Tag Archives: stemi

Introduction Despite primary percutaneous coronary intervention (pPCI) programmes,1-3 ST-elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality.2,3 Total ischaemic time predicts mortality in STEMI,4,5 and was adopted by the European Society of Cardiology (ESC) in the most recent STEMI guidelines.3 This time-period starts at the onset of chest pain and ends at wire cross, including onset-to-door and door-to-balloon time, and outcomes worsen beyond 120 minutes.6 The ESC guideline advises optimal time cut-offs for each step. This document re-highlights ‘time is muscle’, first described by Braunwald 50

Researchers analysed data on more than 45,000 patients (30.8% women) hospitalised for a first heart attack between 2002–2016 in Alberta, Canada. They focused on two types of heart attack: ST-segment elevation myocardial infarction (STEMI), and the less severe non-STEMI or NSTEMI, the latter being more common. Patients were followed for an average of 6.2 years. Women were older and faced a variety of complications and more risk factors that may have put them at a greater risk for heart failure after a heart attack. Regardless of whether their heart attacks were STEMI or NSTEMI, fewer women were prescribed medications such as beta blockers or

The DETO2X-AMI study questioned the current practice of routine oxygen therapy for all patients with suspected myocardial infarction (MI), said Dr Robin Hofmann (Karolinska Institutet at Södersjukhuset, Stockholm, Sweden) who presented the study at the meeting. This prospective, randomised, open label trial enrolled 6,229 patients with suspected heart attack from 35 hospitals across Sweden. Half of the patients were assigned to oxygen given through an open face mask and the other half to room air without a mask. The study – using a registry-based randomised clinical trial protocol – was representative of real world practice and used nati

Definition of ACS Acute coronary syndromes (ACS) include unstable angina and acute myocardial infarction (AMI). AMI is classified according to those patients with electrocardiographic ST-segment elevation, ST-elevation myocardial infarction (STEMI) and those without electrocardiographic ST-segment elevation, non-ST-elevation myocardial infarction (NSTEMI).1 The requirement for a diagnosis of AMI in the universal definition is the detection of troponin release from injured cardiac myocytes with at least one value >99th centile of the upper reference limit.1 Diagnosis is confirmed only if this is associated with at least one of: symptoms of

Introduction An acute myocardial infarction causes a number of electrocardiogram (ECG) changes corresponding to coronary anatomy.1,2 The posterior myocardial infarction (PMI) refers to an infarction of the posterior wall of the left ventricle (LV).3 On the 12-lead ECG, the key to detecting a PMI is through indirect evidence via ST-depression in the antero-septal (V1–V4) leads and evolving R-waves in V1 or V2 with R/S ratios >1.1 A common theory is that these evolving R-waves represent inverted Q-waves. While ST-depression typically occurs in V1–V4, it may also extend into V5 and perhaps other leads.4 In these cases, posterior occlusion

Terry McCormack (Spring Vale Medical Centre, North Yorkshire) It was, therefore, with great interest that I read the paper by Coughlan et al. (see pages 138–40). The authors raise very important points regarding both the importance of adequate discharge information and the poor delivery of appropriate up-titration of medicines when the patient has arrived home post-ST-elevation myocardial infarction (STEMI). They cite the failure of junior doctors to give adequate instructions to GPs on how to up-titrate medications and how educating the juniors improved performance. But they raise more questions than they answer. Why not have a pre-printed

Introduction Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is recommended for up to one year following acute coronary syndrome (ACS) in order to reduce the risk of further cardiac events.1,2 Gastrointestinal bleeding is the main hazard of this treatment; however, although the incidence of bleeding is low, it results in significantly increased morbidity and mortality in these patients,3-5 and proton pump inhibitors (PPIs) are often prescribed to selective patients to reduce this risk. PPIs act by reducing the secretion of gastric acid, neutralising gastric pH, increasing clot formation and decreasing the lysis of blood clots. Th

Introduction Developments along the way have included better patient selection, improved peri-procedural management of patients and, with newer-generation drugs and devices, better results. Recent hurdles have been confronted, including left main stem disease, complex bifurcation lesions and total chronic occlusions. Similarly, primary percutaneous coronary intervention (PCI) has become the treatment of choice in acute myocardial infarction. Challenges remain, however, including restenosis. The fine balance between thrombosis and haemostasis demands that we provide more effective and predictable antiplatelet strategies to optimise risk reduct

Introduction While primary PCI, rather than thrombolysis, is now the reperfusion treatment of choice for STEMI, the majority of patients coming for revascularisation in the UK have stable coronary disease or NSTE-ACS. In the treatment of NSTE-ACS, first principles involve the selection of patients for diagnostic angiography followed by either PCI or coronary artery bypass grafting (CABG). Rates of PCI are increasing annually in the UK, which, in part, is a reflection of greater awareness of coronary artery disease, its earlier diagnosis and treatment in the ageing population. This section looks at coronary intervention in general, how PCI act

Introduction The discovery of the thienopyridines, or ADP receptor antagonists, led to the development of more effective oral antiplatelet agents. Trials assessed dual antiplatelet therapy in high-risk patients versus aspirin alone and the significant benefits observed have resulted in dual antiplatelet therapy becoming a mainstay of treatment. As expected with more potent dual therapy, there is always a fine balance between prevention of thrombosis and bleeding risk. There are still many challenges to overcome. Many patients, such as those with diabetes or with a previous stent thrombosis, are at high risk for further infarction, indicating