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Turk Kardiyoloji Dernegi Arsivi : Turk... Sep 2021It is increasingly evident that the ST-segment elevation (STE) myocardial infarction (MI)/non-STEMI paradigm that equates STEMI with acute coronary occlusion (ACO) is... (Review)
Review
It is increasingly evident that the ST-segment elevation (STE) myocardial infarction (MI)/non-STEMI paradigm that equates STEMI with acute coronary occlusion (ACO) is deceptive. This unfortunate paradigm, adhered to by the current guidelines, misses at least one-fourth of the ACOs, and unnecessarily over-triages a similar fraction of the patients to the catheterization laboratory. Accordingly, we have been calling for a new paradigm, the occlusion/nonocclusion MI (OMI/NOMI). Although this new OMI/NOMI paradigm is not limited to an electrocardiogram (ECG), the ECG will remain the cornerstone of this new paradigm because of its speed, repeatability, noninvasive nature, wide availability, and high diagnostic power for OMI. This review provides a step-by-step approach to ECG for the diagnosis of OMI.
Topics: Cardiac Catheterization; Coronary Occlusion; Electrocardiography; Humans; Myocardial Infarction; Practice Guidelines as Topic; ST Elevation Myocardial Infarction
PubMed: 34523597
DOI: 10.5543/tkda.2021.21026 -
Current Problems in Cardiology Dec 2022For almost 30 years, urgent revascularization termed primary percutaneous coronary intervention has been a cornerstone of modern care for acute myocardial infarction... (Review)
Review
For almost 30 years, urgent revascularization termed primary percutaneous coronary intervention has been a cornerstone of modern care for acute myocardial infarction (AMI). It lowers mortality and improved cardiovascular outcome compared to conservative therapy including thrombolysis. Reperfusion injury, which occurs after successful re-opening of the formerly occluded coronary artery, had been exploited as a potential therapeutic target. When revascularization became faster and primary percutaneous coronary intervention was successfully performed within 60-90 minutes of symptom onset, the interest in a potential additive effect of targeting reperfusion injury vanished. More recently, several meta-analyses indicated that limiting reperfusion injury prevents microvascular obstruction and reduces final infarct size, thereby lowering the probability of heart failure events and improving quality of life in AMI survivors. Here, we describe the current strategies to limit reperfusion injury and to improve post-AMI outcomes such as systemic or intracoronary hypothermia, left-ventricular unloading, intracoronary infusion of super-saturated oxygen, intermittent coronary sinus occlusion, and C-reactive protein apheresis.
Topics: Humans; Quality of Life; Myocardial Infarction; Percutaneous Coronary Intervention; Coronary Vessels; Reperfusion Injury
PubMed: 36108813
DOI: 10.1016/j.cpcardiol.2022.101398 -
Aging Oct 2018
Topics: Humans; Myocardial Infarction
PubMed: 30362961
DOI: 10.18632/aging.101618 -
BMC Cardiovascular Disorders Feb 2017Most studies of outcomes after myocardial infarction (MI) focus on the acute phase after the index event. We assessed mortality and morbidity trends after the first year... (Review)
Review
BACKGROUND
Most studies of outcomes after myocardial infarction (MI) focus on the acute phase after the index event. We assessed mortality and morbidity trends after the first year in survivors of acute MI, by conducting a systematic literature review.
METHODS
Literature searches were conducted in Embase, MEDLINE, and the Cochrane Database of Systematic Reviews to identify epidemiological studies of long-term (>10 years) mortality and morbidity trends in individuals who had experienced an acute MI more than 1 year previously.
RESULTS
Thirteen articles met the inclusion criteria. Secular trends showed a consistent decrease in mortality and morbidity after acute MI from early to more recent study periods. The relative risk for all-cause death and cardiovascular outcomes (recurrent MI, cardiovascular death) was at least 30% higher than that in a general reference population at both 1-3 years and 3-5 years after MI. Risk factors leading to worse outcomes after MI included comorbid diabetes, hypertension and peripheral artery disease, older age, reduced renal function, and history of stroke.
CONCLUSIONS
There have been consistent improvements in secular trends for long-term survival and cardiovascular outcomes after MI. However, MI survivors remain at higher risk than the general population, particularly when additional risk factors such as diabetes, hypertension, or older age are present.
Topics: Age Factors; Aged; Aged, 80 and over; Cause of Death; Comorbidity; Female; Humans; Male; Middle Aged; Myocardial Infarction; Prognosis; Risk Assessment; Risk Factors; Survivors; Time Factors
PubMed: 28173750
DOI: 10.1186/s12872-017-0482-9 -
International Journal of Cardiology Feb 2023Few studies have analyzed the incidence and the risk of acute myocardial infarction (AMI) during the post-acute phase of COVID-19 infection. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Few studies have analyzed the incidence and the risk of acute myocardial infarction (AMI) during the post-acute phase of COVID-19 infection.
OBJECTIVE
To assess the incidence and risk of AMI in COVID-19 survivors after SARS-CoV-2 infection by a systematic review and meta-analysis of the available data.
METHODS
Data were obtained searching MEDLINE and Scopus for all studies published at any time up to September 1, 2022 and reporting the risk of incident AMI in patients recovered from COVID-19 infection. AMI risk was evaluated using the Mantel-Haenszel random effects models with Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins and Thomson I statistic.
RESULTS
Among 2765 articles obtained by our search strategy, four studies fulfilled the inclusion criteria for a total of 20,875,843 patients (mean age 56.1 years, 59.1% males). Of them, 1,244,604 had COVID-19 infection. Over a mean follow-up of 8.5 months, among COVID-19 recovered patients AMI occurred in 3.5 cases per 1.000 individuals compared to 2.02 cases per 1.000 individuals in the control cohort, defined as those who did not experience COVID-19 infection in the same period). COVID-19 patients showed an increased risk of incident AMI (HR: 1.93, 95% CI: 1.65-2.26, p < 0.0001, I = 83.5%). Meta-regression analysis demonstrated that the risk of AMI was directly associated with age (p = 0.01) and male gender (p = 0.001), while an indirect relationship was observed when the length of follow-up was utilized as moderator (p < 0.001).
CONCLUSION
COVID-19 recovered patients had an increased risk of AMI.
Topics: Humans; Male; Middle Aged; Female; COVID-19; SARS-CoV-2; Myocardial Infarction
PubMed: 36535564
DOI: 10.1016/j.ijcard.2022.12.032 -
European Heart Journal. Cardiovascular... Feb 2023Most trials showing benefit of beta-blocker treatment after myocardial infarction (MI) included patients with large MIs and are from an era before modern biomarker-based... (Randomized Controlled Trial)
Randomized Controlled Trial
AIMS
Most trials showing benefit of beta-blocker treatment after myocardial infarction (MI) included patients with large MIs and are from an era before modern biomarker-based MI diagnosis and reperfusion treatment. The aim of the randomized evaluation of decreased usage of beta-blockers after acute myocardial infarction (REDUCE-AMI) trial is to determine whether long-term oral beta-blockade in patients with an acute MI and preserved left ventricular ejection fraction (EF) reduces the composite endpoint of death of any cause or recurrent MI.
METHODS AND RESULTS
It is a registry-based, randomized, parallel, open-label, multicentre trial performed at 38 centres in Sweden, 1 centre in Estonia, and 6 centres in New Zealand. About 5000 patients with an acute MI who have undergone coronary angiography and with EF ≥ 50% will be randomized to long-term treatment with beta-blockade or not. The primary endpoint is the composite endpoint of death of any cause or new non-fatal MI. There are several secondary endpoints, including all-cause death, cardiovascular death, new MI, readmission because of heart failure and atrial fibrillation, symptoms, functional status, and health-related quality of life after 6-10 weeks and after 1 year of treatment. Safety endpoints are bradycardia, AV-block II-III, hypotension, syncope or need for pacemaker, asthma or chronic obstructive pulmonary disease, and stroke.
CONCLUSION
The results from REDUCE-AMI will add important evidence regarding the effect of beta-blockers in patients with MI and preserved EF and may change guidelines and clinical practice.
Topics: Humans; Stroke Volume; Quality of Life; Ventricular Function, Left; Myocardial Infarction; Arrhythmias, Cardiac
PubMed: 36513329
DOI: 10.1093/ehjcvp/pvac070 -
Cardiovascular Diabetology Oct 2023Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable...
BACKGROUND
Among patients with acute coronary syndrome and percutaneous coronary intervention, stress hyperglycemia ratio (SHR) is primarily associated with short-term unfavorable outcomes. However, the relationship between SHR and long-term worsen prognosis in acute myocardial infarction (AMI) patients admitted in intensive care unit (ICU) are not fully investigated, especially in those with different ethnicity. This study aimed to clarify the association of SHR with all-cause mortality in critical AMI patients from American and Chinese cohorts.
METHODS
Overall 4,337 AMI patients with their first ICU admission from the American Medical Information Mart for Intensive Care (MIMIC)-IV database (n = 2,166) and Chinese multicenter registry cohort Cardiorenal ImprovemeNt II (CIN-II, n = 2,171) were included in this study. The patients were divided into 4 groups based on quantiles of SHR in both two cohorts.
RESULTS
The total mortality was 23.8% (maximum follow-up time: 12.1 years) in American MIMIC-IV and 29.1% (maximum follow-up time: 14.1 years) in Chinese CIN-II. In MIMIC-IV cohort, patients with SHR of quartile 4 had higher risk of 1-year (adjusted hazard radio [aHR] = 1.87; 95% CI: 1.40-2.50) and long-term (aHR = 1.63; 95% CI: 1.27-2.09) all-cause mortality than quartile 2 (as reference). Similar results were observed in CIN-II cohort (1-year mortality: aHR = 1.44; 95%CI: 1.03-2.02; long-term mortality: aHR = 1.32; 95%CI: 1.05-1.66). In both two group, restricted cubic splines indicated a J-shaped correlation between SHR and all-cause mortality. In subgroup analysis, SHR was significantly associated with higher 1-year and long-term all-cause mortality among patients without diabetes in both MIMIC-IV and CIN-II cohort.
CONCLUSION
Among critical AMI patients, elevated SHR is significantly associated with and 1-year and long-term all-cause mortality, especially in those without diabetes, and the results are consistently in both American and Chinese cohorts.
Topics: Humans; China; East Asian People; Hyperglycemia; Myocardial Infarction; Prognosis; United States
PubMed: 37865764
DOI: 10.1186/s12933-023-02012-1 -
Balkan Medical Journal Mar 2022Myocardial infarction mostly presents with atypical signs and symptoms and has different risk factors in young individuals compared to older individuals. These risk... (Review)
Review
Myocardial infarction mostly presents with atypical signs and symptoms and has different risk factors in young individuals compared to older individuals. These risk factors are often preventable, therefore recognizing them and taking precautions can save these patients from suffering myocardial infarction. Scarcity of studies and lack of guidelines for assessment and management of young MI patients, make it more challenging for these individuals to get accurate medical care, even though MI in this age group is on the rise. Traditional risk factors, such as smoking, hyperlipidemia, hypertension, male sex, obesity, and family history of premature cardiovascular disease, contribute to the risk of myocardial infarction at a young age, but additional non-traditional risk factors, such as substance abuse, thrombophilia, coronary anomalies, immune disease, allergic reactions, and psychological stressors, uniquely contribute to the risk profile of young individuals. This review is aimed to discuss and guide the risk factor assessment for the development of myocardial infarction in young individuals based on current evidence and our >20-year of experience in Young Myocardial Infarction Clinic.
Topics: Humans; Male; Medical History Taking; Myocardial Infarction; Risk Factors; Smoking
PubMed: 35330552
DOI: 10.4274/balkanmedj.galenos.2022-2-19 -
Journal of the American College of... Jul 2018Myocardial injury induces significant changes in ventricular structure and function at both the cellular and anatomic level, leading to ventricular remodeling and... (Review)
Review
Myocardial injury induces significant changes in ventricular structure and function at both the cellular and anatomic level, leading to ventricular remodeling and subsequent heart failure. Unloading left ventricular pressure has been studied in both the short-term and long-term settings, as a means of preventing or reversing cardiac remodeling. In acute myocardial infarction, cardiac unloading is used to reduce oxygen demand and limit infarct size. Research has demonstrated the benefits of short-term unloading with mechanical circulatory support devices before reperfusion in the context of acute myocardial infarction with cardiogenic shock, and a confirmatory trial is ongoing. In chronic heart failure, ventricular unloading using mechanical circulatory support can reverse many of the cellular and anatomic changes that accompany ventricular remodeling. Ongoing research is evaluating the ability of left ventricular assist devices to promote myocardial recovery and remission from clinical heart failure.
Topics: Heart Failure; Hemodynamics; Humans; Myocardial Infarction; Ventricular Function, Left; Ventricular Remodeling
PubMed: 30056830
DOI: 10.1016/j.jacc.2018.05.038 -
Archives of Cardiovascular Diseases Jan 2022
Topics: Cross-Over Studies; Humans; Myocardial Infarction; ST Elevation Myocardial Infarction
PubMed: 34955438
DOI: 10.1016/j.acvd.2021.10.011