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Cardiovascular Drugs and Therapy Feb 2023Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially... (Review)
Review
Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially represent a unique group of patients posing a therapeutic management dilemma. In this review, we discuss the potential mechanisms underlying SpR, its relation to clinical outcomes and the proposed management options for patients with transient STEMI with a focus on immediate versus early percutaneous coronary intervention. We performed a structured literature search of PubMed and Cochrane Library databases from inception to December 2020. Studies focused on SpR in patients with acute coronary syndrome were selected. Available data suggest that deferral of angiography and revascularization within 24-48 h in these patients is reasonable and associated with similar or perhaps better outcomes than immediate angiography. Further randomized trials are needed to elucidate the best pharmacological and invasive strategies for this cohort.
Topics: Humans; Acute Coronary Syndrome; Coronary Angiography; Electrocardiography; Percutaneous Coronary Intervention; Prevalence; Remission, Spontaneous; Reperfusion; ST Elevation Myocardial Infarction; Treatment Outcome
PubMed: 34245445
DOI: 10.1007/s10557-021-07226-7 -
Perfusion Nov 2013Blood cardioplegia in cardiac surgery contains leukocytes, which causes the inflammatory reaction and promotes myocardial reperfusion injury. The removal of leukocytes... (Meta-Analysis)
Meta-Analysis Review
Blood cardioplegia in cardiac surgery contains leukocytes, which causes the inflammatory reaction and promotes myocardial reperfusion injury. The removal of leukocytes from the cardioplegia line, using specialized filters, has been proposed as one of the effective methods in attenuating the inflammatory response. We performed a two-level search to identify randomized, controlled trials concerning the effects of leukocyte-depleted blood cardioplegia on myocardial reperfusion injury. Sixteen studies, comprising 738 patients, met the selection criteria. There are significant reductions in creatinine kinase isoenzyme MB (CK-MB) during 4-8h postoperatively (SMD - 0.577; 95% CI -0.795 to -0.358; p=0.000), CK-MB peak (SMD - 0.713; 95% CI -1.027 to -0.400; p=0.000), troponin in the period of 4-8h postoperatively (SMD - 0.502; 95% CI -0.935 to -0.069; p=0.023), troponin peak (SMD - 0.826; 95% CI -1.373 to -0.279; p=0.003) and inotropic support (RR, 0.500; 95% CI 0.269 to 0.931; p=0.029). Leukocyte-depleted blood cardioplegia may reduce myocardial reperfusion injury in the early postoperative period, but there has been no evidence to support the clinically significant difference. Larger and more precise randomized control trials are needed to further elucidate the cardioprotective effects of cardioplegia leukofiltration.
Topics: Coronary Artery Bypass; Heart Arrest, Induced; Humans; Leukocyte Reduction Procedures; Leukocytes; Myocardial Reperfusion Injury; Prospective Studies
PubMed: 23784875
DOI: 10.1177/0267659113492837 -
Acta Cardiologica Aug 2020Recent studies have shown that fragmented QRS (fQRS) is associated with unfavourable outcomes in STEMI patients. However, there is controversy amongst studies. We... (Meta-Analysis)
Meta-Analysis
Recent studies have shown that fragmented QRS (fQRS) is associated with unfavourable outcomes in STEMI patients. However, there is controversy amongst studies. We performed a systematic review and meta-analysis to explore the effect of fQRS on reperfusion failure and in-hospital mortality among this population. We searched the databases of MEDLINE and EMBASE from inception to October 2018. Included studies were published cohort studies of STEMI patients that underwent primary percutaneous coronary intervention (pPCI) and thrombolysis. Data from each study were combined using the random-effects model. Ten studies from January 2011 to October 2018 (2753 patients, 1075 patients with fQRS), were included. The fQRS was associated with higher risk of reperfusion failure in pPCI when defined by ST-segment resolution (OR = 3.08, 95% CI = 1.27-7.46, -value = .013) but not when defined by TIMI flow grade (pooled OR = 1.45, 95% CI = 0.83-2.54, -value = .192). In thrombolysis, fQRS was associated with higher risk of reperfusion failure when defined by both ST-segment resolution (pooled OR = 4.35, 95% CI = 1.80-10.49, -value = .001) and TIMI flow grade (OR = 3.70, 95% CI = 2.10-6.53, -value < .001). The fQRS was also associated with an increased risk of in-hospital mortality in both pPCI (pooled OR = 4.41, 95% CI = 1.60-12.16, -value = .004) and thrombolysis (pooled OR = 2.38, 95% CI = 1.06-5.35, -value = .036). Our meta-analysis demonstrated that fQRS in STEMI patients was associated with reperfusion failure as well as in-hospital mortality.
Topics: Electrocardiography; Hospital Mortality; Humans; Myocardial Reperfusion; Percutaneous Coronary Intervention; Prognosis; Risk Assessment; ST Elevation Myocardial Infarction; Thrombolytic Therapy; Treatment Failure
PubMed: 31021694
DOI: 10.1080/00015385.2019.1584696 -
Interventional Cardiology (London,... Jan 2022Ineffective myocardial perfusion despite angiographic success after angioplasty occurs frequently and is associated with an increased risk of mortality. Hence, this... (Review)
Review
Ineffective myocardial perfusion despite angiographic success after angioplasty occurs frequently and is associated with an increased risk of mortality. Hence, this study determined whether myocardial perfusion measured by myocardial blush grade (MBG) identifies ST-elevation MI (STEMI) patients at high risk for poor outcomes after successful angioplasty. The search employed strategies designed for research databases. An article was eligible if it included adults who underwent coronary angioplasty for STEMI, post-angioplasty MBG was assessed, and mortality or major adverse cardiovascular events (MACE) were determined. Risk for bias was assessed using the Quality In Prognosis Studies tool and forest plots in a Mantel-Haenszel fixed effects model were created using RevMan5.4. Eight observational studies with an overall low risk of bias were included, involving 8,044 patients. MBG 0/1 with no to poor myocardial perfusion had a negative prognostic value for mortality (OR 2.68; 95% CI [2.22-3.23]) and MACE (OR 1.20; 95% CI [1.01-1.41]). Furthermore, MBG 2 with moderate myocardial perfusion and MBG 3 with normal myocardial perfusion were associated with increased survival with a logHR of 0.47 (95% CI [0.43-0.52]) and 0.20 percutaneous coronary intervention (95% CI [0.18-0.23]). These results imply MBG is a useful prognostic marker for STEMI patients. MBG 0/1 after primary angioplasty is a strong negative prognostic marker for long-term all-cause mortality and MACE among STEMI patients, and a post-primary angioplasty MBG of 2 or 3 is a robust prognostic marker for long-term survival.
PubMed: 35923767
DOI: 10.15420/icr.2022.01 -
Journal of Cardiothoracic Surgery May 2021The myocardial infarction is the main cause of morbidity and mortality in cardiovascular diseases around the world. Although the timely and complete reperfusion via...
The myocardial infarction is the main cause of morbidity and mortality in cardiovascular diseases around the world. Although the timely and complete reperfusion via Percutaneous Coronary Intervention (PCI) or thrombolysis have distinctly decreased the mortality of myocardial infarction, reperfusion itself may lead to supererogatory irreversible myocardial injury and heart function disorders, namely ischemia-reperfusion (I/R) injury. Extensive studies have indicated that non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long noncoding RNAs (lncRNAs) and circular RNAs (circRNAs), play important roles in the progress of myocardial I/R injury, which is closely correlative with cardiomyocytes autophagy. Moreover, autophagy plays an important role in maintaining homeostasis and protecting cells in the myocardial ischemia reperfusion and cardiomyocyte hypoxia-reoxygenation (H/R) progress. In this review, we first introduced the biogenesis and functions of ncRNAs, and subsequently summarized the roles and relevant molecular mechanisms of ncRNAs regulating autophagy in myocardial I/R injury. We hope that this review in addition to develop a better understanding of the physiological and pathological roles of ncRNAs, can also lay a foundation for the therapies of myocardial I/R injury, and even for other related cardiovascular diseases.
Topics: Animals; Autophagy; Humans; MicroRNAs; Myocardial Reperfusion Injury; RNA, Circular; RNA, Long Noncoding
PubMed: 34022925
DOI: 10.1186/s13019-021-01524-9 -
Scandinavian Journal of Trauma,... Nov 2014For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart... (Meta-Analysis)
Meta-Analysis Review
The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis.
BACKGROUND
For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.
METHODS
Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.
RESULTS
Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.
CONCLUSION
An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.
Topics: Electrocardiography; Emergency Medical Services; Hospital Mortality; Humans; Myocardial Infarction; Myocardial Reperfusion; Patient Admission; Risk Factors; Time Factors
PubMed: 25420752
DOI: 10.1186/s13049-014-0067-x -
Emergency Medicine Journal : EMJ Nov 2011Oxygen (O(2)) is widely recommended in international guidelines for treatment of acute myocardial infarction (AMI), but there is uncertainty about its safety and... (Meta-Analysis)
Meta-Analysis Review
Oxygen (O(2)) is widely recommended in international guidelines for treatment of acute myocardial infarction (AMI), but there is uncertainty about its safety and benefits. A systematic review and meta-analysis were performed to determine whether inhaled O(2) in AMI improves pain or the risk of death. Cochrane CENTRAL Register of Controlled Trials, MEDLINE, MEDLINE In-Process, EMBASE, CINAHL, LILACS and PASCAL were searched from start date to February 2010. Other sources included British Library ZETOC, Web of Science, ISI Proceedings, relevant conferences, expert contacts. Randomised controlled trials of inhaled O(2) versus air in patients with suspected or proven AMI of < 24 h onset were included. Two authors independently reviewed studies to confirm inclusion criteria met, and undertook data abstraction. Quality of studies and risk of bias was assessed according to Cochrane Collaboration guidance. Main outcomes were death, pain, and complications. Measure of effect used was the RR. Three trials (n=387 patients) were included. Pooled RR of death on O(2) compared to air was 2.88 (95%CI 0.88 to 9.39) on ITT analysis and 3.03 (95%CI 0.93 to 9.83) in confirmed AMI. While suggestive of harm, this could be a chance occurrence. Pain was measured by analgesic use. Pooled RR for the use of analgesics was 0.97 (95%CI 0.78 to 1.20). Evidence for O(2) in AMI is sparse, of poor quality and pre-dates advances in reperfusion and trial methods. Evidence is suggestive of harm but lacks power and excess deaths in the O(2) group could be due to chance. More research is required.
Topics: Acute Disease; Humans; Myocardial Infarction; Oxygen Inhalation Therapy; Randomized Controlled Trials as Topic
PubMed: 21346260
DOI: 10.1136/emj.2010.103564 -
The International Journal of Angiology... Dec 2019Myocardial blush grade (MBG) is an indicator of microvascular perfusion and patency and an independent predictor of cardiac outcomes. QRS duration and fragmented QRS...
Myocardial blush grade (MBG) is an indicator of microvascular perfusion and patency and an independent predictor of cardiac outcomes. QRS duration and fragmented QRS (fQRS) before reperfusion and its changes after reperfusion are shown to be associated with MBG. We aimed to assess the latest evidence on the association between fQRS and QRS duration with MBG in reperfusion therapy. We performed a comprehensive search on the association between fQRS and QRS duration in successful/impaired reperfusion measured by MBG. There were a total of 1,311 patients from six studies. A shorter QRS duration immediately and at 60 minutes after reperfusion attempt was associated with successful reperfusion, with a mean difference (MD) of -10.62 ms ([-15.55, -5.70]; < 0.001; = 69%) and -15.66 ms ([-19.96, -11.37]; < 0.001; = 77%), respectively, and upon sensitivity analysis, with exclusion of a study, heterogeneity decreases to 33 and 0%. QRS narrowing immediately and 60 minutes after reperfusion attempt was correlated with reperfusion, with an MD of -10.72 ([-16.57, -4.88] ; < 0.001; = 97%) and -10.93 ([-14.00, -7.85]; < 0.001; = 97%), lesser in impaired reperfusion, respectively. QRS duration on admission was not associated with reperfusion outcome. Two studies reported that fQRS was associated with impaired perfusion, with an odds ratio of 9.88 ([5.62-17.38]; < 0.0001) and 4.74 ([2.45-9.20]; < 0.0001), respectively. A longer QRS duration immediately and at 60 minutes after reperfusion attempt was associated with impaired perfusion. QRS narrowing after reperfusion attempt was correlated with successful reperfusion. fQRS was also associated with a higher probability of impaired perfusion.
PubMed: 31787825
DOI: 10.1055/s-0039-1694790 -
Shock (Augusta, Ga.) May 2011Myocardial ischemia/reperfusion injury (MI/R) is one of the most prominent topics of contemporary research. The frequent failure of potential therapeutic drugs and... (Review)
Review
Myocardial ischemia/reperfusion injury (MI/R) is one of the most prominent topics of contemporary research. The frequent failure of potential therapeutic drugs and interventions to transfer to clinical practice demonstrates the limitations in using experimental animal models. Because a variety of transgenic animals are readily available in mice, researchers in recent years have made use of murine models rather than of larger animal models for experimental MI/R. This review focuses on in vivo and ex vivo murine models of MI/R and aims to characterize the source of our mechanistic understanding in mice. A systematic review of the literature demonstrated that there is great diversity among ex vivo (Langendorff) and in vivo models of MI/R.
Topics: Animals; Disease Models, Animal; Female; Male; Mice; Mice, Inbred C57BL; Myocardial Reperfusion Injury
PubMed: 21192281
DOI: 10.1097/SHK.0b013e318208af64 -
Frontiers in Pharmacology 2024To evaluate the intervention effect of resveratrol on rat model of myocardial ischemia-reperfusion injury. The relevant studies on the intervention of resveratrol on...
To evaluate the intervention effect of resveratrol on rat model of myocardial ischemia-reperfusion injury. The relevant studies on the intervention of resveratrol on rat models of myocardial ischemia reperfusion injury were searched in PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang and China Science and Technology Journal Database from the start of database establishment to January 2023. Data were extracted from studies that met the inclusion criteria. The results included electrocardiogram (ECG) and myocardial injury markers: ST changes, cardiac troponin I (cTn-I), cardiac troponin T (cTn-T), creatine kinase (CK), creatine kinase-MB (CK-MB) and lactate dehydrogenase (LDH); hemodynamic indicators: heart rate (HR), left ventricular diastolic pressure (LVDP), left ventricular end-diastolic pressure (LVEDP), left ventricular systolic pressure (LVSP), maximum rate of increase of left ventricular pressure (+dp/dtmax), maximum rate of decrease of left ventricular pressure (-dp/dtmax); oxidative damage indicators: nitric oxide (NO), reactive oxygen species (ROS), superoxide dismutase (SOD), malondialdehyde (MDA); inflammatory factors: tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6); apoptosis index: B-cell lymphoma-2 (Bcl-2), BCL2-Associated X (Bax), cardiomyocyte apoptosis index (AI); heart tissue structure: myocardial infarction size. Finally, a meta-analysis of these results was conducted. The methodological quality of the studies was assessed using the SYRCLE Bias Risk tool. A total of 43 studies were included in the meta-analysis, and the quality of the included studies was assessed. It was found that the evidence quality of these 43 studies was low, and no study was judged to have low risk bias in all risk assessments. The results showed that resveratrol could reduce ST segment, cTn-I, cTn-T, CK, CK-MB, LDH, LVEDP, ROS, MDA, TNF-α, IL-6, AI levels and myocardial infarction size. HR, LVDP, LVSP, +dp/dtmax, NO, Bcl-2, and SOD levels were increased. However, resveratrol had no significant effect on -dp/dtmax and Bax outcome measures. Resveratrol can reduce ST segment in rat model of myocardial ischemia-reperfusion injury, alleviate myocardial injury, improve ventricular systolic and diastolic ability in hemodynamics, reduce inflammatory response and oxidative damage, and reduce myocardial necrosis and apoptosis. Due to the low quality of the methodologies included in the studies, additional research is required.
PubMed: 38313308
DOI: 10.3389/fphar.2024.1301502