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Current outcomes and outcome measures in acute coronary syndrome
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
Dinkar Bhasin, Shaheer Ahmed, Nitish Naik
Aggressive management of STEMI has been associated with improvements in both short-term and long-term outcomes. Immediate reperfusion with an invasive strategy is superior to fibrinolytic therapy. Many clinical trials have demonstrated superiority of routine early percutaneous intervention of the culprit artery in patients who receive fibrinolysis. Outcomes are superior if patients receive early reperfusion therapy as myocardial salvage is best within the first few hours. Relevant clinical outcomes in STEMI are outlined in Table 3.1.
Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
Early recognition of hemorrhagic transformation of a stroke is critical. It is a major complication of reperfusion therapy such as thrombolysis and tends to occur 12–24 hours following treatment. An initial CT brain scan is performed to diagnose stroke and may have involved contrast to assess related vessels. In the follow-up scan, differentiating acute hemorrhage from residual contrast from the initial scan, can pose a diagnostic challenge in single energy non-contrast CT. DECT can help accurately distinguish intraparenchymal hemorrhage from iodinated contrast medium, by means of iodine mapping (Gupta et al. 2010) (Figure 3.3).
Emergencies
Published in Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson, Pocket Prescriber Psychiatry, 2019
Jonathan P Rogers, Cheryl CY Leung, Timothy RJ Nicholson
Reperfusion therapy: Primary PCI is the preferred option, if unavailable or CI consider thrombolysis. NB: Starting one or the other ASAP is paramount (‘time = myocardium’!) ∴ if appropriate, initiate/organise during previously mentioned steps.
Tongguan capsule for treating myocardial ischemia-reperfusion injury: integrating network pharmacology and mechanism study
Published in Pharmaceutical Biology, 2023
Jiantao Liu, Chunping Liu, Huiqi Chen, Huan Cen, Hailong Yang, Peijian Liu, Fang Liu, Liuling Ma, Quanfu Chen, Lei Wang
Reperfusion therapy is a milestone achievement in the management of acute myocardial infarction (AMI) (Lee and Hanif 2018). Early reperfusion therapy can restore blood flow through the occluded coronary artery immediately upon diagnosis, thus protecting heart function and improving the prognosis of patients with AMI (Vogel et al. 2019). However, even if the arterial stenosis or occlusion is relieved, some patients experience slow coronary blood flow, suggesting cardiac microvascular disorder (Kumar et al. 2019; Wang et al. 2020a, 2020b). In addition, ischemia-reperfusion (I/R) causes functional damage of endothelial cells, which is the crucial mechanism of microvascular diseases (Zhou and Toan 2020; Wang et al. 2020a). Therefore, endothelial homeostasis is critical for alleviating myocardial ischemia-reperfusion injury (MIRI) (Davidson et al. 2019).
Prehospital Time Disparities for Rural Patients with Suspected STEMI
Published in Prehospital Emergency Care, 2023
Jason P. Stopyra, Remle P. Crowe, Anna C. Snavely, Michael W. Supples, Nathan Page, Zachary Smith, Nicklaus P. Ashburn, Kristie Foley, Chadwick D. Miller, Simon A. Mahler
Every year, approximately 172,000 people in the United States have ST-elevation myocardial infarctions (STEMI) (1). Coronary artery disease continues to be among the leading causes of death worldwide (2). Along the spectrum of acute coronary syndrome, STEMI is the most severe presentation and carries a 30-day mortality rate approaching 12% (3). Reperfusion therapy is the mainstay of treatment for STEMI, either by percutaneous coronary intervention (PCI) or thrombolytics (4). Since time to reperfusion is determinative of STEMI outcomes, the American College of Cardiology (ACC) and American Heart Association (AHA) established a 90-minute goal from first medical contact (FMC) to PCI (1,5). For the 50 million Americans who live in rural areas and are therefore farther away from PCI centers, the 90-minute FMC-to-PCI time goal is more challenging to accomplish.
Relationship between lipoprotein(a) and revascularization after percutaneous coronary intervention in type 2 diabetes mellitus patients with acute coronary syndrome
Published in Current Medical Research and Opinion, 2022
Yan Hao, Yulin Yang, Yongchao Wang, Jian Li
The development of atherosclerotic cardiovascular disease (ASCVD) is associated with many risk factors, among which diabetes is an important risk factor [1]. Patients with diabetes are more likely to have diffuse multivessel disease on coronary angiography and a worse prognosis than those without diabetes. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are the two main methods of reperfusion therapy for acute coronary syndrome (ACS). Diabetic patients with coronary cardiovascular disease had a higher incidence of adverse events after PCI than after CABG [2], which is closely related to the need for repeated revascularization. Currently, CABG is preferred for the treatment of ACS patients with diabetes mellitus and complex coronary artery disease. However, CABG has limited use due to its considerable trauma, high cost and short-term surgical complications in patients with diabetes, such as stroke, renal failure, and deep sternal wound infection. A survey showed that the rates of CABG treatment were low among patients with diabetes mellitus complicated with multivessel coronary artery disease; in contrast, the proportional use of PCI has been slowly increasing [3]. Therefore, an indicator that allows the accurate and early identification of high-risk patients is of great importance in formulating revascularization strategies.