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Correlation between Traditional Chinese Medicine Syndromes and Type 2 Myocardial Infarction in Critically Ill Patients with Pulmonary Disease. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:9329683. [PMID: 35356241 PMCID: PMC8959955 DOI: 10.1155/2022/9329683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 11/17/2022]
Abstract
Background Treatment based on syndrome differentiation under the traditional Chinese medicine (TCM) framework has been shown to be helpful in patients with coronary artery disease. We hypothesized that syndrome types could predict the risk of type 2 myocardial infarction (T2MI) caused by imbalance between myocardial oxygen supply and demand in critically ill patients with pulmonary disease. Methods This retrospective study included consecutive critically ill patients with pulmonary disease admitted to the ICU at Jiading District Central Hospital Affiliated Shanghai University of Medicine & Health Sciences from January 1, 2017, to July 1, 2019. Diagnosis of T2MI was based on the fourth universal definition of myocardial infarction. Risk factors associated with T2MI were identified using multivariate regression analysis. Results A total of 244 patients were included in the study: 78 who developed T2MI and the remaining 166 who did not develop T2MI during hospitalization. The incidence of phlegm syndrome and deficiency syndrome was 61.9% and 38.1%, respectively. In comparison with the patients with phlegm syndrome, the incidence of T2MI in patients with deficiency syndrome is significantly higher (40.9% vs. 26.5%, P=0.019). In multivariate logistic regression, T2MI was independently associated with the baseline troponin level (OR 12.682, 95% CI 1.397∼115.121; P=0.024), hemoglobin < 55 g/L (OR 12.76, 95% CI 2.359∼69.021; P=0.003), mechanical ventilation (OR 2.244, 95% CI 1.029∼4.892; P=0.042), and TCM deficiency syndrome (OR 2.214, 95% CI 1.032∼4.749; P=0.041). After adjusting for confounding factors in Cox regression models, the hazard ratio (95% confidence interval) of qi deficiency syndrome groups was 1.183 (95% CI 1.053∼3.123, P=0.032). Conclusions Patients with deficiency syndrome are at high risk of T2MI, especially those combined with qi deficiency syndrome.
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Boyanpally A, Cutting S, Furie K. Acute Ischemic Stroke Associated with Myocardial Infarction: Challenges and Management. Semin Neurol 2021; 41:331-339. [PMID: 33851390 DOI: 10.1055/s-0041-1726333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Acute ischemic stroke (AIS) and acute myocardial infarction (AMI) may co-occur simultaneously or in close temporal succession, with occurrence of one ischemic vascular event increasing a patient's risk for the other. Both employ time-sensitive treatments, and both benefit from expert consultation. Patients are at increased risk of stroke for up to 3 months following AMI, and aggressive treatment of AMI, including use of reperfusion therapy, decreases the risk of AIS. For patients presenting with AIS in the setting of a recent MI, treatment with alteplase, an intravenous tissue plasminogen activator, can be given, provided anterior wall myocardial involvement has been carefully evaluated. It is important for clinicians to recognize that troponin elevations can occur in the setting of AIS as well as other clinical scenarios and that this may have implications for short- and long-term mortality.
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Affiliation(s)
- Anusha Boyanpally
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
| | - Shawna Cutting
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
| | - Karen Furie
- Department of Neurology, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.,The Norman Prince Neuroscience Institute, Rhode Island Hospital, Providence, Rhode Island
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Jogu HR, Arora S, Vaduganathan M, Qamar A, Pandey A, Chevli PA, Pansuriya TH, Ahmad MI, Dutta A, Sunkara PR, Qureshi W, Vasu S, Upadhya B, Bhatt DL, Januzzi JL, Herrington D. Wake Forest University long-term follow-up of type 2 myocardial infarction: The Wake-Up T2MI Registry. Clin Cardiol 2019; 42:592-604. [PMID: 30941774 PMCID: PMC6553563 DOI: 10.1002/clc.23182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background The Wake‐Up T2MI Registry is a retrospective cohort study investigating patients with type 2 myocardial infarction (T2MI), acute myocardial injury, and chronic myocardial injury. We aim to explore risk stratification strategies and investigate clinical characteristics, management, and short‐ and long‐term outcomes in this high‐risk, understudied population. Methods From 1 January 2009 to 31 December 2010, 2846 patients were identified with T2MI or myocardial injury defined as elevated cardiac troponin I with at least one value above the 99th percentile upper reference limit and coefficient of variation of 10% (>40 ng/L) and meeting our inclusion criteria. Data of at least two serial troponin values will be collected from the electronic health records to differentiate between acute and chronic myocardial injury. The Fourth Universal Definition will be used to classify patients as having (a) T2MI, (b) acute myocardial injury, or (c) chronic myocardial injury during the index hospitalization. Long‐term mortality data will be collected through data linkage with the National Death Index and North Carolina State Vital Statistics. Results We have collected data for a total of 2205 patients as of November 2018. The mean age of the population was 65.6 ± 16.9 years, 48% were men, and 64% were white. Common comorbidities included hypertension (71%), hyperlipidemia (35%), and diabetes mellitus (30%). At presentation, 40% were on aspirin, 38% on β‐blockers, and 30% on statins. Conclusion Improved characterization and profiling of this cohort may further efforts to identify evidence‐based strategies to improve cardiovascular outcomes among patients with T2MI and myocardial injury.
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Affiliation(s)
- Hanumantha R Jogu
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Sameer Arora
- Division of Cardiology, University of North Carolina, Chapel Hill, North Carolina
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Arman Qamar
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - Ambarish Pandey
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Parag A Chevli
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tusharkumar H Pansuriya
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Muhammad I Ahmad
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Abhishek Dutta
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Padageshwar R Sunkara
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Waqas Qureshi
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Massachusetts School of Medicine, Worcester, Massachusetts
| | - Sujethra Vasu
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bharathi Upadhya
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, Massachusetts
| | - James L Januzzi
- Cardiology Division, Massachusetts General Hospital, and Cardiometabolic Trials, Baim Institute for Clinical Research, Boston, Massachusetts
| | - David Herrington
- Section on Cardiovascular Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
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