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Birnbaum Y, Levine GN, French J, Kaski JC, Atar D, Alam M, Hasdai D, Jneid H, Uretsky BF. Inferior ST-Elevation Myocardial Infarction Presenting When Urgent Primary Percutaneous Coronary Intervention Is Unavailable: Should We Adhere to Current Guidelines? Cardiovasc Drugs Ther 2020; 34:865-870. [PMID: 32671603 PMCID: PMC7360897 DOI: 10.1007/s10557-020-07039-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2020] [Indexed: 01/09/2023]
Abstract
The pivotal studies that led to the recommendations for emergent reperfusion therapy for ST-elevation myocardial infarction (STEMI) were conducted for the most part over 25 years ago. At that time, contemporary standard treatments including aspirin, statin, and even anticoagulation were not commonly used. The 2013 American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines and the 2017 European Society of Cardiology guidelines give a class I recommendation (with the level of evidence A) for primary percutaneous coronary intervention (pPCI) in patients with STEMI and ischemic symptoms of less than 12 h. However, if the patient presents to a hospital without pPCI capacity, and it is anticipated that pPCI cannot be performed within 120 min of first medical contact, fibrinolytic therapy is indicated (if there are no contraindications) (class I indication, level of evidence A). Our review of the pertinent literature shows that the current recommendation for inferior STEMI is based on the level of evidence lower than A. We can consider level B even C, supporting the recommendation for fibrinolytic therapy if pPCI is not available for inferior STEMI.
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Affiliation(s)
- Yochai Birnbaum
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, MS BCM620, Houston, TX, 77030, USA.
| | - Glenn N Levine
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, MS BCM620, Houston, TX, 77030, USA.,The Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - John French
- Department of Cardiology, Liverpool Hospital, Universities of New South Wales & Western Sydney, Sydney, Australia
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway, and Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Mahboob Alam
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, MS BCM620, Houston, TX, 77030, USA
| | - David Hasdai
- Rabin Medical Center, Tel Aviv University, Petah Tikva, Israel
| | - Hani Jneid
- The Department of Medicine, The Section of Cardiology, Baylor College of Medicine, One Baylor Plaza, MS BCM620, Houston, TX, 77030, USA.,The Section of Cardiology, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Barry F Uretsky
- Central Arkansas Veterans Health System and the University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Namdar H, Imani L, Ghaffari S, Aslanabadi N, Reshadati N, Samani Z, Davarmoin G, Moayyednia N, Nazer Y, Sarhangzadeh S, Separham A. ST-segment depression in left precordial leads in electrocardiogram of patients with acute inferior myocardial infarction undergoing primary percutaneous coronary intervention. Interv Med Appl Sci 2018; 10:191-197. [PMID: 30792911 PMCID: PMC6376358 DOI: 10.1556/1646.10.2018.19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/16/2018] [Accepted: 03/19/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The early identification of patients with acute inferior ST-segment elevation myocardial infarction (STEMI) with high risk features is particularly important. Acute inferior STEMI may be associated with ST-segment depression in the left precordial leads (V4-V6). This study assessed prognostic value of ST-segment depression in these left precordial leads during the admission of patients with acute inferior STEMI treated with primary percutaneous coronary intervention. METHODS This retrospective study enrolled 1,374 patients with acute inferior STEMI who underwent primary percutaneous coronary angioplasty between March 2011 and June 2014. The patients were divided into two groups: one group (n = 687) with left precordial ST-segment depression and the other (n = 687) without such ST-segment changes. RESULTS The patients with left precordial ST-segment depression were older and had higher incidence of hypertension, diabetes mellitus, and higher levels of troponin. In-hospital mortality was higher in patients with left precordial ST-segment depression. Advanced coronary artery disease was more observed in these patients. CONCLUSION In patients with acute inferior STEMI treated with primary coronary intervention, left precordial ST-segment depression during admission of ECG is associated with more advanced coronary artery disease, and worse in-hospital clinical outcomes.
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Affiliation(s)
- Hossein Namdar
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Leyla Imani
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Samad Ghaffari
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Aslanabadi
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Najmeh Reshadati
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zhila Samani
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ghiti Davarmoin
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Naser Moayyednia
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yalda Nazer
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Sarhangzadeh
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Separham
- Department of Cardiology, Cardiovascular Research Center, Madani Heart Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Chen TE, Lo PH, Li TC, Lin KH, Lin JJ, Hsieh LC, Chang CP, Chen YP, Chang KC, Wang HJ. Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention. Am J Emerg Med 2012; 30:1865-71. [DOI: 10.1016/j.ajem.2012.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 03/19/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022] Open
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Carrillo A, Fiol M, Amézaga R, Bayés de Luna A. Diagnóstico electrocardiográfico de la obstrucción del tronco común izquierdo. Rev Esp Cardiol (Engl Ed) 2009. [DOI: 10.1016/s0300-8932(09)70032-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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5
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Electrocardiographic algorithms for predicting the complexity of coronary artery lesions in ST-segment elevation myocardial infarction in ED. Am J Emerg Med 2008; 26:10-7. [DOI: 10.1016/j.ajem.2007.03.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Revised: 03/12/2007] [Accepted: 03/12/2007] [Indexed: 11/18/2022] Open
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Abstract
Structural heart disease, electrical instability, and increased sympathetic activity can generate a number of specific and nonspecific ECG changes and arrhythmias in patients with congestive heart failure (CHF). This review describes direct alterations of the P-QRS-T complex and ECG-derived parameters in CHF, together with the significance of cardiac arrhythmias, markers of atrial and ventricular electrical instability, and the parameters of sympathetic nervous system activity.
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Affiliation(s)
- Vinzenz Hombach
- Department of Internal Medicine II, University Hospital of Ulm, Robet-Koch Strasse 8, Ulm D-89081, Germany.
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Abstract
The ECG is an essential part of the initial evaluation of patients who have chest pain, especially in the immediate decision-making process in patients who have ST-elevation myocardial infarction. This article reviews and summarizes the current information that can be obtained from the admission ECG in patients who have ST-elevation acute myocardial infarction, with an emphasis on: (1) prediction of final infarct size, (2) estimation of prognosis, and (3) the correlations between various ECG patterns and the localization of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Shaul Atar
- Division of Cardiology, University of Texas Medical Branch, 5.106 John Sealy Annex, 301 University Boulevard, Galveston, TX 77555, USA
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Alonso-Gómez ÁM, Belló MC, Fernández MA, Torres A, Alfageme M, Aizpuru F, Martínez-Ferrer J, Díaz A, Arós F. Ecocardiografía de estrés en la detección de enfermedad de la arteria descendente anterior en pacientes con infarto de miocardio inferior y test de esfuerzo positivo. Rev Esp Cardiol 2006. [DOI: 10.1157/13089741] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Eskola MJ, Nikus KC, Niemelä KO, Sclarovsky S. How to use ECG for decision support in the catheterization laboratory. J Electrocardiol 2004; 37:257-66. [PMID: 15484153 DOI: 10.1016/j.jelectrocard.2004.07.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatment of acute myocardial infarction has changed considerably during the last few years with the introduction of primary coronary angioplasty. In the acute phase risk stratification is largely based on simple clinical parameters, laboratory markers of myocardial injury and 12-lead electrocardiography. The electrocardiogram is of crucial importance especially during the first few hours after initiation of chest pain when important therapeutic decisions are made. Biochemical markers of myocardial injury are usually not elevated at that time point. Cases with inferior ST-elevation myocardial infarction from our hospital are presented to show how anatomical interpretation of ECG recorded during chest pain helps to risk stratify patients.
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Affiliation(s)
- Markku J Eskola
- Heart Center, Tampere University Hospital, 33520 Tampere, Finland.
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Rotondo N, Pollack ML, Chan TC, Brady WJ, Harrigan RA. Electrocardiographic manifestations: acute inferior wall myocardial infarction. J Emerg Med 2004; 26:433-40. [PMID: 15093851 DOI: 10.1016/j.jemermed.2004.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The 12-lead electrocardiogram (EKG) is an important tool in evaluating the patient with acute myocardial infarction (MI). Patients with acute inferior wall myocardial infarction (IWMI) represent a heterogeneous group in terms of morbidity, mortality, Emergency Department (ED) management, and site of occlusion in the culprit coronary artery. The standard 12-lead EKG, right-sided chest leads and posterior chest leads, in conjunction with clinical findings often provide the necessary information for the Emergency Physician (EP) to predict complications, morbidity and mortality. IWMI patients may have associated right ventricular infarction (RVI) or lateral and posterior wall extension. Each of these entities is associated with specific hemodynamic abnormalities and increased mortality. In addition, various atrioventricular (AV) blocks are commonly associated with IWMI. This article presents several cases of IWMI with EKGs and a discussion of EKG interpretation in the setting of IWMI.
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Affiliation(s)
- Noelle Rotondo
- Department of Emergency Medicine, York Hospital, York, Pennsylvania 17405, USA
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Birnbaum Y, Drew BJ. The electrocardiogram in ST elevation acute myocardial infarction: correlation with coronary anatomy and prognosis. Postgrad Med J 2003; 79:490-504. [PMID: 13679544 PMCID: PMC1742828 DOI: 10.1136/pmj.79.935.490] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The electrocardiogram is considered an essential part of the diagnosis and initial evaluation of patients with chest pain. This review summarises the information that can be obtained from the admission electrocardiogram in patients with ST elevation acute myocardial infarction, with emphasis on: (1) prediction of infarct size, (2) estimation of prognosis, and (3) the correlations between various electrocardiographic patterns and the localisation of the infarct and the underlying coronary anatomy.
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Affiliation(s)
- Y Birnbaum
- University of Texas Medical Branch, Galveston, Texas 77555-0553, USA.
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