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Boyd W, Young W, Yildiz M, Henry TD, Gorder K. In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care. Expert Rev Cardiovasc Ther 2024:1-11. [PMID: 39076105 DOI: 10.1080/14779072.2024.2383648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/19/2024] [Indexed: 07/31/2024]
Abstract
INTRODUCTION In-Hospital Cardiac Arrest (IHCA) after ST-segment Elevation Myocardial Infarction (STEMI) is a subset of IHCA with high morbidity. While information on this selected group of patients is limited, closer inspection reveals that this is a challenging patient population with certain risk factors for IHCA following treatment of STEMI. AREAS COVERED In this review article, strategies for prevention of IHCA post STEMI are reviewed, as well as best-practices for the care of STEMI patients post-IHCA. EXPERT OPINION Early and successful reperfusion is key for the prevention of IHCA and has a significant impact on in-hospital mortality. A number of pharmacological treatments have also been studied that can impact the progression to IHCA. Development of cardiogenic shock post-STEMI increases mortality and raises the risk of cardiac arrest. The treatment of IHCA follows the ACLS algorithm with some notable exceptions.
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Affiliation(s)
- Walker Boyd
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio, USA
| | - Wesley Young
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio, USA
| | - Mehmet Yildiz
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio, USA
| | - Timothy D Henry
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio, USA
- The Carl and Edyth Lindner Research Center at The Christ Hospital, Cincinnati, Ohio, USA
| | - Kari Gorder
- Heart and Vascular Institute, The Christ Hospital, Cincinnati, Ohio, USA
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Hanada K, Kinjo T, Yokoyama H, Tsushima M, Senoo M, Ichikawa H, Nishizaki F, Shibutani S, Yokota T, Okumura K, Tomita H. Incidence, Predictors, and Outcome Associated With Ventricular Tachycardia or Fibrillation in Patients Undergoing Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction. Circ J 2024; 88:1254-1264. [PMID: 37766557 DOI: 10.1253/circj.cj-23-0023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
BACKGROUND The characteristics and clinical outcomes associated with sustained ventricular tachycardia and fibrillation (VT/VF) in Japanese acute myocardial infarction (AMI) patients remain unknown.Methods and Results: Consecutive AMI patients (n=1,941) transferred to the Hirosaki University Hospital and treated with primary percutaneous coronary intervention (PCI) within 12 h of onset were retrospectively studied. The incidence of VT/VF during hospitalization was 8.3%, and 75% of cases occurred by the end of PCI. Independent predictors associated with VT/VF occurrence by the end of PCI and after PCI, respectively, were identified. Additionally, the differences between patients with VT and VF were examined, which revealed that the characteristics of patients and predictors for VT and VF were clearly different. Additionally, the QRS duration during VT was measured, which demonstrated the possible involvement of Purkinje fibers for VT in the acute phase of AMI. Of the patients with VT/VF, 12% required ECMO support due to refractory VT/VF despite intravenous antiarrhythmic agents such as β-blockers, amiodarone, and nifekalant. Among the patients discharged alive, 1,690 were followed up for a mean of 3.7 years. VT/VF occurrence during hospitalization did not affect the mid-term clinical outcomes even in patients with VT. CONCLUSIONS The results clearly indicated that VT/VF is still a serious complications of AMI. We need to identify patients at high risk of developing VT/VF for careful observation and appropriate intervention.
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Affiliation(s)
- Kenji Hanada
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Takahiko Kinjo
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Hiroaki Yokoyama
- Department of Advanced Cardiovascular Therapeutics, Hirosaki University Graduate School of Medicine
| | - Michiko Tsushima
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Maiko Senoo
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Hiroaki Ichikawa
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Fumie Nishizaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Shuji Shibutani
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | - Takashi Yokota
- Department of Emergency and Disaster Medicine, Hirosaki University Graduate School of Medicine
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital
| | - Hirofumi Tomita
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
- Department of Advanced Cardiovascular Therapeutics, Hirosaki University Graduate School of Medicine
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Liu C, Li X, Li J, Shen D, Sun Q, Zhao J, Zhao H, Fu G. Standby extracorporeal membrane oxygenation: a better strategy for high-risk percutaneous coronary intervention. Front Med (Lausanne) 2024; 11:1404479. [PMID: 38994335 PMCID: PMC11238173 DOI: 10.3389/fmed.2024.1404479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/11/2024] [Indexed: 07/13/2024] Open
Abstract
Background The incidence of cardiac arrest (CA) during percutaneous coronary intervention (PCI) is relatively rare. However, when it does occur, the mortality rate is extremely high. Extracorporeal cardiopulmonary resuscitation (ECPR) has shown promising survival rates for in-hospital cardiac arrests (IHCA), with low-flow time being an independent prognostic factor for CA. However, there is no definitive answer on how to reduce low-flow time. Methods This retrospective study, conducted at a single center, included 39 patients who underwent ECPR during PCI between January 2016 and December 2022. The patients were divided into two cohorts based on whether standby extracorporeal membrane oxygenation (ECMO) was utilized during PCI: standby ECPR (SBE) (n = 13) and extemporaneous ECPR (EE) (n = 26). We compared the 30-day mortality rates between these two cohorts and investigated factors associated with survival. Results Compared to the EE cohort, the SBE cohort showed significantly lower low-flow time (P < 0.01), ECMO operation time (P < 0.01), and a lower incidence of acute kidney injury (AKI) (P = 0.017), as well as peak lactate (P < 0.01). Stand-by ECMO was associated with improved 30-day survival (p = 0.036), while prolonged low-flow time (p = 0.004) and a higher SYNTAX II score (p = 0.062) predicted death at 30 days. Conclusions Standby ECMO can provide significant benefits for patients who undergo ECPR for CA during PCI. It is a viable option for high-risk PCI cases and may enhance the overall prognosis. The low-flow time remains a critical determinant of survival.
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Affiliation(s)
- Chuang Liu
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Xingxing Li
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Jun Li
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Deliang Shen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Qianqian Sun
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Junjie Zhao
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Hui Zhao
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Guowei Fu
- Department of Extracorporeal Life Support Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
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Schnur A, Rav Acha M, Loutati R, Perel N, Taha L, Zacks N, Maller T, Karmi M, Bayya F, Levi N, Sabouret P, Fink N, Marmor D, Shuvy M, Glikson M, Asher E. Incidence of Ventricular Fibrillation and Sustained Ventricular Tachycardia Complicating Non-ST Segment Elevation Myocardial Infarction. J Clin Med 2024; 13:2286. [PMID: 38673559 PMCID: PMC11050986 DOI: 10.3390/jcm13082286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 04/01/2024] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Primary ventricular fibrillation (VF) and sustained ventricular tachycardia (VT) are potentially lethal complications in patients suffering from acute myocardial infarction (MI). In contrast with the profound data regarding the incidence and prognostic value of ventricular arrhythmias in ST elevation myocardial infarction (STEMI) patients, data regarding contemporary non-ST elevation myocardial infarction (NSTEMI) patients with ventricular arrhythmias is scarce. The aim of the current study was to investigate the incidence of VF/VT complicating NSTEMI among patients admitted to an intensive coronary care unit (ICCU). Methods: Prospective, single-center study of patients diagnosed with NSTEMI admitted to ICCU between June 2019 and December 2022. Data including demographics, presenting symptoms, comorbid conditions, and physical examination, as well as laboratory and imaging data, were analyzed. Patients were continuously monitored for arrhythmias during their admission. The study endpoint was the development of VF/sustained VT during admission. Results: A total of 732 patients were admitted to ICCU with a diagnosis of NSTEMI. Of them, six (0.8%) patients developed VF/VT during their admission. Nevertheless, three were excluded after they were misdiagnosed with NSTEMI instead of posterior ST elevation myocardial infarction (STEMI). Hence, only three (0.4%) NSTEMI patients had VF/VT during admission. None of the patients died during 1-year follow-up. Conclusions: VF/VT in NSTEMI patients treated according to contemporary guidelines including early invasive strategy is rare, suggesting these patients may not need routine monitoring and ICCU setup.
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Affiliation(s)
- Asher Schnur
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Moshe Rav Acha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Ranel Loutati
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nimrod Perel
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Louay Taha
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Netanel Zacks
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Tomer Maller
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mohammad Karmi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Feras Bayya
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Nir Levi
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Pierre Sabouret
- ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, Sorbonne Université, 75005 Paris, France;
- Department of Cardiology, National College of French Cardiologists, 13 Rue Niepce, 75014 Paris, France
| | - Noam Fink
- Assuta Medical Centers, Tel Aviv 6329302, Israel;
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - David Marmor
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Mony Shuvy
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Michael Glikson
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
| | - Elad Asher
- Jesselson Heart Center, Shaare Zedek Medical Center, The Eisenberg R&D Authority, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel; (M.R.A.); (R.L.); (N.P.); (L.T.); (N.Z.); (T.M.); (M.K.); (F.B.); (N.L.); (D.M.); (M.S.); (M.G.); (E.A.)
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Chevalier P, Roy P, Bessière F, Morel E, Ankou B, Morgan G, Halder I, London B, Minobe WA, Slavov D, Delinière A, Bochaton T, Paganelli F, Lesavre N, Boiteux C, Mansourati J, Maury P, Clerici G, Winum PF, Huebler SP, Carroll IA, Bristow MR. Impact of Neuroeffector Adrenergic Receptor Polymorphisms on Incident Ventricular Fibrillation During Acute Myocardial Ischemia. J Am Heart Assoc 2023; 12:e025368. [PMID: 36926933 PMCID: PMC10111522 DOI: 10.1161/jaha.122.025368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Background Cardiac adrenergic receptor gene polymorphisms have the potential to influence risk of developing ventricular fibrillation (VF) during ST-segment-elevation myocardial infarction, but no previous study has comprehensively investigated those most likely to alter norepinephrine release, signal transduction, or biased signaling. Methods and Results In a case-control study, we recruited 953 patients with ST-segment-elevation myocardial infarction without previous cardiac history, 477 with primary VF, and 476 controls without VF, and genotyped them for ADRB1 Arg389Gly and Ser49Gly, ADRB2 Gln27Glu and Gly16Arg, and ADRA2C Ins322-325Del. Within each minor allele-containing genotype, haplotype, or 2-genotype combination, patients with incident VF were compared with non-VF controls by odds ratios (OR) of variant frequencies referenced against major allele homozygotes. Of 156 investigated genetic constructs, 19 (12.2%) exhibited significantly (P<0.05) reduced association with incident VF, and none was associated with increased VF risk except for ADRB1 Gly389 homozygotes in the subset of patients not receiving β-blockers. ADRB1 Gly49 carriers (prevalence 23.0%) had an OR (95% CI) of 0.70 (0.49-0.98), and the ADRA2C 322-325 deletion (Del) carriers (prevalence 13.5%) had an OR of 0.61 (0.39-0.94). When present in genotype combinations (8 each), both ADRB1 Gly49 carriers (OR, 0.67 [0.56-0.80]) and ADRA2C Del carriers (OR, 0.57 [0.45- 0.71]) were associated with reduced VF risk. Conclusions In ST-segment-elevation myocardial infarction, the adrenergic receptor minor alleles ADRB1 Gly49, whose encoded receptor undergoes enhanced agonist-mediated internalization and β-arrestin interactions leading to cardioprotective biased signaling, and ADRA2C Del322-325, whose receptor causes disinhibition of norepinephrine release, are associated with a lower incidence of VF. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT00859300.
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Affiliation(s)
- Philippe Chevalier
- Rhythmology Department Hospital Louis Pradel Lyon France
- Université Claude Bernard Lyon 1 Université de Lyon Lyon France
| | - Pascal Roy
- Hospices Civils de Lyon, Services Biostatistiques Lyon France
| | | | - Elodie Morel
- Rhythmology Department Hospital Louis Pradel Lyon France
| | | | - Gina Morgan
- Division of Cardiovascular Medicine University of Iowa Iowa City IA
| | - Indrani Halder
- Division of Cardiovascular Medicine University of Iowa Iowa City IA
| | - Barry London
- Division of Cardiovascular Medicine University of Iowa Iowa City IA
| | - Wayne A Minobe
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | - Dobromir Slavov
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
| | | | - Thomas Bochaton
- Department of Intensive Cardiac Care Hospital Louis Pradel Lyon France
| | | | | | | | - Jacques Mansourati
- Cardiology Department Hôpital de La Cavale Blanche, Brest University Hospital Brest France
| | - Philippe Maury
- Cardiology Department University Hospital Rangueil Toulouse France
| | - Gaël Clerici
- Cardiology Department Saint Pierre University Hospital La Réunion France
| | | | | | - Ian A Carroll
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
- ARCA Biopharma Westminster CO
| | - Michael R Bristow
- Division of Cardiology University of Colorado Anschutz Medical Campus Aurora CO
- ARCA Biopharma Westminster CO
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Klancik V, Kočka V, Sulzenko J, Widimsky P. The many roles of urgent catheter interventions: from myocardial infarction to acute stroke and pulmonary embolism. Expert Rev Cardiovasc Ther 2023; 21:123-132. [PMID: 36706282 DOI: 10.1080/14779072.2023.2174101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality. AREAS COVERED The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided. EXPERT OPINION Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
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Affiliation(s)
- Viktor Klancik
- Department of Cardiology, Ceske Budejovice Hospital, Inc, Ceske Budejovice, Czech Republic.,Department of Cardiology, Charles University, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Jakub Sulzenko
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
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Haugsten Hansen M, Sadredini M, Hasic A, Anderson ME, Sjaastad I, Korseberg Stokke M. CaMKII and reactive oxygen species contribute to early reperfusion arrhythmias, but oxidation of CaMKIIδ at methionines 281/282 is not a determining factor. J Mol Cell Cardiol 2023; 175:49-61. [PMID: 36528076 DOI: 10.1016/j.yjmcc.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Available evidence suggest that Ca2+/calmodulin-dependent protein kinase type IIδ (CaMKIIδ) and reactive oxygen species (ROS) are important in early ischemia-reperfusion arrhythmias (IRA). Since ROS can activate CaMKIIδ by oxidation of two methionines at positions 281/282, oxidized-CaMKIIδ (Ox-CaMKIIδ) has been proposed to be important for IRA. However, direct evidence for this is missing. METHODS We exposed Langendorff-perfused hearts and ventricular cardiomyocytes from C57BL/6 mice to global and simulated ischemia, respectively, and recorded arrhythmic events during early reperfusion. Hearts were collected for immunoblotting of key phosphoproteins. We evaluated the effects of beta-adrenoceptor stimulation, inhibition of CaMKII, and reduced ROS levels with isoprenaline, KN93/AIP and N-acetylcysteine (NAC), respectively. We further tested the importance of Ox-CaMKIIδ by using hearts and cardiomyocytes from mice with CaMKIIδ resistant to oxidation of methionines 281 and 282 (MMVV). RESULTS Hearts treated with KN93, AIP or NAC had lower incidence of early IRA, and NAC-treated cardiomyocytes had lower incidence of arrhythmogenic events. However, hearts from MMVV mice had a similar incidence of early IRA to wild type mice (WT), and MMVV and WT cardiomyocytes had a similar frequency of Ca2+ waves and Ca2+ sparks. Immunoblotting confirmed high levels of oxidation in early reperfusion, but revealed no significant differences in the phosphorylation levels of Ca2+-handling proteins in MMVV and WT hearts. CONCLUSIONS Although CaMKII and ROS both contribute to early IRA, hearts from mice with CaMKII resistant to oxidation at methionines 281/282 were not protected from such arrhythmias, suggesting that oxidation at these sites is not a determining factor.
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Affiliation(s)
- Marie Haugsten Hansen
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mani Sadredini
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Almira Hasic
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mark E Anderson
- Division of Cardiology, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ivar Sjaastad
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway
| | - Mathis Korseberg Stokke
- Institute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway; KG Jebsen Centre for Cardiac Research, University of Oslo, Oslo, Norway; Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway.
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Prognostic value of early sustained ventricular arrhythmias in ST-elevation myocardial infarction treated by primary percutaneous coronary intervention: a sub-study of VALIDATE-SWEDEHEART trial. Heart Rhythm O2 2022; 4:200-206. [PMID: 36993916 PMCID: PMC10041082 DOI: 10.1016/j.hroo.2022.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Prognostic assessment of ventricular tachycardia (VT) or ventricular fibrillation (VF) in ST-segment elevation myocardial infarction (STEMI) is based mainly on distinguishing between early (<48 hours) and late arrhythmias, and does not take into account its time distribution with regard to reperfusion, or type of arrhythmia. Objective We analyzed the prognostic value of early ventricular arrhythmias (VAs) in STEMI with regard to their type and timing. Methods The prespecified analysis of the multicenter prospective Bivalirudin versus Heparin in ST-Segment and Non-ST-Segment Elevation Myocardial Infarctionin Patients on Modern Antiplatelet Therapy in the Swedish Web System for Enhancement and Development of Evidence-based Care in Heart Disease evaluated according to Recommended Therapies Registry Trial included 2886 STEMI patients undergoing primary percutaneous coronary intervention (PCI). VA episodes were characterized regarding their type and timing. Survival status at 180 days was assessed through the population registry. Results Nonmonomorphic VT or VF was observed in 97 (3.4%) and monomorphic VT in 16 (0.5%) patients. Only 3 (2.7%) early VA episodes occurred after 24 hours from symptom onset. VA was associated with higher risk of death (hazard ratio 3.59; 95% confidence interval [CI] 2.01-6.42) after adjustment for age, sex, and STEMI localization. VA after PCI was associated with an increased mortality compared with VA before PCI (hazard ratio 6.68; 95% CI 2.90-15.41). Early VA was associated with in-hospital mortality (odds ratio 7.39; 95% CI 3.68-14.83) but not with long-term prognosis in patients discharged alive. The type of VA was not associated with mortality. Conclusion VA after PCI was associated with an increased mortality compared with VA before PCI. Long-term prognosis did not differ between patients with monomorphic VT and nonmonomorphic VT or VF, but events were few. VA incidence during 24 to 48 hours of STEMI is negligibly low, thus precluding assessment of its prognostic importance.
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Weizman O, Marijon E, Narayanan K, Boveda S, Defaye P, Martins R, Deharo JC, Laurent G, Klug D, Sadoul N, Hocini M, Mansencal N, Anselme F, Da Costa A, Maury P, Ferrières J, Schiele F, Simon T, Danchin N. Incidence, Characteristics, and Outcomes of Ventricular Fibrillation Complicating Acute Myocardial Infarction in Women Admitted Alive in the Hospital. J Am Heart Assoc 2022; 11:e025959. [PMID: 36017613 PMCID: PMC9496428 DOI: 10.1161/jaha.122.025959] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Little data are available in women presenting with ventricular fibrillation (VF) in the setting of acute myocardial infarction (AMI). We assessed frequency, predictors of VF, and outcomes, with a special focus on women compared with men. Methods and Results Data were analyzed from the FAST‐MI (French Registry of Acute ST‐Elevation or Non‐ST‐Elevation Myocardial Infarction) program, which prospectively included 14 406 patients admitted to French cardiac intensive care units ≤48 hours from AMI onset between 1995 and 2015 (mean age, 66±14 years; 72% men; mean left ventricular ejection fraction, 52±12%; 59% with ST‐segment–elevation myocardial infarction). A total of 359 patients developed VF during AMI, including 81 women (2.0% of 4091 women) and 278 men (2.7% of 10 315 men, P=0.02). ST‐segment–elevation myocardial infarction (odds ratio [OR], 2.29 [95% CI, 1.75–2.99]; P<0.001) was independently associated with the onset of VF during AMI. In contrast, female sex (OR, 0.73 [95% CI, 0.56–0.95]; P=0.02), hypertension (OR, 0.75 [95% CI, 0.60–0.94]; P=0.01), and prior myocardial infarction (OR, 0.69 [95% CI, 0.50–0.96]; P=0.03) were protective factors. Women were less likely to have cardiac intervention than men (percutaneous coronary intervention during hospitalization 48.1% versus 66.9%, respectively; P=0.04) with a higher 1‐year mortality in women compared with men (50.6% versus 37.4%, respectively; P=0.03), including increased in‐hospital mortality (42.0% versus 32.7%, respectively; P=0.12). After adjustment, female sex was no longer associated with a worse 1‐year mortality (adjusted hazard ratio, 1.10 [95% CI, 0.75–1.61]; P=0.63). Conclusions Women have lower risk of developing VF during AMI compared with men. However, they are less likely to receive cardiac interventions than men, possibly contributing to missed opportunities of improved outcomes.
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Affiliation(s)
- Orianne Weizman
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Faculté de Médecine Université de Lorraine Vandœuvre-lès-Nancy France
| | - Eloi Marijon
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
| | | | - Serge Boveda
- Cardiology Department Clinique Pasteur Toulouse France
| | - Pascal Defaye
- Cardiology Department CHU Grenoble La Tronche France
| | | | | | | | - Didier Klug
- Cardiology Department CHU Lille Lille France
| | | | - Meleze Hocini
- Cardiology Department Institut de Rythmologie-Hopital Cardiologique, CHU Bordeaux Pessac France
| | - Nicolas Mansencal
- Cardiology Department AP-HP Hopital Ambroise Paré Boulogne Bilancourt France
| | | | - Antoine Da Costa
- Cardiology Department CHU Saint Etienne Saint Priez en Jarez France
| | - Philippe Maury
- Cardiology Department Rangueil University Hospital Toulouse France
| | - Jean Ferrières
- Cardiology Department Rangueil University Hospital Toulouse France
| | - François Schiele
- Cardiology Department University Hospital Jean Minjoz Besançon France
| | - Tabassome Simon
- Clinical Research Unit Saint-Antoine Hospital AP-HP Paris France
| | - Nicolas Danchin
- Université Paris Cité Inserm, PARCC, F-75015 Paris France.,Cardiology Department AP-HP, European Georges Pompidou Hospital Paris France
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10
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Dunning J, Archbold A, de Bono JP, Butterfield L, Curzen N, Deakin CD, Gudde E, Keeble TR, Keys A, Lewis M, O'Keeffe N, Sarma J, Stout M, Swindell P, Ray S. Joint British Societies' guideline on management of cardiac arrest in the cardiac catheter laboratory. BRITISH HEART JOURNAL 2022; 108:e3. [PMID: 35470236 DOI: 10.1136/heartjnl-2021-320588] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
More than 300 000 procedures are performed in cardiac catheter laboratories in the UK each year. The variety and complexity of percutaneous cardiovascular procedures have both increased substantially since the early days of invasive cardiology, when it was largely focused on elective coronary angiography and single chamber (right ventricular) permanent pacemaker implantation. Modern-day invasive cardiology encompasses primary percutaneous coronary intervention, cardiac resynchronisation therapy, complex arrhythmia ablation and structural heart interventions. These procedures all carry the risk of cardiac arrest.We have developed evidence-based guidelines for the management of cardiac arrest in adult patients in the catheter laboratory. The guidelines include recommendations which were developed by collaboration between nine professional and patient societies that are involved in promoting high-quality care for patients with cardiovascular conditions. We present a set of protocols which use the skills of the whole catheter laboratory team and which are aimed at achieving the best possible outcomes for patients who suffer a cardiac arrest in this setting. We identified six roles and developed a treatment algorithm which should be adopted during cardiac arrest in the catheter laboratory. We recommend that all catheter laboratory staff undergo regular training for these emergency situations which they will inevitably face.
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Affiliation(s)
- Joel Dunning
- Department of Cardiothoracic Surgery, James Cook University Hospital, Middlesbrough, Middlesbrough, UK
| | - Andrew Archbold
- Department of General & Interventional Cardiology, Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Joseph Paul de Bono
- Department of Cardiology, Queen Elizabeth Hospital, University of Birmingham, Birmingham, West Midlands, UK
| | - Liz Butterfield
- School of Nursing, Midwifery and Social Work, Faculty of Health and Wellbeing, Canterbury Christ Church University, Canterbury, UK
| | - Nick Curzen
- Faculty of Medicine, University of Southampton and Department of Cardiology, Southampton, UK
| | - Charles D Deakin
- Anaesthesia and Intensive Care, Southampton University Hospitals NHS Trust, Southampton, Southampton, UK
| | - Ellie Gudde
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Trust, Basildon, Essex, UK.,Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Alan Keys
- Cardiovascular Care Partnership (UK), British Cardiovascular Society, London, London, UK
| | - Mike Lewis
- Department of Cardiac Surgery, Royal Sussex County Hospital, Brighton, UK
| | - Niall O'Keeffe
- Department of Cardiothoracic Anaesthesia and Critical Care, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Jaydeep Sarma
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
| | - Martin Stout
- School of Healthcare Science, Manchester Metropolitan University, Manchester, UK
| | | | - Simon Ray
- Department of Cardiology, Manchester University NHS Foundation Trust, Manchester, Greater Manchester, UK
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11
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In-Hospital and One-Year Outcomes of Patients after Early and Late Resuscitated Cardiac Arrest Complicating Acute Myocardial Infarction-Data from a Nationwide Database. J Clin Med 2022; 11:jcm11030609. [PMID: 35160061 PMCID: PMC8836754 DOI: 10.3390/jcm11030609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
The prognostic role of early (less than 48 h) resuscitated cardiac arrest (ErCA) complicating acute myocardial infarction (AMI) is still controversial. The present study aimed to analyse the short-term and one-year outcomes of patients after ErCA and late resuscitated cardiac arrest (LrCA) compared to patients without cardiac arrest (CA) complicating AMI. Data from the prospective nationwide Polish Registry of Acute Coronary Syndromes (PL-ACS) were used to assess patients with resuscitated cardiac arrest (rCA) after AMI. Baseline clinical characteristics and the predictors of all-cause death were assessed. The all-cause mortality rate, complications, performed procedures, and re-hospitalisations were assessed for the in-hospital period, 30 days after discharge, and 6- and 12-month follow-ups. Among 167,621 cases of AMI, CA occurred in 3564 (2.1%) patients, that is, 3100 (87%) and 464 (13%) patients with ErCA and LrCA, respectively. The mortality rates in the ErCA vs. LrCA and CA vs. non-CA groups were as follows: in-hospital: 32.1% vs. 59.1% (p < 0.0001) and 35.6% vs. 6.0% (p < 0.0001); 30-day: 2.2% vs. 3.2% (p = 0.42) and 9.9% vs. 5.2% (p < 0.0001); 6-month: 9.2% vs. 17.9% (p = 0.0001) and 12.3% vs. 21.1% (p < 0.0001); and 12-month: 12.3% vs. 21.1% (p = 0.001) and 13% vs. 7.7% (p < 0.0001), respectively. ErCA (hazard ratio (HR): 1.54, confidence interval (CI):1.28–1.89; p < 0.0001) and LrCA (HR: 2.34, CI: 1.39–3.93; p = 0.001) increased the risk of 12-month mortality. During the 12-month follow-up, patients after LrCA more frequently required hospitalisation due to heart failure compared to patients after ErCA. ErCA was related to a higher hospitalisation rate due to coronary-related causes and a higher rate of percutaneous coronary intervention. An episode of LrCA was associated with higher in-hospital and long-term mortality compared to ErCA. ErCA and LrCA were independent risk factors for one-year mortality.
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12
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Relation of Early Monomorphic Ventricular Tachycardia to Long-Term Mortality in ST-Elevation Myocardial Infarction. Am J Cardiol 2022; 163:13-19. [PMID: 34774287 DOI: 10.1016/j.amjcard.2021.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/24/2021] [Accepted: 09/28/2021] [Indexed: 11/22/2022]
Abstract
Early ventricular tachycardia (VT) and ventricular fibrillation (VF) are associated with increased in-hospital mortality but do not influence the long-term prognosis in ST-elevation myocardial infarction (STEMI). Recent data advocate a differential approach to the type of arrhythmia and indicate long-term mortality hazard associated with monomorphic VT. We aimed to evaluate the prognostic value of early monomorphic VT compared to nonmonomorphic VT/VF in a nonselected cohort of STEMI patients. Consecutive STEMI patients admitted for primary percutaneous coronary intervention from 2007 to 2010 were included. Clinical characteristics were obtained from the Swedish national SWEDEHEART registry. The occurrence and type of early VT/VF were verified in medical records. All-cause mortality 8 years after STEMI was assessed using the Swedish Cause of Death Register. A total of 2,277 STEMI patients were included (age 66 ± 12 years, 70% male), among them 35 (1.5%) with early monomorphic VT and 115 (5.1%) with nonmonomorphic VT/VF. Patients with monomorphic VT had similar clinical characteristics compared to those with nonmonomorphic VT/VF. In total, 22 patients (63%) with monomorphic VT and 43 (37%) with nonmonomorphic VT/VF died by 8 years of follow-up (p = 0.011). Monomorphic VT was associated with a higher risk of all-cause mortality compared to nonmonomorphic VT/VF in univariate analysis (HR 2.03, 95% CI 1.21 to 3.39, p = 0.007) and after adjustment for age and history of myocardial infarction (MI) (HR 1.74, 95% CI 1.02 to 2.97, p = 0.041). Early monomorphic VT in STEMI is associated with a higher risk of all-cause mortality compared to nonmonomorphic VT/VF and deserves further studies to refine risk stratification strategies.
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13
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Auffret V, Bourenane H, Sharobeem S, Leurent G, Didier R, Gilard M, Nicol PP, Payot L, Filippi E, Hacot JP, Rouault G, Saouli D, Druelles P, Coudert I, Boulanger B, Cherfaoui T, Treuil J, Bedossa M, Boulmier D, Le Guellec M, Martins RP, Le Breton H. Early and late ventricular arrhythmias complicating ST-segment elevation myocardial infarction. Arch Cardiovasc Dis 2021; 115:4-16. [PMID: 34953752 DOI: 10.1016/j.acvd.2021.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 08/19/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Ventricular arrhythmias can be life-threatening complications of ST-segment elevation myocardial infarction (STEMI). AIMS To describe the incidence, predictors and in-hospital impact of early ventricular arrhythmia (EVA, occurring<day 2 after STEMI) and late ventricular arrhythmia (LVA, occurring≥day 2 after STEMI) in patients with STEMI. METHODS Data from 13,523 patients enrolled in a prospective registry were analysed. Logistic and Cox regressions were performed to identify predictors of EVA, LVA and in-hospital all-cause mortality. Predictors of LVA were used to build a risk score. RESULTS EVA occurred in 678 patients (5%), whereas 120 patients (0.9%) experienced LVA, at a median timing of 3days after STEMI. EVA was associated with a significantly higher risk of all-cause mortality (hazard ratio: 1.44, 95% confidence interval: 1.17-1.76; P=0.001), whereas no association was observed with LVA (hazard ratio 0.86, 95% confidence interval 0.57-1.28; P=0.45). Multivariable predictors of LVA were: age≥65years; serum creatinine≥85μmol/L on admission; pulse pressure≤45mmHg on admission; presence of a Q wave on admission electrocardiogram; Thrombolysis In Myocardial Infarction flow grade<3 after percutaneous coronary intervention; and left ventricular ejection fraction≤45%. The score derived from these variables allowed the classification of patients into four risk categories: low (0-21); low-to-intermediate (22-34); intermediate-to-high (35-44); and high (≥45). Observed LVA rates were 0.2%, 0.3%, 0.9% and 2.5%, across the four risk categories, respectively. The model demonstrated good discrimination (20-fold cross-validated c-statistic of 0.76) and adequate calibration (Hosmer-Lemeshow P=0.23). CONCLUSIONS EVA is 5-fold more common than LVA in the setting of STEMI, and portends a higher risk of in-hospital all-cause mortality. LVA is mainly associated with the patient's baseline risk profile and surrogate markers of larger infarct size. We developed and internally validated a risk score identifying patients at high risk of LVA for whom early intensive care unit discharge may not be suitable.
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Affiliation(s)
- Vincent Auffret
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France.
| | - Hamed Bourenane
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Sam Sharobeem
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Guillaume Leurent
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Romain Didier
- Cardiology Department, La Cavale Blanche University Hospital, Optimization of Physiological Regulations, Science and Technical Training and Research Unit, 29200 Brest, France
| | - Martine Gilard
- Cardiology Department, La Cavale Blanche University Hospital, Optimization of Physiological Regulations, Science and Technical Training and Research Unit, 29200 Brest, France
| | - Pierre-Philippe Nicol
- Cardiology Department, La Cavale Blanche University Hospital, Optimization of Physiological Regulations, Science and Technical Training and Research Unit, 29200 Brest, France
| | - Laurent Payot
- Cardiology Department, General Hospital Yves Le Foll, 22000 Saint-Brieuc, France
| | - Emmanuelle Filippi
- Cardiology Department, General Hospital of Atlantic Brittany, 56000 Vannes, France
| | - Jean-Philippe Hacot
- Cardiology Department, General Hospital of South Brittany, 56322 Lorient, France
| | - Gilles Rouault
- Cardiology Department, General Hospital René Théophile Laennec, 29000 Quimper, France
| | - Djamel Saouli
- Cardiology Department, General Hospital Broussais, 35403 St-Malo, France
| | | | - Isabelle Coudert
- Medical Emergency Department, General Hospital Yves Le Foll, 22000 Saint-Brieuc, France
| | - Bertrand Boulanger
- Medical Emergency Department, General Hospital of Atlantic Brittany, 56000 Vannes, France
| | - Tarik Cherfaoui
- Medical Emergency Department, Pontchaillou University Hospital, 35000 Rennes, France
| | - Josiane Treuil
- Medical Emergency Department, La Cavale Blanche University Hospital, 29200 Brest, France
| | - Marc Bedossa
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Dominique Boulmier
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Marielle Le Guellec
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Raphael P Martins
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
| | - Hervé Le Breton
- Department of Cardiology and Vascular Diseases, Pontchaillou University Hospital, University of Rennes 1, 35000 Rennes, France; Centre for Clinical Investigation 804, Signal and Image Treatment Laboratory (LTSI), National Institute of Health and Medical Research U1099, 35042 Rennes, France
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14
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Wang S, Li J, Sun L, Cai J, Wang S, Zeng L, Sun S. Application of machine learning to predict the occurrence of arrhythmia after acute myocardial infarction. BMC Med Inform Decis Mak 2021; 21:301. [PMID: 34724938 PMCID: PMC8560220 DOI: 10.1186/s12911-021-01667-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early identification of the occurrence of arrhythmia in patients with acute myocardial infarction plays an essential role in clinical decision-making. The present study attempted to use machine learning (ML) methods to build predictive models of arrhythmia after acute myocardial infarction (AMI). Methods A total of 2084 patients with acute myocardial infarction were enrolled in this study. (All data is available on Github: https://github.com/wangsuhuai/AMI-database1.git). The primary outcome is whether tachyarrhythmia occurred during admission containing atrial arrhythmia, ventricular arrhythmia, and supraventricular tachycardia. All data is randomly divided into a training set (80%) and an internal testing set (20%). Apply three machine learning algorithms: decision tree, random forest (RF), and artificial neural network (ANN) to learn the training set to build a model, then use the testing set to evaluate the prediction performance, and compare it with the model built by the Global Registry of Acute Coronary Events (GRACE) risk variable set. Results Three ML models predict the occurrence of tachyarrhythmias after AMI. After variable selection, the artificial neural network (ANN) model has reached the highest accuracy rate, which is better than the model constructed using the Grace variable set. After applying SHapley Additive exPlanations (SHAP) to make the model interpretable, the most important features are abnormal wall motion, lesion location, bundle branch block, age, and heart rate. Among them, RBBB (odds ratio [OR]: 4.21; 95% confidence interval [CI]: 2.42–7.02), ≥ 2 ventricular walls motion abnormal (OR: 3.26; 95% CI: 2.01–4.36) and right coronary artery occlusion (OR: 3.00; 95% CI: 1.98–4.56) are significant factors related to arrhythmia after AMI. Conclusions We used advanced machine learning methods to build prediction models for tachyarrhythmia after AMI for the first time (especially the ANN model that has the best performance). The current study can supplement the current AMI risk score, provide a reliable evaluation method for the clinic, and broaden the new horizons of ML and clinical research. Trial registration Clinical Trial Registry No.: ChiCTR2100041960. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01667-8.
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Affiliation(s)
- Suhuai Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Jingjie Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Lin Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China.
| | - Jianing Cai
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shihui Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Linwen Zeng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
| | - Shaoqing Sun
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 122 Postal Street, Nangang District, Harbin City, Heilongjiang Province, China
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15
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Outcomes for patients with anterior myocardial infarction and prior cardiac arrest in the home automated external defibrillator trial (HAT). Resuscitation 2021; 168:75-83. [PMID: 34500022 DOI: 10.1016/j.resuscitation.2021.08.047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 07/29/2021] [Accepted: 08/29/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Patients with sudden cardiac arrest occurring in the acute phase of myocardial infarction (MI-SCA) are believed to be at similar risk of death after revascularization compared with MI patients without SCA (MI-no SCA). Among patients with anterior MI, we examined whether those with MI-SCA were at greater risk of all-cause mortality or sudden cardiac death (SCD) than MI-no SCA patients. METHODS The Home Automated External Defibrillator Trial enrolled patients with anterior MI who had not received or were candidates for an implantable cardioverter defibrillator (ICD). Our cohort included patients with a reported SCA event, in the acute phase of an MI, prior to HAT trial enrollment. Cox proportional hazards models examined the adjusted association between MI-SCA versus MI-no SCA patients and all-cause mortality and sudden cardiac death (SCD). We also determined whether the relationship between prior SCA and outcomes changed with subsequent events (syncope, revascularization, and recurrent MI) during follow-up. RESULTS Of 6849 patients, 650 (9.5%) had MI-SCA before trial enrollment. Approximately 48% of patients had the MI-SCA event ≤1 year prior to enrollment; 71% of SCA events were in-hospital. MI-SCA patients were younger, more frequently white, and had higher rates of prior PCI versus MI-no SCA patients. There were no differences in adjusted all-cause mortality (hazard ratio [HR 0.95; 95% CI 0.65-1.38]) or SCD (HR 1.12; 95% CI 0.68-1.83) for MI-SCA vs. MI-no SCA. After ICD implantation, MI-SCA patients experienced higher all-cause mortality risk (HR 5.01, 95% CI 1.05-23.79) versus MI-no SCA patients; there was no mortality difference between MI-SCA and MI-no SCA patients without ICD implantation (HR 0.89, 95% CI 0.60-1.31), [interaction p = 0.035]. CONCLUSIONS Patients with MI-SCA had similar adjusted risk of all-cause mortality and SCD compared with MI-no SCA. After ICD implantation, MI-SCA patients had higher mortality compared with MI-no SCA patients.
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16
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Kosmopoulos M, Bartos JA, Yannopoulos D. ST-Elevation Myocardial Infarction Complicated by Out-of-Hospital Cardiac Arrest. Interv Cardiol Clin 2021; 10:359-368. [PMID: 34053622 DOI: 10.1016/j.iccl.2021.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
5-10% of ST-elevated myocardial infarctions (STEMI) present with out-of-hospital cardiac arrest (OHCA). Although this subgroup of patients carries the highest in-hospital mortality among the STEMI population, it is the least likely to undergo coronary angiography and revascularization. Due to the concomitant neurologic injury, patients with OHCA STEMI require prolonged hospitalization and adjustments to standard MI management. This review systematically assesses the course of patients with OHCA STEMI from development of the arrest to hospital discharge, assesses the limiting factors for their treatment access, and presents the evidence-based optimal intervention strategy for this high-risk MI population.
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Affiliation(s)
- Marinos Kosmopoulos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Jason A Bartos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
| | - Demetris Yannopoulos
- Cardiovascular Division, Center for Resuscitation Medicine, University of Minnesota Medical School, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
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17
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Medvedev RY, Sanchez-Alonso JL, Mansfield CA, Judina A, Francis AJ, Pagiatakis C, Trayanova N, Glukhov AV, Miragoli M, Faggian G, Gorelik J. Local hyperactivation of L-type Ca 2+ channels increases spontaneous Ca 2+ release activity and cellular hypertrophy in right ventricular myocytes from heart failure rats. Sci Rep 2021; 11:4840. [PMID: 33649357 PMCID: PMC7921450 DOI: 10.1038/s41598-021-84275-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
Right ventricle (RV) dysfunction is an independent predictor of patient survival in heart failure (HF). However, the mechanisms of RV progression towards failing are not well understood. We studied cellular mechanisms of RV remodelling in a rat model of left ventricle myocardial infarction (MI)-caused HF. RV myocytes from HF rats show significant cellular hypertrophy accompanied with a disruption of transverse-axial tubular network and surface flattening. Functionally these cells exhibit higher contractility with lower Ca2+ transients. The structural changes in HF RV myocytes correlate with more frequent spontaneous Ca2+ release activity than in control RV myocytes. This is accompanied by hyperactivated L-type Ca2+ channels (LTCCs) located specifically in the T-tubules of HF RV myocytes. The increased open probability of tubular LTCCs and Ca2+ sparks activation is linked to protein kinase A-mediated channel phosphorylation that occurs locally in T-tubules. Thus, our approach revealed that alterations in RV myocytes in heart failure are specifically localized in microdomains. Our findings may indicate the development of compensatory, though potentially arrhythmogenic, RV remodelling in the setting of LV failure. These data will foster better understanding of mechanisms of heart failure and it could promote an optimized treatment of patients.
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Affiliation(s)
- Roman Y Medvedev
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.,Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy.,Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Jose L Sanchez-Alonso
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Catherine A Mansfield
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Aleksandra Judina
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Alice J Francis
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | | | - Natalia Trayanova
- Department of Biomedical Engineering and Alliance for Cardiovascular Diagnostic and Treatment Innovation, Johns Hopkins University, Baltimore, USA
| | - Alexey V Glukhov
- Department of Medicine, Cardiovascular Medicine, Madison School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Michele Miragoli
- Humanitas Clinical and Research Center - IRCCS, Rozzano, MI, Italy.,Dipartimento Di Medicina E Chirurgia, Università Degli Studi di Parma, Via Gramsci 14, 43124, Parma, Italy
| | - Giuseppe Faggian
- Dipartimento Di Cardiochirurgia, Università Degli Studi Di Verona, Ospedale Borgo Trento, P.le Stefani 1, 37126, Verona, Italy
| | - Julia Gorelik
- National Heart and Lung Institute, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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18
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Szapary LB, Szakacs Z, Farkas N, Schonfeld K, Babocsay D, Gajer M, Kittka B, Magyari B, Hegyi P, Szokodi I, Horvath IG. The Effect of Magnesium on Reperfusion Arrhythmias in STEMI Patients, Treated With PPCI. A Systematic Review With a Meta-Analysis and Trial Sequential Analysis. Front Cardiovasc Med 2021; 7:608193. [PMID: 33585581 PMCID: PMC7873853 DOI: 10.3389/fcvm.2020.608193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/02/2020] [Indexed: 11/13/2022] Open
Abstract
Aims: The restoration of coronary circulation plays a crucial role in treating ST-segment elevation myocardial infarction (STEMI), however successful reperfusion with primary percutaneous coronary intervention (PPCI) may induce life-threatening arrhythmias. The relation between myocardial electrical instability, as a background factor in reperfusion arrhythmia, and magnesium administered periprocedurally is still questionable. Several randomized clinical trials have been conducted predominantly in the thrombolysis era. Due to the contradictory results of these studies, there is little evidence of the potential preventive effect of magnesium on reperfusion arrhythmias. The aim of our study is to review and meta-analytically analyze data from all studies published so far in the PPCI era, comparing STEMI patients who have undergone primary PCI and received either magnesium or a placebo before the reperfusion procedure. Methods and Results: Our meta-analysis follows the points in the PRISMA protocol and, meets all of their criteria. We conducted a search in five scientific databases using the following keyword combination: (myocardial infarction OR myocardial injury OR acute coronary syndrome OR acs OR stemi) AND magnesium. The 7,295 collected publications were filtered with the Endnote program by title, abstract and full-text based on predefined criteria. A statistical analysis was performed on three randomized-controlled trials using three common parameters, involving 336 patients Trial sequential analysis (TSA) was applied to assess the risk of random error associated with sparse data and multiple testing which can affect cumulative meta-analysis. The incidence of ventricular tachycardias (VTs) was not significantly increased in the non-magnesium control group. (OR: 1.36; CI: 0.619; -2.986, P = 0.263). For the ejection fraction (EF), a non-significant decrease was observed in the magnesium group by weighted mean difference calculation. (WMD: 7.262, 95% CI: -0.238; 0.053; P = 0.057). There was significant decrease in the infarct zone wall motion index (IZWMSI) in the magnesium treatment group. (WMD: 0.384, 95% CI: -0.042; 0.811, P = 0.015). Based on the TSA assessments, the results of all parameters are not significant, objectively demonstrating the lack of reasonable data pertaining to our question. Conclusions: The preventive effect of magnesium on reperfusion arrhythmia associated with primary PCI can still be considered contradictory based on previous studies. In our study, we found, that magnesium is ineffective with a very weak evidence, due to the small number of patients and the biases of the included studies, and a well-designed clinical trial is needed in this area, based on the TSA.
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Affiliation(s)
- Laszlo B Szapary
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Zsolt Szakacs
- Medical School, Heart Institute, University of Pécs, Pécs, Hungary
| | - Nelli Farkas
- Medical School, Heart Institute, University of Pécs, Pécs, Hungary
| | - Kristof Schonfeld
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Dora Babocsay
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Mate Gajer
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Balint Kittka
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Balazs Magyari
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Peter Hegyi
- Medical School, Heart Institute, University of Pécs, Pécs, Hungary
| | - Istvan Szokodi
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
| | - Ivan G Horvath
- Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.,Szentágothai Research Centre, University of Pécs, Pécs, Hungary
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19
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Kalarus Z, Svendsen JH, Capodanno D, Dan GA, De Maria E, Gorenek B, Jędrzejczyk-Patej E, Mazurek M, Podolecki T, Sticherling C, Tfelt-Hansen J, Traykov V, Lip GYH, Fauchier L, Boriani G, Mansourati J, Blomström-Lundqvist C, Mairesse GH, Rubboli A, Deneke T, Dagres N, Steen T, Ahrens I, Kunadian V, Berti S. Cardiac arrhythmias in the emergency settings of acute coronary syndrome and revascularization: an European Heart Rhythm Association (EHRA) consensus document, endorsed by the European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Acute Cardiovascular Care Association (ACCA). Europace 2020; 21:1603-1604. [PMID: 31353412 DOI: 10.1093/europace/euz163] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 12/22/2022] Open
Abstract
Despite major therapeutic advances over the last decades, complex supraventricular and ventricular arrhythmias (VAs), particularly in the emergency setting or during revascularization for acute myocardial infarction (AMI), remain an important clinical problem. Although the incidence of VAs has declined in the hospital phase of acute coronary syndromes (ACS), mainly due to prompt revascularization and optimal medical therapy, still up to 6% patients with ACS develop ventricular tachycardia and/or ventricular fibrillation within the first hours of ACS symptoms. Despite sustained VAs being perceived predictors of worse in-hospital outcomes, specific associations between the type of VAs, arrhythmia timing, applied treatment strategies and long-term prognosis in AMI are vague. Atrial fibrillation (AF) is the most common supraventricular tachyarrhythmia that may be asymptomatic and/or may be associated with rapid haemodynamic deterioration requiring immediate treatment. It is estimated that over 20% AMI patients may have a history of AF, whereas the new-onset arrhythmia may occur in 5% patients with ST elevation myocardial infarction. Importantly, patients who were treated with primary percutaneous coronary intervention for AMI and developed AF have higher rates of adverse events and mortality compared with subjects free of arrhythmia. The scope of this position document is to cover the clinical implications and pharmacological/non-pharmacological management of arrhythmias in emergency presentations and during revascularization. Current evidence for clinical relevance of specific types of VAs complicating AMI in relation to arrhythmia timing has been discussed.
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Affiliation(s)
- Zbigniew Kalarus
- SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.,Department of Cardiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Davide Capodanno
- Division of Cardiology, CAST, P.O. "Rodolico", Azienda Ospedaliero-Universitaria "Policlinico-Vittorio Emanuele", University of Catania, Catania, Italy
| | - Gheorghe-Andrei Dan
- "Carol Davila" University of Medicine, Colentina University Hospital, Bucharest, Romania
| | - Elia De Maria
- Ramazzini Hospital, Cardiology Unit, Carpi (Modena), Italy
| | | | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Michał Mazurek
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Tomasz Podolecki
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jacob Tfelt-Hansen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Forensic Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vassil Traykov
- Department of Invasive Electrophysiology and Cardiac Pacing, Clinic of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Laurent Fauchier
- Service de Cardiologie, Centre Hospitalier Universitaire Trousseau et Université de Tours, Faculté de Médecine., Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | | | | | - Georges H Mairesse
- Department of Cardiology - Electrophysiology, Cliniques du Sud Luxembourg - Vivalia, Arlon, Belgium
| | - Andrea Rubboli
- Department of Cardiovascular Diseases - AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Thomas Deneke
- Clinic for Electrophysiology, Rhoen-Clinic Campus Bad Neustadt, Germany
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Torkel Steen
- Department of Cardiology, Pacemaker- & ICD-Centre, Oslo University Hospital Ullevaal, Oslo, Norway
| | - Ingo Ahrens
- Department of Cardiology & Intensive Care, Augustinerinnen Hospital, Cologne, Germany
| | - Vijay Kunadian
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Berti
- Department of Cardiology, Fondazione C.N.R. Reg. Toscana G. Monasterio, Heart Hospital, Massa, Italy
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20
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Shaik FA, Slotwiner DJ, Gustafson GM, Dai X. Intra-procedural arrhythmia during cardiac catheterization: A systematic review of literature. World J Cardiol 2020; 12:269-284. [PMID: 32774779 PMCID: PMC7383354 DOI: 10.4330/wjc.v12.i6.269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cardiac catheterization is among the most performed medical procedures in the modern era. There were sporadic reports indicating that cardiac arrhythmias are common during cardiac catheterization, and there are risks of developing serious and potentially life-threatening arrhythmias, such as sustained ventricular tachycardia (VT), ventricular fibrillation (VF) and high-grade conduction disturbances such as complete heart block (CHB), requiring immediate interventions. However, there is lack of systematic overview of these conditions.
AIM To systematically review existing literature and gain better understanding of the incidence of cardiac arrhythmias during cardiac catheterization, and their impact on outcomes, as well as potential approaches to minimize this risk.
METHODS We applied a combination of terms potentially used in reports describing various cardiac arrhythmias during common cardiac catheterization procedures to systematically search PubMed, EMBASE and Cochrane databases, as well as references of full-length articles.
RESULTS During right heart catheterization (RHC), the incidence of atrial arrhythmias (premature atrial complexes, atrial fibrillation and flutter) was low (< 1%); these arrhythmias were usually transient and self-limited. RHC associated with the development of a new RBBB at a rate of 0.1%-0.3% in individuals with normal conduction system but up to 6.3% in individuals with pre-existing left bundle branch block. These patients may require temporary pacing due to transient CHB. Isolated premature ventricular complexes or non-sustained VT are common during RHC (up to 20% of cases). Sustained ventricular arrhythmias (VT and/or VF) requiring either withdrawal of catheter or cardioversion occurred infrequently (1%-1.3%). During left heart catheterizations (LHC), the incidence of ventricular arrhythmias has declined significantly over the last few decades, from 1.1% historically to 0.1% currently. The overall reported rate of VT/VF in diagnostic LHC and coronary angiography is 0.8%. The risk of VT/VF was higher during percutaneous coronary interventions for stable coronary artery disease (1.1%) and even higher for patients with acute myocardial infarctions (4.1%-4.3%). Intravenous adenosine and papaverine bolus for fractional flow reserve measurement, as well as intracoronary imaging using optical coherence tomography have been reported to induce VF. Although uncommon, LHC and coronary angiography were also reported to induce conduction disturbances including CHB.
CONCLUSION Cardiac arrhythmias are common and potentially serious complications of cardiac catheterization procedures, and it demands constant vigilance and readiness to intervene during procedures.
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Affiliation(s)
- Fatima A Shaik
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - David J Slotwiner
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Gregory M Gustafson
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
| | - Xuming Dai
- Division of Cardiology, New York Presbyterian Queens Hospital, Flushing, NY 11355, United States
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21
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Al-Hijji MA, Gulati R, Bell M, Kaplan RJ, Feind JL, Lewis BR, Borah BJ, Moriarty JP, Yoon Park J, El Sabbagh A, Kanwar A, Barsness G, Munger T, Asirvatham S, Lerman A, Singh M. Routine Continuous Electrocardiographic Monitoring Following Percutaneous Coronary Interventions. Circ Cardiovasc Interv 2019; 13:e008290. [PMID: 31884835 DOI: 10.1161/circinterventions.119.008290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The clinical utility of routine electrocardiographic monitoring following percutaneous coronary interventions (PCI) is not well studied. METHODS We prospectively evaluated the incidence, cost, and the clinical implications of actionable arrhythmia alarms on telemetry monitoring following PCI. One thousand three hundred fifty-eight PCI procedures (989 [72.8%] for acute coronary syndrome and 369 [27.2%] for stable angina) on patients admitted to nonintensive care unit were identified and divided into 2 groups; group 1, patients with actionable alarms (AA) and group 2, patients with non-AA. AA included (1) ≥3 s electrical pause or asystole; (2) high-grade Mobitz type II atrioventricular block or complete heart block; (3) ventricular fibrillation; (4) ventricular tachycardia (>15 beats); (5) atrial fibrillation with rapid ventricular response; (6) supraventricular tachycardia (>15 beats). Primary outcomes were 30-day all-cause mortality. Cost-savings analysis was performed. RESULTS Incidence of AA was 2.2% (37/1672). Time from end of procedure to AA was 5.5 (0.5, 24.5) hours. Patients with AA were older, presented with acute congestive heart failure or non-ST-segment-elevation myocardial infarction, and had multivessel or left main disease. The 30-day all-cause mortality was significantly higher in patients with AA (6.5% versus 0.3% in non-AA [P<0.001]). Applying the standardized costing approach and tailored monitoring per the American Heart Association guidelines lead to potential cost savings of $622 480.95 for the entire population. CONCLUSIONS AA following PCI were infrequent but were associated with increase in 30-day mortality. Following American Heart Association guidelines for monitoring after PCI can lead to substantial cost saving.
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Affiliation(s)
- Mohammed A Al-Hijji
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Rajiv Gulati
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Malcolm Bell
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Revelee J Kaplan
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Jeanna L Feind
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Bradley R Lewis
- Division of Biomedical Statistics and Informatics (B.R.L.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Bijan J Borah
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (B.J.B., J.P.M.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - James P Moriarty
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (B.J.B., J.P.M.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Jae Yoon Park
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Abdallah El Sabbagh
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Ardaas Kanwar
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Gregory Barsness
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Thomas Munger
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Samuel Asirvatham
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Amir Lerman
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
| | - Mandeep Singh
- Division of Cardiovascular Medicine (M.A.A.-H., R.G., M.B., R.J.K., J.L.F., J.Y.P., A.E.S., A.K., G.B., T.M., S.A., A.L., M.S.), Mayo Clinic and Mayo Foundation, Rochester, MN
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22
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Oikawa J, Fukaya H, Ako J, Nakao K, Ozaki Y, Kimura K, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Miyamoto Y, Ogawa H, Ishihara M. Risk Factors of In-Hospital Lethal Arrhythmia Following Acute Myocardial Infarction in Patients Undergoing Primary Percutaneous Coronary Intervention - Insight From the J-MINUET Study. Circ Rep 2019; 2:17-23. [PMID: 33693170 PMCID: PMC7929703 DOI: 10.1253/circrep.cr-19-0081] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background:
Lethal arrhythmias including ventricular tachycardia and fibrillation (VT/VF) are common complications of acute myocardial infarction (AMI). Predictors of in-hospital VT/VF after AMI, however, have not been thoroughly investigated. In this study, we sought to elucidate the predictors of in-hospital VT/VF events after AMI in the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). Methods and Results:
In-hospital VT/VF was defined as a hemodynamically unstable VT or VF in the first week of hospitalization, on which the patients were classified as the VT/VF group. Of the patients in the J-MINUET study, 3,175 were finally enrolled in this study. A total of 114 patients had VT/VF. On multivariate logistic analysis, maximum creatine kinase >3,000 IU/L (adjusted OR, 1.67; 95% CI: 1.085–2.572; P=0.02), Killip class III or IV (adjusted OR, 8.93; 95% CI: 5.668–14.082; P<0.0001), initial Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 or 1 (adjusted OR, 1.67; 95% CI: 1.035–2.709; P=0.03), and concomitant chronic kidney disease (CKD; adjusted OR, 1.80; 95% CI: 1.105–2.938; P=0.02) were identified as independent predictors for in-hospital VT/VF. Conclusions:
From the J-MINUET study, extensive myocardial damage, cardiogenic shock, lower grade initial TIMI flow on coronary angiography, and concomitant CKD were independent predictors of in-hospital VT/VF after AMI.
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Affiliation(s)
- Jun Oikawa
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Hidehira Fukaya
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine Sagamihara Japan
| | - Koichi Nakao
- Cardiovascular Center, Saiseikai Kumamoto Hospital Kumamoto Japan
| | - Yukio Ozaki
- Department of Cardiovascular Medicine, Fujita Health University Toyoake Japan
| | - Kazuo Kimura
- Department of Cardiology, Yokohama City University Medical Center Yokohama Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital Izunokuni Japan
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization Kumamaoto Medical Center Kumamoto Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | - Takashi Morita
- Department of Cardiology, Osaka General Medical Center Osaka Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School Tokyo Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University Kashihara Japan
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama Okayama Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital Ogaki Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University Tochigi Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital Osaka Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital Amagasaki Japan
| | - Yoshihiro Miyamoto
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center Suita Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center Suita Japan
| | - Masaharu Ishihara
- Division of Cardiovascular and Renal Medicine, Hyogo College of Medicine Nishinomiya Japan
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23
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Effect of Using a Cardiac Catheterization Table-Stabilizing Stick on the Quality of Cardiopulmonary Resuscitation in the Cardiac Catheterization Laboratory: A Simulation-Based Study. J Interv Cardiol 2019; 2019:6303978. [PMID: 31772537 PMCID: PMC6739776 DOI: 10.1155/2019/6303978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/04/2019] [Indexed: 11/18/2022] Open
Abstract
Rapid defibrillation and high-quality cardiopulmonary resuscitation (CPR) are necessary for patients with cardiopulmonary arrest, one of the most serious and frequently encountered complications in cardiac catheterization laboratories. However, when the catheterization table is withdrawn from its neutral position for fluoroscopy, it is unstable and unsuitable for resuscitation because of its cantilever structure. To stabilize the table in its withdrawn position, the use of a table-stabilizing stick might improve CPR quality. To investigate the effect of using a cardiac catheterization table-stabilizing stick on CPR quality, a CPR simulation mannequin was placed on a cardiac catheterization table that was withdrawn from the C-arm of the X-ray machine. CPR quality was assessed with or without the use of a table-stabilizing stick under the table. The CPR quality assessment (Q-CPR) scores were 79.6 ± 11.4% using the table-stabilizing stick and 47.7 ± 30.3% without the use of the stick device (p = 0.02). In this simulation-based study, the use of a table-stabilizing stick in a cardiac catheterization table withdrawn from the C-arm of the X-ray machine improved the quality of CPR.
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24
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Risk stratification for complex ventricular arrhythmia complicating ST-segment elevation myocardial infarction. Coron Artery Dis 2019; 29:681-686. [PMID: 30234552 DOI: 10.1097/mca.0000000000000662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary aim of the study was to evaluate risk factors for ventricular fibrillation/sustained ventricular tachycardia (VF/VT) and to develop the risk score for prediction of VF/VT in patients with ST-segment elevation myocardial infarction (STEMI) treated invasively. The secondary aim was to assess the effect of VF/VT on mortality depending on timing of arrhythmia. PATIENTS AND METHODS We analyzed 4363 consecutive patients with STEMI treated invasively. Among them, 163 patients with pre-reperfusion arrhythmia were excluded from the study. Group ventricular arrhythmias (VA) encompassed patients with VF/VT - those with reperfusion-induced arrhythmia were included into group VA1, whereas group VA2 consisted of patients with postreperfusion arrhythmia. The control group comprised patients free of VF/VT. RESULTS VF or VT occurred in 313 (7.45%) patients - group VA1 encompassed 103 (32.9%) and group AV2 210 (67.1%) patients. Cardiogenic shock on admission [hazard ratio (HR) 3.5], new-onset atrial fibrillation (HR 2.1), incomplete revascularization (HR 1.7), prior myocardial infarction (HR 1.6) and symptom-to-balloon time more than 3 h (HR 1.3) were the independent predictors of VF/VT occurrence. In group VA2, the in-hospital and long-term mortality were 4- and 1.5-fold higher than in the arrhythmia-free population (20.5 vs. 4.5% and 36.2 vs. 22.6%, respectively; P<0.001). On the contrary, in group VA1, the long-term mortality was not significantly higher compared with the control group (26.2 vs. 22.6%; P=NS), whereas in-hospital mortality was almost three-fold increased (12.5 vs. 4.5%, respectively; P<0.001). CONCLUSION The risk score based on simple clinical parameters might be useful for risk stratification for VF/VT in patients with STEMI. The predictive value of VF/VT was strongly dependent on timing of arrhythmia.
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Prolonged Tpeak-Tend interval is associated with ventricular fibrillation during reperfusion in ST-elevation myocardial infarction. Int J Cardiol 2019; 280:80-83. [DOI: 10.1016/j.ijcard.2019.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 12/04/2018] [Accepted: 01/02/2019] [Indexed: 11/22/2022]
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Yannopoulos D, Bartos JA, Aufderheide TP, Callaway CW, Deo R, Garcia S, Halperin HR, Kern KB, Kudenchuk PJ, Neumar RW, Raveendran G. The Evolving Role of the Cardiac Catheterization Laboratory in the Management of Patients With Out-of-Hospital Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation 2019; 139:e530-e552. [DOI: 10.1161/cir.0000000000000630] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Coronary artery disease is prevalent in different causes of out-of-hospital cardiac arrest (OHCA), especially in individuals presenting with shockable rhythms of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT). The purpose of this report is to review the known prevalence and potential importance of coronary artery disease in patients with OHCA and to describe the emerging paradigm of treatment with advanced perfusion/reperfusion techniques and their potential benefits on the basis of available evidence. Although randomized clinical trials are planned or ongoing, current scientific evidence rests principally on observational case series with their potential confounding selection bias. Among patients resuscitated from VF/pVT OHCA with ST-segment elevation on their postresuscitation ECG, the prevalence of coronary artery disease has been shown to be 70% to 85%. More than 90% of these patients have had successful percutaneous coronary intervention. Conversely, among patients resuscitated from VF/pVT OHCA without ST-segment elevation on their postresuscitation ECG, the prevalence of coronary artery disease has been shown to be 25% to 50%. For these patients, early access to the cardiac catheterization laboratory is associated with a 10% to 15% absolute higher functionally favorable survival rate compared with more conservative approaches of late or no access to the cardiac catheterization laboratory. In patients with VF/pVT OHCA refractory to standard treatment, a new treatment paradigm is also emerging that uses venoarterial extracorporeal membrane oxygenation to facilitate return of normal perfusion and to support further resuscitation efforts, including coronary angiography and percutaneous coronary intervention. The burden of coronary artery disease is high in this patient population, presumably causative in most patients. The strategy of venoarterial extracorporeal membrane oxygenation, coronary angiography, and percutaneous coronary intervention has resulted in functionally favorable survival rates ranging from 9% to 45% in observational studies in this patient population. Patients with VF/pVT should be considered at the highest severity in the continuum of acute coronary syndromes. These patients have a significant burden of coronary artery disease and acute coronary thrombotic events. Evidence from randomized trials will further define optimal clinical practice.
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Twenty-five year trends (1986-2011) in hospital incidence and case-fatality rates of ventricular tachycardia and ventricular fibrillation complicating acute myocardial infarction. Am Heart J 2019; 208:1-10. [PMID: 30471486 DOI: 10.1016/j.ahj.2018.10.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 10/06/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Long-term trends in the incidence rates (IRs) and hospital case-fatality rates (CFRs) of ventricular tachycardia (VT) and ventricular fibrillation (VF) among patients hospitalized with acute myocardial infarction (AMI) have not been recently examined. METHODS We used data from 11,825 patients hospitalized with AMI at all 11 medical centers in central Massachusetts on a biennial basis between 1986 and 2011. Multivariable adjusted logistic regression modeling was used to examine trends in hospital IRs and CFRs of VT and VF complicating AMI. RESULTS The median age of the study population was 71 years, 57.9% were men, and 94.7% were white. The hospital IRs declined from 14.3% in 1986/1988 to 10.5% in 2009/2011 for VT and from 8.2% to 1.7% for VF. The in-hospital CFRs declined from 27.7% to 6.9% for VT and from 49.6% to 36.0% for VF between 1986/1988 and 2009/2011, respectively. The IRs of both early (<48 hours) and late VT and VF declined over time, with greater declines in those of late VT and VF. The incidence rates of VT declined similarly for patients with either an ST-segment elevation myocardial infarction (STEMI) or non-STEMI, whereas they only declined in those with VF and a STEMI. CONCLUSIONS The hospital IRs and CHRs of VT and VF complicating AMI have declined over time, likely because of changes in acute monitoring and treatment practices. Despite these encouraging trends, efforts remain needed to identify patients at risk for these serious ventricular arrhythmias so that preventive and treatment strategies might be implemented as necessary.
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Huang J, Peng X, Fang Z, Hu X, Zhou S. Risk assessment model for predicting ventricular tachycardia or ventricular fibrillation in ST-segment elevation myocardial infarction patients who received primary percutaneous coronary intervention. Medicine (Baltimore) 2019; 98:e14174. [PMID: 30681585 PMCID: PMC6358344 DOI: 10.1097/md.0000000000014174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 12/14/2018] [Accepted: 12/28/2018] [Indexed: 12/02/2022] Open
Abstract
Ventricular tachycardia/ventricular fibrillation (VT/VF) is a kind of malignant arrhythmia in ST-segment elevation myocardial infarction (STEMI) patients who received primary percutaneous coronary intervention (PPCI). However, there are no risk assessment tools to anticipate the occurrence of VT/VF.This study is to build a risk assessment model to predict the possibility of VT/VF onset in STEMI patients undergoing PPCI.A retrospective study was conducted to analyze the patients who underwent PPCI from January 2006 to May 2015. Subjects were divided into VT/VF group and no VT/VF group based on whether VT/VF had occurred or not. In addition, the VT/VF group was further separated into early-onset group (from the time that symptoms began to before the end of PPCI) and late-onset group (after the end of PPCI) based on the timing of when VT/VF happened. Multivariate regression analysis was carried out to distinguish the independent risk factors of VT/VF and an additional statistical method was executed to build the risk assessment model.A total of 607 patients were enrolled in this study. Of these patients, 67 cases (11%) experienced VT/VF. In addition, 91% (61) of patients experienced VT/VF within 48 h from the time that the symptoms emerged. Independent risk factors include: age, diabetes mellitus, heart rate, ST-segment maximum elevation, ST-segment total elevation, serum potassium, left ventricular ejection fraction (LVEF), culprit artery was right coronary artery, left main (LM) stenosis, Killip class > I class, and pre-procedure thrombolysis in myocardial infarction (TIMI) flow zero grade. Risk score model and risk rank model have been established to evaluate the possibility of VT/VF. Class I: ≤ 4 points; Class II: > 4 points, ≤ 5.5 points; Class III: > 5.5 points, < 6.5 points; and Class IV ≥ 6.5 points. The higher the class, the higher the risk.The incidence of VT/VF in STEMI patients undergoing PPCI is 11% and it occurs more frequently from the time that symptoms begin to before the end of PPCI, which, in most cases, occurs within 48 h of the event. Our risk assessment model could predict the possible occurrence of VT/VF.
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Kobayashi Y, Tanno K, Ueno A, Fukamizu S, Murata H, Watanabe N, Sasaki T, Yamamoto T, Takayama M, Nagao K. In-Hospital Electrical Storm in Acute Myocardial Infarction ― Clinical Background and Mechanism of the Electrical Instability ―. Circ J 2018; 83:91-100. [DOI: 10.1253/circj.cj-18-0785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoshinori Kobayashi
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | - Akira Ueno
- Tokyo CCU Network Scientific Committee
- Cardiology Division, Tokai University Hachioji-Hospital
| | | | | | | | | | | | | | - Ken Nagao
- Tokyo CCU Network Scientific Committee
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Kim HB, Hong YJ, Park HJ, Ahn Y, Jeong MH. Effects of Ivabradine on Left Ventricular Systolic Function and Cardiac Fibrosis in Rat Myocardial Ischemia-Reperfusion Model. Chonnam Med J 2018; 54:167-172. [PMID: 30288372 PMCID: PMC6165924 DOI: 10.4068/cmj.2018.54.3.167] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/14/2018] [Accepted: 08/16/2018] [Indexed: 12/12/2022] Open
Abstract
We evaluated the effects of Ivabradine on left ventricle (LV) ejection fraction (EF) and LV infarcted tissue in the rat myocardial ischemia-reperfusion model. Twenty rats were randomly assigned to group 1 (ischemia-reperfusion, no treatment, n=10) and group 2 (ischemia-reperfusion + Ivabradine 10 mg/kg, n=10). Ivabradine was administered for 28 days. Echocardiography was performed at 7 days and at 28 days after the induction of ischemia-reperfusion injury. Cardiac fibrosis induced by ischemia-reperfusion injury was evaluated by Masson's trichrome staining. The infarct size was quantified using the Image J program. At the 28-day follow-up, LVEF was significantly higher (36.02±6.16% vs. 45.72±2.62%, p<0.001) and fractional shortening was significantly higher (15.23±2.84% vs. 20.13±1.38%, p<0.001) in group 2 than group 1. Delta (28 day minus 7 day) EF was significantly higher in group 2 than group 1 (-4.36±3.49% vs. 4.31±5.63%, p<0.001). Also, heart rate (beats/min) was significantly lower in group 2 than group 1 (251.67±25.19 vs. 199.29±31.33, p=0.025). Group 2 had a smaller infarct size (40.70±8.94% vs. 30.19±5.89%, p<0.01) than group 1 at 28-day follow-up. Oral administration of Ivabradine could improve LV systolic function and reduce infarcted tissue area in rat myocardial ischemia-reperfusion model.
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Affiliation(s)
- Han Byul Kim
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Young Joon Hong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Hyuk Jin Park
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Cardiovascular Convergence Research Center Nominated by Korea Ministry of Health and Welfare, Gwangju, Korea
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Current Status of Knowledge about Cardiopulmonary Resuscitation among the University Students in the Northern Region of Saudi Arabia. Cardiol Res Pract 2018; 2018:3687472. [PMID: 29983997 PMCID: PMC6015685 DOI: 10.1155/2018/3687472] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 05/02/2018] [Accepted: 05/12/2018] [Indexed: 01/01/2023] Open
Abstract
Background Sudden cardiac arrest is a major public health problem in the world. Immediate initiation of high-quality cardiopulmonary resuscitation (CPR) significantly increased patient survival rate. Therefore, it is very important to train young people and increase public awareness of CPR for the long-term benefit of the community. Objective We aimed at estimating the level of knowledge and attitude towards cardiopulmonary resuscitation (CPR) among the university students in the northern region of Saudi Arabia. Methodology A cross-sectional, prospective study was conducted among the students of four northern region universities of Saudi Arabia (Jouf, Hail, Northern Borders, and Tabuk) between March and November 2017. A self-administered questionnaire was prepared in both Arabic and English languages and distributed to all the participants. All the data were collected and analyzed by using SPSS version 21. Results A total of 947 students from four universities completed the questionnaire: Jouf (57%), Hail (15%), Northern Borders (13%), and Tabuk (15%). Although 72% of students have previous knowledge about CPR, 49% of them lack knowledge about a medical emergency. Moreover, 59% failed to answer regarding CPR where only 41% wrote the ABC steps in the correct sequence. However, 67% of the participants had very poor knowledge, 89% of participants desired to receive additional CPR training course, and 49% of the students thought that CPR training should be a mandatory graduation requirement for all universities. There were no significant differences between male and female students. Students from medicine-related colleges have significantly (p < 0.001) more knowledge and scored better compared with non-medicine-related colleges. Tabuk University scored better compared to the others, but the overall knowledge and attitude scored were low. Conclusions Overall knowledge about CPR among the university students was not satisfactory; however, attitude towards CRP training was very positive. Our results suggested that there is a need for improvement of CPR education among Saudi university students, which will help to reduce the cardiac arrest mortality rate among the community.
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Podolecki T, Lenarczyk R, Kowalczyk J, Jedrzejczyk-Patej E, Chodor P, Mazurek M, Francuz P, Streb W, Mitrega K, Kalarus Z. Prognostic Significance of Complex Ventricular Arrhythmias Complicating ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2018; 121:805-809. [PMID: 29452692 DOI: 10.1016/j.amjcard.2017.12.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 12/08/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
The aim of the study was to assess the clinical significance of complex ventricular arrhythmias (VAs) (sustained ventricular tachycardia [sVT] and ventricular fibrillation [VF]) in patients with ST-segment elevation myocardial infarction (STEMI) depending on timing of arrhythmia. We analyzed 4,363 consecutive patients with STEMI treated invasively between 2004 and 2014. The median follow-up was 69.6 months (range: 0 to 139.8 months). The study population was divided into 2 main groups; VA group encompassed 476 patients (10.91%) with VAs, whereas 3,887 subjects (89.09%) without VT or VF were included into the control group. In VA population, prereperfusion VA (34.24%; n = 163) was the most common arrhythmia, whereas reperfusion-induced, early postreperfusion, and late postreperfusion VAs were diagnosed in 103 (21.64%), 103 (21.64%), and 107 (22.48%) patients, respectively. Every type of sVT or VF complicating STEMI portended significantly worse in-hospital prognosis, however a late onset arrhythmia was associated with the highest (over fivefold) and reperfusion-induced VA with the lowest (less than threefold) increase in mortality risk compared with the control group. On the contrary, long-term mortality was significantly increased only in subjects with late postreperfusion and prereperfusion VAs compared with VA-free population (43.93% and 36.81%, respectively vs 22.58%; p <0.001). Apart from cardiogenic shock on admission, late postreperfusion (hazard ratio 3.39) and prereperfusion VAs (hazard ratio 2.76) were the strongest independent predictors of death in the analyzed population. In conclusion, 1 in 10 patients with STEMI treated invasively was affected by sVT or VF. The clinical impact of VAs was strongly dependent on timing of arrhythmia.
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A lower eicosapentaenoic acid/arachidonic acid ratio is associated with in-hospital fatal arrhythmic events in patients with acute myocardial infarction: a J-MINUET substudy. Heart Vessels 2017; 33:481-488. [DOI: 10.1007/s00380-017-1084-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 11/10/2017] [Indexed: 10/18/2022]
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Kosmidou I, Embacher M, McAndrew T, Dizon JM, Mehran R, Ben-Yehuda O, Mintz GS, Stone GW. Early Ventricular Tachycardia or Fibrillation in Patients With ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention and Impact on Mortality and Stent Thrombosis (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol 2017; 120:1755-1760. [PMID: 28867126 DOI: 10.1016/j.amjcard.2017.07.080] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/18/2017] [Accepted: 07/24/2017] [Indexed: 11/15/2022]
Abstract
The prevalence and impact of early ventricular arrhythmias (ventricular tachycardia [VT]/ventricular fibrillation [VF]) occurring before mechanical revascularization for acute ST segment elevation myocardial infarction (STEMI) treated with percutaneous coronary intervention are poorly understood. We sought to investigate the association between early VT/VF and long-term clinical outcomes using data from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial. Among 3,602 patients with STEMI, 108 patients (3.0%) had early VT/VF. Baseline clinical characteristics were similar in patients with versus without early VT/VF. Patients with early VT/VF had shorter symptom-to-balloon times and lower left ventricular ejection fraction and underwent more frequent thrombectomy compared with patients without early VT/VF. Adjusted 3-year rates of all-cause death (15.7% vs 6.5%; adjusted hazard ratio 2.62, 95% confidence interval 1.48 to 4.61, p <0.001) and stent thrombosis (13.7% vs 5.7%; adjusted hazard ratio 2.74, 95% confidence interval 1.52 to 4.93, p <0.001) were significantly higher in patients with early VT/VF compared with patients without early VT/VF. In conclusion, in the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction trial, VT/VF occurring before coronary angiography and revascularization in patients with STEMI was strongly associated with increased 3-year rates of death and stent thrombosis. Further investigation into the mechanisms underlying the increased risk of early stent thrombosis in patients with early VT/VF is required.
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Affiliation(s)
- Ioanna Kosmidou
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; St Francis Hospital, Arrhythmia Center, New York, New York.
| | - Monica Embacher
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Thomas McAndrew
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - José M Dizon
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Roxana Mehran
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ori Ben-Yehuda
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York
| | - Gregg W Stone
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York; Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Yannopoulos D. The interventional cardiologist as a resuscitator: a new era of machines in the cardiac catheterization laboratory. Hellenic J Cardiol 2017; 58:401-402. [DOI: 10.1016/j.hjc.2018.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 12/19/2017] [Indexed: 11/26/2022] Open
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Prognostic implication of early ventricular fibrillation among patients with ST elevation myocardial infarction. Coron Artery Dis 2017; 28:570-576. [DOI: 10.1097/mca.0000000000000532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Becher T, Baumann S, Eder F, Perschka S, Loßnitzer D, Fastner C, Behnes M, Doesch C, Borggrefe M, Akin I. Comparison of peri and post-procedural complications in patients undergoing revascularisation of coronary artery multivessel disease by coronary artery bypass grafting or protected percutaneous coronary intervention with the Impella 2.5 device. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:360-368. [PMID: 28660768 DOI: 10.1177/2048872617717687] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND While coronary artery bypass grafting remains the standard treatment of complex multivessel coronary artery disease, the advent of peripheral ventricular assist devices has enhanced the safety of percutaneous coronary intervention. We therefore evaluated the safety in terms of inhospital outcome comparing protected high-risk percutaneous coronary intervention with the Impella 2.5 device and coronary artery bypass grafting in patients with complex multivessel coronary artery disease. METHODS This retrospective study included patients with complex multivessel coronary artery disease (SYNTAX score >22) undergoing either coronary artery bypass grafting before the implementation of a protected percutaneous coronary intervention programme with a peripheral ventricular assist device or protected percutaneous coronary intervention with the Impella 2.5 device following the start of the programme. The primary endpoint consisted of inhospital major adverse cardiac and cerebrovascular events. The combined secondary endpoint included peri and post-procedural adverse events. RESULTS A total of 54 patients (mean age 70.1±9.9 years, 92.6% men) were enrolled in the study with a mean SYNTAX score of 34.5±9.8. Twenty-six (48.1%) patients underwent protected percutaneous coronary intervention while 28 (51.9%) patients received coronary artery bypass grafting. The major adverse cardiac and cerebrovascular event rate was numerically higher in the coronary artery bypass grafting group (17.9 vs. 7.7%; P=0.43) but was not statistically significant. The combined secondary endpoint was not different between the groups; however, patients undergoing coronary artery bypass grafting experienced significantly more peri-procedural adverse events (28.6 vs. 3.8%; P<0.05). CONCLUSION Patients with complex multivessel coronary artery disease undergoing protected percutaneous coronary intervention with the Impella 2.5 device experience similar intrahospital major adverse cardiac and cerebrovascular event rates when compared to coronary artery bypass grafting. Protected percutaneous coronary intervention represents a safe alternative to coronary artery bypass grafting in terms of inhospital adverse events.
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Affiliation(s)
- Tobias Becher
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Stefan Baumann
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Frederik Eder
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany
| | - Simon Perschka
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany
| | - Dirk Loßnitzer
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Christian Fastner
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Michael Behnes
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Christina Doesch
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Martin Borggrefe
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
| | - Ibrahim Akin
- 1 First Department of Medicine, University Medical Center Mannheim (UMM), Faculty of Medicine Mannheim, Mannheim, Germany.,2 DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Germany
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Gong W, Feng S, Wang X, Fan J, Li A, Nie SP. Beta-blockers reduced the risk of cardiac rupture in patients with acute myocardial infarction: A meta-analysis of randomized control trials. Int J Cardiol 2017; 232:171-175. [PMID: 28109576 DOI: 10.1016/j.ijcard.2017.01.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/02/2017] [Accepted: 01/04/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiac rupture (CR) is a catastrophic complication that occurs after acute myocardial infarction (MI) and, at present, there are no effective pharmacological strategies for preventing this condition. The objective of this meta-analysis was to assess the effect of beta-blockers on CR in patients with acute MI. METHODS An extensive search of the PUBMED, EMBASE, ISI Web of Science, MEDLINE and Cochrane was performed to retrieve the studies of beta-blockers treatment in patients with acute MI. Data were combined using a random effects model. A meta-analysis was performed using Review Manager 5.3. RESULTS Four randomized controlled trials (RCTs) involving 68, 842 patients, 603 of whom occurred CR, were met criteria. Meta analysis showed that beta-blockers caused a statistically and clinically significant decrease in the incidence of CR of 32% (RR: 0.68, 95% CI: 0.47 to 0.99, P=0.04). CONCLUSIONS The findings of this meta-analysis confirmed that the early use of beta-blockers is associated with decreased incidence of CR, suggesting some beneficial effects of beta-blockers on infarct healing after acute MI.
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Affiliation(s)
- Wei Gong
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Siting Feng
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiao Wang
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Jingyao Fan
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Aobo Li
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Shao-Ping Nie
- Emergency & Critical Care Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
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40
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Nosaka K, Miyoshi T, Iwamoto M, Kajiya M, Okawa K, Tsukuda S, Yokohama F, Sogo M, Nishibe T, Matsuo N, Hirohata S, Ito H, Doi M. Early initiation of eicosapentaenoic acid and statin treatment is associated with better clinical outcomes than statin alone in patients with acute coronary syndromes: 1-year outcomes of a randomized controlled study. Int J Cardiol 2016; 228:173-179. [PMID: 27865182 DOI: 10.1016/j.ijcard.2016.11.105] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/06/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Early initiation of EPA treatment in combination with a statin within 24h after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (MI) reduces inflammation and ventricular arrhythmia compared with statin monotherapy; however, the impact of early initiation of EPA treatment on cardiovascular events is unclear. We determined whether early eicosapentaenoic acid (EPA) treatment in patients with acute coronary syndrome (ACS) reduces adverse cardiovascular events. METHODS This prospective, open-label, blind end point-randomized trial consisted of 241 patients with ACS. Patients were randomly assigned to receive pitavastatin (2mg/day) with or without 1800mg/day of EPA initiated within 24h after PCI. The primary endpoint was defined as cardiovascular events occurring within 1year, including death from a cardiovascular cause, nonfatal stroke, nonfatal MI and revascularization. RESULTS The mean EPA/arachidonic acid ratio at follow-up was 0.40 in the control group and 1.15 in the EPA group. A primary endpoint event occurred in 11 patients (9.2%) in the EPA group and 24 patients (20.2%) in the control group (absolute risk reduction, 11.0%; hazard ratio, 0.42; 95% confidence interval, 0.21 to 0.87; P=0.02). Notably, death from a cardiovascular cause at 1year was significantly lower in the EPA group than in the control group (0.8% vs. 4.2%, P=0.04). CONCLUSIONS Early initiation of treatment with EPA combined with statin after successful primary PCI reduced cardiovascular events after ACS. CLINICAL TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN-CTR); Registry Number, UMIN000016723; URL, http://www.umin.ac.jp/ctr/index-j.htm.
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Affiliation(s)
- Kazumasa Nosaka
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Toru Miyoshi
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan.
| | - Mutsumi Iwamoto
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Masahito Kajiya
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Keisuke Okawa
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Saori Tsukuda
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Fumi Yokohama
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Masahiro Sogo
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Tomoyuki Nishibe
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Naoaki Matsuo
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
| | - Satoshi Hirohata
- Department of Medical Technology, Okayama University Graduate School of Health, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan.
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama City 700-8558, Japan.
| | - Masayuki Doi
- Department of Cardiology, Kagawa Prefectural Central Hospital, 1-2-1 Asahi-machi, Takamatsu City, Kagawa 760-8557, Japan.
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41
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Elgendy IY, Elgendy AY, Mahmoud AN, Mansoor H, Mojadidi MK, Bavry AA. Intravenous β-blockers for patients undergoing primary percutaneous coronary intervention: A meta-analysis of randomized trials. Int J Cardiol 2016; 223:891-897. [DOI: 10.1016/j.ijcard.2016.08.293] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 01/03/2023]
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42
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Liang JJ, Fender EA, Cha YM, Lennon RJ, Prasad A, Barsness GW. Long-Term Outcomes in Survivors of Early Ventricular Arrhythmias After Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention. Am J Cardiol 2016; 117:709-13. [PMID: 26796195 DOI: 10.1016/j.amjcard.2015.12.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/01/2015] [Accepted: 12/01/2015] [Indexed: 10/22/2022]
Abstract
Guidelines do not recommend an implantable cardioverter defibrillator (ICD) for prevention of sudden death in patients who develop ventricular arrhythmia (VA) within 48 hours of acute myocardial infarction (AMI) if they are successfully revascularized. We aimed to determine long-term survival in a cohort of early VA survivors treated with percutaneous coronary intervention (PCI) and to determine whether certain high-risk characteristics predicted worse outcomes. This retrospective study included all patients with early VA after AMI treated with PCI at our institution from 2002 to 2012 who survived to hospital discharge. Patients who had an ICD before their index AMI and those who received ICD before hospital discharge were excluded. Overall survival in the early VA survivors was analyzed based on post-MI left ventricular ejection fraction (LVEF) (≥50% vs <50%), MI type (ST-segment elevation myocardial infarction [STEMI] vs non-ST-segment elevation myocardial infarction [NSTEMI]), and single-vessel versus multivessel disease. Baseline presenting clinical and PCI characteristics plus outcomes were compared with matched controls with PCI-treated AMI but no early VA. Of the 79 early VA survivors treated with PCI, there were no significant differences in long-term overall survival between AMI type (STEMI vs NSTEMI), single-vessel versus multivessel disease, and LVEF at time of MI (>50% vs <50%). Despite having lower presenting LVEF (46% vs 55%, p <0.001) and higher rates of cardiogenic shock (28% vs 4%; p <0.001), survivors of early VA had similar overall survival compared with PCI-treated controls whose post-AMI hospital course was not complicated by early VA (p = 0.61). In conclusion, patients with early VA treated with PCI who survive to discharge were more likely to have STEMI, lower LVEF, and cardiogenic shock. Type of AMI or the presence of systolic dysfunction or multivessel disease did not predict long-term mortality. With early PCI, early VA survivors have similar long-term prognosis compared with those without early VA.
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Lavonas EJ, Drennan IR, Gabrielli A, Heffner AC, Hoyte CO, Orkin AM, Sawyer KN, Donnino MW. Part 10: Special Circumstances of Resuscitation: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S501-18. [PMID: 26472998 DOI: 10.1161/cir.0000000000000264] [Citation(s) in RCA: 172] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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William P, Rao P, Kanakadandi UB, Asencio A, Kern KB. Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory. Circ J 2016; 80:1292-9. [DOI: 10.1253/circj.cj-16-0330] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Álvarez-Álvarez B, Bouzas-Cruz N, Abu-Assi E, Raposeiras-Roubin S, López-López A, González Cambeiro MC, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Impacto de la fibrilación ventricular que complica el curso de un síndrome coronario agudo en la incidencia a largo plazo de muerte súbita cardiaca. Rev Esp Cardiol 2015. [DOI: 10.1016/j.recesp.2014.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Álvarez-Álvarez B, Bouzas-Cruz N, Abu-Assi E, Raposeiras-Roubin S, López-López A, González Cambeiro MC, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Impact of Acute Coronary Syndrome Complicated by Ventricular Fibrillation on Long-term Incidence of Sudden Cardiac Death. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2015; 68:878-884. [PMID: 25800166 DOI: 10.1016/j.rec.2014.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/03/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES There is little information on the effect of acute coronary syndrome complicated by ventricular fibrillation on the long-term incidence of sudden cardiac death. We analyzed this effect in a contemporary cohort of patients with acute coronary syndrome. METHODS We studied 5302 consecutive patients with acute coronary syndrome between December 2003 and December 2012. We compared mortality during and after hospitalization according to the presence or absence of ventricular fibrillation. RESULTS Ventricular fibrillation was observed in 163 (3.1%) patients, and was early onset in 72.4% of these patients. In-hospital mortality was 36.2% in the group with ventricular fibrillation and 4.7% in the group without (p<.001). After a mean follow-up of 4.7 years (standard deviation, 2.6 years), mortality was 30.7% in the ventricular fibrillation group and 24.7% in the other group (P=.23). After adjusting for confounding variables, the presence of ventricular fibrillation was not associated with an increased risk of death in the follow-up period (hazard ratio=1.29; 95% confidence interval, 0.90-1.87). The cause of death was established in 72% of patients. The incidence of sudden death was 12.9% in the ventricular fibrillation group and 11.9% in the other group (P=.71). Cardiovascular-cause mortality was also similar between the 2 groups (35.5% and 34.4%, respectively. CONCLUSIONS Patients with acute coronary syndrome complicated by ventricular fibrillation who survive the in-hospital phase do not appear to be at an increased risk of sudden cardiac death or other cardiovascular-cause death.
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Affiliation(s)
- Belén Álvarez-Álvarez
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain.
| | - Noelia Bouzas-Cruz
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Andrea López-López
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - María Cristina González Cambeiro
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Carlos Peña-Gil
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José María García-Acuña
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Ramón González-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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Jabbari R, Risgaard B, Fosbøl EL, Scheike T, Philbert BT, Winkel BG, Albert CM, Glinge C, Ahtarovski KA, Haunsø S, Køber L, Jørgensen E, Pedersen F, Tfelt-Hansen J, Engstrøm T. Factors Associated With and Outcomes After Ventricular Fibrillation Before and During Primary Angioplasty in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2015; 116:678-85. [PMID: 26150175 DOI: 10.1016/j.amjcard.2015.05.037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 05/28/2015] [Accepted: 05/28/2015] [Indexed: 10/23/2022]
Abstract
We aimed to assess the risk factors and outcome of ventricular fibrillation (VF) before and during primary percutaneous coronary intervention (PPCI) in patients with ST-segment elevation myocardial infarction. From 1999 to 2012, we consecutively enrolled 5,373 patients with ST-segment elevation myocardial infarction. In total, 410 of the patients had VF before and 88 had VF during PPCI. During a mean follow-up of 4.2 years, 1,196 subjects died. A logistic regression model identified younger age, anterior infarct, Killip class >I at admission, and a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I to be significantly associated with VF before PPCI, whereas inferior infarct, a preprocedural Thrombolysis In Myocardial Infarction flow grade of 0 to I, and Killip class >I at admission were significantly associated with VF during PPCI. All-cause mortality was evaluated using the Cox regression model. Compared with the patients without VF, those with VF before or during PPCI had a significantly increased 30-day mortality, with an adjusted hazard ratio = 3.40 (95% confidence interval 1.70 to 6.70) and 4.20 (95% confidence interval 1.30 to 13.30), respectively. Importantly, there was no tendency of 30-day mortality difference between VF before and during PPCI (p = 0.170). In patients with VF before or during PPCI who survived for at least 30 days, there was no increase in the long-term mortality. In conclusion, our data suggest that 30-day mortality is the same for patients with VF before PPCI compared with VF during PPCI, and the occurrence of VF before or during PPCI was associated with increased 30-day mortality but not with long-term mortality.
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Orvin K, Eisen A, Goldenberg I, Gottlieb S, Kornowski R, Matetzky S, Golovchiner G, Kuznietz J, Gavrielov-Yusim N, Segev A, Strasberg B, Haim M. Outcome of contemporary acute coronary syndrome complicated by ventricular tachyarrhythmias. Europace 2015; 18:219-26. [DOI: 10.1093/europace/euv027] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/27/2015] [Indexed: 11/14/2022] Open
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Araszkiewicz A, Grygier M, Pyda M, Rajewska J, Lesiak M, Grajek S. Postconditioning attenuates early ventricular arrhythmias in patients with high-risk ST-segment elevation myocardial infarction. J Cardiol 2015; 65:459-65. [PMID: 25828740 DOI: 10.1016/j.jjcc.2015.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND It has been demonstrated that postconditioning (postcon), brief episodes of ischemia during reperfusion period, in patients with ST-segment elevation myocardial infarction (STEMI) confers protection against ischemia-reperfusion injury and as a result, postcon might reduce infarct size. However, whether postcon may exert its beneficial effect on STEMI patients by reducing the occurrence of early malignant ventricular arrhythmias (VA) is still unknown. The aim of the study was to evaluate the influence of postcon on the presence of VA in early presenters with high-risk STEMI treated with primary coronary intervention (PCI). METHODS Seventy-five STEMI patients treated with primary PCI within 6h from symptoms onset were randomly assigned to postcon group (n=37) or conventional PCI group (n=38) in 1:1 ratio. Postcon was performed immediately after restoration of coronary flow as follows: the angioplasty balloon was inflated 4× 1min with low-pressure inflations, each separated by 1min of deflation. After that the patients were continuously monitored electrographically for 48h. The end-point of the study was the occurrence of VA (ventricular fibrillation-VF, sustained ventricular tachycardia-sVT, non-sustained ventricular tachycardia-nsVT) within 48h after the procedure. RESULTS In the postcon group, the occurrence of VAs was significantly lower: VF-3, sVT-0, nsVT-15, i.e. (18 patients - 48.6%) in comparison to control group: VF-2, sVT-4, nsVT-23 (29 patients - 76.3%); p=0.013. The occurrence of accelerated idioventricular rhythm varied insignificantly between both groups (postcon - 45.9% vs control - 34.2%; p=NS). CONCLUSIONS Postcon may reduce the occurrence of malignant VA in patients with STEMI treated with primary PCI.
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Affiliation(s)
| | - Marek Grygier
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | - Małgorzata Pyda
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | - Justyna Rajewska
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
| | - Stefan Grajek
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland
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