ABSTRACT
BACKGROUND: The simple risk index recorded in the emergency room (ER-SRI), which is calculated using the formula (heart rate × [age / 10]2) / systolic blood pressure, was shown to be able to stratify the prognosis in ST-elevation myocardial infarction (STEMI) patients. However, the prognostic impact of the prehospital simple risk index (Pre-SRI) remains unknown.MethodsâandâResults: This study enrolled 2,047 STEMI patients from the Mie Acute Coronary Syndrome (ACS) registry. Pre-SRI was calculated using prehospital data and ER-SRI was calculated using emergency room data. The primary endpoint was 30-day all-cause mortality. The cut-off values of Pre-SRI and ER-SRI for predicting 30-day mortality were 34.8 and 34.1, with accuracies of 0.816 and 0.826 based on receiver operating characteristic analyses (P<0.001 for both). There was no difference in the accuracy of the 2 indices. Multivariate Cox regression analysis demonstrated that a High Pre-SRI (≥34) was a significant independent predictor of 30-day mortality. With combined Pre-SRI and ER-SRI assessment, patients with High Pre-SRI/High ER-SRI showed significantly higher mortality than those with High Pre-SRI/Low ER-SRI, Low Pre-SRI/High ER-SRI, and Low Pre-SRI/Low ER-SRI (P<0.001). The addition of High Pre-SRI to High ER-SRI showed incremental prognostic value of the Pre-SRI. CONCLUSIONS: Pre-SRI can identify high-risk STEMI patients at an early stage and combined assessment with Pre-SRI and ER-SRI could be of incremental prognostic value for risk stratification in STEMI patients.
Subject(s)
Acute Coronary Syndrome , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Child , Prognosis , Risk , Acute Coronary Syndrome/diagnosis , Emergency Service, Hospital , Risk AssessmentABSTRACT
Recurrent in-stent restenosis of the coronary artery is a rare but intractable problem. In this situation, coronary arteritis should be considered as an etiology. This case highlights the use of immunosuppressive drugs, including tocilizumab, and follow-up F-18-fluorodeoxyglucose positron emission tomography/computed tomography to break the vicious circle of recurrent stenosis caused by isolated coronary arteritis of unknown cause.
ABSTRACT
This case highlights the diagnostic challenge associated with myocarditis, especially when accompanied by coronary spasm. Any coronary spasm with hemodynamic instability and/or an inexplicable widespread electrocardiogram should alert the clinician to the possibility of fulminant myocarditis and the necessity of endomyocardial biopsy for treatment decisions. (Level of Difficulty: Beginner.).
ABSTRACT
Calcified amorphous tumor (CAT) is a non-neoplastic tumor composed of calcified nodules consisting of amorphous fibrous material, and it may eventually cause cerebral infarction (CI). We experienced a 67-year-old woman with CAT who had recurrent CI. After excision of the CAT, the CI did not show recurrence. A review of previous papers on CI due to CAT in Pubmed revealed that 7 of 13 studies originated in Japan and that CI can occur even with small CAT. Surgical treatment is recommended to prevent CI recurrence, especially when CAT is accompanied by mitral annular calcification or has marked mobility.
Subject(s)
Heart Neoplasms , Intracranial Embolism , Cerebral Infarction/diagnostic imaging , Cerebral Infarction/etiology , Humans , Intracranial Embolism/diagnostic imaging , Intracranial Embolism/etiology , Japan , Neoplasm Recurrence, LocalSubject(s)
Breast Neoplasms/radiotherapy , Coronary Circulation , Heart Diseases/diagnostic imaging , Myocardial Perfusion Imaging , Radiation Injuries/diagnostic imaging , Tomography, X-Ray Computed , Aged , Female , Heart Diseases/etiology , Heart Diseases/physiopathology , Humans , Predictive Value of Tests , Radiation Injuries/etiology , Radiation Injuries/physiopathology , Radiotherapy, AdjuvantABSTRACT
BACKGROUND: Although the renal toxicity of Deferasirox, an oral iron chelator, has been reported to be mild, there have been reports of acute interstitial nephritis or Fanconi syndrome due to this agent. Thin basement membrane disease (TBMD) is a hereditary disease characterized primarily by hematuria, with gross hematuria also observed in about 7% of cases. We herein report a case of TBMD that presented with acute kidney injury and gross hematuria during treatment with Deferasirox. CASE PRESENTATION: The patient was a 63-year-old man who had been diagnosed with myelodysplastic syndrome 6 years ago. He had started taking Deferasirox at 125 mg due to post-transfusion iron overload 6 months ago. Deferasirox was then increased to 1000 mg three months ago. When the serum creatinine level increased, Deferasirox was reduced to 500 mg three weeks before hospitalization. Although the serum creatinine level decreased once, he developed a fever and macroscopic hematuria one week before hospitalization. The serum creatinine level increased again, and Deferasirox was stopped four days before hospitalization. He was admitted for the evaluation of acute kidney injury and gross hematuria. Treatment with temporary hemodialysis was required, and a kidney biopsy was performed on the eighth day of admission. Although there was no major abnormality in the glomeruli, the leakage of red blood cells into the Bowman's space was observed. Erythrocyte cast formation was observed in the tubular lumen, which was associated with acute tubular necrosis. The results of an electron microscopic study were compatible with TBMD. CONCLUSION: Although Deferasirox is known to be nephrotoxic, gross hematuria is relatively rare. When we encounter a case of acute kidney injury with gross hematuria during treatment with Deferasirox, TBMD should be considered as a possible cause of gross hematuria.
