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PubMed2003

[Application of risk stratification scores in acute myocardial infarction. Results of RICO (observation of infarction in the Ivory Coast)].

Several risk stratification scores for myocardial infarction have been developed in recent years, based on clinical trials. The object of this study was to assess the application of these scores in an unselected population of myocardial in farction in a French department. One thousand and fifty-four patients with acute myocardial infarction were included in the RICO observatory in the Côte d'Or. Those with ST elevation (SST), N = 746, had 30 day-mortality rates which increased with the TIMI and GUSTO scores (khi2 tendency, p < 0.001). There was a good discriminatory power of both these scores (correlations of 0.71 and 0.69 respectively). Similarly, logistic regression analysis showed a significant relationship between TIMI and GUSTO scores and 30 day mortality (p < 0.001). No correlation was observed between mortality and increased TIMI score in cases of infarction without ST elevation, N = 308, p = 0.344. Moreover, this score had a low discriminatory value in the study population with a correlation of 0.54. On the other hand, regression analysis showed a strong predictive value of the PURSUIT score in infarction without ST elevation for mortality. In addition, there was a correlation between death and the value of this score (p < 0.05). This score also showed a good discriminatory power with a correlation of 0.71. This study shows that, in an unselected population, risk stratification scores may be used as a routine in myocardial infarction, especially in cases with ST elevation.

Aged↗
PubMed1992

[Verapamil therapy improves the prognosis after acute myocardial infarction. A review over the Danish studies of verapamil therapy during and after acute myocardial infarction].

The effect of verapamil therapy in a dosage of 120 thrice daily on the mortality and re-infarction from the time of admission and for the subsequent six months was investigated in a double-blind, randomized, placebo-controlled, multicentre investigation (The Danish Verapamil Infarction Trial (DAVIT I)). Seven hundred and seventeen patients were treated with verapamil and 719 with placebo. The mortalities after six months were 12.8% in the verapamil group and 13.9% in the placebo group (NS) and re-infarction occurred in 7.0% and 8.3%, respectively (NS). The effect of verapamil on the mortality and major events, i.e. death or the first re-infarction from the second week after an acute myocardial infarction was investigated in a double-blind, randomized, placebo-controlled, multicentre investigation (DAVIT II) in which 878 patients commenced treatment with verapamil in a dosage of 360 mg daily and 897 patients received a placebo. This treatment was continued for up to 18 months, on an average for 16 months. Ninety-five patients died and 146 major events were registered in the verapamil group while 119 died and 180 major events occurred in the placebo group. The 18 months mortality rates were 11.1 and 13.8% (hazard ratio 0.80, 95% confidence limits 0.63-1.05, p = 0.11) and the major event rates were 18.0 and 21.6% (0.80, 0.64-0.99, p = 0.03) in the verapamil and placebo groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Denmark↗
PubMed1991

[Right ventricular infarction following acute inferior myocardial infarction confirmed by dual isotope single photon emission computed tomography (SPECT) of [99mTc] pyrophosphate and [201Tl] chloride].

A 56-year-old man, complaining of severe substernal chest pain, was admitted. In this patient, right ventricular infarction following by acute inferior myocardial infarction was suggested by serial enzymes, electrocardiogram, echocardiogram, and hemodynamic data, but it was not confirmed. A dual isotope SPECT with 99mTc-pyrophosphate and 201Tl-Cl was performed and color-coded tomograms were obtained. It showed a characteristic image of right ventricular infarction, especially in the short axis view right ventricular infarction looked like shape of a tongue which protruded from left ventricle. We concluded that though the diagnosis of right ventricular infarction is difficult, a dual isotope SPECT is a useful method because it shows a characteristic image.

Diphosphates↗
PubMed2006

Peri-infarct reorganization of motor function in patients with pontine infarct.

OBJECTIVES: Combined functional MRI (fMRI) and diffusion tensor tractography (DTT) imaging provides a powerful vehicle for the investigation of motor recovery mechanisms. Using this combined method, we investigated the motor recovery mechanism in patients with pontine infarct. DESIGN: We evaluated six healthy control subjects and two patients with pontine infarct at 6 months from onset. fMRI was performed at 1.5 T with timed hand grasp-release movements. For DTT, we used each of the 32 noncollinear diffusion-sensitizing gradients. Three-dimensional reconstructions of the fiber tracts were obtained with FA <0.3, angle >45 degrees as termination criteria. RESULTS: fMRI data revealed activation only in the contralateral primary sensorimotor cortex during movement of either hand. DTI findings from controls and the unaffected hemisphere of the patients showed that the corticospinal tract descended through the known corticospinal tract pathway. However, the tracts of the affected hemisphere in the patients were observed to pass along peri-infarct areas (patient 1: lateral, patient 2: posterior) in the pons. CONCLUSIONS: It seems that the peri-infarct areas compensate for corticospinal tract damage at the pons; this may be one mechanism of motor recovery for patients with pontine infarct.

Adult↗
PubMed1975

Direct revascularization of acute myocardial infarction by implantation of left internal mammary artery into infarcted left ventricular myocardium.

This is a preliminary report. Clearly, the internal mammary artery implanted into the infarcted anterolateral portion of the wall of the left ventricle has been of help in decreasing the size of the infarction and in maintaining the life of the dogs and normal function six hours after a large left ventricular wall myocardial infarction had been created. More animals need to be studied at the end of six hours, eight hours, and ten hours after implantation. More studies are needed to learn if ligation of the coronary veins at the same time as the arteries is beneficial or not. Two internal mammary arteries may act better than one when implanted side by side into a 5 by 5 centimeter infarction. In man, both internal mammary arteries and the right gastroepiploic artery could be used to revascularize acute myocardial infarctions in the posterior and anterolateral parts of the left ventricle.

Acute Disease↗
PubMed1991

[Non-Q wave myocardial infarction. Recurrent myocardial infarction, unstable angina and arrhythmia in 8-year observation].

UNLABELLED: The contradictory views on long term clinical course of patients after non-Q wave myocardial infarction (NQMI) as compared with those after Q wave myocardial infarction (QMI)--induced us to undertake a comparative study of both types of myocardial infarction during a 8 year follow-up. The study was carried out in 400 patients (pts) with NQMI (mean age 51) and 485 pts with QMI (mean age 53). Both groups were compared. We have analysed the following parameters: the dynamics of ischaemic heart disease (unstable angina, reinfarction, arrhythmias, mortality) and coronary arteriography. During 8 year observation unstable angina and arrhythmias, were statistically more frequent in pts after NQMI. Recurrent myocardial infarction occurred in 196 (49%) of pts after NQMI and only in 87 pts (18%) after QMI (p less than 0.001). However, the difference in mortality between both groups was not significant (37% vs 39% respectively). Coronary angiography was performed at 1-6 months after myocardial infarction. In 65% of pts after NQMI detected lesions were limited to proximal part of one or two coronary arteries. CONCLUSION: NQMI is characterized by unstable long-term clinical course, and that is why pts with NQMI should be recommended for early coronary angiography and revascularization.

Adult↗
PubMed1990

[Acute myocardial infarction with patent infarct-related artery: selection of treatment based on qualitative analysis of coronary angiograms during the acute phase].

To evaluate the benefit of emergency coronary angioplasty (PTCA) among patients with acute myocardial infarction having patent infarct-related arteries, we investigated 104 patients who received thrombolysis and/or PTCA within 24 hrs after onset of symptoms. The morphology of coronary artery lesions was qualitatively assessed by angiography and categorized as symmetrical or asymmetrical narrowing with smooth margins (S-group, 72 cases) and asymmetrical narrowing in the form of convex intraluminal obstruction representing a thrombus (T-group, 32 cases). Soon after intervention, angiographic success (residual stenosis less than 75%) was achieved in 85% with PTCA (92% in the T-group vs 82% in the S-group) and in 29% without PTCA (53% vs 16%). At hospital discharge, the figures were 82% with PTCA (75% vs 87%) and 43% without PTCA (73% vs 30%). The incidence of re-infarction and/or total occlusion of the infarct-related artery was 9% with PTCA in both the T- and S-groups but 26% in those without PTCA (6% in the T-group vs 31% in the S-group). These data suggest that in patients with patient infarct-related arteries and severe original stenosis, PTCA has an advantage over thrombolysis alone. Qualitative analysis of coronary morphology by angiography provides a framework for selecting adequate therapy.

Adult↗
PubMed1989

[Improved detection of acute myocardial infarct with combined simultaneous thallium-201/technetium-99m-PPi tomography in comparison with planar infarct scintigraphy].

UNLABELLED: The combined TI-201/Tc-99mPPi tomography was compared to planar Tc-99m-PPi scintigraphy in terms of diagnosis and localization of the infarction. In 32 consecutive patients with recent myocardial infarctions, the necrosis could be detected by means of planar imaging in 17 out of 22 patients with transmural and in three out of 10 patients with intramural infarctions. Six out of seven patients without recent myocardial infarctions were accurately diagnosed. Double radionuclide tomography made possible accurate diagnoses in all patients. Artefacts resulting from residual radioactivity within the cardiac blood pool and uptake of tracer in bones that overlie the heart were only observed with planar imaging. CONCLUSION: double radionuclide tomography is superior to planar imaging in the diagnosis of acute myocardial infarction.

Adult↗
PubMed1989

[Precordial ST segment depression in acute inferior myocardial infarction: the importance of posterolateral wall infarction].

To determine whether precordial ST segment depression during acute inferior myocardial infarction indicates posterolateral wall ischemia, anatomical predominance of coronary circulation was examined by coronary angiography and evaluated in 43 patients who experienced first acute inferior myocardial infarction. Among patients who underwent intracoronary thrombolysis within six hours from the onset of symptoms, the infarct-related artery was the right coronary artery (RCA) in 35. In addition, their early 12-lead electrocardiographic features were compared with those in eight patients having the infarct-related left circumflex coronary artery (group Cx). Thirty-five patients with RCA obstruction were categorized in four groups: Four patients with left predominant type (group L), 10 with balanced type (group B), five with right super-predominant type (group SR), and 16 with right intermediate type (group RI). Seventeen of the 21 patients in groups SR and RI demonstrated precordial ST segment depression, whereas it was present in only six of the 14 patients in groups L and B (p less than 0.05). Of the 29 patients in groups SR, Cx and RI, total ST segment depression in leads V1 through V4 (sigma ST) was greater in the 14 patients in groups L and B (p less than 0.05) than in other groups. Furthermore, in these 29, all patients in groups SR and Cx had greater sigma ST than did the patients in group RI (p less than 0.05). There was no significant difference in sigma ST between groups SR and Cx. Precordial ST segment depression did not correlate with concomitant disease of the left anterior descending artery and was not a mirror image of ST segment elevation in inferior leads. On thallium-201 scintigraphy, additional perfusion defects of the posterolateral wall were present in all eight patients in group Cx and in ten of the 21 patients in groups SR and RI. Thus, precordial ST segment depression during acute inferior myocardial infarction seemed to be affected by the pattern of coronary circulation. It was concluded that this ST depression represents more extensive involvement of the posterolateral wall in patients with right predominant coronary circulation as well as in those with left circumflex artery obstruction.

Adult↗
PubMed1977

Acute myocardial infarction: clinical application of technetium 99m stannous pyrophosphate infarct scintigraphy.

Acute myocardial infarction is being recognized as a spectrum of clinical subsets. This appreciation has been brought about to a large degree by the development of several new tools that can be applied clinically to aid in evaluation of patients with acute infarction, and in some cases to provide short and long-term prognostic information. In the realm of noninvasive methods, several tests utilizing radiopharmaceuticals and scintillation cameras have emerged and are rapidly becoming reliable diagnostic parameters in patients with coronary disease and infarction. Technetium 99m (stannous) pyrophosphate (TcPYP) scintigraphy, one of the first of these techniques to find clinical use, has been shown to be an accurate indicator of acute transmural myocardial infarction and provides added sensitivity and specificity to the diagnosis. Increased diagnostic accuracy, the dimension of visible localization and the potential for infarct sizing promise physicians better understanding of a patient's clinical presentation and a more rational approach to management.

Acute Disease↗
PubMed1978

[Coronary atherosclerosis, coronary thrombosis and myocardial infarction in autopsy cases. 8th communication: Relationship of coronary atherosclerosis and myocardial infarction (author's transl)].

The autopsy reports of the Pathological Institute Erfurt of the period from 1.1.1951 until 31.12.1969 were scored for cases of coronary atherosclerosis and myocardial infarction and analysed concerning frequency and distribution of age and sex, resp. In 89.05 per cent (2131 cases) of all myocardial infarctions a coronary sclerosis was present. Males suffered significantly more frequent from these forms of ischaemic heart disease. During the period of nineteen years a significant increase of the coronary atherosclerosis in combination with a myocardial infarction was observed. This is due to the more frequent occurrence of severe forms. The increase of the frequency of the myocardial infarctions and of the weak and moderately coronary sclerosis particularly concerns the younger age groups. Callous infarcts were more frequent than fresh and relapsing ones.

Adolescent↗
PubMed1983

Anteroseptal myocardial infarction complicated by right ventricular myocardial infarction.

A 73 year old man presented with an acute anteroseptal myocardial infarction. He became progressively hypotensive without signs of left heart decompensation or major rhythm disturbances. Swan-Ganz catheterisation revealed a pattern of right ventricular infarction and under appropriate treatment the patient recovered remarkably well. The importance of recognition of right ventricular infarction is stressed especially in this case where an anteroseptal myocardial infarction was present without the usual left posterior infarction.

Aged↗
PubMed1982

[Acute myocardial infarct register: the intravital and morphological criteria of "definite" and "possible" infarct].

The analysis of frequency and significance of standardized clinical diagnostic criteria of acute myocardial infarction was performed in 258 patients with ischaemic heart disease in the groups of "certain" (227 cases) and "possible" (31 cases) acute myocardial infarction in Kaunas myocardial infarction register. For the analysis of morphological criteria the pathology of coronary arteries and of the myocardium of 85 males, brought in dead, was studied in detail. 26 of these cadavers were classified as "certain" and 59 as "possible" myocardial infarction. The results of investigation showed the accepted criteria to be inadequate for complete identification of acute myocardial infarction. Frequent and more comprehensive electrocardiographic examinations and detailed histological studies may be helpful for reaching this aim.

Adult↗
PubMed1980

Experimental myocardial infarction in rhesus monkeys. Verapamil pretreatment in the reduction of infarct size.

An experimental model of acute myocardial infarction has been created in the rhesus monkey by surgical ligation of the anterior descending branch of the left coronary artery. The effect of verapamil on the size of myocardial infarct was investigated. Four groups of experiments were carried out. Group I animals served as operated controls. In group II, verapamil (Isoptin) was administered intravenously half an hour after coronary ligation and repeated every 6 hr for 24 hr. Group III animals were given verapamil orally in the dosage of 4 mg/kg, three times a day, 10 days before coronary ligation. In group IV, the chest was opened by the coronary artery was not ligated (sham-operated group). The infarct size was measured 5 days after coronary ligation by the histochemical technique of nitro-blue tetrazolium staining. The size of the infarct amounted to 22.05% +/- 1.34% of the left ventricular weight in group I, 19.40% +/- 2.08% in group II, and 14.08% +/- 1.26% (P < 0.01) in group III. No infarct was detected in group IV monkeys.

Administration, Oral↗
PubMed1995

The influence of clinical risk factors on the use of angiography and revascularization after acute myocardial infarction. Myocardial Infarction Triage and Intervention Project Investigators.

BACKGROUND: Coronary revascularization provides the greatest survival advantage in those patients with the greatest mortality risk. This study examines the relationship between variables that predict mortality and the use of angiography and revascularization after acute myocardial infarction. METHODS: Study of 4823 survivors of acute myocardial infarction, who underwent angiography between 6 hours and 5 days of admission, to determine the relationship between factors that predict mortality and the use of angiography (n = 2274), angioplasty (n = 692), and bypass surgery (n = 469). RESULTS: Except for recurrent angina, clinical factors that predict higher mortality were associated with a lower use of angiography (the multivariable adjusted odds ratio was 0.47 for older age, 0.85 for a history of infarction, 0.50 for patients not receiving thrombolytic medications, 0.64 for new heart failure, and 2.75 for recurrent angina [P < .001 for all factors]). A similar relationship was observed among patients selected for angioplasty (the odds ratio was 0.51 for an ejection fraction of < 40%, 0.72 for those patients not receiving thrombolytic medications, 0.74 for a history of infarction, and 1.94 for recurrent angina [P < .001 for all factors]). In contrast, patients with unfavorable prognostic profiles were much more likely to undergo coronary bypass surgery (the odds ratio was 1.46 for recurrent angina, 1.28 for older age groups, 2.23 for new heart failure, 1.28 for patients not receiving thrombolytic medications, and 1.46 for a history of infarction [P < .001 for all factors]). CONCLUSIONS: These data suggest that aside from symptoms of recurrent angina, the use of angiography and angioplasty is not driven by mortality risk stratification. In contrast, bypass surgery is preferentially performed in patients at increased risk for mortality.

Age Factors↗
PubMed1995

[Evaluation of late potentials in patients with acute myocardial infarction--relationship with right ventricular infarction].

Late Potential (LP) is known to be easily detected in inferior myocardial infarction (AMI) patients. And it is also well known that high incidence of LP positive in the patients with arrhythmogenic right ventricular dysplasia are seen. However, there is no report that LP in patients with right ventricular (RV) infarction is easily detectable. This following study was conducted to distinguish how LP was affected by RV infarction. 36 inferior AMI patients (27 male, 9 female) who were performed PTCA in acute stage were selected. They were divided into three groups in accordance to the position of infarct related artery (Group A is proxysmal RCA, Group B is distal RCA and Group C is LCx). There were no significant difference among these groups in terms of filtered QRS duration and last 40 msec RMS voltage. It was concluded that RV infarction could not affect to the rate of LP positive in inferior AMI patients.

Adult↗
PubMed1994

[Infarction of the caudate nucleus or anterior striato-capsular infarction?].

Eight patients with caudate nucleus infarcts are reported. The main clinical findings were often transient facio-brachial weakness (6 patients), depression (4 patients), subcortical aphasia with decreased spontaneous verbal activity (2 patients), and aboulia (2 patients). The ischemic lesions of caudate nucleus often extend into the adjacent anterior limb of the internal capsule and the anterior putamen owing to vascularization pattern. The specific clinical picture of this entity also includes lesions of nearby white matter tracts. Risk factors, etiology of infarcts, clinical findings and prognosis were similar to those reported in striato-capsular infarcts. We suggest replacing the term caudate infarct by anterior striato-capsular infarct.

Adult↗
PubMed1995

Captopril in acute myocardial infarction. Beneficial effects on infarct size and arrhythmias.

OBJECTIVE: It is known from experiments that angiotensin converting enzyme (ACE) inhibitors can limit infarct size. We examined the effect in patients. METHODS: In a prospective, randomized, placebo-controlled double blind study, 22 patients were given 1.5-2.0 mg captopril/h i.v., while 24 patients were given placebo. Medication was started between 2 hours and 18 hours from the onset of infarction. The two groups were matched for age, infarct location, and time of intervention. With exception of one patient in either group, all were concurrently given nitroglycerin. The necrosis parameters were provided by the quantitative measurement of the QRS complex. RESULTS: The Q wave decreased with captopril treatment (-0.003 mV), but increased with placebo (+0.14 mV) (p < 0.05). The number of ventricular premature beats at 24 hours from the start of treatment was 25/h with placebo, and 9/h with captopril (p < 0.02). Ventricular fibrillation occurred 7 times in the placebo group, but did not occur in the captopril group. The creatine kinase (CK) infarct weight was 59 gram-equivalents (gEq) with placebo, and 45 gEq with captopril (p = NS). The mean arterial pressure was reduced by 12 mmHg with captopril treatment. CONCLUSIONS: The results show a beneficial effect of captopril on infarct size and electrical instability, over and above the effect of standard management with nitroglycerin and thrombolysis.

Arrhythmias, Cardiac↗