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Latest & greatest articles for myocardial infarction
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Meta-analysis Comparing Culprit Vessel Only Versus Multivessel Percutaneous Coronary Intervention in Patients With Acute MyocardialInfarction and Cardiogenic Shock Cardiogenic shock (CS) after a myocardialinfarction continues to be associated with high mortality. Whether percutaneous coronary intervention (PCI) of noninfarct coronary arteries (multivessel intervention [MVI]) improves outcomes in CS after acute myocardialinfarction (AMI) remains controversial. MEDLINE, Cochrane CENTRAL
Relation of CHA2DS2VASC Score With Hemorrhagic Stroke and Mortality in Patients Undergoing Fibrinolytic Therapy for ST Elevation MyocardialInfarction Hemorrhagic stroke (HS) is a feared complication of Fibrinolytic therapy (FT). Risk assessment scores may help in risk stratification to reduce this complication. Patients (admissions) ≥18 years with a primary diagnosis of ST-elevation myocardialinfarction (STEMI) who received systemic thrombolysis were extracted from Nationwide Inpatient Sample
Sex differences in risk factors for myocardialinfarction: cohort study of UK Biobank participants. To investigate sex differences in risk factors for incident myocardialinfarction (MI) and whether they vary with age.Prospective population based study.UK Biobank.471 998 participants (56% women; mean age 56.2) with no history of cardiovascular disease.Incident (fatal and non-fatal) MI.5081 participants (1463 (28.8%) of whom were women) had MI over seven years' mean follow-up, resulting
Evolocumab (Repatha) - In adults with established atherosclerotic cardiovascular disease (myocardialinfarction, stroke or peripheral arterial disease) Published 12 November 2018 Statement of advice SMC2133 evolocumab 140mg solution for injection in pre-filled syringe / 140mg solution for injection in pre-filled pen / 420mg solution of injection in cartridge (Repatha®) Amgen Ltd 5 October 2018 ADVICE: in the absence of a submission from the holder of the marketing authorisation evolocumab (...) (Repatha®) is not recommended for use within NHSScotland. Indication under review: In adults with established atherosclerotic cardiovascular disease (myocardialinfarction, stroke or peripheral arterial disease) to reduce cardiovascular risk by lowering LDL-C levels, as an adjunct to correction of other risk factors: ? in combination with the maximum tolerated dose of a statin with or without other lipid- lowering therapies or, ? alone or in combination with other lipid-lowering therapies in patients
Timing of revascularization in patients with transient ST-segment elevation myocardialinfarction: a randomized clinical trial Patients with acute coronary syndrome who present initially with ST-elevation on the electrocardiogram but, subsequently, show complete normalization of the ST-segment and relief of symptoms before reperfusion therapy are referred to as transient ST-segment elevation myocardialinfarction (STEMI) and pose a therapeutic challenge. It is unclear what the optimal timing (...) of revascularization is for these patients and whether they should be treated with a STEMI-like or a non-ST-segment elevation myocardialinfarction (NSTEMI)-like invasive approach. The aim of the study is to determine the effect of an immediate vs. a delayed invasive strategy on infarct size measured by cardiac magnetic resonance imaging (CMR).In a randomized clinical trial, 142 patients with transient STEMI with symptoms of any duration were randomized to an immediate (STEMI-like) [0.3 h; interquartile range (IQR
Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute MyocardialInfarction? TAKE-HOME MESSAGE A single, undetectable, high-sensitivity, cardiac troponin T (hs-cTnT) test in combination with a nonischemic ECG result may effectively rule out acute myocardialinfarction in emergency department (ED) patients presenting greater than 3 hours after symptom onset. Can a Negative High-Sensitivity Troponin Result Rapidly Rule Out Acute MyocardialInfarction? EBEM Commentators Nathan M (...) . Overall acute myocardial infarc- tion prevalence was 15.4%. Of the total included patient population, 30.6% were classi?ed as being at low risk for acute myocardialinfarction by a single negative hs-cTnT result and a nonischemic ECG result. Of these patients, 14 (0.5%) received a diagnosis of acute myocardialinfarction. In 7 of these cases, the time between symptom onset and blood sam- pling was less than 3 hours. The pooled performance estimates for Performanceofhs
In Patients With ST-Segment Elevation MyocardialInfarction, Which Fibrinolytic Agent Is the Safest and Most Effective? TAKE-HOME MESSAGE In patients with ST-segment elevation myocardialinfarction (STEMI), when percutaneous coronary intervention is not an option, reperfusion therapy with the ?brinolytic agents tenecteplase, reteplase, or accelerated alteplase (90 minutes of infusion) plus parenteral anticoagulation has better overall safety and ef?cacy than other regimens. In Patients With ST (...) -Segment Elevation MyocardialInfarction, Which Fibrinolytic Agent Is the Safest and Most Effective? EBEM Commentators Ashis Shrestha, MD Department of General Practice and Emergency Medicine Patan Academy of Health Sciences Kathmandu, Nepal Darlene R. House, MD, MS Department of General Practice and Emergency Medicine Patan Academy of Health Sciences Kathmandu, Nepal Department of Emergency Medicine Indiana University School of Medicine Indianapolis, IN Julie L. Welch, MD Department of Emergency
In Patients With Acute MyocardialInfarction and No Hypoxemia, Does Oxygen Therapy Improve Outcomes Compared With No Supplemental Oxygen? TAKE-HOME MESSAGE Oxygen therapy does notreduce therisk of all-cause mortality,recurrent ischemia or myocardialinfarction, heart failure, or arrhythmias compared with no supplemental oxygen therapy for patients with acute myocardialinfarction and normal oxygen saturation. InPatientsWithAcuteMyocardialInfarctionandNo Hypoxemia, Does Oxygen Therapy Improve (...) , and the most common comorbidities were hypertension, hyperlipid- emia, diabetes, and smoking. Overall, there was no association between oxygen supplementa- tion with any bene?tinpatients with acute myocardialinfarction (Table). Six studies reported all-cause mortality, 6 reported recurrent ischemia or myocardialinfarction, 3 reported heart fail- ure, and 5 reported arrhythmia. Studies varied in quality, with no studies powered to detect a difference in clinically signi?- cant adverse cardiac events. De
Six months versus 12 months dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardialinfarction (DAPT-STEMI): randomised, multicentre, non-inferiority trial. To show that limiting dual antiplatelet therapy (DAPT) to six months in patients with event-free ST-elevation myocardialinfarction (STEMI) results in a non-inferior clinical outcome versus DAPT for 12 months.Prospective, randomised, multicentre, non-inferiority trial.Patients with STEMI treated (...) for an additional six months. All patients that were randomised were then followed for another 18 months (ie, 24 months after the primary PCI).The primary endpoint was a composite of all cause mortality, any myocardialinfarction, any revascularisation, stroke, and thrombolysis in myocardialinfarction major bleeding at 18 months after randomisation.A total of 1100 patients were enrolled in the trial between 19 December 2011 and 30 June 2015. 870 were randomised: 432 to SAPT versus 438 to DAPT. The primary
Meta-Analysis Comparing Primary Percutaneous Coronary Intervention Versus Pharmacoinvasive Therapy in Transfer Patients with ST-Elevation MyocardialInfarction ST-elevation myocardialinfarction patients presenting at non-percutaneous coronary intervention (PCI)-capable hospitals often need to be transferred for primary percutaneous coronary intervention (PPCI). This increases time to revascularization, leading to increased risk of in-hospital mortality. With recent focus on total ischemic time (...) rather than door-to-balloon time as the principal determinant of outcomes in ST-elevation myocardialinfarction patients, pharmacoinvasive therapy (PIT) has gained attention as a possible improvement over PPCI in patients requiring transfer. Our objective was to observe how PIT stands against PPCI in terms of safety and efficacy. Electronic databases were searched for randomized controlled trials and observational studies comparing PPCI to PIT. PIT was defined as administration of thrombolytic drugs
Impact of age on the performance of the ESC 0/1h-algorithms for early diagnosis of myocardialinfarction We aimed to evaluate the impact of age on the performance of the European Society of Cardiology (ESC) 0/1h-algorithms and to derive and externally validate alternative cut-offs specific to older patients.We prospectively enrolled patients presenting to the emergency department (ED) with symptoms suggestive of acute myocardialinfarction in three large diagnostic studies. Final diagnoses were
Combining High Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute MyocardialInfarction Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardialinfarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT (...) for the early diagnosis of acute myocardial infarction.The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardialinfarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients
Wearable Cardioverter-Defibrillator after MyocardialInfarction. Despite the high rate of sudden death after myocardialinfarction among patients with a low ejection fraction, implantable cardioverter-defibrillators are contraindicated until 40 to 90 days after myocardialinfarction. Whether a wearable cardioverter-defibrillator would reduce the incidence of sudden death during this high-risk period is unclear.We randomly assigned (in a 2:1 ratio) patients with acute myocardialinfarction (...) ), and nonarrhythmic death in 1.4% and 2.2%, respectively (relative risk, 0.63; 95% CI, 0.33 to 1.19; uncorrected P=0.15). Of the 48 participants in the device group who died, 12 were wearing the device at the time of death. A total of 20 participants in the device group (1.3%) received an appropriate shock, and 9 (0.6%) received an inappropriate shock.Among patients with a recent myocardialinfarction and an ejection fraction of 35% or less, the wearable cardioverter-defibrillator did not lead to a significantly
ST-elevation myocardialinfarction ST-elevation myocardialinfarction - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search ST-elevation myocardialinfarction Last reviewed: February 2019 Last updated: September 2018 Summary Presents with central chest pain that is classically heavy in nature, like a sensation of pressure or squeezing. Examination is variable, and findings range from normal to a critically unwell patient (...) in cardiogenic shock. ST-elevation myocardialinfarction (STEMI) is suspected when a patient presents with persistent ST-segment elevation in 2 or more anatomically contiguous ECG leads in the context of a consistent clinical history. Creatine kinase-MB and cardiac-specific troponins confirm diagnosis. Treatment should, however, be started immediately in patients with a typical history and ECG changes, without waiting for laboratory results. Immediate and prompt revascularisation can prevent or decrease
Clinical chemistry score versus high-sensitivity cardiac troponin I and T tests alone to identify patients at low or high risk for myocardialinfarction or death at presentation to the emergency department Testing for high-sensitivity cardiac troponin (hs-cTn) may assist triage and clinical decision-making in patients presenting to the emergency department with symptoms of acute coronary syndrome; however, this could result in the misclassification of risk because of analytical variation (...) or laboratory error. We sought to evaluate a new laboratory-based risk-stratification tool that incorporates tests for hs-cTn, glucose level and estimated glomerular filtration rate to identify patients at risk of myocardialinfarction or death when presenting to the emergency department.We constructed the clinical chemistry score (CCS) (range 0-5 points) and validated it as a predictor of 30-day myocardialinfarction (MI) or death using data from 4 cohort studies involving patients who presented
Prospective Validation of the 0/1-h Algorithm for Early Diagnosis of MyocardialInfarction The safety of the European Society of Cardiology (ESC) 0/1-h algorithm for rapid rule-out and rule-in of non-ST-segment elevation myocardialinfarction (NSTEMI) using high-sensitivity cardiac troponin (hs-cTn) has been questioned.This study aimed to validate the diagnostic performance of the 0/1-h algorithm in a large multicenter study.The authors prospectively enrolled unselected patients in 6 countries
Chest discomfort in a patient with dengue â€“ is it an acute myocardialinfarction? Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic dilemma. We describe a case of dengue myocarditis mimicking an acute myocardialinfarction in a 56-year-old woman.
Supplemental Oxygen Protects Heart Against Acute MyocardialInfarctionMyocardialinfarction (MI), which occurs often due to acute ischemia followed by reflow, is associated with irreversible loss (death) of cardiomyocytes. If left untreated, MI will lead to progressive loss of viable cardiomyocytes, deterioration of cardiac function, and congestive heart failure. While supplemental oxygen therapy has long been in practice to treat acute MI, there has not been a clear scientific basis (...) . Myocardial oxygen tension (pO2), cardiac function and pro-survival/apoptotic signaling molecules were used as markers of treatment outcome. OxCy resulted in a significant reduction of infarct size and improvement of cardiac function. An optimal condition of 30-min OxCy with 95% oxygen + 5% CO2 under normobaric conditions was found to be effective for cardioprotection.
Coronary CT Angiography and 5-Year Risk of MyocardialInfarction. Although coronary computed tomographic angiography (CTA) improves diagnostic certainty in the assessment of patients with stable chest pain, its effect on 5-year clinical outcomes is unknown.In an open-label, multicenter, parallel-group trial, we randomly assigned 4146 patients with stable chest pain who had been referred to a cardiology clinic for evaluation to standard care plus CTA (2073 patients) or to standard care alone (...) (2073 patients). Investigations, treatments, and clinical outcomes were assessed over 3 to 7 years of follow-up. The primary end point was death from coronary heart disease or nonfatal myocardialinfarction at 5 years.The median duration of follow-up was 4.8 years, which yielded 20,254 patient-years of follow-up. The 5-year rate of the primary end point was lower in the CTA group than in the standard-care group (2.3% [48 patients] vs. 3.9% [81 patients]; hazard ratio, 0.59; 95% confidence interval