ABSTRACT
The conus artery (CA) supplies the right ventricular outflow tract (RVOT). ST-segment elevation in leads V1-3, which can resemble Brugada electrocardiogram (EKG) patterns, has been reported due to occlusion of the CA. A 68-year-old male was admitted to the hospital with a diagnosis of non-ST-elevation myocardial infarction. A coronary angiogram revealed a dissection in the conus artery, most likely caused by the catheter. Due to the small caliber of the CA, medical therapy was chosen as the course of action. However, after the procedure, an EKG showed changes consistent with features of both type-1 and type-2 Brugada patterns, with ST-segment elevations in leads V1-4. Subsequent coronary imaging revealed that the CA had progressed to total occlusion. Despite multiple attempts to gain reentry into the true lumen, they were unsuccessful. Based on the risk-benefit ratio, the decision was made to continue with medical therapy. This is the first reported case of CA occlusion induced by catheter dissection, which manifested as anteroseptal ST-segment elevation. The patient did not report any anginal symptoms or arrhythmic events, which contrasts with conventional knowledge. Not all CA obstructions or RVOT infarcts cause Brugada-like patterns. When they do, ST elevations tend to be less than those in true Brugada syndrome.
A artéria do cone (AC) irriga a via de saída do ventrículo direito (VSVD). A elevação do segmento ST nas derivações V1-3, que pode assemelhar-se aos padrões de eletrocardiograma (ECG) de Brugada, foi relatada devido à oclusão da AC. Um paciente do sexo masculino, 68 anos de idade, foi internado no hospital com diagnóstico de infarto do miocárdio sem supradesnivelamento do segmento ST. Uma angiografia coronária revelou uma dissecção na AC, provavelmente causada pelo cateter. Devido ao pequeno calibre da AC, a terapia medicamentosa foi escolhida como curso de ação. No entanto, após o procedimento, um ECG mostrou alterações consistentes com características dos padrões de Brugada tipo 1 e tipo 2, com elevações do segmento ST nas derivações V1-4. A imagem coronariana subsequente revelou que a AC havia progredido para oclusão total. Apesar das diversas tentativas de obter a reentrada no lúmen verdadeiro, não houve êxito. Com base na relação risco-benefício, foi tomada a decisão de continuar com a terapia medicamentosa. Este é o primeiro caso relatado de oclusão da AC induzida por dissecção por cateter, que se manifesta como elevação ântero-septal do segmento ST. O paciente não relatou sintomas anginosos ou eventos arrítmicos, o que contrasta com o conhecimento convencional. Nem todas as obstruções da AC ou infartos da VSVD causam padrões semelhantes aos de Brugada. Quando isso ocorre, as elevações de ST tendem a ser menores do que as da verdadeira síndrome de Brugada.
Subject(s)
Brugada Syndrome , Coronary Angiography , Electrocardiography , Humans , Male , Aged , Brugada Syndrome/physiopathology , Coronary Occlusion/diagnostic imaging , Coronary Occlusion/physiopathology , Coronary Occlusion/etiology , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/diagnostic imagingABSTRACT
Wellens syndrome, an ST Elevation Myocardial Infarction (STEMI) equivalent, is also known as T-wave left anterior descending (LAD) coronary artery disease. Wellens syndrome is characterized by a unique electrocardiogram (ECG) pattern that suggests a significant stenosis in the left anterior descending coronary artery that warrants immediate intervention. Hereby, we present a case report of Wellens syndrome in a patient with a history of hypertension and chronic obstructive pulmonary disease (COPD) that may be potentially mistaken for pseudo- Wellens syndrome because the ECG pattern mimics left ventricular strain pattern (LVSP) in left ventricular hypertrophy (LVH). Thus, cautious examination of recent chest pain and ECG is important to differentiate Wellens syndrome and LVSP in patients with hypertension and COPD to perform early detection and aggressive intervention since they may help to lessen the adverse results.
Subject(s)
Electrocardiography , Hypertension , Pulmonary Disease, Chronic Obstructive , Humans , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/physiopathology , Hypertension/complications , Male , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/etiology , Middle Aged , Hypertrophy, Left Ventricular/diagnosis , Hypertrophy, Left Ventricular/physiopathology , Hypertrophy, Left Ventricular/etiology , Diagnosis, Differential , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/complications , Coronary Stenosis/diagnosis , Coronary Stenosis/physiopathology , Chest Pain/etiology , Chest Pain/diagnosis , Coronary Angiography , SyndromeABSTRACT
Brugada phenocopies are conditions that have an electrocardiography (ECG) pattern that mimics typical patterns seen in Brugada syndrome (BS). We report a rare case of a patient who had a Brugada-like ECG pattern caused by ischemia due to strangulation of the septal artery. The patient was treated with thrombolytic therapy after a probable diagnosis of ST-elevation myocardial infarction (STEMI), which resulted in hematologic complications.
Subject(s)
Brugada Syndrome , Electrocardiography , Humans , Brugada Syndrome/diagnosis , Male , Middle Aged , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiologySubject(s)
Heart Septal Defects, Ventricular , ST Elevation Myocardial Infarction , Humans , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , Heart Septal Defects, Ventricular/surgery , Male , Electrocardiography , Treatment OutcomeABSTRACT
A male patient presented with cardiac arrest attributed to anterior ST-segment elevation myocardial infarction from type 1 spontaneous coronary artery dissection. Subsequent imaging confirmed fibromuscular dysplasia in noncoronary arterial segments. The patient was started on guideline-directed medical therapy and referred to cardiac rehabilitation, showing substantial improvements in clinical status. With greater awareness and advancements in imaging, spontaneous coronary artery dissection has been more frequently recognized, and although as many as 81% to 92% of all cases occur in female patients, it can be seen among men, as well. Adjunctive imaging for arteriopathies may help establish the diagnosis for equivocal causes of acute coronary syndrome in women and men.
Subject(s)
Coronary Angiography , Coronary Vessel Anomalies , Fibromuscular Dysplasia , Vascular Diseases , Humans , Fibromuscular Dysplasia/complications , Fibromuscular Dysplasia/diagnosis , Male , Coronary Vessel Anomalies/diagnosis , Coronary Vessel Anomalies/complications , Vascular Diseases/congenital , Vascular Diseases/diagnosis , Vascular Diseases/etiology , Coronary Vessels/diagnostic imaging , Electrocardiography , Middle Aged , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnosis , Computed Tomography AngiographyABSTRACT
BACKGROUND: The benefit of fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease remains unclear. METHODS: In this multinational, registry-based, randomized trial, we assigned patients with STEMI or very-high-risk non-STEMI (NSTEMI) and multivessel disease who were undergoing primary percutaneous coronary intervention (PCI) of the culprit lesion to receive either FFR-guided complete revascularization of nonculprit lesions or no further revascularization. The primary outcome was a composite of death from any cause, myocardial infarction, or unplanned revascularization. The two key secondary outcomes were a composite of death from any cause or myocardial infarction and unplanned revascularization. RESULTS: A total of 1542 patients underwent randomization, with 764 assigned to receive FFR-guided complete revascularization and 778 assigned to receive culprit-lesion-only PCI. At a median follow-up of 4.8 years (interquartile range, 4.3 to 5.2), a primary-outcome event had occurred in 145 patients (19.0%) in the complete-revascularization group and in 159 patients (20.4%) in the culprit-lesion-only group (hazard ratio, 0.93; 95% confidence interval [CI], 0.74 to 1.17; P = 0.53). With respect to the secondary outcomes, no apparent between-group differences were observed in the composite of death from any cause or myocardial infarction (hazard ratio, 1.12; 95% CI, 0.87 to 1.44) or unplanned revascularization (hazard ratio, 0.76; 95% CI, 0.56 to 1.04). There were no apparent between-group differences in safety outcomes. CONCLUSIONS: Among patients with STEMI or very-high-risk NSTEMI and multivessel coronary artery disease, FFR-guided complete revascularization was not shown to result in a lower risk of a composite of death from any cause, myocardial infarction, or unplanned revascularization than culprit-lesion-only PCI at 4.8 years. (Funded by the Swedish Research Council and others; FULL REVASC ClinicalTrials.gov number, NCT02862119.).
Subject(s)
Coronary Artery Disease , Fractional Flow Reserve, Myocardial , Myocardial Revascularization , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Aged , Female , Humans , Male , Middle Aged , Coronary Artery Disease/complications , Coronary Artery Disease/mortality , Coronary Artery Disease/therapy , Follow-Up Studies , Kaplan-Meier Estimate , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Percutaneous Coronary Intervention/methods , Registries , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Myocardial Revascularization/methods , Coronary Vessels/diagnostic imaging , Coronary Vessels/surgery , Reoperation , Europe , AustralasiaABSTRACT
We present a case of a man in his 30s presenting with ST-segment elevation myocardial infarction and eosinophilia. The patient underwent thrombus aspiration and initially echocardiographic evaluation was normal. The patient was discharged after 2 days, but was hospitalised again after 6 days. Echocardiographic evaluation now revealed a thrombus formation on the aortic valve. Laboratory data revealed increasing eosinophilia, and treatment with high-dosage corticosteroids and hydroxyurea was initiated as eosinophilic disease with organ manifestations could not be precluded. Eosinophils normalised and the patient was discharged again. The combination of hypereosinophilia and absence of infection, rheumatological disorders and malignancy, led to reactive or idiopathic hypereosinophilic syndrome being the most plausible diagnoses. The patient was closely monitored in the cardiology and haematology outpatient clinics. Echocardiographic evaluation, performed 6 weeks after the patient was discharged, showed significant regression in the size of the thrombus mass.
Subject(s)
Hypereosinophilic Syndrome , ST Elevation Myocardial Infarction , Thrombosis , Male , Humans , ST Elevation Myocardial Infarction/etiology , Aortic Valve/diagnostic imaging , Hypereosinophilic Syndrome/complications , Hypereosinophilic Syndrome/diagnosis , Hypereosinophilic Syndrome/drug therapy , Hydroxyurea , Thrombosis/diagnostic imaging , Thrombosis/drug therapy , Thrombosis/etiologyABSTRACT
The most common mechanical complications of acute myocardial infarction include free-wall rupture, ventricular septal rupture (VSR), papillary muscle rupture and pseudoaneurysm. It is rare for a patient to experience more than one mechanical complication simultaneously. Here, we present a case of ST-segment elevation myocardial infarction (STEMI) complicated with three mechanical complications, including ventricular apical wall rupture, ventricular aneurysm formation and ventricular septal dissection (VSD) with VSR. Cardiac auscultation revealed rhythmic S1 and S2 with a grade 3 holosystolic murmur at the left sternal border. Electrocardiogram indicated anterior ventricular STEMI. Serological tests showed a significant elevated troponin I. Bedside echocardiography revealed ventricular apical wall rupture, apical left ventricle aneurysm and VSD with VSR near the apex. This case demonstrates that several rare mechanical complications can occur simultaneously secondary to STEMI and highlights the importance of bedside echocardiography in the early diagnosis of mechanical complications.
Subject(s)
Heart Aneurysm , Heart Rupture, Post-Infarction , ST Elevation Myocardial Infarction , Ventricular Septal Rupture , Aged , Humans , Electrocardiography , Heart Aneurysm/diagnostic imaging , Heart Aneurysm/etiology , Heart Aneurysm/complications , Heart Aneurysm/physiopathology , Heart Rupture, Post-Infarction/etiology , Heart Rupture, Post-Infarction/diagnostic imaging , Heart Rupture, Post-Infarction/diagnosis , Point-of-Care Testing , Predictive Value of Tests , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/complications , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/diagnostic imaging , Treatment Outcome , Ventricular Septal Rupture/etiology , Ventricular Septal Rupture/diagnostic imaging , Ventricular Septal Rupture/physiopathology , Ventricular Septal Rupture/diagnosis , Ventricular Septal Rupture/surgery , FemaleABSTRACT
Cardiac tumors are rare entities, among which atrial myxoma (AM) stands as the most frequent, accounting for approximately half of all reported cases. The incidence of AM is estimated to range from 0.001% to 0.3% within the general population, yet only about 0.06% of these cases present with coronary embolic events. We report on a 33-year-old male smoker who experienced acute, severe precordial pain radiating to the left upper limb, lasting for one hour. The electrocardiographic evaluation demonstrated ST-segment elevation in leads D2, D3, and aVF, alongside significantly elevated serum troponin levels, confirming a diagnosis of ST-segment elevation myocardial infarction (STEMI). Subsequent coronary angiography revealed proximal occlusion of the right coronary artery due to thrombus. An initial attempt of thrombus aspiration was unsuccessful, followed by primary angioplasty with balloon inflation without stent placement. Further diagnostic exploration through transthoracic echocardiography identified a homogenous, smooth-surfaced mass measuring 5.2 cm x 2.3 cm attached to the interatrial septum. This mass, characterized by lobulations, prolapsed into the mitral valve and left ventricle during diastole, consistent with AM. Surgical resection of the mass was successfully performed, with the patient being discharged asymptomatic. In the reported case, the patient's profile, notably his age, and gender, diverges from the typical epidemiological characteristics associated with AM. This case adds to the limited number of reports where the inferior wall is affected by the right coronary artery being occluded. This report emphasizes the significance of differential diagnoses in younger patients presenting with STEMI.
Neoplasias cardíacas são raras, tendo como principal representante o mixoma atrial (MA), que corresponde a cerca de metade de todos os casos. O MA tem incidência estimada entre 0.001% e 0.3% na população em geral, no entanto apenas aproximadamente 0,06% desses cursam com eventos embólicos coronarianos. Homem de 33 anos, tabagista, admitido com quadro de precordialgia intensa e irradiação para membro superior esquerdo com duração de uma hora. O eletrocardiograma evidenciou elevação de segmento ST nas derivações D2, D3 e aVF troponina sérica elevada, confirmando infarto com supra desnivelamento do segmento ST (IAMCSST). Foi realizada cineangiocoronariografia, a qual revelou oclusão em terço proximal de artéria coronária direita por trombo. Realizada tentativa de aspiração do trombo, sem sucesso, seguido por angioplastia primária com balão sem colocação de stent. Durante a investigação do quadro, paciente realizou ecocardiograma transtorácico o qual demonstrou massa homogênea de superfície regular, de 5.2 cm x 2.3 cm, aderida ao septo interatrial, com lobulações de características emboligênicas prolapsando para valva mitral e ventrículo esquerdo na diástole, compatível com MA. Foi realizada ressecção cirúrgica com paciente evoluindo assintomático, recebendo alta para seguimento ambulatorial. O caso relatado difere em idade e sexo do perfil epidemiológico típico sendo um dos poucos descritos com acometimento da parede inferior apresentando a artéria coronária direita como culpada. Este relato ratifica a importância do diagnóstico diferencial frente às apresentações de IAMCSST em jovens.
Subject(s)
Heart Atria , Heart Neoplasms , Myxoma , ST Elevation Myocardial Infarction , Humans , Male , Adult , Myxoma/diagnostic imaging , Myxoma/complications , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/complications , Heart Neoplasms/pathology , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnostic imaging , Heart Atria/diagnostic imaging , Heart Atria/pathology , Echocardiography , Electrocardiography , Coronary AngiographyABSTRACT
ST-elevation myocardial infarction (STEMI) in a trauma patient with solid abdominal organ or vascular injuries can present complex diagnostic and therapeutic challenges. Evidence for managing such demanding cases is scarce, and isolated case reports remain the source of information in treating these patients. We present a patient with traumatic mesenteric and hepatic injuries who developed acute STEMI in the immediate postoperative period.
Subject(s)
Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/surgery , Myocardial Infarction/complications , Myocardial Infarction/therapy , Myocardial Infarction/diagnosisABSTRACT
BACKGROUND: Primary percutaneous coronary intervention (pPCI) has improved clinical outcomes in patients with ST-segment-elevation myocardial infarction. However, as many as 50% of patients still have suboptimal myocardial reperfusion and experience extensive myocardial necrosis. The PiCSO-AMI-I trial (Pressure-Controlled Intermittent Coronary Sinus Occlusion-Acute Myocardial Infarction-I) evaluated whether PiCSO therapy can further reduce myocardial infarct size (IS) in patients undergoing pPCI. METHODS: Patients with anterior ST-segment-elevation myocardial infarction and Thrombolysis in Myocardial Infarction flow 0-1 were randomized at 16 European centers to PiCSO-assisted pPCI or conventional pPCI. The PiCSO Impulse Catheter (8Fr balloon-tipped catheter) was inserted via femoral venous access after antegrade flow restoration of the culprit vessel and before proceeding with stenting. The primary end point was the difference in IS (expressed as a percentage of left ventricular mass) at 5 days by cardiac magnetic resonance. Secondary end points were the extent of microvascular obstruction and intramyocardial hemorrhage at 5 days and IS at 6 months. RESULTS: Among 145 randomized patients, 72 received PiCSO-assisted pPCI and 73 conventional pPCI. No differences were observed in IS at 5 days (27.2%±12.4% versus 28.3%±11.45%; P=0.59) and 6 months (19.2%±10.1% versus 18.8%±7.7%; P=0.83), nor were differences between PiCSO-treated and control patients noted in terms of the occurrence of microvascular obstruction (67.2% versus 64.6%; P=0.85) or intramyocardial hemorrhage (55.7% versus 60%; P=0.72). The study was prematurely discontinued by the sponsor with no further clinical follow-up beyond 6 months. However, up to 6 months of PiCSO use appeared safe with no device-related adverse events. CONCLUSIONS: In this prematurely discontinued randomized trial, PiCSO therapy as an adjunct to pPCI did not reduce IS when compared with conventional pPCI in patients with anterior ST-segment-elevation myocardial infarction. PiCSO use was associated with increased procedural time and contrast but no increase in adverse events up to 6 months. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03625869.
Subject(s)
Coronary Sinus , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Coronary Sinus/diagnostic imaging , Coronary Circulation , Treatment Outcome , Prospective Studies , Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/etiology , Percutaneous Coronary Intervention/adverse effects , Hemorrhage/etiologySubject(s)
Acute Coronary Syndrome , Coronary Stenosis , Myocardial Revascularization , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/etiology , Acute Coronary Syndrome/physiopathology , Acute Coronary Syndrome/therapy , Myocardial Revascularization/methods , Percutaneous Coronary Intervention/methods , Practice Guidelines as Topic , Randomized Controlled Trials as Topic , Fractional Flow Reserve, Myocardial , Coronary Angiography , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/therapy , Coronary Stenosis/complications , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/physiopathology , Coronary Stenosis/therapyABSTRACT
BACKGROUND: Suboptimal coronary reperfusion (no reflow) is common in acute coronary syndrome percutaneous coronary intervention (PCI) and is associated with poor outcomes. We aimed to develop and externally validate a clinical risk score for angiographic no reflow for use following angiography and before PCI. METHODS: We developed and externally validated a logistic regression model for prediction of no reflow among adult patients undergoing PCI for acute coronary syndrome using data from the Melbourne Interventional Group PCI registry (2005-2020; development cohort) and the British Cardiovascular Interventional Society PCI registry (2006-2020; external validation cohort). RESULTS: A total of 30â 561 patients (mean age, 64.1 years; 24% women) were included in the Melbourne Interventional Group development cohort and 440â 256 patients (mean age, 64.9 years; 27% women) in the British Cardiovascular Interventional Society external validation cohort. The primary outcome (no reflow) occurred in 4.1% (1249 patients) and 9.4% (41â 222 patients) of the development and validation cohorts, respectively. From 33 candidate predictor variables, 6 final variables were selected by an adaptive least absolute shrinkage and selection operator regression model for inclusion (cardiogenic shock, ST-segment-elevation myocardial infarction with symptom onset >195 minutes pre-PCI, estimated stent length ≥20 mm, vessel diameter <2.5 mm, pre-PCI Thrombolysis in Myocardial Infarction flow <3, and lesion location). Model discrimination was very good (development C statistic, 0.808; validation C statistic, 0.741) with excellent calibration. Patients with a score of ≥8 points had a 22% and 27% risk of no reflow in the development and validation cohorts, respectively. CONCLUSIONS: The no-reflow prediction in acute coronary syndrome risk score is a simple count-based scoring system based on 6 parameters available before PCI to predict the risk of no reflow. This score could be useful in guiding preventative treatment and future trials.
Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , No-Reflow Phenomenon , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Adult , Humans , Female , Middle Aged , Aged , Male , Percutaneous Coronary Intervention/adverse effects , Acute Coronary Syndrome/diagnostic imaging , Acute Coronary Syndrome/therapy , Coronary Angiography , Treatment Outcome , Risk Factors , Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/therapy , ST Elevation Myocardial Infarction/etiology , No-Reflow Phenomenon/diagnostic imaging , No-Reflow Phenomenon/etiologyABSTRACT
Lyme disease, caused by Borrelia burgdorferi and transmitted via Ixodes ticks, is a common vector-borne illness in the United States, with an estimated 476,000 annual cases. While primarily known for its neurological and rheumatological manifestations, Lyme disease can also involve the cardiac system, known as Lyme carditis, which occurs in about 4% to 10% of cases. This case report details a rare instance of Lyme carditis presenting as ST-segment elevation myocardial infarction (STEMI) in a 31-year-old female with no significant medical history. The patient exhibited symptoms of chest pressure and shortness of breath, with laboratory results showing significantly elevated troponin levels and other indicative markers. Notably, cardiac catheterization revealed no coronary occlusion, suggesting an alternative diagnosis to acute coronary syndrome (ACS). Further testing confirmed Lyme carditis through positive serological tests for Lyme-specific IgM antibodies. The case underscores the importance of considering Lyme myopericarditis in differential diagnoses for STEMI in Lyme-endemic areas and in patients without typical risk factors for coronary artery disease. This report aims to increase clinical awareness of this condition, highlighting the need for thorough investigation in atypical cardiac presentations.
Subject(s)
Acute Coronary Syndrome , Borrelia burgdorferi , Lyme Disease , Myocarditis , ST Elevation Myocardial Infarction , Female , Humans , United States , Adult , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/complications , Myocarditis/diagnosis , Myocarditis/etiology , Lyme Disease/complications , Lyme Disease/diagnosisABSTRACT
Background: Heart attacks including acute ST-segment elevation myocardial infarction (STEMI) and acute decompensated heart failure (ADHF) caused from the particulate matter (PM) and air pollutant exposures are positively associated with regional air pollution severity and individual exposure. The exceptional coronavirus disease epidemic of 2019 (COVID-19) may enhance the air conditions in areas under COVID-19 pandemic. We sought to study the impact of COVID-19 pandemic on air particulate matter (PM) exposure and heart attacks in Taiwan. Methods: This retrospective cohort study was conducted in one teaching hospital in Taichung, Taiwan. We examined emergency patients diagnosed with acute STEMI and ADHF from January 1, 2017, to March 31, 2020, (i.e., before the COVID-19 pandemic) and from April 1, 2020, to December 31, 2021, (after the COVID-19 pandemic). The effects of particulate matter with a diameter of less than 2.5 micrometers (PM2.5) and PM10 as well as temperature and humidity on environmental air pollutants were recorded. The analysis was performed with a unidirectional case-crossover research design and a conditional logistic regression model. Results: Both PM2.5 and PM10 levels had a positive association with the risk of acute STEMI before the COVID-19 pandemic (PM2.5 adjusted odds ratio (OR): 1.016, 95% confidence interval (CI): 1.003-1.032 and PM10 adjusted OR: 1.009, 95% CI: 1.001-1.018) and ADHF (PM2.5 adjusted OR: 1.046, 95% CI: 1.034-1.067 and PM10 adjusted OR: 1.023, 95% CI: 1.027-1.047). Moreover, the results demonstrated that PM2.5 and PM10 were not associated with the risk of acute STEMI or ADHF after the COVID-19 pandemic. Reduction in PM2.5 and PM10 levels after the COVID-19 pandemic were noted. Hospital admissions for acute STEMI (7.4 and 5.8/per month) and ADHF (9.7 and 8.2/per month) also decreased (21.6 and 15.5%) after the COVID-19 pandemic. Conclusion: In Taiwan, paradoxical reductions in PM2.5 and PM10 levels during the COVID-19 pandemic may decrease the number of hospital admissions for acute STEMI and ADHF. As the COVID-19 pandemic eases, the condition of air pollution may gradually become worse again. The governments should formulate better policies to improve the health of the public and the quality of the air.
Subject(s)
Air Pollutants , COVID-19 , Myocardial Infarction , ST Elevation Myocardial Infarction , Humans , Particulate Matter/analysis , ST Elevation Myocardial Infarction/epidemiology , ST Elevation Myocardial Infarction/etiology , Retrospective Studies , Pandemics , Taiwan , COVID-19/epidemiology , Air Pollutants/analysisABSTRACT
BACKGROUND: ST-elevation myocardial infarction (STEMI) systems of care have reduced inter-hospital transfer times and facilitated timely reperfusion goals. Helicopters may be an option when land transportation is not feasible; however, the safety of air transport in patients with acute coronary syndrome (ACS) is a factor to consider. OBJETIVES: The aim of this study was to evaluate the safety of helicopter transport for patients with ACS. METHODS: Prospective, observational, and descriptive study including patients diagnosed with ACS within the STEMI network of a metropolitan city transferred by helicopter to a large cardiovascular center to undergo percutaneous coronary intervention. The primary outcome of the study was the incidence of air-travel-related complications defined as IV dislodgement, hypoxia, arrhythmia, angina, anxiety, bleeding, and hypothermia. Secondary outcomes included the individual components of the primary outcome. RESULTS: A total of 106 patients were included in the study; the mean age was 54 years and 84.9% were male. The most frequent diagnosis was STEMI after successful fibrinolysis (51.8%), followed by STEMI with failed fibrinolysis (23.7%) and non-reperfused STEMI (9.4%). Five patients (4.7%) developed at least one complication: IV dislodgement (1.8%) and hypoxemia (1.8%) in two patients and an episode of angina during flight (0.9%). A flight altitude of > 10,000 ft was not associated with complications. CONCLUSIONS: The results of this study suggest that helicopter transportation is safe in patients undergoing acute coronary syndrome, despite the altitude of a metropolitan area.
ANTECEDENTES: Los sistemas de atención de IAMCEST han reducido los tiempos de transferencia interhospitalaria y han facilitado las metas de reperfusión oportuna. Los helicópteros pueden ser una opción cuando el transporte terrestre no es factible; sin embargo, la seguridad del transporte aéreo en pacientes con síndrome coronario agudo (SICA) es un factor a considerar. OBJETIVOS: Evaluar la seguridad del transporte en helicóptero para pacientes con SICA. MÉTODOS: Estudio prospectivo, observacional, descriptivo. Se incluyeron pacientes con diagnóstico de SICA dentro de la red IAMCEST en metrópolis extensa, trasladados en helicóptero a un centro cardiovascular. El resultado primario del estudio fue la incidencia de complicaciones relacionadas con los viajes aéreos definidas cómo desalojo de catéter intravenoso, hipoxia, arritmia, angina, ansiedad, sangrado e hipotermia. RESULTADOS: Total de 106 pacientes; la edad media fue de 54 años y 84,9% eran hombres. La altitud media de vuelo fue de 10,100 pies y la distancia media de vuelo fue de 50,0 km. El diagnóstico más frecuente fue IAMCEST tras fibrinolisis exitosa (51,8%), seguido de IAMCEST con fibrinolisis fallida (23,7%). Cinco pacientes (4,7%) desarrollaron una complicación: desalojo IV (1,8%) e hipoxemia (1,8%) en dos pacientes y un episodio de angina durante el vuelo (0,9%). Una altitud de vuelo mayor de 10,000 pies no se asoció a complicaciones. CONCLUSIONES: Los resultados de este estudio sugieren que el transporte en helicóptero es seguro en pacientes con SICA, incluso en altitudes > 10,000 pies.
Subject(s)
Acute Coronary Syndrome , Myocardial Infarction , Non-ST Elevated Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Male , Middle Aged , Female , Acute Coronary Syndrome/therapy , ST Elevation Myocardial Infarction/etiology , Myocardial Infarction/etiology , Prospective Studies , Travel , Travel-Related Illness , Aircraft , Percutaneous Coronary Intervention/methods , Angina Pectoris/etiologyABSTRACT
INTRODUCTION: ST-segment elevation myocardial infarction (STEMI) is a fatal disease with significant burden worldwide. Despite advanced medical treatment performed, STEMIrelated morbidity and mortality remains high due to ischemia reperfusion injury after primary angioplasty mediated by NLRP3 inflammasome. Adding colchicine expected to reduce inflammation both in vitro and in vivo. We want to evaluate the effect of colchicine administration on the NLRP3 level of STEMI patient who undergo primary cutaneous intervention (PCI). MATERIALS AND METHODS: Randomised controlled trial was conducted on STEMI patients who undergo PCI in two hospitals in Jakarta, 104 patients enrolled to this study, and 77 patients completed the trial. 37 patients were randomly assigned to receive colchicines (2 mg loading dose; 0.5 mg thereafter every 12 hour for 48 hours) while 40 patients received placebo. NLRP3 level was measured from venous blood at baseline (BL), after procedure (AP), dan 24-hour post procedure (24H). RESULTS: No NLRP3 difference was observed initially between colchicine arm and placebo arm 38,69 and 39,0138, respectively (p >0.05). Measurement conducted at 24H, patients received colchicine demonstrate reduction in NLRP3 level (37.67), while placebo arm results increase in NLRP3 level (42.89) despite not statistically significant (p >0,05). CONCLUSION: Colchicine addition to standard treatment of STEMI patients undergo PCI reduce NLRP3 level despite statistically insignificant.
Subject(s)
Myocardial Infarction , Percutaneous Coronary Intervention , Reperfusion Injury , ST Elevation Myocardial Infarction , Humans , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/etiology , NLR Family, Pyrin Domain-Containing 3 Protein , Treatment Outcome , Percutaneous Coronary Intervention/adverse effectsABSTRACT
Background and Objectives: Acute coronary syndrome (ACS), a prevalent global cardiovascular disease and leading cause of mortality, is significantly correlated with meteorological factors. This study aims to analyze the impact of short-term changes in meteorological factors on the risk of ACS, both with and without ST-segment elevation, and to identify vulnerable subgroups. Materials and Methods: Daily ACS admissions and meteorological variables were collected from October 2016 to December 2021. A generalized linear model (GLM) with a Poisson distribution was employed to examine how short-term fluctuations in meteorological parameters influence ACS hospitalizations. Subgroup analyses were conducted to identify the populations most vulnerable to climate change. Results: Multiple regression analyses showed that short-term fluctuations in atmospheric pressure (≥10 mbar) and air temperature (≥5 °C) seven days prior increased the number of ACS hospitalizations by 58.7% (RR: 1.587; 95% CI: 1.501-1.679) and 55.2% (RR: 1.552; 95% CI: 1.465-1.644), respectively, notably impacting ST-segment elevation myocardial infarctions (STEMIs). The least pronounced association was observed between the daily count of ACS and the variation in relative air humidity (≥20%), resulting in an 18.4% (RR: 1.184; 95% CI: 1.091-1.286) increase in the risk of hospitalization. Subgroup analysis revealed an increased susceptibility among men and older adults to short-term variations in weather parameters. Conclusions: The findings indicate that short-term changes in weather conditions are associated with an increased risk of ACS hospitalizations, particularly STEMIs. Male and older adult patients exhibit heightened susceptibility to variations in climatic factors. Developing effective preventive strategies is imperative to alleviate the adverse consequences of these environmental risk factors.
Subject(s)
Acute Coronary Syndrome , ST Elevation Myocardial Infarction , Humans , Male , Aged , Acute Coronary Syndrome/epidemiology , Acute Coronary Syndrome/etiology , Weather , Hospitalization , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/complications , TemperatureABSTRACT
A 77-year-old man presented with an acute inferior ST-segment elevation myocardial infarction.
Subject(s)
Coronary Aneurysm , Coronary Angiography , Electrocardiography , ST Elevation Myocardial Infarction , Humans , Male , Aged , Coronary Aneurysm/diagnosis , Coronary Aneurysm/surgery , Coronary Aneurysm/complications , Coronary Angiography/methods , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/etiology , ST Elevation Myocardial Infarction/surgery , Coronary Vessels/diagnostic imaging , Percutaneous Coronary Intervention/methods , Myocardial Infarction/diagnosis , Myocardial Infarction/etiology , Treatment OutcomeABSTRACT
In the Targeted therapy with a localised abluminal coated, low-dose sirolimus-eluting, biodegreadable polymer coronary stent (TARGET; NCT02520180) All Comers trial the biodegradable polymer (BP) sirolimus-eluting FIREHAWK stent was noninferior to the durable polymer (DP) everolimus-eluting XIENCE stent with respect to target lesion failure (TLF) at 1 and 5 years; however, the long-term safety and efficacy in the setting of acute coronary syndromes (ACS) are not known. We sought to assess the long-term outcomes in ACS versus chronic coronary syndromes (CCS) with BP sirolimus-eluting stent (SES) versus DP everolimus-eluting stent (EES). The TARGET AC study was a multicenter, open-label, noninferiority trial of all comer patients randomly allocated 1:1 to BP SES or DP EES (stratified by ST-elevation myocardial infarction and study site). In this predefined substudy, the outcomes were compared based on clinical presentation (ACS vs CCS) and treatment allocation. A total of 1,653 patients were enrolled (728 with ACS and 922 with CCS), with 94% completing the 5-year follow-up. The baseline characteristics were well-matched between the 2 stent types; however, co-morbidities were more prevalent in the CCS than in the ACS population. TLF (15.5% vs 17.7%, p = 0.24), patient-oriented outcomes (32.0% vs 34.4%, p = 0.31), and stent thrombosis (4.1% vs 3.3%, p = 0.40) were similar between patients with ACS and patients with CCS. In the ACS cohort, the outcomes at 5 years for BP SES versus DP EES were similar for TLF (16.0% vs 14.9%, p = 0.70), ischemia-driven target lesion revascularization (5.6% vs 8.3%, p = 0.17), and definite/probable stent thrombosis (2.7% vs 4.6%, p = 0.18). The same was true for the CCS cohort, with 5-year outcomes for BP SES versus DP EES for TLF (18.0% vs 17.4%, p = 0.82), ischemia-driven target lesion revascularization (6.4% vs 5.0%, p = 0.37), and definite/probable stent thrombosis (3.0% vs 1.8%, p = 0.26). In conclusion, in the TARGET AC trial, 1 in 3 patients had a major adverse event at 5 years, irrespective of CCS or ACS presentation. Long-term, the BP sirolimus-eluting FIREHAWK stent was as safe and effective as the DP everolimus-eluting XIENCE stent across the spectrum of clinical presentations.