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Bleeding characteristics and mortality outcomes following ST-elevation myocardial infarction thrombolysis:a 5-year analysis in an Asian population
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作者 Hock Peng Koh Jivanraj RNagarajah +1 位作者 Hasnita Hassan Noel Thomas Ross 《World Journal of Emergency Medicine》 SCIE CAS CSCD 2024年第6期433-440,共8页
BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-el... BACKGROUND:Bleeding outcomes are crucial primary safety endpoints in studies involving thrombolytic agents.This study aimed to determine the incidence,characteristics and mortality outcomes of bleeding following ST-elevation myocardial infarction(STEMI)thrombolysis in an Asian population.METHODS:This single-centre retrospective study included all STEMI patients who received thrombolytic therapy from 2016 to 2020 in a Malaysian tertiary hospital.Total population sampling was used in this study.The primary outcome was bleeding events post-thrombolysis,categorised using the Thrombolysis in Myocardial Infarction(TIMI)bleeding criteria.Inferential statistics were used to determine the associations between relevant variables.RESULTS:Data from 941 patients were analysed.A total of 156(16.6%)STEMI patients bled post-thrombolysis.Major,minor,and minimal TIMI occurred in 7(0.7%),17(1.8%),and 132(14.0%)patients,respectively.Age 65 years(P=0.031)and Malaysian Chinese(P=0.008)were associated with a higher incidence of bleeding post-thrombolysis.Conversely,foreigners(P=0.032)and current smoker(P=0.007)were associated with a lower incidence of bleeding.Both TIMI major(P<0.001)and TIMI minor(P<0.001)were associated with a higher incidence of all-cause in-hospital mortality among STEMI patients.TIMI minor bleeding was significantly higher in the streptokinase recipients.The bleeding sites were comparable between streptokinase and tenecteplase recipients,except for a significantly higher incidence of gastrointestinal bleeding in the streptokinase recipients(P=0.027).CONCLUSION:In our Asian population,the incidence of total bleeding events following STEMI thrombolysis is comparable to that previously reported.The development of TIMI major and minor bleeding complications is associated with higher mortality. 展开更多
关键词 BLEEDING st-elevation myocardial infarction thrombolysis ASIAN TENECTEPLASE STREPTOKINASE
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Development of Primary Percutaneous Coronary Intervention as a National Reperfusion Strategy for Patients with ST-Elevation Myocardial Infarction and Assessment of Its Use in Egypt 被引量:2
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作者 Mohamed Sobhy Ahmed Elshal +12 位作者 Noha Ghanem Hosam Hasan-Ali Nabil Farag Nireen Okasha El Sayed Farag Mohamed Sadaka Hisham Abo El Enein Sameh Salama Hazem Khamis Khaled Shokry Hany Ragy Amany Elshorbagy Radwa Mehanna 《Cardiovascular Innovations and Applications》 2020年第2期269-278,共10页
Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome a... Objective:Early treatment of acute ischemia of the heart by performing immediate percutaneous coronary intervention(PCI)to restore blood fl ow in patients with the clinical presentation of an acute coronary syndrome and more specifi cally with ST-elevation myocardial infarction(STEMI)can save lives.This study aims to identify the mean time(door to balloon time and fi rst contact to balloon time)to primary PCI for STEMI patients and to assess the percentage of primary PCI and its success rate in Egypt.Methods:A registry study of patients presenting to cardiac centers in Egypt was designed,where patients’basic characteristics,the treatment strategy,and the door to balloon time and the fi rst contact to balloon time were assessed.Results:One thousand six hundred fi fty STEMI patients with a mean age of 57 years were included in the study.Immediate transfer for primary PCI was the most used treatment strategy,representing 74.6%of all treatment strategies used.The door to balloon time and the fi rst contact to balloon time were 50 and 60 minutes,respectively,with a primary PCI success rate of 65.1%.Conclusion:The registry study results showed a marked improvement by implementation of the best treatment strategy with respect to the time factor to achieve a better outcome for STEMI patients in Egypt. 展开更多
关键词 st-elevation myocardial infarction primary percutaneous coronary intervention door to balloon time fi rst medical contact to balloon time
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Impact of liver cirrhosis on ST-elevation myocardial infarction related shock and interventional management,a nationwide analysis 被引量:1
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作者 Sophia Haroon Dar Mehek Rahim +1 位作者 Davood K Hosseini Khurram Sarfraz 《World Journal of Hepatology》 2022年第4期766-777,共12页
BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in c... BACKGROUND Critical care is rapidly evolving with significant innovations to decrease hospital stays and costs.To our knowledge,there is limited data on factors that affect the length of stay and hospital charges in cirrhotic patients who present with STelevation myocardial infarction-related cardiogenic shock(SRCS).AIM To identify the factors that increase inpatient mortality,length of stay,and total hospital charges in patients with liver cirrhosis(LC)compared to those without LC.METHODS This study includes all adults over 18 from the National Inpatient Sample 2017 database.The study consists of two groups of patients,including SRCS with LC and without LC.Inpatient mortality,length of stay,and total hospital charges are the primary outcomes between the two groups.We used STATA 16 to perform statistical analysis.The Pearson's chi-square test compares the categorical variables.Propensity-matched scoring with univariate and multivariate logistic regression generated the odds ratios for inpatient mortality,length of stay,and resource utilization.RESULTS This study includes a total of 35798453 weighted hospitalized patients from the 2017 National Inpatient Sample.The two groups are SRCS without LC(n=758809)and SRCS with LC(n=11920).The majority of patients were Caucasian in both groups(67%vs 72%).The mean number of patients insured with Medicare was lower in the LC group(60%vs 56%)compared to the other group,and those who had at least three or more comorbidities(53%vs 90%)were significantly higher in the LC group compared to the non-LC group.Inpatient mortality was also considerably higher in the LC group(28.7%vs 10.63%).Length of Stay(LOS)is longer in the LC group compared to the non-LC group(9 vs 5.6).Similarly,total hospital charges are higher in patients with LC($147407.80 vs$113069.10,P≤0.05).Inpatient mortality is lower in the early percutaneous coronary intervention(PCI)group(OR:0.79<0.11),however,it is not statistically significant.Both early Impella(OR:1.73<0.05)and early extracorporeal membrane oxygenation(ECMO)(OR:3.10 P<0.05)in the LC group were associated with increased mortality.Early PCI(-2.57 P<0.05)and Impella(-3.25 P<0.05)were also both associated with shorter LOS compared to those who did not.Early ECMO does not impact the LOS;however,it does increase total hospital charge(addition of$24717.85,P<0.05).CONCLUSION LC is associated with a significantly increased inpatient mortality,length of stay,and total hospital charges in patients who develop SRCS.Rural and Non-teaching hospitals have significantly increased odds of extended hospital stays and higher adjusted total hospital charges.The Association of LC with worse outcomes outlines the essential need to monitor these patients closely and treat them early on with higher acuity care.Patients with early PCI had both shorter LOS and reduced inpatient mortality,while early Impella was associated with increased mortality and shorter LOS.Early ECMO is associated with increased mortality and higher total hospital charges.This finding should affect the decision to follow through with interventional management in this cohort of patients as it is associated with poor outcomes and immense resource utilization. 展开更多
关键词 GASTROENTEROLOGY HEPATOLOGY Liver st-elevation myocardial infarction Cardiogenic Shock Percutaneous coronary intervention IMPELLA Extracorporeal membrane oxygenation
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Serum uric acid in patients with acute ST-elevation myocardial infarction 被引量:2
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作者 Li Chen Xian-lun Li +5 位作者 Wei Qiao Zhou Ying Yan-li Qin Yong Wang Yu-jie Zeng Yuan-nan Ke 《World Journal of Emergency Medicine》 CAS 2012年第1期35-39,共5页
BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST... BACKGROUND:Few studies investigated serum uric acid levels in patients with acute STelevation myocardial infarction(STEMI).The study was to assess the clinical value of serum uric acid levels in patients with acute ST-elevation myocardial infarction(STEMI).METHODS:Totally 502 consecutive patients with STEMI were retrospectively studied from January 2005 to December 2010.The level of serum lipid,echocardiographic data and in-hospital major adverse cardiovascular events(MACE) in patients with hyperuricemia(n=119) were compared with those in patients without hyperuricemia(n=383).The relationship between the level of serum uric acid and the degree of diseased coronary artery was analyzed.All data were analyzed with SPSS version 17.0 software for Student's t test,the Chi-square test and Pearson's correlation coefficient analysis.RESULTS:Serum uric acid level was positively correlated with serum triglyceride level.Hyperlipidemia was more common in hyperuricemia patients than in non-hyperuricemia patients(43.7%vs.33.7%,P=0.047),and serum triglyceride level was significantly higher in hyperuricemia patients(2.11±1.24 vs.1.78±1.38,P=0.014).But no significant association was observed between serum uric acid level and one or more diseased vessels(P>0.05).Left ventricular end-diastolic diameter(LVEDd) was larger in hyperuricemia patients than in non-hyperuricemia patients(53.52±6.19 vs.52.18±4.89,P=0.041).The higher rate of left systolic dysfunction and diastolic dysfunction was discovered in hyperuricemia patients(36.4%vs.15.1%,P<0.001;68.2%vs.55.8%,P=0.023).Also,hyperuricemia patients were more likely to have in-hospital MACE(P<0.05).CONCLUSIONS:Serum uric acid level is positively correlated with serum triglyceride level,but not with the severity of coronary artery disease.Hyperuricemia patients with STEMI tend to have a higher rate of left systolic dysfunction and diastolic dysfunction and more likely to have more in-hospital MACE. 展开更多
关键词 Acute st-elevation myocardial infarction Serum uric acid TRIGLYCERIDE Coronary angiography ECHOCARDIOGRAPHY Left ventricular systolic dysfunction Left ventricular diastolic dysfunction Major adverse cardiovascular events
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Effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention
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作者 Jian WANG Song-Yuan HE 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2019年第9期695-700,共6页
Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total o... Objective To investigate the effect of ramipril on progression of nonculprit lesions in patients with ST-elevation myocardial infarction(STEMI) after primary percutaneous coronary intervention(PPCI). Methods A total of 200 patients(60.1 ± 11.3 years) with STEMI who underwent successful PPCI from January 2010 to December 2013 were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions. Patients were divided into two groups according to the dosage of ramipril used at hospital discharge as follows: high dosage group(2.5–10 mg, q.d.) and low dosage group(1.25–2.5 mg, q.d.). Clinical and angiographic follow-up was performed for 12 months. The primary endpoint was clinically-driven percutaneous coronary intervention(PCI) for nonculprit lesions. The clinical and angiographic features were analyzed. Results Clinical and angiographic follow-up was performed with 87 patients in the high dosage group and 113 patients in the low dosage group. The numbers of patients who underwent additional PCI were six and 20 in the high and low dosage groups, respectively. The rate of having additional PCI performed was lower in the high dosage group than in the low dosage group(6.90% vs. 17.70%, P = 0.03). Conclusions A high dosage of ramipril may prevent progression of nonculprit lesions, which could be the major cause of recurrent PCI in patients with STEMI after PPCI. 展开更多
关键词 Nonculprit LESION Primary PERCUTANEOUS coronary intervention RAMIPRIL st-elevation myocardial infarction
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Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic:A systematic review and meta-analysis
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作者 Anwar Khedr Hussam Al Hennawi +14 位作者 Muhammed Khuzzaim Khan Mostafa Elbanna Abbas B Jama Ekaterina Proskuriakova Hisham Mushtaq Mikael Mir Sydney Boike Ibtisam Rauf Aalaa Eissa Meritxell Urtecho Thoyaja Koritala Nitesh Jain Lokesh Goyal Salim Surani Syed A Khan 《World Journal of Cardiology》 2023年第6期309-323,共15页
BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommende... BACKGROUND ST-elevation myocardial infarction(STEMI)is the result of transmural ischemia of the myocardium and is associated with a high mortality rate.Primary percutaneous coronary intervention(PPCI)is the recommended first-line treatment strategy for patients with STEMI.The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019(COVID-19)pandemic,leading to a projected steep rise in mortality.These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion.It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.METHODS PubMed,Google Scholar,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic.Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality.Data were meta-analyzed using the random effects model to derive odds ratios(OR)and 95%confidence intervals.Quality assessment was carried out using the Newcastle-Ottawa scale.RESULTS Fourteen studies including 50136 STEMI patients(n=15142 in the pandemic arm;n=34994 in the pre-pandemic arm)were included.The mean age was 61 years;79%were male,27%had type 2 diabetes,and 47%were smokers.Compared with the pre-pandemic period,there was a significantly increased overall incidence of fibrinolysis during the pandemic period[OR:1.80(1.18 to 2.75);I2=78%;P=0.00;GRADE:Very low].The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting.The countries with a low-and middle-income status reported a higher incidence of fibrinolysis[OR:5.16(2.18 to 12.22);I2=81%;P=0.00;GRADE:Very low]and an increased risk of all-cause mortality in STEMI patients[OR:1.16(1.03 to 1.30);I2=0%;P=0.01;GRADE:Very low].Meta-regression analysis showed a positive correlation of hyperlipidemia(P=0.001)and hypertension(P<0.001)with all-cause mortality.CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period,but it has no effect on the risk of all-cause mortality.The low-and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis. 展开更多
关键词 st-elevation myocardial infarction myocardial infarction Thrombolytic therapy FIBRINOLYSIS COVID-19 Pandemics
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Optimizing care for ST-elevation myocardial infarction patients: application of systems engineering
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作者 Joel A. Strom Charles Sand Lyndon C. Box 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2016年第11期883-887,共5页
Timely reperfusion for patients with an ST-elevation myocardial infarction (STEMI) reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significant... Timely reperfusion for patients with an ST-elevation myocardial infarction (STEMI) reduces myocardial cell loss resulting in preserved LV performance, a reduced incidence of congestive heart failure, and significantly lower early and late mortality, while conversely, any delay in reperfusion has a deleterious effect on morbidity and mortality. 展开更多
关键词 Primary percutaneous angioplasty st-elevation myocardial infarction care systems
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E/e’ as a Predictor of Short-Term Survival Following ST-Elevation Myocardial Infarction
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作者 Sivaprasad Naidu Nallapati Adikesava Naidu Otikunta +1 位作者 Y. V. Subba Reddy Ravi Srinivas 《International Journal of Clinical Medicine》 2015年第11期831-837,共7页
Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastol... Background: We examined the usefulness of tissue Doppler imaging in evaluating the diastolic dysfunction and assessed the prognostic value of ratio between early mitral inflow velocity and mitral annular early diastolic velocity (E/e’) in unselected patients with acute ST-elevation myocardial infarction (STEMI). Methods: Patients presenting with acute STEMI at Osmania General Hospital, Hyderabad, India between January-2012 and June-2012 were examined in this study. All patients underwent echocardiographic examination comprising Doppler assessment of transmitral flow velocities (peak E-wave velocity) and Doppler tissue imaging of the medial mitral valve annulus (e’). All patients were followed up for 6 months and all-cause mortality was measured as the study endpoint. Role of E/e’ ratio as a predictor of survival after acute STEMI was evaluated by a comparative analysis of patients with E/e’ ≤15 and >15. Results: A total of 50 patients with acute STEMI (mean age: 52.2 ± 13.2 years;80% males) were analyzed in this study. Of them, 23 (46%) patients had an E/e’ >15. Clinical parameters such as Killip class ≥2 as well as left ventricular ejection fraction of 15. Five (10%) patients died during the 6-month follow-up period. All deaths occurred among patients from the E/e’ >15 group, indicating that E/e’ is an effective predictor of overall survival. Conclusion: E/e’ ratio was identified as a strong predictor of survival after acute myocardial infarction and can be suitable for risk-stratification of patients in this setting. Further studies are warranted to substantiate the findings. 展开更多
关键词 st-elevated myocardial infarction ECHOCARDIOGRAPHY Transmitral Flow Velocity MEDIAL MITRAL Valve ANNULUS E/e’ Ratio SURVIVAL
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Correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction
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作者 Hong-Mei Li 《Journal of Hainan Medical University》 2017年第3期21-24,共4页
Objective:To analyze the correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Methods:80 patients with acute ST-elevation myocardial infar... Objective:To analyze the correlation of serum iron levels with myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Methods:80 patients with acute ST-elevation myocardial infarction were divided into high iron group (serum iron≥8.95μmol/L) (n=43) and low iron group (serum iron<8.95μmol/L) (n=37) according to serum iron levels, differences in myocardial injury markers, ventricular remodeling indexes and pump failure-related indexes on admission were compared between two groups of patients, and the correlation of serum iron levels with myocardial damage and pump failure in patients with acute ST-elevation myocardial infarction was further analyzed. Results:Serum myocardial injury markers troponin I (cTnI), creatine kinase isoenzyme (CK-MB), myoglobin (Myo), ischemia modified albumin (IMA) and hydroxybutyrate dehydrogenase (HBDH) content of high iron group on admission were significantly lower than those of low iron group (P<0.05);left ventricular posterior wall thickness (LVPWT), left ventricular end-systolic interventricular septal thickness (IVST), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), end-systolic volume index (ESVI), end-diastolic volume index (EDVI), and the left ventricular mass index (LVMI) levels under color Doppler ultrasound were lower than those of low iron group (P<0.05);serum N-terminal pro-brain natriuretic peptide (NT-proBNP), galectin-3, adiponectin (APN), soluble P-selectin (sP-selectin) and Copeptin content were lower than those of low iron group (P<0.05). Pearson test showed that serum iron level was directly correlated with the degree of myocardial injury and pump failure in patients with acute ST-elevation myocardial infarction. Conclusions:Low serum iron levels is one of key factors causing severe cases and pump failure in STEMI patients, and early iron supplementation is expected to improve outcomes in STEMI patients with iron deficiency. 展开更多
关键词 ACUTE st-elevation myocardial infarction SERUM iron myocardial injury PUMP failure
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Influence of hyperbaric oxygenation treatment (HBOT) on clinical outcomes (recurrent myocardial infarction and survival rate) during five-year monitoring period after acute myocardial infarction 被引量:1
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作者 Eduard Dotsenko Dmitry Salivonchyk +6 位作者 Osain Menizibeya Welcome Konstantin Dotsenko Sergei Salivonchyk Valery Bobkov Natalia Nikulina Eugenia Semeniago Svetlana Nerobeeva 《Health》 2014年第1期51-56,共6页
Surgical treatments of acute myocardial infarction (MI) possess a high clinical effectiveness, but there are fixed limitations, related to the patient’s state, which are limited by medical resources and organizationa... Surgical treatments of acute myocardial infarction (MI) possess a high clinical effectiveness, but there are fixed limitations, related to the patient’s state, which are limited by medical resources and organizational problems. The development of new medical technologies provides a better and effective non-surgical treatment of acute MI and increases long-term prognosis in this category of patients. The study aims to investigate the influence of hyperbaric oxygenation treatment on clinical outcomes (survival rate and recurrent myocardial infarction (rMI)) during the five-year period of monitoring. The study involved 697 patients who suffered from acute MI, having undergone the standard treatment. The patients were randomly divided into two groups: Group 1 (reference, n = 363);Group 2 (test, n = 334). Patients of Group 2 were given the traditional treatment, accompanied with HBOT (isopression for forty minutes at a working pressure of 0.03 MPa). HBOT was applied first through the fifth day following MI. The treatment course included six cycles, once per day. The clinical assessment was focused on clinical outcome: rMI and mortality related to cardiovascular events. HBOT application that accompanied the acute MI with traditional pharmacotherapy has been proved to reduce rMI within five years following inpatient discharge (rMI rate was 14% in the reference group and 5.4% in the test group, χ2 = 13.3, р < 0.05). The combination of HBOT with traditional methods in treating acute MI makes it possible to raise the five-year survival rate from 84.4% up to 95.9%. 展开更多
关键词 HYPERBARIC OXYGENATION treatment myocardial infarction Recurrent myocardial infarction Clinical Outcomes Mortality RATE Survival RATE
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Effective treatment of depression improves post-myocardial infarction survival 被引量:8
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作者 Soudabeh Khojasteh Banankhah Erika Friedmann Sue Thomas 《World Journal of Cardiology》 CAS 2015年第4期215-223,共9页
AIM: To examine the contribution of treatment resistant depression(TRD) to mortality in depressed postmyocardial infarction(MI) patients independent of biological and social predictors.METHODS: This secondary analysis... AIM: To examine the contribution of treatment resistant depression(TRD) to mortality in depressed postmyocardial infarction(MI) patients independent of biological and social predictors.METHODS: This secondary analysis study utilizes the Enhancing Recovery in Coronary Heart Disease(ENRICHD) clinical trial data.From 1834 depressed patients in the ENRICHD study,there were 770 depressed post-MI patients who were treated for depression.In this study,TRD is defined as having a less than 50% reduction in Hamilton Depression(HAM-D) score from baseline and a HAM-D score of greater than 10 in 6 mo after depression treatment began.Cox regression analysis was used to examine the independent contributions of TRD to mortality after controlling for the biological and social predictors.RESULTS: TRD occurred in 13.4%(n = 103) of the 770 patients treated for depression.Patients with TRD were significantly younger in age(P = 0.04)(mean = 57.0 years,SD = 11.7) than those without TRD(mean = 59.2 years,SD = 12.0).There was a significantly higher percentage of females with TRD(57.3%) compared to females without TRD(47.4%) [χ2(1) = 4.65,P = 0.031].There were significantly more current smokers with TRD(44.7%) than without TRD(33.0%) [χ2(1) = 7.34,P = 0.007].There were no significant differences in diabetes(P = 0.120),history of heart failure(P = 0.258),prior MI(P = 0.524),and prior stroke(P = 0.180) between patients with TRD and those without TRD.Mortality was 13%(n = 13) in patients with TRD and 7%(n = 49) in patients without TRD,with a mean follow-up of 29 mo(18 mo minimum and maximum of 4.5 years).TRD was a significant independent predictor of mortality(HR =1.995; 95%CI: 1.011-3.938,P = 0.046) after controlling for age(HR = 1.036; 95%CI: 1.011-1.061,P = 0.004),diabetes(HR = 2.912; 95%CI: 1.638-5.180,P < 0.001),heart failure(HR = 2.736; 95%CI: 1.551-4.827,P = 0.001),and smoking(HR = 0.502; 95%CI: 0.228-1.105,P = 0.087).CONCLUSION: The analysis of TRD in the ENRICHD study shows that the effective treatment of depression reduced mortality in depressed post-MI patients.It is important to monitor the effectiveness of depression treatment and change treatments if necessary to reduce depression and improve cardiac outcomes in depressed post-MI patients. 展开更多
关键词 DEPRESSION treatment Post-myocardial infarction Mortality ANTI-DEPRESSANT Cognitive behavioral therapy
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Treatment of severe upper gastrointestinal bleeding caused by Mallory-Weiss syndrome after primary coronary intervention for acute inferior wall myocardial infarction: A case report 被引量:1
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作者 Bei-Bei Du Xing-Tong Wang +4 位作者 Xiang-Dong Li Pei-Pei Li Wei-Wei Chen Si-Ming Li Ping Yang 《World Journal of Clinical Cases》 SCIE 2019年第24期4407-4413,共7页
BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive ble... BACKGROUND Upper gastrointestinal bleeding(UGIB) after an acute myocardial infarction(AMI) is not an uncommon complication. Acute UGIB caused by Mallory-Weiss syndrome(MWS) is usually a dire situation with massive bleeding and hemodynamic instability. Acute UGIB caused by MWS after an AMI has not been previously reported.CASE SUMMARY A 57-year-old man with acute inferior wall ST elevation myocardial infarction underwent a primary coronary intervention of the acutely occluded right coronary artery. Six hours after the intervention, the patient had a severe UGIB,followed by vomiting. His hemoglobin level dropped from 15.3 g/d L to 9.7 g/d L. In addition to blood transfusion and a gastric acid inhibition treatment,early endoscopy was employed and MWS was diagnosed. Bleeding was stopped by endoscopic placement of titanium clips.CONCLUSION Bleeding complications after stent implantation can pose a dilemma. MWS is a rare but severe cause of acute UGIB after an AMI that requires an early endoscopic diagnosis and a hemoclip intervention to stop bleeding. 展开更多
关键词 Acute upper gastrointestinal bleeding Mallory-Weiss syndrome Primary coronary intervention Acute myocardial infarction Endoscopic treatment Case report
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General awareness of symptoms of myocardial infarction and the need for urgent treatment:A cross-sectional,street survey in Chennai,Tamil Nadu
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作者 Thirumurugan E Gomathi K +4 位作者 Swathy P Syed Ali Afrin Ponduri Lakshmi Alekhya Jishnu B Banashree Das 《Journal of Acute Disease》 2023年第2期51-56,I0001-I0003,共9页
Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive resear... Objective:To investigate the golden-time-awareness of and the necessary actions in response to acute myocardial infarction among the general public.Methods:This study was conducted with the use of a descriptive research design and convenience sampling.A sample of 800 subjects,using self-structured knowledge questionnaires,was selected for data collection and analysis.The study was conducted at Dr.M.G.R.Educational and Research Institute,India,from February to November 2022.Awareness of myocardial infarction symptoms and intervention timeline(the golden time)was investigated.A multivariate logistic regression analysis was performed to identify the demographic factors affecting the recognition of the golden time of acute myocardial infarction.Results:A total of 800 subjects were included.Among the subjects,367(45.8%)were male,433(54.2%)were female,and 443(55.3%)participants failed to recognize the golden time.Our multivariate logistic regression analysis showed that people with a bachelor’s degree(OR=0.41,95%CI:0.23-0.74,P=0.03)and a high school level diploma(OR=0.55,95%CI:0.31-0.97,P=0.03)are more likely to know about myocardial infarction(golden time)than illiterate people.Additionally,people who are employed(OR=0.59,95%CI:0.41-0.85,P=0.05)are more likely to know about myocardial infarction(golden time)than those who are not.Conclusions:The majority of people in the awareness group realize that taking myocardial infarction patients to the hospital would be the best course of action.The unawareness of the ideal treatment window for myocardial infarction may cause a delay in seeking medical attention,which can lead to an increase in mortality and morbidity. 展开更多
关键词 Heart attack Intervention timeline SYMPTOMS treatment myocardial infarction Percutaneous coronary interven­tion
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The impact analysis of the oxidative stress injury and inflammatory factor level for ticagrelor assisted PCI in the treatment the elderly patients with ST segment elevation acute myocardial infarction
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作者 Hai-Wen Hou Bo Chen +2 位作者 Cheng-Liang Tian Ying Chen Lan-Fang Zhai 《Journal of Hainan Medical University》 2017年第11期17-20,共4页
Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total ... Objective:To investigate the effect of ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI) on oxidative stress and inflammatory factor level.Methods:A total of 100 cases elderly patients with STEMI were selected that they were being treated with PCI. According to the digital list method was divided into the study group and control group, and 50 cases in each group. The control group was treated with PCI and the strong heart, anticoagulation, vasodilation, prevention of infection and other comprehensive treatment of myocardial infarction, the study group were given ticagrelor treatment which was based on the comprehensive treatment of myocardial infarction. The level change were compared that oxidative stress index (MDA), glutathione peroxidase (GSH-Px), superoxide dismutase (SOD) activity and inflammatory factor hypersensitive C reactive protein (hs-CRP), N-terminal pro brain natriuretic peptide (NT-proBNP) and interleukin -6 (IL-6) between the two groups in before treatment (T0), treatment with 7 d (T1), 14 d (T2), 30 d (T3).Results:(1)There was no significant difference in serum MDA, GSH-Px and SOD levels between the two groups in the T0. Two groups serum MDA level were higher than theT0, and the GSH-Px and SOD levels were lower than the T0 after operation in the T1.And the serum MDA level were lower than T0, T1, GSH-Px and SOD levels were higher than T0, T1in the T2, T3.The T3 serum MDA level was lower than T2, GSH-Px and SOD levels were higher than T2.Even the serum MDA was significantly lower than the control group T1, T2, T3 and the GSH-Px and SOD were higher than those of the control group T1, T2, T3 at the study groupT1, T2, T3, the difference was statistically significant. (2)There was no significant difference in T0 of the serum hs-CRP, IL-6 and NT-proBNP levels between the two groups. Two groups serum hs-CRP, IL-6 and NT-proBNP level were higher than the T0 after operation in the T1.And the serum hs-CRP, IL-6 and NT-proBNP levels were higher than T0, T1in the T2, T3.The T3 serum hs-CRP, IL-6 and NT-proBNP levels were lower than T2.and that the serum hs-CRP, IL-6 and NT-proBNP levels were significantly lower than the control group T1, T2, T3 at the study groupT1, T2, T3, so the difference was statistically significant.Conclusion:The treatment method will be able to reduce oxidative stress injury and effectively control the inflammatory response that ticagrelor assisted PCI in treatment the elderly patients with acute ST elevation myocardial infarction (STEMI). 展开更多
关键词 Ticagrelor TABLETS st-elevation acute myocardial infarction (STEMI) Oxidative stress INFLAMMATORY factor
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Progress in diagnosis,treatment and treatment of acute myocardial infarction with traditional C hinese medicine
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作者 Ming-Hui Sun Bing-Lin Shi +4 位作者 Xue-Hai Wei Yu-Xin Wei Xiu-Ling Wei Rui Liu Shi-Bo Zhao 《TMR Pharmacology Research》 2022年第1期1-6,共6页
Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Comb... Acute myocardial infarction is the main cause of human death.Traditional Chinese medicine,as an important part of the wisdom of the Chinese nation,plays an important role in the treatment of myocardial infarction.Combining the latest research on the treatment of acute myocardial infarction with traditional Chinese medicine and related literature reports,it summarizes the theories and treatments of traditional Chinese medicine,aiming to provide clinicians with ideas and references in clinical diagnosis and treatment. 展开更多
关键词 Acute myocardial infarction TCM theory TCM treatment research progress
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Effects of intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction after emergency PCI 被引量:31
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作者 Guo-xiong Chen Hong-na Wang +1 位作者 Jin-lin Zou Xiao-xu Yuan 《World Journal of Emergency Medicine》 SCIE CAS CSCD 2020年第3期157-163,共7页
BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial... BACKGROUND:This study investigated the effects of the intracoronary injection of nicorandil and tirofiban on myocardial perfusion and short-term prognosis in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)after emergency percutaneous coronary intervention(PCI).METHODS:Seventy-eight STEMI patients with age>65 years who underwent emergency PCI were consecutively enrolled.These patients received conventional PCI and were randomly divided into a control group and a treatment group(n=39 per group).The control group received an intracoronary injection of tirofiban followed by a maintenance infusion for 36 hours after surgery.The treatment group received intracoronary injection of tirofiban and nicorandil,and then intravenous infusion of tirofiban and nicorandil 36 hours after surgery.The following parameters were measured:TIMI grade,corrected TIMI frame count(c TFC),TIMI myocardial perfusion grade(TMPG),STsegment resolution(STR)rate 2 hours post-operatively,resolution of ST-segment elevation(STR)at 2 hours postoperatively,peak level of serum CK-MB,left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)at 7–10 days postoperatively,and major adverse cardiac events(MACEs)in-hospital and within 30 days post-operatively.RESULTS:Compared with the control group,more patients in the treatment group had TIMI 3 and TMPG 3,and STR after PCI was significantly higher.The treatment group also had significantly lower c TFC,lower infarction relative artery(IRA),lower peak CK-MB,and no reflow ratio after PCI.The treatment group had significantly higher LVEDD and LVEF but lower incidence of MACEs than the control group.CONCLUSION:The intracoronary injection of nicorandil combined with tirofiban can effectively improve myocardial reperfusion in elderly STEMI patients after emergency PCI and improve shortterm prognoses. 展开更多
关键词 Acute st-elevation myocardial infarction Elderly Emergency coronary intervention NICORANDIL Tirofiban myocardial REPERFUSION
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Cardioprotection and pharmacological therapies in acute myocardial infarction: Challenges in the current era 被引量:18
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作者 Alberto Dominguez-Rodriguez Pedro Abreu-Gonzalez Russel J Reiter 《World Journal of Cardiology》 CAS 2014年第3期100-106,共7页
In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, ... In patients with an acute ST-segment elevation myocardial infarction, timely myocardial reperfusion using primary percutaneous coronary intervention is the most effective therapy for limiting myocardial infarct size, preserving left-ventricular systolic function and reducing the onset of heart failure. Within minutes after the restoration of blood flow, however, reperfusion itself results in additional damage, also known as myocardial ischemia-reperfusion injury. An improved understanding of the pathophysiological mechanisms underlying reperfusion injury has resulted in the identification ofseveral promising pharmacological(cyclosporin-A, exenatide, glucose-insulin-potassium, atrial natriuretic peptide, adenosine, abciximab, erythropoietin, metoprolol and melatonin) therapeutic strategies for reducing the severity of myocardial reperfusion injury. Many of these agents have shown promise in initial proofof-principle clinical studies. In this article, we review the pathophysiology underlying myocardial reperfusion injury and highlight the potential pharmacological interventions which could be used in the future to prevent reperfusion injury and improve clinical outcomes in patients with coronary heart disease. 展开更多
关键词 st-elevation myocardial infarction CARDIOPROTECTION myocardial REPERFUSION injury infarct size ADJUNCTIVE therapy
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Combination therapy reduces the percutaneous coronary intervention acute myocardial infarction incidence of no-reflow after primary in patients with ST-segment elevation 被引量:20
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作者 Shan-Shan ZHOU Feng TIAN Yun-Dai CHEN Jing WANG Zhi-Jun SUN Jun GUO Qin-Hua JIN 《Journal of Geriatric Cardiology》 SCIE CAS CSCD 2015年第2期135-142,共8页
Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) and is... Background No-reflow is associated with an adverse outcome and higher mortality in patients with ST-segment elevation acute myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) and is considered a dynamic process characterized by multiple pathogenetic components. The aim of this study was to investigate the effectiveness of a combination therapy for the prevention of no-reflow in patient with acute myocardial infarction (AMI) undergoing primary PCI. Methods A total of 621 patients with STEMI who underwent emergency primary PCI were enrolled in this study. Patients with high risk of no-reflow (no-flow score 〉 10, by using a no-flow risk prediction model, n = 216) were randomly divided into a controlled group (n = 108) and a combination therapy group (n = 108). Patients in the controlled group received conventional treatment, while patients in combination therapy group received high-dose (80 mg) atorvastatin pre-treatment, intracoronary administration of adenosine (140 ~tg/min per kilogram) during PCI procedure, platelet membrane glycoprotein lib/Ilia receptor antagonist (tirofiban, 101.tg/kg bolus followed by 0.15 ~tg/kg per minute) and thrombus aspiration. Myocardial contrast echocardiography was performed to assess the myocardial perfusion 72 h after PCI. Major adverse cardiac events (MACE) were followed up for six months. Results Incidence of no-reflow in combination therapy group was 2.8%, which was similar to that in low risk group 2.7% and was significantly lower than that in control group (35.2%, P 〈 0.01). The myocardial perfusion (A= 13) values were higher in combination therapy group than that in control group 72 h after PCI. After 6 months, there were six (6.3%) MACE events (one death, two non-fatal MIs and three revasculafizations) in combination therapy group and 12 (13.2%) (four deaths, three non-fatal MIs and five revascularizations, P 〈 0.05) in control group. Conclusions Combination of thrombus aspiration, high-dose statin pre-treatment, intmcoronary administration of adenosine during PCI procedure and platelet membrane glycoprotein Ⅱ b/Ⅲa receptor antagonist reduces the incidence of no-reflow after primary PCI in patients with acute myocardial infarction who are at high risk of no-reflow. 展开更多
关键词 Acute myocardial infarction myocardial contrast echocardiography No-reflow phenomenon Percutaneous coronary interven-tion st-elevation myocardial infarction
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Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention:Mechanisms,incidence and identification of patients at risk 被引量:15
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作者 Thomas J Cahill Rajesh K Kharbanda 《World Journal of Cardiology》 CAS 2017年第5期407-415,共9页
Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repai... Myocardial infarction(MI) remains the most common cause of heart failure(HF) worldwide. For almost 50 years HF has been recognised as a determinant ofadverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention(PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-STelevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents. 展开更多
关键词 ANGIOPLASTY Heart failure myocardial infarction Percutaneous coronary intervention st-elevation myocardial infarction
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Does heart rate variability correlate with long-term prognosis in myocardial infarction patients treated by early revascularization? 被引量:10
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作者 Leonida Compostella Nenad Lakusic +3 位作者 Caterina Compostella Li Van Stella Truong Sabino Iliceto Fabio Bellotto 《World Journal of Cardiology》 CAS 2017年第1期27-38,共12页
AIMTo assess the prevalence of depressed heart rate variability (HRV) after an acute myocardial infarction (MI), and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODSTime-doma... AIMTo assess the prevalence of depressed heart rate variability (HRV) after an acute myocardial infarction (MI), and to evaluate its prognostic significance in the present era of immediate reperfusion.METHODSTime-domain HRV (obtained from 24-h Holter recordings) was assessed in 326 patients (63.5 ± 12.1 years old; 80% males), two weeks after a complicated MI treated by early reperfusion: 208 ST-elevation myocardial infarction (STEMI) patients (in which reperfusion was successfully obtained within 6 h of symptoms in 94% of cases) and 118 non-ST-elevation myocardial infarction (NSTEMI) patients (percutaneous coronary intervention was performed within 24 h and successful in 73% of cases). Follow-up of the patients was performed via telephone interviews a median of 25 mo after the index event (95%CI of the mean 23.3-28.0). Primary end-point was occurrence of all-cause or cardiac death; secondary end-point was occurrence of major clinical events (MCE, defined as mortality or readmission for new MI, new revascularization, episodes of heart failure or stroke). Possible correlations between HRV parameters (mainly the standard deviation of all normal RR intervals, SDNN), clinical features (age, sex, type of MI, history of diabetes, left ventricle ejection fraction), angiographic characteristics (number of coronary arteries with critical stenoses, success and completeness of revascularization) and long-term outcomes were analysed.RESULTSMarkedly depressed HRV parameters were present in a relatively small percentage of patients: SDNN < 70 ms was found in 16% and SDNN < 50 ms in 4% of cases. No significant differences were present between STEMI and NSTEMI cases as regards to their distribution among quartiles of SDNN (χ<sup>2</sup> =1.536, P = 0.674). Female sex and history of diabetes maintained a significant correlation with lower values of SDNN at multivariate Cox regression analysis (respectively: P = 0.008 and P = 0.008), while no correlation was found between depressed SDNN and history of previous MI (P = 0.999) or number of diseased coronary arteries (P = 0.428) or unsuccessful percutaneous coronary intervention (PCI) (P = 0.691). Patients with left ventricle ejection fraction (LVEF) < 40% presented more often SDNN values in the lowest quartile (P < 0.001). After > 2 years from infarction, a total of 10 patients (3.1%) were lost to follow-up. Overall incidence of MCE at follow-up was similar between STEMI and NSTEMI (P = 0.141), although all-cause and cardiac mortality were higher among NSTEMI cases (respectively: 14% vs 2%, P = 0.001; and 10% vs 1.5%, P = 0.001). The Kaplan-Meier survival curves for all-cause mortality and for cardiac deaths did not reveal significant differences between patients with SDNN in the lowest quartile and other quartiles of SDNN (respectively: P = 0.137 and P = 0.527). Also the MCE-free survival curves were similar between the group of patients with SDNN in the lowest quartile vs the patients of the other SDNN quartiles (P = 0.540), with no difference for STEMI (P = 0.180) or NSTEMI patients (P = 0.541). By the contrary, events-free survival was worse if patients presented with LVEF < 40% (P = 0.001).CONCLUSIONIn our group of patients with a recent complicated MI, abnormal autonomic parameters have been found with a prevalence that was similar for STEMI and NSTEMI cases, and substantially unchanged in comparison to what reported in the pre-primary-PCI era. Long-term outcomes did not correlate with level of depression of HRV parameters recorded in the subacute phase of the disease, both in STEMI and in NSTEMI patients. These results support lack of prognostic significance of traditional HRV parameters when immediate coronary reperfusion is utilised. 展开更多
关键词 Heart rate variability Autonomic nervous system Primary percutaneous coronary intervention myocardial infarction st-elevation myocardial infarction Non-st-elevation myocardial infarction Left ventricle ejection fraction Long-term prognosis
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