Acute cardiac care最新文献

Introduction: This case describes a patient who suffered three myocardial infarctions over a two-week period. Testing confirmed thrombophilia as the etiology.

Case: A 55-year old male initially presented to the emergency department with a complaint of chest pain. Testing showed an elevated troponin at 2.2 ng/ml and ST elevations on electrocardiogram. The patient was transferred to the cardiac catheterization laboratory and a drug-eluting stent was placed. One day after the initial stent placement, in-stent thrombosis of the drug-eluting stent was discovered. Angioplasty and aspiration thrombectomy were performed, and the patient was released from the hospital three days later. 72 h after his discharge, the patient returned to the emergency department due to recurrent chest pain and diaphoresis. Shortly after arrival he became unresponsive and telemetry showed ventricular tachycardia which resolved with cardioversion. Reocclusion of the right coronary artery was again noted in the catheterization laboratory and three bare metal stents were placed. Laboratory testing found presence of anticardiolipin antibody and evidence of PT20201A mutation.

Conclusion: Hypercoagulable states, although an uncommon cause of myocardial infarction, should be considered when investigating the etiology of recurrent coronary events. Prompt treatment is important in the prevention of future occurrences.

Introduction: Oxygen is considered to have analgesic effects, but the evidence is weak. Oxygen may be harmful to the ischemic myocardium. The aim was to investigate the analgesic effect of oxygen during percutaneous coronary intervention (PCI) and to evaluate cardiac injury.

Material and methods: The OXYPAIN was a phase II randomized trial with a double blind design. 305 patients were randomized to receive oxygen or atmospheric air during PCI. The patients were asked to score chest pain by the Visual-Analog Scale (VAS). The use of analgesic agents and troponin-t was measured.

Results: There was no significant difference in pain between the groups: oxygen: 2.0, [2.0-4.0], air: 2.0, [2.0-5.0] (median, interquartile range: 25-75%, P = 0.12). The median difference in score of VAS was [95% CI]: 0, [0-1.0]. The oxygen group received 0.44 ± 0.11 mg of morphine versus 0.46 ± 0.13, P = n.s. The peak value of troponin-t post-PCI was 38, [11-352] nmol/ml in the oxygen group and 61, [16-241] for patients treated with air, P = 0.46.

Conclusions: The use of oxygen during PCI did not demonstrate any analgesic effect. There was no difference in myocardial injury measured with troponin-t or in the morphine dose. Our results do not support routine use of oxygen. (NCT01413841.).

Objective: Evaluate treatment times and clinical outcome in a consecutive series of ST segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) in Los Angeles County.

Background: Primary PCI for STEMI is beneficial if performed in a timely manner. Conflicting data exist regarding potential treatment delays for primary PCI performed during off hours.

Methods: The Emergency Medical Services STEMI Receiving Center Database was queried from 2007 to 2009 to identify patients with a pre-hospital ECG showing STEMI who underwent PCI. On-hour PCI (On-hour Group, n = 1324) was defined as PCI occurring from 8 am to 5 pm and off-hour PCI (Off-hour Group, n = 922) was defined as occurring from 5 pm to 8 am. Treatment times, length of stay, vascular complications, achievement of TIMI 3 flow and in-hospital mortality were evaluated.

Results: Off-hours PCI occurred in 41% of patients. Medical contact to door time was similar in the Off-hour Group compared to the On-hour Group, 20.7 ± 14.6 versus 20.3 ± 12.3 min, respectively, P = 0.47. In patients with available data (n = 1366), the door-to-catheterization laboratory (CL) activation time was significantly shorter in the On-hour Group as compared to the Off-hour Group, -4.9 ± 11.9 versus -0.2 ± 27.5 min, respectively, P < 0.0001. Door-to-balloon time was significantly longer in the Off-hour Group compared to the On-hour Group, 74 ± 35 versus 60 ± 26 min respectively, P < 0.0001. Length of stay, vascular complications, final TIMI 3 flow and in-hospital mortality were similar between both groups.

Conclusions: In STEMI patients receiving primary PCI in Los Angeles County, off-hour PCI was common. Short-term clinical outcomes were similar despite longer door-to-balloon time in patients receiving off-hour PCI. The longer door-to-balloon time in the off-hour PCI patients were partly explained by longer door-to-CL activation time.

Introduction: Stress hyperglycemia (SH) in STEMI is associated with high risk of in-hospital mortality. It is still controversial if SH is marker of high post-hospital risk.

Objectives: The aim was to analyze in-hospital and one-year risk associated with SH in STEMI and to study if SH is marker of LV remodeling.

Methods: We enrolled 275 patients who were admitted with first STEMI and reperfused. Patients were divided according to admission glycemia in three groups: (1) with diabetes mellitus (DM); (2) with SH, without DM and; (3) without both DM and SH. SH was defined as admission blood glucose level ≥ 8 mmol/l.

Results: In-hospital mortality was higher in patients with known DM (5%) and highest in patients with SH without previous DM (9.3%), and only 1.6% in the third group, P < 0.05. In patients without known DM, SH was associated with 6.378-fold higher in-hospital mortality. Total mortality was double in group with SH without DM compared to the third group (13.9% versus 6.3%). EDV changed in patients with SH without DM from 126 ± 37 to 145 ± 30 ml after one year, P < 0.05.

Conclusion: SH is associated with high in-hospital mortality risk and it could be marker of LV remodeling (significant increase of EDV during one year).

Background: Relationship between obstructive sleep apnoea and atherosclerosis has not been confirmed using coronary angiography. We sought to investigate the relationships between the apnoea-hypopnoea index (AHI) and angiographic coronary disease phenotypes.


Methods: SYNTAX score, lesion complexity, and thrombus burden grade were determined in 125 patients presenting with acute myocardial infarction and had undergone a screening sleep study. Severe OSA was defined as AHI ≥ 30.


Results: Most of the recruited patients were male (97.6%). Severe obstructive sleep apnoea was diagnosed in 37% of the patients. The severe obstructive sleep apnoea group (n = 46) was older (P = 0.039) and more obese (P = 0.003) than the non-severe group (n = 79). There was no evidence of difference between the severe and non-severe obstructive sleep apnoea groups with regard to SYNTAX score (P = 0.871), number of complex lesions (P = 0.241), and thrombus burden grade (P = 0.433). Multivariate analysis adjusting for difference in age and body mass index did not change the findings.

Conclusion: Using the three angiographic scoring systems, we found no association between AHI and angiographic coronary disease phenotypes, suggesting a limited effect of obstructive sleep apnoea on the amount and distribution of coronary plaques in patients presenting with acute myocardial infarction.

Introduction: In-hospital cardiac arrest is a leading cause of death and despite recent advances in cardiopulmonary resuscitation, the survival to hospital discharge is poor. The aim of our study was to evaluate the success of resuscitation efforts in a tertiary hospital.

Patients and methods: We retrospectively collected and analysed data on all patients in whom cardiopulmonary resuscitation was attempted after in-hospital cardiac arrest in one-year period.

Results: 96 cardiac arrest victims were studied. Sustained return of spontaneous circulation was achieved in 15 (15.6%) patients, while all of them survived for 24 h. Training in cardiopulmonary resuscitation, initiation of resuscitation efforts in less than 5 min, and intubation time < 1 min after team arrival were predictive factors associated with restoration of spontaneous circulation. Non-certified residents resuscitated 87 (90.6%) patients with 6 (6.8%) of them achieving return of spontaneous circulation and surviving for 24 h. On the contrary, certified ward residents resuscitated nine (9.3%) patients with 100% immediate and 24-h survival.

Conclusion: In our hospital, certified providers had remarkably higher successful resuscitation rates for in-hospital cardiac arrest than non-certified providers. This finding suggests that training in cardiopulmonary resuscitation, continuing medical education, and implementation of the existing legislation will result in increased survival.

This is a report of a 58-year-old man with severe hypertrophic obstructive cardiomyopathy who underwent alcohol septal ablation to relieve symptoms due to severe left ventricular outflow obstruction. Cardiac magnetic resonance was performed before and after the procedure. This case highlights the potential use of cardiac magnetic resonance imaging in the surgical planning of alcohol septal ablation as well as following the procedure to assess for complications and morphological changes.