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International Journal of Cardiology Oct 2022Contemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited.
INTRODUCTION
Contemporary data on the epidemiology of acute myocardial infarction (AMI) in Vietnam are extremely limited.
METHODS
We established population-based registries of residents from 2 provinces in a northern urban (Hai Phong), and a central rural (Thanh Hoa), province of Vietnam hospitalized with a validated first AMI in 2018. We described patient characteristics, in-hospital management and clinical complications, and estimated incidence rates of AMI in these two registries.
RESULTS
A total of 785 patients (mean age = 71.2 years, 64.7% men) were admitted to the two hospitals with a validated first AMI. Approximately 64% of the AMI cases were ST-segment-elevation AMI. Patients from Thanh Hoa compared with Hai Phong were more likely to delay seeking acute hospital care. The incidence rates (per 100,000 population) of initial AMI in Thanh Hoa and Hai Phong were 16 and 30, respectively. Most patients were treated with aspirin (Thanh Hoa: 96%; Hai Phong: 90%) and statins (both provinces: 91%) during their hospitalization. A greater proportion of patients in Hai Phong (69%) underwent percutaneous revascularization than those in Thanh Hoa (58%). The most common in-hospital complications were heart failure (both provinces:12%), cardiogenic shock (Thanh Hoa: 10%; Hai phong: 7%); and cardiac arrest (both provinces: 9%). The in-hospital case-fatality rates for patients from Thanh Hoa and Hai Phong were 6.8% and 3.8%, respectively.
CONCLUSIONS
The incidence and hospital case-fatality rates of AMI were low in two Vietnamese provinces. Extent of pre-hospital delay and in-hospital use of evidence-based therapies were suboptimal, being more prominent in the rural province.
Topics: Aged; Female; Hospital Mortality; Hospitals; Humans; Male; Myocardial Infarction; ST Elevation Myocardial Infarction; Shock, Cardiogenic; Vietnam
PubMed: 35716944
DOI: 10.1016/j.ijcard.2022.06.044 -
The American Journal of Medicine May 2015Lowering the diagnostic threshold for troponin is controversial because it may disproportionately increase the diagnosis of myocardial infarction in patients without...
BACKGROUND
Lowering the diagnostic threshold for troponin is controversial because it may disproportionately increase the diagnosis of myocardial infarction in patients without acute coronary syndrome. We assessed the impact of lowering the diagnostic threshold of troponin on the incidence, management, and outcome of patients with type 2 myocardial infarction or myocardial injury.
METHODS
Consecutive patients with elevated plasma troponin I concentrations (≥50 ng/L; n = 2929) were classified with type 1 (50%) myocardial infarction, type 2 myocardial infarction or myocardial injury (48%), and type 3 to 5 myocardial infarction (2%) before and after lowering the diagnostic threshold from 200 to 50 ng/L with a sensitive assay. Event-free survival from death and recurrent myocardial infarction was recorded at 1 year.
RESULTS
Lowering the threshold increased the diagnosis of type 2 myocardial infarction or myocardial injury more than type 1 myocardial infarction (672 vs 257 additional patients, P < .001). Patients with myocardial injury or type 2 myocardial infarction were at higher risk of death compared with those with type 1 myocardial infarction (37% vs 16%; relative risk [RR], 2.31; 95% confidence interval [CI], 1.98-2.69) but had fewer recurrent myocardial infarctions (4% vs 12%; RR, 0.35; 95% CI, 0.26-0.49). In patients with troponin concentrations 50 to 199 ng/L, lowering the diagnostic threshold was associated with increased healthcare resource use (P < .05) that reduced recurrent myocardial infarction and death for patients with type 1 myocardial infarction (31% vs 20%; RR, 0.64; 95% CI, 0.41-0.99), but not type 2 myocardial infarction or myocardial injury (36% vs 33%; RR, 0.93; 95% CI, 0.75-1.15).
CONCLUSIONS
After implementation of a sensitive troponin assay, the incidence of type 2 myocardial infarction or myocardial injury disproportionately increased and is now as frequent as type 1 myocardial infarction. Outcomes of patients with type 2 myocardial infarction or myocardial injury are poor and do not seem to be modifiable after reclassification despite substantial increases in healthcare resource use.
Topics: Aged; Female; Humans; Incidence; Length of Stay; Male; Middle Aged; Myocardial Infarction; Troponin I
PubMed: 25436428
DOI: 10.1016/j.amjmed.2014.10.056 -
Journal of the Royal College of... 1994A conference on myocardial infarction (MI) was held at the Royal College of Physicians on 6 June 1994, organised by Dr K S Channer. The management of myocardial...
A conference on myocardial infarction (MI) was held at the Royal College of Physicians on 6 June 1994, organised by Dr K S Channer. The management of myocardial infarction has changed dramatically in the last few years with the introduction of effective measures to reduce early mortality and improve longterm prognosis. The purpose of this conference was to review these approaches and determine how they may be introduced into practice. The conference was divided into three sections: preventing myocardial infarction, acute intervention at the time of infarction, and preventing reinfarction.
Topics: Humans; Myocardial Infarction; Recurrence; Risk Factors
PubMed: 7884718
DOI: No ID Found -
The American Journal of Medicine Feb 2022Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary...
BACKGROUND
Perioperative myocardial infarction is frequently attributed to type 2 myocardial infarction, a mismatch in myocardial oxygen supply-demand without unstable coronary artery disease. Our aim was to identify characteristics, management, and outcomes of perioperative type 1 versus type 2 myocardial infarction among surgical inpatients.
METHODS
Adults age ≥45 years hospitalized for noncardiac surgery were identified in the United States. Perioperative myocardial infarction were identified using International Classification of Diseases, 10th revision (ICD-10) codes. Clinical characteristics, invasive myocardial infarction management, mortality, and readmissions were assessed by myocardial infarction subtype.
RESULTS
Among 4,755,382 surgical hospitalizations, we identified 38,975 perioperative myocardial infarctions (0.82%), with type 2 infarction in 42%. Patients with type 2 myocardial infarction were older, more likely to be women, and less likely to have cardiovascular comorbidities compared with type 1 myocardial infarction. Fewer patients with type 2 myocardial infarction underwent invasive management than type 1 myocardial infarction (6.7% vs 28.8%, P < .001). Type 2 myocardial infarction mortality was lower than type 1 myocardial infarction mortality (12.1% vs 17.4%, P < .001; adjusted odds ratio [aOR] 0.51, 95% confidence interval [CI] 0.45-0.59). Invasive management of perioperative myocardial infarction was associated with lower mortality in type 1 (aOR 0.56, 95% CI 0.49-0.74) but not type 2 (aOR 1.19, 95% CI 0.77-1.85) myocardial infarction. Among survivors, there was no difference in 90-day hospital readmission between type 2 and type 1 perioperative myocardial infarction (36.5% vs 36.1%, P = .72).
CONCLUSIONS
Type 2 myocardial infarctions account for approximately 40% of perioperative myocardial infarctions. Patients with type 2 perioperative myocardial infarction are less likely to undergo invasive management and have lower mortality compared with those with type 1 perioperative myocardial infarction.
Topics: Female; Humans; Male; Myocardial Infarction; Perioperative Period; Risk Factors; Surgical Procedures, Operative; Treatment Outcome; United States
PubMed: 34560032
DOI: 10.1016/j.amjmed.2021.08.028 -
BMC Cardiovascular Disorders Aug 2023The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In...
BACKGROUND
The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI).
METHODS
From the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up.
RESULTS
An IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73-11.85] ng/ml vs. 1.99 [0.55-5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63-212] hours vs. 83 [43-163] hours, p-value = 0.005; 250 [128-435] hours vs. 170 [86-294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455-3208] ml vs. 1915 [1110-2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70-1.54, p-value = 0.851).
CONCLUSION
IABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.
Topics: Humans; Shock, Cardiogenic; Percutaneous Coronary Intervention; Myocardial Infarction; Heart-Assist Devices; Hospitals
PubMed: 37644466
DOI: 10.1186/s12872-023-03465-8 -
Internal Medicine (Tokyo, Japan) Jan 2021
Topics: Adolescent; Female; Humans; Myocardial Infarction; Schools; Sex Factors
PubMed: 32921694
DOI: 10.2169/internalmedicine.5883-20 -
Henry Ford Hospital Medical Journal 1991Non-Q wave myocardial infarction is a distinct and changing clinical entity characterized by lower initial mortality and a higher rate of reinfarction compared to Q wave... (Review)
Review
Non-Q wave myocardial infarction is a distinct and changing clinical entity characterized by lower initial mortality and a higher rate of reinfarction compared to Q wave infarction. Clinical and pathologic data suggest that the syndrome results from transient or incomplete coronary occlusion resulting in an infarct which is smaller than when Q waves are present. High-risk patients can be identified during hospitalization, allowing for aggressive therapy aimed at revascularization. Relatively few clinical trials have examined initial therapy or secondary prevention in this group of patients. These studies are reviewed and management guidelines suggested.
Topics: Algorithms; Electrocardiography; Humans; Myocardial Infarction; Prognosis; Risk Factors
PubMed: 1804833
DOI: No ID Found -
Journal of Accident & Emergency Medicine Mar 1996The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific... (Review)
Review
The effective early diagnosis of acute myocardial infarction still rests primarily on the clinical history and the electrocardiogram. ST segment elevation is specific though sometimes short lived and less than ideally sensitive; but with bundle branch block it defines a population that benefits importantly from thrombolysis. Novel electrode configurations can further enhance diagnosis but have not become popular. Biochemical markers are rarely of help in the first four hours and cardiac scanning is impractical for routine care. Computerised diagnostic systems show promise in prototype but are not widely available. Early management involves reestablishing coronary flow by thrombolytic and antithrombotic agents and reducing myocardial oxygen requirement by analgesics and beta blockers. Nitrates and magnesium have limited roles. Immediate access to defibrillation and advanced life support is mandatory. Diagnosis and management can only begin after help has been sought. Public alertness to the symptoms of myocardial infarction and a coordinated response by health care personnel are fundamental to successful care.
Topics: Biomarkers; Creatine Kinase; Electrocardiography; Humans; Isoenzymes; Myocardial Infarction; Thrombolytic Therapy
PubMed: 8653254
DOI: 10.1136/emj.13.2.74 -
Journal of the American College of... Feb 1983Because hypertension and myocardial infarction are closely linked in several ways, a better understanding of this relation leads to more effective prophylaxis and... (Clinical Trial)
Clinical Trial
Because hypertension and myocardial infarction are closely linked in several ways, a better understanding of this relation leads to more effective prophylaxis and management. Management should be directed at three different areas: 1) the prevention of a first myocardial infarction, 2) the prevention of complications after an infarction, and 3) the management of hypertension during evolution of an acute infarction. There is good evidence that beta-receptor blocking agents are beneficial to long-term management. When therapy is required in the acute situation, arteriolar vasodilators are to be avoided and combined arteriolar/venular dilators are the drugs of choice.
Topics: Antihypertensive Agents; Blood Pressure; Clinical Trials as Topic; Humans; Hypertension; Myocardial Infarction
PubMed: 6338085
DOI: 10.1016/s0735-1097(83)80084-9 -
BMC Cardiovascular Disorders Jul 2016Conflicting reports on the efficacy of intra-aortic balloon pump (IABP) during percutaneous coronary intervention (PCI) incited us to evaluate the utility of IABP in... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Conflicting reports on the efficacy of intra-aortic balloon pump (IABP) during percutaneous coronary intervention (PCI) incited us to evaluate the utility of IABP in patients with acute myocardial infarction (AMI).
METHODS
Randomized clinical trials comparing patients, who received IABP vs. control (no IABP) during PCI, were hand-searched from MEDLINE, Cochrane, and EMBASE databases using the terms "intra-aortic balloon pump, percutaneous coronary intervention, myocardial infarction, acute coronary syndrome". Mortality rate (30-day and 6-month mortality) was the primary outcome, while the secondary outcomes included 30-day bleeding rate, reinfarction rate, revascularization rate and stroke rate.
RESULTS
Pooled results of the seven trials identified indicated that the 30-day and 6-month mortality rate were not significantly different between the IABP and control groups. However, in patients with MI, but without cardiogenic shock (CS), IABP was associated with lower odds of 30-day mortality (OR = 0.35, p = 0.015) and 6-month mortality (OR = 0.41, p = 0.020). The pooled results of 30-day bleeding rate was not significantly higher in patients with IABP than the control group, but for the patients with high risk PCI without CS, it was higher in patients with IABP than the control group (OR = 1.58, p = 0.009). The re-infarction, revascularization, and the stroke rate at 30 days of follow-up were not significantly different between the two groups.
CONCLUSIONS
The present results do not favor the clinical utility of IABP in patients suffering high-risk PCI without CS and AMI complicated with CS. However, in patients with AMI, but without CS, IABP may reduce the 30-day and 6-month mortality rate.
Topics: Heart-Assist Devices; Humans; Intra-Aortic Balloon Pumping; Myocardial Infarction; Shock, Cardiogenic; Treatment Outcome
PubMed: 27391391
DOI: 10.1186/s12872-016-0323-2