation in anteroseptal leads together with reciprocal ST depression in inferior leads. An emergency coronary angiogram was performed, revealing a 100% occlusion at segment 6 of the coronary artery and we established a diagnosis of STEMI. The lesion was expanded to 0% stenosis through plain old balloon angioplasty, after which a third-generation drug-eluting stent was installed there. Afterwards, the patient was discharged on day 17. In this case, a combination of mild six risk factors plus family history of hypertension might lead to this atypical event.

15.
Heart Views ; 22(2): 146-149, 2021.
Article in English | MEDLINE | ID: mdl-34584628

ABSTRACT

Despite all well-known benefits of transradial access, patients presenting with cardiogenic shock are usually submitted to coronary angiography and percutaneous coronary intervention via traditional transfemoral access, mainly due to challenge puncture of radial artery in the setting of hemodynamic instability. We report a challenging case of STEMI-related cardiogenic shock requiring primary PCI of an occluded and unprotected left main, safety, and successfully performed via right distal trans radial access in the anatomical snuffbox.

16.
Ann Clin Lab Sci ; 50(6): 775-780, 2020 Nov.
Article in English | MEDLINE | ID: mdl-33334793

ABSTRACT

OBJECTIVE: To investigate the relationship between Transient Receptor Potential Vanilloid 6 (TRPV6) and ST-elevation acute myocardial infarction (STEMI) patients. METHODS: This observational research included a total of 221 patients with STEMI admitted during January 2017~August 2019. Additionally, 50 cases of non-ST-elevation acute myocardial infarction (NSTEMI) patients and 50 healthy individuals were enrolled as the control. Serum levels of TRPV6 were detected by ELISA method. The relationship between TRPV6, clinical characteristics, laboratory indices of CK-MB, TnI, NT-pro-B-type natriuretic peptide (NT-pro-BNP), C-reactive protein (CRP), and the left ventricular ejection fraction (LVEF%) was analyzed by statistical methods. K-M curve was performed for survival time. RESULTS: Serum levels of TRPV6 were remarkably lower in STEMI and NSTEMI patients compared with the healthy control. Levels of NT-pro-BNP and CK-MB were significantly higher and serum levels of TRPV6 were dramatically lower in deceased STEMI patients in comparison with the surviving patients. The levels of TRPV6 were negatively correlated with CK-MB and NT-pro-BNP. Meanwhile, TRPV6 was negatively expressed in tissues of STEMI patients and positively expressed in normal tissues. Patients with lower TRPV6 levels had remarkably lower LVEF ratio, higher GRACE scores, higher CK-MB and NT-pro-BNP levels, as well as higher ratios of cardiovascular death, malignant arrhythmia, cumulative MACE, and shorter survival time than patients with higher TRPV6. CONCLUSION: The lower expression of TRPV6 was associated with poor clinical outcomes and prognosis of STEMI patients.


Subject(s)
Calcium Channels/metabolism , ST Elevation Myocardial Infarction/metabolism , TRPV Cation Channels/metabolism , Adult , Aged , Biomarkers/blood , C-Reactive Protein/metabolism , Calcium Channels/blood , Calcium Channels/genetics , Female , Humans , Male , Middle Aged , Myocardial Infarction/blood , Myocardial Infarction/metabolism , Natriuretic Peptide, Brain/metabolism , Peptide Fragments/metabolism , Prognosis , ROC Curve , ST Elevation Myocardial Infarction/blood , ST Elevation Myocardial Infarction/genetics , Stroke Volume/physiology , TRPV Cation Channels/blood , TRPV Cation Channels/genetics , Ventricular Function, Left/physiology
17.
Int J Cardiovasc Imaging ; 36(1): 161-170, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31451993

ABSTRACT

Data on the efficacy of excimer laser coronary atherectomy (ELCA) for patients with ST-elevation myocardial infarction (STEMI) are limited. Therefore, we sought to evaluate the impact of ELCA on myocardial salvage using nuclear scintigraphy in patients with STEMI. Between September 2014 and April 2017, we retrospectively enrolled 316 consecutive patients undergoing primary PCI (p-PCI) after their first STEMI in our institute. Of those, 72 patients with STEMI, an initial thrombolysis in myocardial infarction (TIMI) flow-0/1, and an onset to balloon time (OBT) < 6 h were included (ELCA, n = 32; non-ELCA, n = 40). The endpoint was the myocardial salvage index (MSI) based on a 17-segment model with a 5-point scoring system. MSI was calculated as: MSI = (∑123I-BMIPP defect score at 3-7 days after p-PCI - ∑99mTc-tetrofosmin defect score at 3-6 months after p-PCI)/∑123I-BMIPP defect score × 100 (%) at 3-7 days after p-PCI. The groups were compatible except in age (ELCA: 62.9 ± 12.4 years vs. non-ELCA: 69.8 ± 11.0 years) and loading antiplatelet drug (prasugrel: 100% vs. 40.0%). Direct implantation of shorter stents more frequently occurred in the ELCA group than in the non-ELCA group. MSI seemed to be better in the ELCA group compared with the non-ELCA group (57.6% vs. 45.6%, p = 0.09). This trend was emphasized when the final TIMI-3 flow was achieved (67.1% vs. 45.7%, p = 0.01). The nuclear scintigraphy results showed that ELCA can potentially improve myocardial salvage in patients with STEMI with OBT < 6 h and initial TIMI flow-0/1.


Subject(s)
Atherectomy, Coronary/instrumentation , Lasers, Excimer/therapeutic use , Myocardial Perfusion Imaging/methods , Myocardium/pathology , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , Tomography, Emission-Computed, Single-Photon , Aged , Clinical Decision-Making , Fatty Acids/administration & dosage , Feasibility Studies , Female , Humans , Iodobenzenes/administration & dosage , Male , Middle Aged , Organophosphorus Compounds/administration & dosage , Organotechnetium Compounds/administration & dosage , Patient Selection , Percutaneous Coronary Intervention/instrumentation , Predictive Value of Tests , Radiopharmaceuticals/administration & dosage , Retrospective Studies , ST Elevation Myocardial Infarction/pathology , Stents , Time Factors , Time-to-Treatment , Treatment Outcome
18.
Intern Med ; 59(13): 1597-1603, 2020.
Article in English | MEDLINE | ID: mdl-32612063

ABSTRACT

Objective In primary percutaneous coronary intervention (PCI), the door-to-balloon time (DTBT) is known to be associated with in-hospital death in patients with ST-segment elevation myocardial infarction (STEMI). However, little is known regarding the association between the DTBT and the mid-term clinical outcomes in patients with STEMI. The purpose of this study was to investigate the association between the DTBT and mid-term all-cause death. Methods The study population included 309 STEMI patients, who were divided into the short DTBT (DTBT<60 minutes, n=103), intermediate DTBT (DTBT 60-120 minutes, n=174) and long DTBT (DTBT >120 minutes, n=32) groups. The median follow-up period was 287 days (interquartile range: 182-624 days). Results The incidence of all-cause death in the long DTBT group was significantly higher in comparison to the other groups (p<0.001). In the multivariate Cox regression analysis, although a short DTBT [vs. intermediate DTBT: hazard ratio (HR) 1.00, 95% confidence interval (CI) 0.39-2.55, p=0.99] was not associated with all-cause death, a long DTBT (vs. intermediate DTBT: HR 2.80, 95% CI 1.26-6.17, p=0.011) was significantly associated with all-cause death, after controlling for confounding factors such as Killip class 4, an impaired renal function, and the number of diseased vessels. Conclusion The DTBT was significantly associated with the incidence of mid-term all-cause death. Our results support the strong adherence to the DTBT in patients with STEMI.


Subject(s)
Angioplasty, Balloon, Coronary , ST Elevation Myocardial Infarction/therapy , Time-to-Treatment , Aged , Analysis of Variance , Cause of Death , Female , Humans , Incidence , Kaplan-Meier Estimate , Male , Middle Aged , Proportional Hazards Models , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/mortality , Treatment Outcome
19.
Int J Cardiol ; 301: 7-13, 2020 02 15.
Article in English | MEDLINE | ID: mdl-31810815

ABSTRACT

BACKGROUND: International guidelines recommend that for NSTEMI, the timing of invasive strategy (IS) is a function of patient's baseline risk. The extent to which this is delivered across and within healthcare systems is unknown. METHODS: Data were derived from 137,265 patients admitted with an NSTEMI diagnosis between 2010 and 2015 in England and Wales. Patients were stratified into low, intermediate and high-risk in keeping with international guidelines. Time to IS was categorised into early (24 h), intermediate (25-72 h) and late (>72 h). Multivariable logistic regression models were used to identify independent predictors of guidelines recommended receipt of IS. RESULTS: There were 3608 (2.6%) low, 5037 (3.7%) intermediate and 128,621 (93.7%) high-risk patients. Guidelines recommended use of IS was significantly lower in high-risk (16.4%) compared to intermediate (64.7%) and low-risk (62.5%) groups. Both men and women in the low-risk category were almost twice as likely to receive early IS compared to high-risk men (28.9% vs 17%, p < 0.001) and women (26.9% vs 15%, p < 0.001). Women (OR 0.91 95%CI 0.88-0.94), troponin elevation (OR 0.39 95%CI 0.36-0.43) and acute heart failure on admission (OR 0.65 95%CI 0.61-0.70) were strong negative predictors of receiving IS within recommended time in the high-risk group. CONCLUSION: Our study shows that IS for management of NSTEMI is not delivered according to international guidelines recommendations. Specifically, the disconnect between baseline risk and utility of IS increases with increasing risk and women achieve slower access than men to IS.


Subject(s)
Guideline Adherence , Myocardial Revascularization , Non-ST Elevated Myocardial Infarction , Risk Assessment/methods , Time-to-Treatment , Aged , Female , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Heart Failure/diagnosis , Heart Failure/etiology , Humans , Male , Middle Aged , Myocardial Revascularization/methods , Myocardial Revascularization/statistics & numerical data , Non-ST Elevated Myocardial Infarction/diagnosis , Non-ST Elevated Myocardial Infarction/physiopathology , Non-ST Elevated Myocardial Infarction/surgery , Outcome and Process Assessment, Health Care , Practice Guidelines as Topic , Procedures and Techniques Utilization/standards , Procedures and Techniques Utilization/statistics & numerical data , Registries/statistics & numerical data , Sex Factors , Time-to-Treatment/standards , Time-to-Treatment/statistics & numerical data , United Kingdom/epidemiology
20.
Circ Rep ; 1(8): 313-319, 2019 Jul 09.
Article in English | MEDLINE | ID: mdl-33693156

ABSTRACT

Background: Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan. Methods and Results: From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67-3.47, P=0.32). Conclusions: There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.

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