acute myocardial infarction – JCE – Journal of Cardiovascular Emergencies https://www.jce.ro Cardiology, Emergency Medicine and Intensive-Care Medicine, Radiology Tue, 18 Oct 2016 10:57:52 +0000 en-US hourly 1 https://wordpress.org/?v=6.1.1 Factors Associated with In-hospital Mortality in Patients with Acute Coronary Syndrome https://www.jce.ro/article/factors-associated-with-in-hospital-mortality-in-patients-with-acute-coronary-syndrome/ Wed, 23 Dec 2015 12:02:31 +0000 http://www.jce.ro/?post_type=article&p=269 Read More ...]]>

ABSTRACT

Introduction: The recent development of large networks dedicated to ST-segment elevation myocardial infarction (STEMI) led to a significant increase in the number of primary percutaneous interventions (p-PCI) parallel with mortality reduction in Acute Coronary Syndrome (ACS). The number of non ST segment elevation myocardial infarction (NSTEMI) is increasing and the highest mortality rates are encountered in patients with cardiogenic shock and/or out of hospital cardiac arrest associated to ACS. The aim of this study was to identify the factors associated with a higher mortality rate in a global population with acute coronary syndromes presented  in  the  emergency  department  of  a  county  clinical  hospital  which  serves  as  a  regional center for a STEMI network.
Material and method: This is a retrospective study including 684 patients with acute coronary syndrome admitted in the Clinic of Cardiology from the County Clinical Emergency Hospital Tîrgu Mureș in 2014. In all the cases, the factors that correlated with in hospital mortality were identified and analyzed.
Results: The incidence of arterial hypertension was significantly higher in patients admitted with unstable angina (75.0%) and STEMI cases with less than 12 hours onset of symptomatology (68.1%), while impaired renal function correlated with the presence of NSTEMI (66.6%). The presence of a multivessel disease was significantly correlated with cardiogenic shock. The localisation of the culprit lesion in the left anterior descending artery (LAD) significantly correlated with the development of cardiogenic shock, LAD culprit lesions being present in 44.4% of CS cases as compared with 21.7% of noCS cases in STEMI patients. In NSTEMI patients, the localisation of the culprit lesion in the left main artery (LM) significantly correlated with the development of cardiogenic shock, culprit lesions in the left main being present in 47.0% of CS cases as compared with 28.5% of noCS cases in STEMI patients.
Conclusion: Patients presenting with out-of-hospital resuscitated cardiac arrest due to Acute Myocardial  Infarction  associate  higher  in-hospital  mortality  rates.  In-hospital  mortality seems to be highly correlated with the female gender, STEMI myocardial infarction and the presence of multivascular lesions.

]]> Impact of a Preexisting STEMI Network in Improving STEMI Diagnostic and Treatment in the Community after the Introduction of a National Program of Interventional Treatment in Acute Myocardial Infarction https://www.jce.ro/article/impact-of-a-preexisting-stemi-network-in-improving-stemi-diagnostic-and-treatment-in-the-community-after-the-introduction-of-a-national-program-of-interventional-treatment-in-acute-myocardial-infarcti/ Sun, 28 Jun 2015 22:40:31 +0000 http://www.jce.ro/?post_type=article&p=181 Read More ...]]>

ABSTRACT

Introduction: According to European guidelines, ST elevation acute myocardial infarction should be treated by immediate reperfusion, if diagnosed within 12 hours from the onset of symptoms. We aimed to show the impact of a well-functioning pre-existing STEMI network in improving the results of a national program dedicated to the invasive treatment of AMI.
Methods: We followed the comparison between primary PCI rates and STEMI-related mortality in two regions, after the introduction of a nationwide program for the interventional treatment of acute myocardial infarction: region A, where the territory has been appropriately prepared via previous organizational measures in the network, and region B, where the territory has not been previously prepared.
Results: In 2011, one year after the initiation of the national program, a primary PCI rate of 12.1%, a thrombolysis rate of 10.1% and a no-reperfusion treatment rate of 77.8% have been found in these new centers for patients arriving similar to the new centers) showed in 2011 a 73.85% primary PCI rate, 12.09% thrombolysis rate and a 14.07% conservative treatment rate, reflected in a mortality of 6.81% for “early presentations” in the registry centers.
Conclusions: The national strategy for reduction of STEMI related mortality via implementation of primary PCI, started in 2010, had a significant impact especially in that region where the territory was previously prepared with appropriate organizational efforts, including educational and logistic measures.

 

]]> Correlation Between Acute Impairment of Regional Contractility and Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction https://www.jce.ro/article/correlation-between-acute-impairment-of-regional-contractility-and-left-ventricular-remodeling-after-revascularized-acute-myocardial-infarction/ Sun, 28 Jun 2015 22:27:48 +0000 http://www.jce.ro/?post_type=article&p=197 Read More ...]]>

ABSTRACT

Introduction: The present study aims to demonstrate the role of acute impairment of regional contractility, as assessed by 3D echocardiography, in predicting LV remodeling in post acute myocardial infarction (AMI) patients.
Methods: We enrolled in the study a number of 48 subjects with AMI who underwent primary PCI followed by optimum medical therapy. In all these cases we followed the correlation between the amplitude of ventricular remodeling at 6 months postinfarction and regional contractility in the immediate postinfarction period, as assessed by 3D echo parameters at baseline: regional index of contraction amplitude (RICA) and the index of contraction amplitude (ICA). Positive remodeling (PR) was defined as an increase in LV end-diastolic global volume with >15% compared with baseline.
Results: Patients with positive remodeling (PR) presented at baseline a significantly lower ejection fraction (44.75% versus 49.95%, p = 0.009), associated with a higher end-systolic volume (80.34 ml vs. 70.63 ml, p = 0.02) and lower values for index of contraction amplitude — ICA (3.05 vs. 3.53, p = 0.01) and for regional index of contraction amplitude — RICA (1.38 vs. 2.78, p <0.0001), in comparison with the patients who did not experience ventricular remodeling. RICA achieved the best statistical significance for predicting the development of LV remodeling during the evolution of the disease. For RICA, the ROC curve using logistic analysis showed an area under the curve (AUC) of 0.88, highly significant (p = 0.0001).
Conclusions: Impairment of regional contractility is associated with development of LV remodeling
to a more significant extent than the global impairment of ventricular contractility.

]]>