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PubMed2000

Measurement of myocardial fractional flow reserve during coronary angioplasty in infarct-related and non-infarct related coronary artery lesions.

Myocardial fractional flow reserve (FFRmyo) has been demonstrated to be a useful method for determining the physiologic importance of a given coronary lesion. However, the reliability of the FFRmyo measurement is unknown in infarct-related arteries (IRA). The aim of this study was to measure and correlate the FFRmyo results of 14 consecutive patients who had recent acute myocardial infarction (AMI) (Group 1) with 14 consecutive patients who didnOt have AMI (Group 2) before and after percutaneous transluminal coronary angioplasty (PTCA). Quantitative coronary angiography (QCA) and FFRmyo measurements were determined both before and after optimal PTCA for all patients. FFRmyo was measured by use of a 0.014 inch guidewire as the ratio of the pressure distal to the target lesion to the aortic pressure taken during the maximal hyperemia induced by intracoronary adenosine. There were no differences between the two groups related to gender, target artery reference diameter, minimal luminal diameter and percent diameter stenosis of the vessel both before and after PTCA. While FFRmyo results after PTCA were not different between the groups, they were statistically different before PTCA (Group 1: 77.6+/-5.4%, Group 2: 63.3+/-8.4%; p<0.001). Although QCA-determined percent diameter stenosis revealed a significant degree of stenosis (66.5+/-10.5%) for Group 1, FFRmyo values were higher than 75% (77.6+/-5.4%), indicating insignificant stenosis. Thus, it was concluded that FFRmyo measurements before PTCA were significantly different between IRA and non-IRA and that the method may not be valid for the determination of stenosis significance in IRA.

Aged↗
PubMed2000

Emergency room referral to internal medicine wards or to coronary care units of patients with first acute myocardial infarction. Israel Study Group on First Acute Myocardial Infarction.

The objective of the study was to assess factors associated with ward assignment in the emergency room for patients < or = 65 years old with first acute myocardial infarction. We analysed uni- and multivariate predictors for ward assignment (coronary care unit versus internal ward). Eight major centrally located Israeli hospitals provided data during one year. The study population included 1252 patients, of whom 83% were men, 37% were hypertensives, 22% were diabetics, and 14% had previous anginal syndrome. Most patients (83%) were admitted to the coronary care unit. Internal medicine ward assignment was significantly associated with advanced age, history of hypertension or diabetes, a longer time from appearance of symptoms to arrival at the hospital, and myocardial infarction type (non-Q-wave or non-anterior). The likelihood of medical ward referral increased stepwise with the increasing number of a patient's predictive factors: those with > or = 4 factors had a > 30% chance of being assigned to a medical ward compared to a < 10% chance when there were 0-3 risk factors. Exclusion of patients with thrombolysis had no effect on the results. The shortage of cardiac care unit beds apparently leads to emergency room selection acting in detriment of patients with poorest prognoses. Clear guidelines for decision making in the emergency room are needed to resolve this paradoxical situation.

Coronary Care Units↗
PubMed2001

Primary angioplasty in acute inferior myocardial infarction with anomalous-origin right coronary arteries as infarct-related arteries: focus on anatomic and clinical features, outcomes, selection of guiding catheters and management.

BACKGROUND: Inferior wall myocardial infarction caused by obstruction of an anomalous-origin right coronary artery (RCA) is a rare angiographic finding; primary angioplasty to an anomalous-origin RCA has never been reported. METHODS: In 185 patients with acute inferior wall myocardial infarction resulting from RCA occlusion who underwent primary angioplasty, eight patients (4.3%) had anomalous-origin RCAs. RESULTS: Coronary angiography showed that all 8 patients had a dominant RCA. Six patients (75%) had an anomalous-origin RCA arising from the anterior aspect of the ascending aorta above the sinotubular line and the other 2 patients (25%) had an anomalous-origin RCA arising from the left sinus of Valsalva with a separate ostium from the left main coronary artery. The standard Judkins right guiding catheter did not offer adequate support in these patients. In the group of 6 patients, an Amplatz guiding catheter offered good support, while a standard Judkins left guiding catheter was adequate in the other 2 patients. Obstruction of the proximal RCA occurred in 6 patients (75%). Successful reperfusion was achieved in 6 patients (75%), resulting in an uneventful clinical course and long-term survival (mean follow-up, 24.9 +/- 16.5 months). Two patients (25%) had unsuccessful reperfusion and died from cardiogenic shock. CONCLUSIONS: In this small series, anomalous-origin RCAs were the dominant artery and predisposed to atherosclerosis at the proximal portions. We suggest that appropriate guide catheter selection and careful manipulation are essential for the success of revascularization. Complete reperfusion results in an excellent clinical and long-term outcome in patients with anomalous-origin RCAs.

Angioplasty, Balloon, Coronary↗
PubMed2001

[Correlation of somatotropic hormone with post-infarction myocardial remodelling and clinical prognosis in patients with myocardial infarction].

To evaluate pathogenetic link of ischemic heart dysfunction with the level of endogenic STH in myocardial infarction (MI) patients at different MI stages and to specify prognostic value of STH for MI outcomes, we examined 78 males on MI day 21-26, month 3-6 and a year later. 20 healthy males served control and 17 patients with ischemic heart diseases without MI according to coronaroventriculography (CVG) were a comparison group. STH was measured in all the patients with radioimmunoassay, CVG was made according to M. Judkins. We found that in patients with high level of endogenic STH (> 1 nm/l) within the first postmyocardial infarction month development of reparative and adaptive fibrosis continues 3 to 6 months and is more favorable. If STH physiological level maintains, myocardial contractility remains satisfactory for a long period. In high STH levels, patients with myocardial ischemia more frequently exhibit ventricular arrhythmia. Low STH blood levels lead to left ventricular dilatation, deterioration of cardiac contractility, stenotic coronary atherosclerosis, intracardiac hemodynamics and IHD clinical course. Lethal outcomes occur more frequently.

Adult↗
PubMed2002

The impact of very late revascularization of occluded infarct-related artery on cardiac mortality and the incidence of sudden death in survivors of acute myocardial infarction - long-term observation.

BACKGROUND: In survivors of acute myocardial infarction (AMI), an occluded infarct-related artery (IRA) is an important predictor of cardiac death (CD) and sudden death (SD). Early reperfusion of the IRA was associated with improved survival rate. The purpose of the present study was to assess if late IRA revascularization, performed 10-30 days after AMI, also has a beneficial effect on the incidence of CD and SD during an 18-month follow-up. MATERIAL/METHODS: The study population consisted of 93 post-MI patients with occluded IRA on coronary angiography. The patients were divided into 2 groups according to IRA status at discharge -- revascularized (47 patients) or occluded (46 patients) -- and followed. Before revascularization, the two groups of patients did not differ in the prevalence of clinical and angiographic variables, or in the incidence of risk factors for SD. In patients who underwent angioplasty or bypass graft surgery of closed IRA, the markers of electrical instability demonstrated no significant improvement after revascularization. RESULTS: During the 18-month follow-up a significantly lower incidence of CD (0% vs 15%, p<0.01) and SD (0% vs 11%, p<0.03) was observed in the group of patients with revascularized IRA than in the group of patients with occluded IRA. CONCLUSIONS: In survivors of AMI, late reperfusion of occluded IRA is associated with reduced 18-month cardiac mortality. The beneficial effect of this procedure on the incidence of sudden death, not associated with improvement in myocardial electrical stability, suggests that ischemia can be considered an important factor modulating the arrhythmogenic substrate.

Adult↗
PubMed2002

Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT).

BACKGROUND: Patients with a depressive disorder after myocardial infarction (MI) have a significantly increased risk of major cardiac events. The Myocardial INfarction and Depression-Intervention Trial (MIND-IT) investigates whether antidepressive treatment can improve the cardiac prognosis for these patients. The rationale and outline of the study are described. METHODS: In this multicenter randomized clinical trial, 2140 patients admitted for MI are screened for depressive symptoms with a questionnaire 0, 3, 6, 9, and 12 months after MI. Patients with symptoms undergo a standardized psychiatric interview. Those with a post-MI depressive episode are randomized to intervention (ie, antidepressive treatment; n = 190) or care-as-usual (CAU; n = 130). In the intervention arm, the research diagnosis is to be confirmed by a psychiatrist. First-choice treatment consists of placebo-controlled treatment with mirtazapine. In case of refusal or nonresponse, alternative open treatment with citalopram is offered. In the CAU arm, the patient is not informed about the research diagnosis. Psychiatric treatment outside the study is recorded, but no treatment is offered. Both arms are followed for end points (cardiac death or hospital admission for MI, unstable angina, heart failure, or ventricular tachyarrhythmia) during an average period of 27 months. Analysis is on an intention-to-treat basis. CONCLUSION: The MIND-IT study will show whether treatment of post-MI depression can improve cardiac prognosis.

Adult↗
PubMed2002

[Monitoring myocardial infarct (diagnostic combination, prodromal period, behavioral characteristics) using the WHO program "Registry of Acute Myocardial Infarct", Monica].

AIM: A 22-year study of diagnostic categories of myocardial infarction (MI), a prodromal period, behavioral characteristics of the patients. MATERIAL AND METHODS: WHO programs Acute Myocardial Infarction Register and MONICA were performed in Novosibirsk population aged 25-64 years. From January 1, 1977, to December 31, 1998, monitoring registered 5180 cases of MI (1774 lethal outcomes). RESULTS: The diagnostic category "Possible" MI occurred more frequently than "definite" MI, this difference being more noticeable in women than in men. In both diagnostic categories the disease presented with a typical clinical picture. In the category "definite" MI there were many cases of atypical disease. Most cases of MI developed at home though it occurred outdoors more frequently in men and at home in women. Half of the patients had arterial hypertension (AH) and effort angina (EA), one third of the patients had survived MI before. 91% of MI men were heavy smokers. Alcohol intake at MI onset was insignificant. Pain syndrome 2 weeks before MI was the same in survivors and the deceased. Those who died suddenly felt extremely tied before MI, those whose death was not sudden experienced exacerbation of EA and dyspnea, those who survived experienced exacerbation of EA. CONCLUSION: Long-term monitoring showed that MI clinical presentation did not differ for 2 decades. A significant number of MI patients with a history of hypertension, effort angina, previous MI, heavy smoking evidenced for the lack of prophylactic education among population.

Adult↗
PubMedDate not supplied

[Posterior (dorsal) infarction and right ventricle infarction].

The classical-electrocardiographic concepts of the death, injured and ischemic zones based on the action potential changes and its vectorial manifestations in the surface ECG in relation with the solid angle theory are described. The necessary recognition of this three concentrical zones to sustain the diagnosis of myocardial infarction is described. The special case of the pure dorsal and the posteroinferior infarction extension to the right ventricle explain the necessity to utilize additional leads, other of the 12 classically used and the findings that permit the diagnosis.

Biophysical Phenomena↗
PubMed2004

[Survivor of cardiogenic shock following acute myocardial infarction with Churg-Strauss syndrome: first angiographic documention of coronary recanalization of infarct-related arteries: a case report].

A 42-year-old man was treated under a diagnosis of Churg-Strauss syndrome with predonisolone pulse therapy. Three days later, he developed cardiogenic shock following acute myocardial infarction. Coronary angiography showed total occlusions in three peripheral coronary vessels. Intraaortic balloon pumping was used to maintain hemodynamics and predonisolone pulse therapy was repeated. However, he developed cardiogenic shock again after the second pulse therapy and needed percutaneous cardiopulmonary support and intraaortic balloon pumping. Accordingly, combination therapy of predonisolone and cyclophosphamide was given. He then recovered. Follow-up angiography showed recanalization of the infarct-related arteries.

Adult↗
PubMed2005

[Effects of delayed opening of infarct-related artery on late left ventricular remodeling in patients with acute anterior myocardial infarction].

OBJECTIVE: To assess the effect of delayed opening of the infarct-related artery (IRA) by percutaneous coronary intervention (PCI) on the late left ventricular remodeling after acute anterior myocardial infarction (AAMI). METHODS: Sixty four patients with initial Q-wave AAMI and with the total occluded IRA conformed by angiogram at 9.1 +/- 2.3 (2 - 14) days after the onset were divided into successful PCI group and control group (not receiving PCI or the IRA not re-opened). Two-D echocardiogram was performed at acute phase (about 3 weeks), 2 and 6 months after onset of AAMI respectively to detect the left ventricular function and left ventricular wall motion abnormality (VWMA). The total congestive heart failure events were recorded during 6 months follow-up. RESULTS: VWMA scores, left ventricular ejection fraction (LVEF), left ventricular end-diastolic and end-systolic volume indexes (LVEDVI and LVESVI) were similar in 2 groups at acute phase and 2 months after the onset of AAMI. There were no differences between the parameters above at acute phase and 2 months in each group too. VWMA scores and LVEF did not changed significantly at 6 months in each group compared with those at acute phase and 2 months (P > 0.05). But LVEDVI and LVESVI were significantly smaller in the successful PCI group than those in the control group (P < 0.01, P < 0.05). The rate of congestive heart failure events was 19% in control group and 2.0% in successful PCI group (P > 0.05) respectively. CONCLUSIONS: Delayed opening of IRA in AAMI could prevent the late phase but not the early phase of left ventricular remodeling after AMI.

Aged↗
PubMed1992

Morning peak in the incidence of myocardial infarction: experience in the ISIS-2 trial. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group.

To investigate the circadian pattern of acute myocardial infarction (MI) in a large international patient population, the time of day of the onset of symptoms was prospectively determined in 12,163 consecutive patients randomized in the ISIS-2 Trial (Second International Study of Infarct Survival). Overall, there was a marked circadian variation (P less than 0.001) in the incidence of MI characterized by a sharp increase from 0600 h to 0800 h, with a peak period from 0800 h to 1100 h followed by a gradual decline from 1100 h to 1800 h. During the evening and night there was a steady trough, with no evidence of a second peak. Although there was some scatter, this circadian pattern was similar among patients of five different geographic regions on three continents and in various subcategories of patients defined with respect to age, gender, previous MI, and aspirin intake prior to MI. The circadian pattern of diabetics, however, was different compared with non-diabetics (P less than 0.005, adjusted less than 0.01), and it demonstrated no significant variation. This increased morning incidence of MI indicates specific triggering mechanisms that are particularly likely to occur during, or just before, that time of day. Further investigation of physiological changes during the day is needed to identify any such triggers of MI and so perhaps to aid in improving preventive strategies of the disease.

Adult↗
PubMed2005

Hypotensive spinal cord infarction associated with vertebral body infarction after treatment with short-acting antihypertensive agent.

Spinal cord infarction is a rare condition with heterogeneous causes. An 80-year-old diabetic woman was brought to the emergency department because of retrosternal pain and high blood pressure. Twenty minutes after treatment with sublingual nitroglycerin and short-acting oral antihypertensive agent, blood pressure had dropped from 201/91 mm Hg to 158/68 mm Hg, followed by abrupt onset of weakness in lower limbs, urinary retention and sensory loss in bilateral T4-L1 levels and the left lower limb at two hours after treatment. Magnetic resonance imaging showed contrast-enhanced and high-intensity lesions in the mid and lower thoracic cord, which were consistent with ischemic changes within the spinal cord and in the T4 vertebral body. After rehabilitation therapy for 2 months, she became able to ambulate with the aid of a walker. To reduce the risk of hypotensive sequelae such as spinal cord infarction, blood pressure should be closely monitored in elderly patients presenting with retrosternal chest pain who are treated with short-acting oral antihypertensive agent, particularly when additional risk factors such as atherosclerosis, diabetes mellitus or hypertension are present.

Aged↗
PubMedDate not supplied

Concentration of soluble P-selectin and white blood cell counts in infarct coronary arteries in patients with acute myocardial infarction differ from the systemic circulation.

BACKGROUND: Previously, researchers have suggested that Soluble (s) P-selectin mediates the accumulation of leukocytes which in turn promotes fibril deposition. Soluble P-selectin and white blood cell (WBC) counts have been shown to be increased in the systemic circulation after acute myocardial infarction (AMI). However, whether the infarct coronary artery (ICA) and systemic circulation differs with respect to the concentration of sP-selectin and WBC counts following AMI remain unknown. In this study, we investigated whether the concentration of sP-selectin and WBC counts differed between the ICA and the systemic circulation after AMI. METHODS: Blood samples for circulating sP-selectin and WBC counts were immediately obtained after vascular puncture in 72 patients with AMI of < 12 h undergoing primary percutaneous coronary intervention (PCI). Additionally, blood samples for ICA sP-selectin and WBC counts were obtained via Export Suction Catheter during PCI. For comparison, blood samples for sP-selectin and WBC counts were obtained once in 30 healthy subjects. RESULTS: The results demonstrated that the circulating sP-selectin [64.7 +/- 18.1 (ng/ml) vs. 29.5 +/- 6.3 (ng/ml), p < 0.0001] and WBC counts [12.1 +/- 3.6 (x 10(3)/ml) vs. 5.0 +/- 1.0 (x 10(3)/ml), p < 0.0001] were significantly higher in our patients than in healthy subjects. Furthermore, the sP-selectin [72.7 +/- 23.3 (ng/ml) vs. 64.7 +/- 18.1 (ng/ml), p < 0.0001] and the WBC counts [16.2 +/- 3.8 (x 10(3/)ml) vs. 12.1 +/- 3.6 (x 10(3)/ml), p < 0.0001] were markedly higher in the ICA than in the systemic circulation for the patients. CONCLUSIONS: The plasma level of sP-selectin and WBC counts were more elevated in the ICA than in the systemic circulation of patients with AMI undergoing primary PCI. These findings strengthen the role of sequestration of WBC and sP-selectin in the ICA as crucial in thrombus formation.

Adult↗
PubMed1991

Association of wake time and the onset of myocardial infarction. Triggers and mechanisms of myocardial infarction (TRIMM) pilot study. TRIMM Study Group.

A morning increase in onset of acute myocardial infarction (MI) has been documented, but its association with wake time and possible triggering events is unclear. The community-based, ongoing Triggers and Mechanisms of Myocardial Infarction (TRIMM) study was designed to investigate the factors associated with the transition from chronic coronary artery disease to acute MI. During the pilot phase in 1989, 224 consecutive hospitalized MI patients (176 men and 48 women, aged 60.3 +/- 9.2 years) of the prospectively defined Monitoring of Trends and Determinates of Cardiovascular Disease (MONICA) Augsburg MI register were interviewed 16.8 +/- 6.5 days after the event. The frequency of onset of MI was significantly higher (p less than 0.01) during the morning from 6 to 9 AM compared with other times of day. After adjustment for individual wake times, the peak of onset of MI was markedly sharper; the relative risk of MI during the 3-hour peak interval (the 3 hours after awakening) compared with other times of day increased from 1.8 (95% confidence interval, 1.3-2.4) to 2.4 (95% confidence interval, 1.8-3.1). Sixty-seven percent of the patients reported possible acute triggers of MI and/or unusual life events; among those, 52% reported stress or emotional upset. The TRIMM pilot study demonstrated the feasibility of a community-based study of possible triggering events of MI. The circadian variation of MI appears to result primarily from increased onset after awakening. This narrowing of the time frame of increased risk of MI should facilitate study of pathogenic mechanisms and aid in the design of more effective preventive regimens.

Adrenergic beta-Antagonists↗
PubMedDate not supplied

[Incidence of acute myocardial infarction in Tuscany, 1997-2002: data from the Acute Myocardial Infarction Registry of Tuscany (Tosc-AMI)].

OBJECTIVE: The Acute Myocardial Infarction Regional Registry of Tuscany was aimed to assess incidence and prognosis of acute myocardial infarction (AMI) in Tuscany, and the spread of interventional cardiology (coronarography and coronary angioplasty) in AMI treatment. DESIGN: Record-linkage between current hospitalisation and mortality databases, aimed to identify total events (hospitalised AMI cases + out-of-hospital coronary deaths), also including recurrent events (rule of 28 days or more after any previous event in the same patient). SETTING: Population based registry (residents in Tuscany). MAIN OUTCOME MEASURES: Age-standardised attack rates, 28-day case-fatality and proportion of patients who underwent coronarography or coronary angioplasty. RESULTS: In Tuscany, between 1997 and 2002, AMI attack rates were stable in both genders. Rates of out-of-hospital coronary death (progressively decreasing) and of hospitalised AMI cases (increasing after the year 2000) showed opposite trends. Case-fatality decreased both for total events (largely explained by the reduction of out-of-hospital deaths) and for hospitalised cases. In the same period, the spread of coronarography and coronary angioplasty progressively increased. AMI attack rates and interventional cardiology procedures utilization were significantly different across Tuscany areas, whereas 28-day case-fatality of hospitalised cases did not significantly differ within the region. CONCLUSIONS: Notwithstanding the importance of cardiovascular disease, scanty population-based incidence, case-fatality and treatment data were available in Italy. Monitoring systems based on current hospitalisation and mortality databases could represent an economical and timely tools, providing data useful in a public health perspective and for health planning. The validation of diagnostic codes with standardised criteria could ensure the comparability with other Italian areas.

Adult↗
PubMed1991

The effect of verapamil on major events in patients with exercise-induced ischemia recovering from acute myocardial infarction: a review. The Danish Study Group on Verapamil in Myocardial Infarction.

The effect of verapamil on death and reinfarction in patients with and without exercise-induced myocardial ischemia after acute myocardial infarction was studied in a double-blind, placebo-controlled multicenter study. Two hundred ninety-eight patients were included. A symptom-limited exercise test was carried out 9 days after the myocardial infarction but before randomization. Forty-four patients with and 111 without exercise-induced ischemia were randomly assigned to verapamil and 39 and 104, respectively, to placebo treatment. The patients were observed for 18 months. The overall 18-month event rate was 12.1%. The lowest event rate was seen in patients with myocardial ischemia and verapamil treatment (9.1%), and the highest in patients with myocardial ischemia receiving a placebo (15.4%), while rates of patients without ischemia were sandwiched in between (12.5 and 12.6%). The differences were not statistically significant.

Blood Pressure↗
PubMed1991

[The clinical and prognostic significance of the infarct size in patients discharged after a myocardial infarct].

The authors report their experience in the determination of the infarct size (IS) by means of enzymatic analysis in a series of 281 consecutive patients (230 males, 51 females) admitted to the CCU because of myocardial infarction (MI), who did not benefit from thrombolytic therapy in the acute phase. To obtain the enzymatic IS, the serum activity of creatine kinase (CK) is determined every 4 hours for 48 hours and after 72 hours; Sobel's formula is used and results are expressed as CK-g-Eq of tissue. The enzymatic IS was compared to the degree of left ventricular dysfunction (assessed by echocardiography); to the electrocardiographic extension of necrosis; to the severity of ventricular arrhythmias (expressed as Lown's class) on 24-hour Holter monitoring; to cardiac mortality at 2 years. Mean estimated enzymatic IS of the population under study was 129 +/- 101 g-Eq. Patients with extensive MI (216 +/- 144 g-Eq) had significantly (p less than 0.05) higher IS compared to patients with inferior (131 +/- 93 g-Eq), anterior (105 +/- 65 g-Eq) and non-Q wave MI (73 +/- 54 g-Eq); also, a statistically significant difference (p less than 0.05) was found between inferior and non-Q wave MI. Patients with severely compromised left ventricular function (defined as an echocardiographic ejection fraction less than 30%), had significantly higher values of IS compared to patients with preserved left ventricular function (171 +/- 130 vs 120 +/- 93 g-Eq; p less than 0.05). A poor correlation was found between enzymatic IS and ventricular arrhythmias documented at pre-discharge 24-hour Holter monitoring.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗