Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation

Pulmonary Embolism Presenting as ST-Elevation Myocardial Infarction: A Report of Two Cases

Pulmonary embolism (PE) is often underrecognized due to its ability to mimic other conditions; however, ultrasound can provide diagnostic clues to aid in the diagnosis of PE. We describe two patients who presented with symptoms suggestive of cardiac ischemia and had electrocardiograms (EKGs) indicative of anteroseptal myocardial infarction. In both cases, cardiac point-of-care ultrasonography showed signs of large pulmonary emboli, which were then confirmed on computed tomography angiography of the chest. Both patients underwent successful aspiration thrombectomy with rapid resolution of cardiac dysfunction. Point-of-care ultrasonography should be used as an adjunct in patients presenting with anterior ischemia on EKG to evaluate for signs of PE.

Polymeric Nanofibers for Drug Delivery Applications: A Recent Review

With the rapid development of biomaterials and biotechnologies, various functional materials-based drug delivery systems (DDS) are developed to overcome the limitations of traditional drug release formulations, such as uncontrollable drug concentration in target organs/tissues and unavoidable adverse reactions. Polymer nanofibers exhibit promising characteristics including easy preparation, adjustable features of wettability and elasticity, tailored surface and interface properties, and surface-to-volume ratio, and are used to develop new DDS. Different kinds of drugs can be incorporated into the polymer nanofibers. Additionally, their release kinetics can be modulated via the preparation components, component proportions, and preparation processes, enabling their applications in several fields. A timely and comprehensive summary of polymeric nanofibers for DDS is thus highly needed. This review first describes the common methods for polymer nanofiber fabrication, followed by introducing controlled techniques for drug loading into and release from polymer nanofibers. Thus, the applications of polymer nanofibers in drug delivery were summarized, particularly focusing on the relation between the physiochemical properties of polymeric nanofibers and their DDS performance. It is ended by listing future perspectives. Graphical abstract.

Door-to-balloon time and mortality in patients with ST-elevation myocardial infarction undergoing primary angioplasty

AIMS

The evidence are not conclusive that a small incremental increase in door-to-balloon (D2B) time leads to a significant increase in death of ST-elevation myocardial infarction (STEMI) patients. In a previous study, we described a quality improvement intervention that reduced D2B time in 333 patients with STEMI. The aim of the current study was to compare mortality rates of the patients, before and after the intervention.

METHODS AND RESULTS

We examined the survival of 133 consecutive patients with STEMI treated prior to an intervention to decrease D2B time and 200 treated after the intervention. The mortality rate was the same before and after the quality intervention. The median D2B time for the entire cohort was 55 min. The number of patients with D2B time >55 min prior to the intervention was 82/133 (61%) and after the intervention 74/200 (37%) P < 0.00001. Thirty-day mortality among the patients with D2B time ≤55 min was 5/178 (2.8%) and among those with D2B time >55 min was 15/155 (9.7%), P < 0.008. The hazard ratio for 30-day mortality when the D2B time was >55 min was 3.7 (1.3-10.4).

CONCLUSION

Mortality and non-fatal complications did not differ significantly between STEMI patients before and after a quality improvement intervention. However, the number of patients treated within 55 min from arrival was significantly higher after the intervention; and coronary intervention within this time was associated with a lower death rate.