Optimal timing of coronary artery bypass grafting in hemodynamically stable patients after myocardial infarction and definition of poor prognostic factors

Publication date: January 2020Source: Archives of Cardiovascular Diseases Supplements, Volume 12, Issue 1Author(s): C. Bernard, M.C. Morgant, A. Jazayeri, A. Bernard, O. BouchotDuring acute phase of myocardial infarction (MI), the culprite artery must be revascularized quickly with angioplasty. Then, surgery complete the procedure in a second time. If surgery is emergent, resulting death rate is really high; 15 to 20% of patients operated on within the first 48 hours and 4 to 5% for patients operated on after. Various factors influence mortality rate; timing of surgical revascularization and patient's preoperative state.Methods2007 to 2017 retrospective and monocentric study including 477 patients after MI, hemodynamically stable who underwent urgent coronary bypass. Three groups were described, depending on surgery timing; during the first two days (n = 32, 6.7%), between 3 and 10 days (n = 321, 67.3%) and after 11 days (n = 124, 26%). The primary end point was 30-day mortality.ResultsThe 3 groups didn’t differ in their clinical characteristics. Mean Euroscore 2 was 3.0 ± 4.1. Thirty-day mortality was 5.5% (n = 26). Main causes of death were multi-organ failure (n = 12, 46.1%), cardiorespiratory arrest or cardiogenic shock (n = 9, 35%), mesenteric ischemia (n = 2, 8%) and stroke (n = 1, 4%). Death rate was significantly higher in group 1 (n =&n...
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research

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This is by one of ouroutstanding 3rd year residents, Aaron Robinson, with some edits and comments by SmithEMS responded to a reported seizure in a 42 year old male. Per bystanders, he went down after some intense sporting activity, and had “shaking” type movement. He reports no personal or familial history of seizures.One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department. When the physicians approached him, he was ashen, diaphoretic, and appeared in shock. Fire was able to obtain a BP of 60/palp and a pulse in the 40s. The physicians ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Authors: Alsadat N, Hyun K, D'Souza M, Chew D, Weaver J, Juergens C, Kritharides L, Hammett C, Brieger D Abstract BACKGROUND: Approximately 50% of patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) have multivessel coronary disease (MVD). Evidence on the best PCI approach for these patients is conflicting. The aim of this study is to examine Australian data from the CONCORDANCE registry to describe the practice and outcomes of patients receiving multivessel vs culprit-only PCI. METHODS: Two cohorts were constructed from MVD-STEMI patients undergoi...
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
Publication date: Available online 15 December 2018Source: Canadian Journal of CardiologyAuthor(s): Derrick Y. Tam, Faisal Bakaeen, Dmitriy N. Feldman, Philippe Kolh, Gaetano Antonio Lanza, Marc Ruel, Raffaele Piccolo, Stephen E. Fremes, Mario FL. GaudinoAbstractThe management of severe left main (LM) disease remains controversial and continues to evolve as new evidence emerges. Patient selection for CABG or PCI relies on both predicting mortality with CABG from clinical characteristics using the Society of Thoracic Surgeons risk score and anatomical complexity using the SYNTAX score. LM stenting techniques continue to evo...
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research
We report a case of STEMI occurring 40 minutes after thrombolytic therapy for AIS and discuss the possible mechanisms and therapeutic approaches. Patient concerns: A 87-year-old woman with a history of arterial hypertension was admitted for acute onset of right-sided limb weakness 2 hours before arrival at the emergency department. Forty minutes after intravenous recombinant tissue plasminogen activator (i.v. rtPA) administration for AIS, STEMI occurred (signaled by a third-degree atrioventricular block). Diagnoses: The diagnoses were AIS and STEMI. Coronary angiography confirmed right coronary artery occlusion. ...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion: This observational study showed that pharmacoinvasive strategy was as good as primary PCI in STEMI, in our setting, where primary PCI may be delayed or not possible at all due to financial and logistic constraints.
Source: Journal of Postgraduate Medicine - Category: Internal Medicine Authors: Source Type: research
AbstractAimsTo derive and validate a readily useable risk score to identify patients at high-risk of in-hospital ST-segment elevation myocardial infarction (STEMI)-related cardiogenic shock (CS).Methods and resultsIn all, 6838 patients without CS on admission and treated by primary percutaneous coronary intervention (pPCI), included in the Observatoire R égional Breton sur l’Infarctus (ORBI), served as a derivation cohort, and 2208 patients included in the obseRvatoire des Infarctus de Côte-d’Or (RICO) constituted the external validation cohort. Stepwise multivariable logistic regression was used t...
Source: European Heart Journal - Category: Cardiology Source Type: research
I was reading through ECGs on the system when I saw this one:Sinus tachycardia, rate 120Computerized QTc = 380 msWhat do you think? I was immediately worried about a proximal LAD occlusion.  Although sinus tachycardia generally argues against ACS, a large anterior MI may result in such poor stroke volume that there is compensatory tachycardia and possibly impending cardiogenic shock. I looked to see if there was an ED cardiac ultrasound, and there was:Parasternal Long Axis:Poor image, but one can see that there is poor apical functionParasternal short axis:This shows poor contractility of the anterior wall.C...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Conclusions:Although the frequency of pericarditis, mural hemorrhage and subsequent myocardial rupture after MI is declining following PCI, clinicians should be mindful of this potential complication in tPA treated patients with recent MI. Further, cardiac wall rupture should be considered in patients who develop acute hypotension and bradycardia following tPA administration. The current literature is limited and insufficient to provide generalizable guidance on managing AIS patients with recent MI.Disclosure: Dr. Neu has nothing to disclose. Dr. Albright has nothing to disclose. Dr. Lyerly has nothing to disclose.
Source: Neurology - Category: Neurology Authors: Tags: Cerebrovascular Disease Case Reports II Source Type: research
ConclusionsDespite identical technical success rates of PCI between the 2 sexes, women with PCI for ST elevation myocardial infarction have a 20% higher age‐adjusted risk of death and of ischemic cardiac and cerebrovascular events. Further research is needed to determine the reasons for these differences.
Source: JAHA:Journal of the American Heart Association - Category: Cardiology Authors: Tags: Cardiovascular Disease, Women, Percutaneous Coronary Intervention, Stent, Treatment Original Research Source Type: research
We examined patients presenting with acute myocardial infarction treated with percutaneous coronary intervention at 233 US hospitals in the TRANSLATE‐ACS observational study from April 2010 to October 2012. We developed a multivariable logistic regression model to identify factors associated with prasugrel selection. Prasugrel use rates and associated 1‐year risk‐adjusted major adverse cardiovascular events and Global Utilization of Streptokinase and t‐PA for Occluded Coronary Arteries (GUSTO) moderate/severe bleeding outcomes were also examined in relation to predicted mortality and bleeding using the validated Ac...
Source: JAHA:Journal of the American Heart Association - Category: Cardiology Authors: Tags: Acute Coronary Syndromes, Coronary Artery Disease Original Research Source Type: research
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