Successful Aging in Research
Thomas S. Inui, Richard M. Frankel in Enhancing the Professional Culture of Academic Health Science Centers, 2022
When I was a third-year medical student, the Hypertension Detection and Follow-up program reported that the treatment of hypertension using a step-care approach that included high-dose diuretics as the first-line agent reduced total mortality. That finding represented powerful prevention. Yet only one randomized trial had compared various first-line agents for the treatment of hypertension in terms of the prevention of major cardiovascular events such as myocardial infarction. My first case-control study at GHC involved an observational study of the comparison between high-dose diuretics and beta-blockers. This early effort in comparative effectiveness research was driven by the epidemiological need to control for confounding by indication. Additionally, we were interested in both the potential benefits and risks of drug therapies. The advantage of the computerized pharmacy records became apparent in a secondary analysis when we showed that non-compliance with beta-blockers was associated with a transient increase in the risk of MI.1
Current status of fibrinolytic therapy
K Sarat Chandra, AJ Swamy in Acute Coronary Syndromes, 2020
ST-elevated myocardial infarction remains one of the major public health problems, the incidence of which is on the rise all over the world, especially in developing countries, despite advancement in the diagnosis and management. Over the years, the primary mode of care of STEMI patients has changed from a primary pharmacologic strategy to a catheter-based one. Progressive loss of myocyte after a STEMI is linearly related to the duration of occlusion of infarct related artery. Hence, the goal of therapy of such patients is to do reperfusion of the occluded artery at the earliest. For most patients of STEMI, primary PCI is the preferred option. RCTs have shown that if time delay is similar, then primary PCI is superior to fibrinolysis in reducing mortality, reinfarction and stroke [1–5]. Fibrinolytic therapy is to be offered in a timely manner (in absence of any contraindications) to all patients who do not have the option of primary PCI, especially if they present early in their window period. As the time of presentation increases, the efficacy and clinical benefit of fibrinolytic therapy decreases [7]. It can prevent 30 deaths out of 1000 patients treated within 6 hours of onset of AMI [6]. Such pharmacologic therapy is capable of establishing antegrade flow in 75% of cases. However, there is 30% chance of re-occlusion after fibrinolysis alone.
Answers
Andrew Schofield, Paul Schofield in The Complete SAQ Study Guide, 2019
The major risk factors for ischaemic heart disease are smoking, hypertension, diabetes and hypercholesterolaemia. For the diagnosis of myocardial infarction, two of the following are required: cardiac-sounding chest pain, positive ECG changes and raised biochemical markers. If the ECG shows ST elevation, the diagnosis is an ST-segment elevation myocardial infarction (STEMI). If the cardiac enzymes are raised and the chest pain sounds cardiac, the diagnosis is a non-ST-segment elevation myocardial infarction (NSTEMI). Both are encompassed by the term acute coronary syndrome (ACS), as is unstable angina. This is angina of new onset, angina that is increasing in severity or frequency or angina that comes on with minimal exertion or at rest. Cardiac chest pain is often described as a crushing or heavy central pain and may radiate to the neck/jaw or arms. Many centres now offer 24-hour PCI, and this is the treatment of choice for the majority of patients. Following a myocardial infarction, patients should be taking aspirin, an ACE inhibitor, a β-blocker and a statin as long as there are no contraindications. In addition to these, clopidogrel should be taken for 1 year if PCI has been performed. Nonpharmacological measures also play a significant role, including cardiac rehabilitation programmes, smoking cessation, encouraging weight loss and dietary changes.
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].
Lower ST-elevation myocardial infarction incidence during COVID-19 epidemic in Northern Europe
Published in Scandinavian Cardiovascular Journal, 2020
Jarkko Piuhola, Risto Kerkelä, Mika Laine, Geir Øystein Andersen, Andrejs Ērglis, Indulis Kumsārs, Leif Thuesen, Juha Sinisalo, Matti Niemelä, M. Juhani Junttila
Our aim was to determine the incidence of ST-elevation myocardial infarction (STEMI) during the COVID-19 pandemic in four Northern European countries. We focused on STEMI since non ST-elevation myocardial infarction (NSTEMI) is a heterogenous patient group regarding diagnosis and etiology. Furthermore, fear of contracting COVID-19 infection may make some NSTEMI patients reluctant to go to the hospital during the pandemic. STEMI patients have more severe symptoms and are more likely to seek medical attention. In Nordic countries, public health care is widely available and the issue of cost is not a factor in seeking treatment. This also makes the analysis of patient numbers reliable in tertiary centers in this study. To determine the seasonal variation in STEMI incidence during influenza and other respiratory viral infection season and the effects of COVID-19 pandemic, we collected the incidence of STEMI from five different tertiary centers performing primary PCI (Oulu, Finland; Helsinki, Finland; Oslo, Norway; Aalborg, Denmark; Riga, Latvia) from January to March 2017–2020. The data were collected from local angiographic registries in each center. We compared the STEMI incidence during COVID-19 pandemic (March 2020) to January-February 2020 and to the same time period in earlier years 2017–2019. We used one-way ANOVA test to calculate p-value for proportional change of overall average incidence compared to the incidence in March 2020 (SPSS version 21; IBM Corp., Armonk, NY).
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