Revisiting Reperfusion Therapy in Inferior Myocardial Infarction

AbstractAlthough thrombolytic therapy for acute myocardial infarction (MI) is recommended without regard for infarct location, treatment results are less impressive for inferior than for anterior MI because the amount of myocardium at risk is smaller and less strategically located, and the mortality risk is lower. Whereas the risks associated with anterior MI are relatively constant, high risk subsets of patients with an inferior MI can be identified by simple electrocardiographic criteria, including left precordial ST segment depression, complete atrioventricular heart block and right precordial ST segment elevation. Unfortunately, none of the placebo-controlled, randomized trials have analyzed the benefit of thrombolytic therapy for inferior MI in high risk versus low risk subsets.Thrombolytic therapy should be more successful in reducing infarct size and decreasing mortality in high risk patients with an inferior MI. Thrombolytic therapy may not decrease hospital mortality in low risk patients (baseline risk 2% to 4%) or those with symptom duration >6 h. Whereas it is arguable whether coronary angioplasty is superior to thrombolytic therapy in anterior MI, there are no mortality data to support using angioplasty as a primary or rescue reperfusion strategy instead of thrombolytic therapy in inferior MI, unless thrombolytic contraindications are present or the patient is in cardiogenic shock

Is Early Infarct Artery Patency the Goal or Not?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/73711/1/j.1540-8183.1992.tb00816.x.pd

Reperfusion Therapy Reduces the Risk of Myocardial Rupture Complicating ST‐Elevation Myocardial Infarction

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139071/1/jah3738.pd

Genetic Causes of Clopidogrel Nonresponsiveness: Which Ones Really Count?

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/91111/1/phco.30.3.265.pd

Primordial helium recombination III: Thomson scattering, isotope shifts, and cumulative results

Upcoming precision measurements of the temperature anisotropy of the cosmic microwave background (CMB) at high multipoles will need to be complemented by a more complete understanding of recombination, which determines the damping of anisotropies on these scales. This is the third in a series of papers describing an accurate theory of HeI and HeII recombination. Here we describe the effect of Thomson scattering, the $^3$He isotope shift, the contribution of rare decays, collisional processes, and peculiar motion. These effects are found to be negligible: Thomson and $^3$He scattering modify the free electron fraction $x_e$ at the level of several $\times 10^{-4}$. The uncertainty in the $2^3P^o-1^1S$ rate is significant, and for conservative estimates gives uncertainties in $x_e$ of order $10^{-3}$. We describe several convergence tests for the atomic level code and its inputs, derive an overall $C_\ell$ error budget, and relate shifts in $x_e(z)$ to the changes in $C_\ell$, which are at the level of 0.5% at $\ell =3000$. Finally, we summarize the main corrections developed thus far. The remaining uncertainty from known effects is $\sim 0.3$ in $x_e$.Comment: 19 pages, 15 figures, to be submitted to PR

Echocardiographic diagnosis of flail anterior leaflet in tricuspid endocarditis

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/25376/1/0000825.pd

Coronary artery dissection caused by exit of the guidewire through the distal perfusion sidehole of an auto-perfusion angioplasty balloon catheter

A previously unrecognized cause of coronary artery dissection is reported. A 67-year-old woman underwent angioplasty of the right coronary artery using an autoperfusion balloon catheter. Dissection occurred because the balloon catheter was advanced while the guidewire exited from one of the distal perfusion sideholes. © Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38219/1/1810330109_ftp.pd

Dissolution of angiographically detected intracoronary thrombus for unstable angina pectoris after aspirin therapy

Atherosclerotic plaque disruption with nonocclusive coronary artery thrombosis plays a major role in the pathogenesis of unstable angina pectoris.1 Progression to cardiac death or nonfatal acute myocardial infarction (AMI) occurs in more than 10% of these patients within 3 months2 and is not prevented by conventional medical treatment with nitrate, [beta]-blocking or calcium antagonist drugs. Two multicenter, randomized, double-blind, placebo-controlled trials have shown a 50% reduction in mortality and nonfatal AMI rates with aspirin therapy,2,3 presumably from inhibition of platelet-dependent thrombus formation. This report provides arteriographic evidence of thrombus dissolution in patients with unstable angina whose condition improved on aspirin therapy.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26575/1/0000114.pd

Cardiogenic shock complicating acute myocardial infarction: The use of coronary angioplasty and the integration of the new support devices into patient management

Conventional therapy for cardiogenic shock complicating acute myocardial infarction continues to be associated with a high in-hospital mortality rate. Hemodynamic support with new mechanical devices and emergency coronary revascularization may alter the long-term prognosis for patients with this complication. Between July 1985 and March 1990, 68 patients presented to the University of Michigan with acute myocardial infarction and cardiogenic shock. Interventions performed included thrombolytic therapy (46%), intraaortic balloon pump counterpulsation (70%), cardiac catheterization (86%), coronary angioplasty (73%), emergency coronary artery bypass grafting/ventricular septal defect repair (15%), Hemopump insertion (11%), percutaneous cardiopulmonary support (4%) and ventricular assist device (3%).The 30-day survival rate was significantly better in patients who had successful angioplasty of the infarct-related artery than in patients with failed angioplasty (61% vs. 7%, p = 0.002) or no attempt at angioplasty (61% vs. 14%, p = 0.003). This difference was maintained over the 1-year follow-up period. The only clinical variable that predicted survival was age <65 years.The early use of the new support devices in 10 patients was associated with death in 8 (80%), but this poor outcome may reflect a selection bias for an especially high risk population. Collectively, these recent data continue to suggest that emergency revascularization with angioplasty may reduce the mortality rate, but further study is required to define optimal utilization and integration of new support devices