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2.
Angiology ; 70(10): 921-928, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31387358

RESUMO

New-onset atrial fibrillation (NOAF) during acute myocardial infarction (AMI) has significant consequences but is often misdiagnosed. The aim of the study was to evaluate predictors of NOAF throughout different phases of AMI. Patients with AMI admitted to a tertiary medical center were analyzed. Exclusion criteria were preexisting AF, AMI onset ≥24 hours prior to admission, in-hospital death, significant valvular disease, and in-hospital coronary artery bypass graft. Study population were AMI without-NOAF, early-AF (AF terminated within 24 hours of admission), and late-AF (beyond the first 24 hours). Overall 5946 patients were included, age: 64.8 ±14.8 years; 30% women. The incidence of NOAF was 4.6%: 1.6% early-AF, and 3% late-AF. Patients with NOAF comprised greater rate of women, cardiovascular risk-factors burden, severe left ventricular-dysfunction, pulmonary hypertension, valvular disorders, and left atrial enlargement compared with patients without-NOAF. Non-ST-elevation myocardial infarction and inferior-ST-elevation myocardial infarction (STEMI) were significantly more prevalent among early-AF group, while anterior-STEMI, in late-AF. The final multivariate models showed c-statistics of 0.73 and 0.76 for the prediction of new-onset early-AF and late-AF, respectively. In conclusion, there are different clinical predictors of early- versus late-NOAF. The study points out "high risk" AMI population for more meticulous heart rate monitoring for NOAF.


Assuntos
Fibrilação Atrial/diagnóstico , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Ponte de Artéria Coronária/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Fatores de Risco
3.
J Assoc Physicians India ; 67(3): 91-92, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31304720
4.
Int Heart J ; 60(4): 974-978, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31204378

RESUMO

A 72-year-old woman with hypertension, dyslipidemia, and diabetes mellitus presented to our hospital because of the sudden onset of chest pain. Emergency coronary angiography showed acute occlusion of the distal left anterior descending artery and coronary intervention with a drug-eluting stent was performed. Sudden cardiopulmonary arrest occurred on the sixth day of hospitalization, but coronary angiography showed no remarkable progression of the coronary artery diseases, including the site of stent implantation. An autopsy revealed that the cause of the sudden death was apical free wall rupture. In addition, the different timing of acute and sub-acute infarct findings were observed in the apical wall by histology, which indicated cardiac rupture was due to reinfarction at early phase of apical acute myocardial infarction. Although the rate of mechanical complications, including cardiac rupture, is decreasing in the era of primary coronary intervention, in addition to the well-known risk factors of cardiac rupture, the reinfarction of the culprit myocardial site in the early phase of acute myocardial infarction was considered as a possible risk factor of cardiac rupture.


Assuntos
Ruptura Cardíaca/etiologia , Ventrículos do Coração/diagnóstico por imagem , Miocárdio/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Idoso , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Evolução Fatal , Feminino , Ruptura Cardíaca/diagnóstico , Humanos , Recidiva , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
6.
Nat Rev Dis Primers ; 5(1): 39, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171787

RESUMO

ST-segment elevation myocardial infarction (STEMI) is the most acute manifestation of coronary artery disease and is associated with great morbidity and mortality. A complete thrombotic occlusion developing from an atherosclerotic plaque in an epicardial coronary vessel is the cause of STEMI in the majority of cases. Early diagnosis and immediate reperfusion are the most effective ways to limit myocardial ischaemia and infarct size and thereby reduce the risk of post-STEMI complications and heart failure. Primary percutaneous coronary intervention (PCI) has become the preferred reperfusion strategy in patients with STEMI; if PCI cannot be performed within 120 minutes of STEMI diagnosis, fibrinolysis therapy should be administered to dissolve the occluding thrombus. The initiation of networks to provide around-the-clock cardiac catheterization availability and the generation of standard operating procedures within hospital systems have helped to reduce the time to reperfusion therapy. Together with new advances in antithrombotic therapy and preventive measures, these developments have resulted in a decrease in mortality from STEMI. However, a substantial amount of patients still experience recurrent cardiovascular events after STEMI. New insights have been gained regarding the pathophysiology of STEMI and feed into the development of new treatment strategies.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Biomarcadores/análise , Biomarcadores/sangue , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/fisiopatologia , Ecocardiografia/métodos , Eletrocardiografia/métodos , Humanos , Programas de Rastreamento/métodos , Intervenção Coronária Percutânea/métodos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Resultado do Tratamento , Troponina I/análise , Troponina I/sangue
8.
Eur J Radiol ; 114: 6-13, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31005178

RESUMO

BACKGROUND: This study was designed to investigate the agreement of 2D transthoracic echocardiography (2D TTE) with cardiovascular magnetic resonance imaging (CMR) in a contemporary population of ST-elevation myocardial infarction (STEMI) patients. METHODS: In this subanalysis of the GIPS-III trial, a randomized controlled trial investigating the administration of metformin in STEMI patients to prevent reperfusion injury, we studied 259 patients who underwent same-day CMR and 2D TTE assessments four months after hospitalization for a first STEMI. Bland-Altman analyses were performed to assess agreement between LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction (LVEF), and LV mass measurements. Sensitivity and specificity of 2D TTE to detect categories of LVEF (≤35%, 35-50%, ≥50%) was determined. Linear regression of absolute differences in measurements between imaging modalities was used to investigate whether patient characteristics impact measurement bias. RESULTS: Pairwise difference (bias) and 95% limits of agreement between CMR and 2D TTE measurements were +84 (37, 147) ml for LVEDV, +39 (6, 85) ml for LVESV, -1.1 ± 13.5% for LVEF, and -75 (-154, -14) g for LV mass. Sensitivity and specificity of 2D TTE to detect subjects with moderately depressed LVEF (35-50%) as measured by CMR were 52% and 88% respectively. We observed a significant effect of enzymatic infarct size on bias between 2D TTE and CMR in measuring LVESV and LVEF (P = 0.029, P = 0.001 respectively), of age and sex on bias between 2D TTE and CMR in measuring LV mass (P = 0.027, P < 0.001) and LVEDV (P = 0.001, P = 0.039), and of heart rate on bias between 2D TTE and CMR in LV volume measurements (P = 0.004, P = 0.016). CONCLUSIONS: Wide limits of agreement, underestimation of LV volumes and overestimation of LV mass was observed when comparing 2D TTE to CMR. Enzymatic infarct size, age, sex, and heart rate are potential sources of bias between imaging modalities.


Assuntos
Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Fármacos Cardiovasculares/administração & dosagem , Esquema de Medicação , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Angiografia por Ressonância Magnética/métodos , Masculino , Metformina/administração & dosagem , Pessoa de Meia-Idade , Imagem Multimodal/métodos , Traumatismo por Reperfusão Miocárdica/diagnóstico , Traumatismo por Reperfusão Miocárdica/prevenção & controle , Reprodutibilidade dos Testes , Infarto do Miocárdio com Supradesnível do Segmento ST/tratamento farmacológico , Sensibilidade e Especificidade , Disfunção Ventricular Esquerda/diagnóstico
9.
Scand J Trauma Resusc Emerg Med ; 27(1): 39, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961648

RESUMO

BACKGROUND: Cardiovascular disease accounts for nearly half of all deaths in Poland. The aim of this study was to assess both the duration and the delays of prehospital treatment in ST-segment elevation myocardial infarction (STEMI) patients and how it impacts left ventricle ejection fraction (LVEF) measured at the time of discharge and the frequency of in-hospital patient mortality. METHODS: This study retrospectively analyzed medical records from January 2011 to December 2015 (excluding the year 2013) of 573 patients who were transported to a hospital with a diagnosis of STEMI. RESULTS: The mean time of prehospital system delays was 59 min with a maximum time of 152 min and a minimum time of 23 min. The relationship between reduced LVEF (< 55%) and in-hospital patient mortality and the relationship between length of time from first medical contact (FMC) to hospital admission was analysed in 515 respondents. Extending the time of FMC to hospital admission by 1 min increased the chances of lowering LVEF by 2% (95% CI: 1.004-1.041) and increased the chances of death by 2% (95% CI: 1.002-1.04) in STEMI patients. CONCLUSIONS: This study emphasised how vital it is to minimise time spent with STEMI patients at the scene of their cardiovascular event by performing an ECG as quickly as possible and by immediately transporting the patient to the hospital with the targeted treatment. This may lead to the implementation of additional training in the field of ECG interpretation, increase the prevalence of teletransmission systems, and improve communication between Emergency Medical Services (EMS) and catheterization laboratories ultimately reducing patient mortality.


Assuntos
Eletrocardiografia , Serviços Médicos de Emergência/normas , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Tempo para o Tratamento , Idoso , Cateterismo Cardíaco , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Polônia/epidemiologia , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Fatores de Tempo , Resultado do Tratamento
10.
Aerosp Med Hum Perform ; 90(4): 405-408, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30922429

RESUMO

BACKGROUND: Handling cases of chest pain aboard commercial flights is challenging for crewmembers, onboard medical volunteers, and ground-based doctors providing remote advice. Obtaining an electrocardiogram (ECG) in-flight could help in dictating the management of such cases. The ability to diagnose or rule out ST-segment elevation myocardial infarction (STEMI) would have clinical and prognostic implications. The feasibility of obtaining good quality ECG tracings by flight attendants in flight is not known.METHODS: A series of 200 consecutive ECG tracings transmitted to a ground-based medical support provider were independently reviewed by four observers who ranked the ECG tracings according to a quality score (QS) criteria, as well as trying to identify or rule-out cases of STEMI.RESULTS: ECG quality was considered good enough to extract useful information in 170 of 200 tracings (85%). Seven cases of STEMI were identified. A STEMI was confidently ruled out in 104 cases. Additional abnormalities of variable clinical importance were also detected.DISCUSSION: ECGs are essential in the prehospital management of chest pain cases. ECGs obtained in flight by airline flight attendants were mostly of diagnostic quality, allowing confirmation or ruling out of STEMI, as well as detecting arrhythmias of clinical significance in case management.Alves PM, Lindgren JA, Streitwieser DR, Anzola E, Ahmed N, Nerwich N. Quality of electrocardiograms obtained in flight by airline flight attendents. Aerosp Med Hum Perform. 2019; 90(4):405-408.


Assuntos
Aeronaves , Dor no Peito/diagnóstico , Eletrocardiografia/métodos , Primeiros Socorros/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Dor no Peito/etiologia , Estudos de Viabilidade , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
11.
J Coll Physicians Surg Pak ; 29(3): 205-209, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30823942

RESUMO

OBJECTIVE: To determine the association between hypertensive retinopathy (HR) and post ST elevation myocardial infarction (STEMI) complications among successfully thrombolysed patients. STUDY DESIGN: A cohort study. PLACE AND DURATION OF STUDY: Cardiology Unit, Lady Reading Hospital, Peshawar, from June 2016 to December 2017. METHODOLOGY: Patients with history of hypertension for at least 5 years who presented with STEMI and were successfully thrombolysed, were included. On the basis of fundoscopy, patients were grouped into no, mild, moderate, and severe hypertensive retinopathy. Primary and secondary endpoints included a composite of death, re-MI, stroke, re-hospitalisation secondary to left ventricular failure, cardiogenic shock, arrhythmia, heart block, and ventricular septal rupture at 30 days and 4 months, respectively. Association between hypertensive retinopathy and post STEMI complications was determined by Chi-square test. Regression model was used to calculate relative risk of complications with hypertensive retinopathy. P <0.05 was taken as significant. RESULTS: A total of 118 patients with a mean age of 54.83 ±8.6 years were included in the study. Of these, 49.2% (n=58) were males. Moreover, 38.1% (n=45) of patients were grouped under no HR, 22.8% (n=27) under mild HR, 21.1% (n=25) and 17.7% (n=21) under moderate and severe HR, respectively. Primary endpoints achieved were 0% in no HR group and 19% in severe HR group x² = 18.1, p <0.001). Secondary endpoints were achieved in 2.2% in no HR group and 40.7%, 56% and 100% in mild, moderate and severe HR group, respectively, ( x² = 81.1, p <0.001). HR also increased the relative risk of complications by 3.17 times (p <0.001) and death by 1.75 times (p <0.001). CONCLUSION: Hypertensive retinopathy is an independent risk factor for post-acute STEMI complications in successfully thrombolysed patients and increased the relative risk for complications by 3.17 times.


Assuntos
Causas de Morte , Insuficiência Cardíaca/epidemiologia , Retinopatia Hipertensiva/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Choque Cardiogênico/epidemiologia , Ruptura do Septo Ventricular/epidemiologia , Doença Aguda , Distribuição por Idade , Idoso , Distribuição de Qui-Quadrado , Estudos de Coortes , Comorbidade , Feminino , Bloqueio Cardíaco/diagnóstico , Bloqueio Cardíaco/epidemiologia , Insuficiência Cardíaca/diagnóstico , Humanos , Retinopatia Hipertensiva/diagnóstico , Retinopatia Hipertensiva/terapia , Incidência , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Paquistão , Intervenção Coronária Percutânea/métodos , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Medição de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Índice de Gravidade de Doença , Distribuição por Sexo , Choque Cardiogênico/diagnóstico , Taxa de Sobrevida , Ruptura do Septo Ventricular/diagnóstico
12.
Medicine (Baltimore) ; 98(10): e14791, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30855493

RESUMO

Primary percutaneous coronary intervention (PPCI) is the preferred treatment method for ST-segment elevation myocardial infarction (STEMI). Many efforts had been made to reduce door-to-balloon (DTB) time in patients with STEMI. The objective of this study is to demonstrate how intrahospital social media communication reduced DTB times in STEMI patients requiring an interhospital transfer.We retrospectively enrolled patients with STEMI who had been transferred from other hospitals during 2016 and 2017. Patients were divided into 2 groups. The previewed group had an electrocardiogram (ECG) done at the first hospital that was previewed by the cardiologist via social media. The control group was treated using the conventional clinical approach. We compared DTB time and outcome between 2 groups.The 2 groups shared some similar clinical characteristics. However, the previewed group had significantly shorter DTB times than the control group (n = 51, DTB 52.61 ±â€Š42.20 vs n = 89, DTB time 78.40 ±â€Š50.64, P = .003). The time elapsed between ECG and the call to the laboratory decreased most apparently in the previewed group (-11.24 ±â€Š48.81 vs 16.96 ±â€Š33.08, P < .001). The previewed group also tended to have less in-hospital major adverse cardiovascular events (P = .091).When the patients with STEMI required transfer to the PCI-capable hospital, using social media to preview ECG reduced DTB time, mainly because the cardiologists activated the catheter laboratories much earlier, sometimes even before the patients arrived at the PCI-capable hospital.


Assuntos
Angioplastia Coronária com Balão , Comunicação em Saúde , Transferência de Pacientes , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Mídias Sociais , Tempo para o Tratamento , Cardiologistas , Eletrocardiografia , Serviços Médicos de Emergência , Feminino , Comunicação em Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Melhoria de Qualidade , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico
13.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(2): 123-128, 2019 Feb 24.
Artigo em Chinês | MEDLINE | ID: mdl-30818940

RESUMO

Objective: To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization. Results: There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all P>0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, P<0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, P=0.004). Multivariate logistic regression analysis showed that FAR (OR=0.492, 95%CI 0.354-0.686, P<0.001), serum uric acid (OR=0.994, 95%CI 0.989-0.999, P=0.018) and high-sensitivity C-reactive protein (OR=0.774, 95%CI 0.614-0.975, P=0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95%CI 0.630-0.758, P<0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%. Conclusion: The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.


Assuntos
Albuminas , Fibrinogênio , Infarto do Miocárdio com Supradesnível do Segmento ST , Grau de Desobstrução Vascular , Idoso , Albuminas/análise , Angiografia Coronária , Fibrinogênio/análise , Humanos , Infarto , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recidiva , Estudos Retrospectivos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Ácido Úrico
17.
BMJ Case Rep ; 12(2)2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709890

RESUMO

We herein describe a case of acute myocarditis which may mimic myocardial infarction, since affected patients experience 'typical' chest pain, the ECG changes are identical to those observed in acute coronary syndromes, and serum markers are increased. This case emphasises the importance of performing appropriate cardiac MRI to help in the differential and definitive diagnosis as well as the extent of myocardial involvement. ST elevation myocardial infarction is rare in young adults and when it is encountered, it should raise the differential diagnosis of its mimickers.


Assuntos
Dor no Peito/diagnóstico , Miocardite/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Adulto , Dor no Peito/etiologia , Diagnóstico Diferencial , Eletrocardiografia/métodos , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Miocardite/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações
18.
BMJ Case Rep ; 12(2)2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30733249

RESUMO

Pneumomediastinum (PNMD) entails the presence of air or other gas in the mediastinum and is also known as mediastinal emphysema. PNMD may cause a wide variety of signs and symptoms, as well as ECG abnormality, including ST segment changes. We present a 56-year-old man admitted to our hospital after a facial trauma. After undergoing tracheostomy, he complained of chest discomfort. A chest X-ray in the posteroanterior view showed PNMD, and an ECG was suggestive of inferior-lateral wall myocardial infarction. An urgent cardiac catheterisation identified a critical obstruction at the origin of the right coronary artery. Following a balloon angioplasty, chest discomfort continued; and the ECG ST segments did not show any dynamic change during the subsequent 72 hours. We urge clinicians to perform a comprehensive workup for every patient presenting with PNMD and ST segment changes, to prevent unnecessary invasive procedures.


Assuntos
Oclusão Coronária/diagnóstico , Traumatismos Faciais/terapia , Infarto Miocárdico de Parede Inferior/diagnóstico , Enfisema Mediastínico/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Traqueostomia , Angioplastia Coronária com Balão , Cateterismo Cardíaco , Dor no Peito , Oclusão Coronária/cirurgia , Diagnóstico Diferencial , Eletrocardiografia , Humanos , Masculino , Enfisema Mediastínico/fisiopatologia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/fisiopatologia
19.
Crit Care Nurs Clin North Am ; 31(1): 49-64, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30736935

RESUMO

Coronary artery disease is the leading cause of death in both men and women in the United States. Annually, 790,000 Americans will experience a myocardial infarction. Early recognition and appropriate management of myocardial infarction are imperative to improving patient outcomes. This article discusses the pathophysiology, presentation, and diagnosis and management of both ST-elevation myocardial infarction (STEMI) and non-STEMI.


Assuntos
Infarto do Miocárdio sem Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio sem Supradesnível do Segmento ST/fisiopatologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/fisiopatologia , Humanos , Infarto do Miocárdio sem Supradesnível do Segmento ST/terapia , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Estados Unidos
20.
Int Heart J ; 60(2): 255-263, 2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30799375

RESUMO

Previous clinical studies have shown inconsistent results regarding the effect of erythropoietin in ST-segment elevation myocardial infarction (STEMI). This study investigated whether directed intracoronary infusion of darbepoetin-α into ischemic myocardium before reperfusion would reduce infarct size or post-infarct remodeling in STEMI patients.Eighty STEMI patients received one of the following treatments simultaneously with the first balloon inflation: intracoronary darbepoetin-α 300 µg (n = 40) or saline (n = 40), administered via the over-the-wire balloon system. The primary endpoint was infarct size estimated by serial cardiac enzyme levels after procedure. The secondary endpoints were (1) infarct size and proportion of salvaged myocardium measured with cardiac magnetic resonance (CMR) at baseline; (2) post-infarct remodeling (PIR), defined as an increase in left ventricular end-diastolic volume more than 20% at 4 months compared to the baseline on CMR; and (3) composite cardiovascular endpoints assessed at 4 months.The peak CK-MB [median 270.0 (interquartile range 139.8-356.3) versus 231.5 (131.0-408.5) ng/mL, P = 0.55] and troponin-I [128.5 (63.5-227.8) versus 109.0 (43.8-220.0) ng/mL, P = 0.52) ] did not differ between the darbepoetin-α and control group. Fifty-seven patients completed the baseline and 4-month follow-up CMR. There were no differences in infarct size [30.6 (18.1-49.8) versus 31.5 (22.5-47.3) cm3, P = 0.91), proportion of salvaged myocardium [26.7% (15.9-42.6%) versus 35.8% (22.4-48.8%), P = 0.12) or PIR (8.0% versus 6.7%, P = 0.62) between the two groups. Composite cardiovascular outcomes did not differ between the two groups.In conclusion, administration of intracoronary darbepoetin-α before reperfusion did not reduce infarct size or post-infarct remodeling in STEMI patients.


Assuntos
Angioplastia Coronária com Balão/métodos , Darbepoetina alfa , Miocárdio/patologia , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Remodelação Ventricular/efeitos dos fármacos , Idoso , Vasos Coronários , Darbepoetina alfa/administração & dosagem , Darbepoetina alfa/efeitos adversos , Monitoramento de Medicamentos/métodos , Feminino , Hematínicos/administração & dosagem , Hematínicos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Volume Sistólico/efeitos dos fármacos , Resultado do Tratamento
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