ABSTRACT
OBJECTIVES: Coronavirus disease-19 (COVID-19) is caused by severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) -that can affect the cardiovascular system. The aim of our study was to assess the cardiovascular manifestations and its effect on the overall mortality among patients with severe COVID-19 who were admitted in the intensive care units (ICU). METHODS: This is a retrospective, multicenter cohort study that included all adult patients admitted to the ICU with laboratory-confirmed COVID-19 in three major hospitals in Oman between March 1, 2020, and August 10, 2020. RESULTS: A total of 541 patients (mean age of 50.57 ± 15.57 years; 401 [74.1%] male) were included in the study of which 452 (83.5%) were discharged and 89 (16.5%) died during hospitalization.Evidence of cardiac involvement was found in 185 (34.2%) patients, which included raised troponin (31.6%), arrhythmias (4.3%), myocardial infarctions (2.6%), or drop in ejection fraction (0.9%). High troponin of >100 ng/l was associated with higher mortality (odds ratio [OR] = 7.98; 95% confidence interval [CI]: 4.20-15.15); P < 0.001). Patients with any cardiovascular involvement also had a high risk of dying (OR = 8.8; 95% CI: 4.6-16.5; P < 0.001). CONCLUSION: Almost a third of patients in our study had evidence of cardiovascular involvement which was mainly myocardial injury. This was associated with increased mortality.
ABSTRACT
Managing a high intracoronary (IC) thrombus burden is a major challenge in patients with ectatic coronary arteries who present with an ST-elevation myocardial infarction (STEMI). We report a 45-year-old male patient who presented to the Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman, in 2017 with an inferior STEMI. Coronary angiography revealed ectatic coronary arteries with an occluded right coronary artery (RCA). The RCA had a massive thrombus burden that did not resolve with aspiration thrombectomy or balloon angioplasty. Subsequently, IC thrombolysis was administered resulting in significant reperfusion. During the course of his treatment, the patient suffered from intracranial bleeding as a complication; however, he recovered completely with no residual neurological sequelae. This case report demonstrates that IC thrombolysis is a valid option in patients with a massive thrombus burden in the setting of a STEMI, albeit with an increased risk of major bleeding.
Subject(s)
Coronary Thrombosis , ST Elevation Myocardial Infarction , Coronary Thrombosis/drug therapy , Coronary Vessels , Humans , Male , Middle Aged , Thrombectomy , Thrombolytic TherapyABSTRACT
OBJECTIVES: The aim of this study was to assess the diagnostic and prognostic value of heart-type fatty acid-binding protein (H-FABP) in elective percutaneous coronary intervention (PCI) and compare it with standard cardiac markers. METHODS: A prospective evaluation was done of 80 consecutive patients admitted for elective PCI. Serum cardiac troponin T (cTnT), cardiac troponin I (cTnI), creatine kinase-MB (CK-MB mass), myoglobin, and H-FABP were determined pre-angioplasty and 1, 2, 4, and 16-24 hrs post-angioplasty. Elevated cardiac markers were correlated with demographic, angiographic and procedural variables. Patients were followed up for 20-26 months. RESULTS: H-FABP peaked early at 2 hours and was useful for the early detection of evolving AMI within 1-3 hours after angioplasty. Cardiac-TnI, myoglobin, H-FABP, CK-MB mass, and cTnT concentrations were elevated in 46.25%, 17.5%, 13.3%, 11.25%, and 7.5% respectively. Cardiac-TnI was the most sensitive marker for detecting all complications and was superior to all other markers. Elevated cardiac markers were correlated with old age (P < 0.02); chest pain ± ECG changes of ischaemia (P < 0.003); use of stents (P < 0.019) and major complications such as major dissection (P < 0.004); transient vessel closure (P < 0.022); bail out stent (P < 0.003), and AMI (P < 0.042). Elevated cardiac markers were associated with a reduction of event-free survival (16.92 versus 20.67 months, P < 0.03). CONCLUSION: Heart-type-FABP measurements at 1 hour (or thereafter) post-PCI may offer an early chance of detecting evolving AMI; cTnI was the most sensitive marker for the detection of major complications in patients undergoing PCI. Measurements of cTnI 16-24 hours post-PCI should be part of the routine management of patients following elective PCI.
ABSTRACT
OBJECTIVES: The objective of this study was to evaluate the diagnostic value of heart-type fatty acid-binding protein (H-FABP) in patients with acute chest pain and compare it with standard cardiac markers. METHODS: We undertook a prospective evaluation of 100 consecutive patients admitted with acute chest pain suggestive of acute coronary syndromes (ACS). Serum cardiac troponin I (cTnI), cardiac troponin T (cTnT), creatine kinase-MB (CK-MB) mass, myoglobin, and H-FABP were determined at presentation and 2, 4, 8-10, and 16-24 hours after presentation. The main outcome measure was the best sensitivity value within 6 hours after symptom onset. RESULTS: H-FABP peak concentration occurred at 8 hours after symptoms onset and was the most sensitive early marker with 79.9% and 98% of patients with AMI identified at presentation and 2 hours after presentation respectively. The sensitivity of all other cardiac markers (CK-MB mass, cTnI, cTnT, and myoglobin) at presentation was < 62%. The negative predictive value of H-FABP (94%) was also superior to other markers within the first 2 hours of presentation. Myoglobin was the second most sensitive early marker at presentation. Peak sensitivity of cTnI, CK-MB mass, and cTnT were present at 4, 8-10, and 8-10 hours respectively after presentation. CONCLUSION: Combined measurement of H-FABP and cTnI on two occasions during the first 8 hours after symptom onset was sufficiently sensitive and specific for the early diagnosis of most patients with acute MI and may provide advantages over other cardiac marker combinations.
