China
Africa
Explore chapters and articles related to this topic
PCI post-thrombolysis
Published in K Sarat Chandra, AJ Swamy, Acute Coronary Syndromes, 2020
ST-elevation myocardial infarction (STEMI) is a medical emergency and timely revascularisation is essential for reducing the infarct size and improving short-term and long-term outcomes. Thrombolysis and primary percutaneous coronary intervention (PCI) are the two most commonly used strategies to achieve timely reperfusion. Evidence from many trials underlines the superiority of primary PCI over thrombolysis in the management of ST-elevation myocardial infarction (STEMI) [1]. Primary PCI is superior to thrombolysis strategy in reducing myocardial ischaemia, reinfarction, death, intracranial bleeding and re-occlusion of the infarct-related artery in STEMI patients irrespective of the patient's risk or whether inter-hospital transfer for PCI is required [1]. As compared to thrombolysis, PCI is able to preserve the myocardium and improve clinical outcomes over a wider window period following symptom onset and is the treatment of choice for patients who present early or late after symptom onset.
Medical management of the cardiac patient undergoing coronary angiography
Published in John Edward Boland, David W. M. Muller, Interventional Cardiology and Cardiac Catheterisation, 2019
Sara Hungerford, Peter Ruchin, Gerard Carroll
Indeed, since the early pioneering days of coronary angioplasty, multiple randomised trials have now shown that PCI enhances survival and results in a lower rate of intracranial haemorrhage and recurrent myocardial infarction (MI) compared to fibrinolysis.4 As such, the American College of Cardiology Foundation/American Heart Association guideline for the management of ST-elevation myocardial infarction recommends use of primary percutaneous coronary intervention (PCI) for any patient with an acute ST-elevation myocardial infarction who can undergo the procedure in a timely manner by persons skilled in the procedure.5 Timely is defined as an ideal first medical contact to PCI time of 90 minutes or less for patients transported to PCI-capable hospital, or 120 minutes or less for patients who initially arrive at or are transported to a non-PCI capable hospital and are then taken to a PCI-capable hospital. For patients presenting with ST-elevation myocardial infarction 12–14 hours after symptom onset, randomised trials of routine late PCI have shown an improvement in left ventricular function, but not in hard clinical outcomes. If primary PCI cannot be achieved in a timely manner (i.e. <90 minutes from patient arrival to balloon angioplasty), then systemic lysis is preferred to ensure timely reperfusion. Lysis remains the reperfusion strategy of choice in the setting of excessive distance or anticipated prolonged ‘door-to-balloon’ time.
Diagnosis of coronary heart disease in the elderly
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Wilbert S. Aronow, Jerome L. Fleg
The Copenhagen Heart Study obtained ECGs in 6991 asymptomatic participants without cardiovascular disease at age 65 years and older (70). At 9.8-year follow-up, patients with an ECG abnormality increased fatal cardiovascular events by 33% (p < 0.001) and fatal or nonfatal cardiovascular events by 21% (p < 0.001) (70). In a study of 131 patients, mean age 64 years, with acute myocardial infarction and angiographic single-vessel obstructive CHD, 29 patients (22%) had ST-elevation myocardial infarction (STEMI), and 102 patients (78%) had non-ST-elevation myocardial infarction (NSTEMI) (71). Eleven of 11 patients (100%) with anterior STEMI diagnosed by ECG had left anterior descending artery obstructive disease (71). Of 18 patients with inferior STEMI diagnosed by ECG, 14 patients (78%) had right coronary artery obstructive disease, 3 patients (17%) had left circumflex artery obstructive disease, and 1 patient (5%) had left anterior descending artery obstructive disease (71). Of 102 NSTEMI patients, 53 (52%) had definite ischemic abnormalities (71%). Of 31 patients with anterior definite ECG ischemic abnormalities, 30 (97%) had left anterior descending artery obstructive CHD, and 1 (3%) had right coronary artery obstructive CHD (71).
Practice and long-term outcome of unprotected left main PCI: real-world data from a nationwide registry
Published in Acta Cardiologica, 2022
Peter Kayaert, Mathieu Coeman, Claude Hanet, Marc J. Claeys, Walter Desmet, Michel De Pauw, Steven Haine, Yves Taeymans
Table 2 summarises the indication for PCI in the non-LM and LM cohort. Indications were categorised as ST-elevation myocardial infarction (‘STEMI’), non-STEMI (‘NSTEMI’), ‘emergent PCI’ for unstable angina and ‘elective’. For the further outcome analysis, all LM PCI patients except from the ‘elective’ category were considered to have an urgent indication. However, in line with the QERMID eCRF, the STEMI indication was subdivided into ‘urgent PCI’, ‘rescue PCI’ (after failed thrombolysis), ‘late PCI’ (>12 h after symptom onset), and ‘non-urgent PCI’ (>12 but <24 h after symptom onset). The NSTEMI indication was subdivided into ‘elective PCI’ and ‘late PCI’ (>72 h after symptom onset). As the measurement of troponin levels over time became a routine practice in patients with unstable angina, it is likely that some of the patients categorised as ‘emergent’, would have been categorised as NSTEMI if the troponin level would have been available at that time. Likewise, some other ‘emergent’ patients may have been more stable and categorised as ‘elective’, if troponin was normal.
Prognostic impact of bundle branch blocks in patients with ST-segment elevation myocardial infarction
Published in Acta Cardiologica, 2021
Flora Ozkalayci, Erdem Turkyilmaz, Bernas Altıntaş, Ozgur Yasar Akbal, Ali Karagoz, Can Yucel Karabay, İbrahim Halil Tanboga, Vecih Oduncu
ST-elevation myocardial infarction was defined as; ongoing ischaemic chest pain accompanied by persistent ST elevation ≥0,25mV in men below the age of 40 years, ≥0,2mV in men over the age of 40 years, or ≥0,15mV in women in leads V2-3 and/or ≥0,1mV in other leads measured at least two contiguous derivations (in the absence of left ventricular hypertrophy or LBBB), or a new onset LBBB [12]. ST-elevation MI in the presence of LBBB was defined according to the Sgarbossa criteria [13]. Left BBB was described as widened QRS complex (QRS ≥120msn), monomorphic R wave in D1, V5,6, ST and T wave displacement opposite to the major deflection of the QRS complex, absence of Q waves in lead I, V5, V6 while RBBB was defined as widened QRS complex (QRS ≥120msn), slurred S waves in leads D1, aVL and V5,6, rSR’ in V1-3 [14].
Impact of plaque burden and composition on coronary slow flow in ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention: intravascular ultrasound and virtual histology analysis
Published in Acta Cardiologica, 2021
Sreenivas Reddy, Raghavendra Rao K, Jeet Ram Kashyap, Vikas Kadiyala, Hithesh Reddy, Samir Malhotra, Ramesh Daggubati, Suraj Kumar, Hariom Soni, Naindeep Kaur, Jaspreet Kaur, Vadivelu Ramalingam
Percutaneous coronary intervention (PCI) has become the accepted standard of care in the management of acute ST-elevation myocardial infarction (STEMI) [1–3]. A varying number of patients fail to achieve thrombolysis in myocardial infarction (TIMI) III flow in STEMI mainly because of coronary slow flow (SF). The incidence of coronary SF in patients with STEMI undergoing PCI ranges widely from 11% to 45% [4–7]. The occurrence of SF increases not only the in-hospital mortality but also 6 months and long-term mortality [8–11]. The exact mechanism responsible for SF has not been identified but various mechanisms have been proposed like ischemic–reperfusion injury, atherothrombotic distal embolisation, and individual predisposition of coronary microcirculation, making it a multifactorial pathogenesis [12–14]. In view of the significant short-term and long-term morbidity as well as mortality associated with SF, it is of pivotal importance to identify its predictors in patients with STEMI planned for PCI to help the clinician to identify the high-risk patients and adopt aggressive therapeutic strategies so as to decrease the occurrence of SF and improve clinical outcomes [9].