Epidemiology of Myocardial Infarction

Coronary heart disease (CHD) is the leading cause of morbidity and mortality throughout the world. The most common form of CHD is the myocardial infarction. It is responsible for over 15% of mortality each year, among the vast majority of people suffering from non-ST-segment elevation myocardial infarction (NSTEMI) than ST-segment elevation myocardial infarction (STEMI). The prevalence of myocardial infarction (MI) is higher in men in all age-specific groups than women. Although the incidence of MI is decreased in the industrialized nations partly because of improved health systems and implementation of effective public health strategies, nevertheless the rates are surging in the developing countries such as South Asia, parts of Latin America, and Eastern Europe. The modifiable risk factors represent over 90% of the risk for acute MI. The risk factors such as dyslipidemia, smoking, psychosocial stressors, diabetes mellitus, hypertension, obesity, alcohol consumption, physical inactivity, and a diet low in fruits and vegetables were strongly associated with acute MI

Clinical effectiveness of complete revascularization versus infarct-related artery-only percutaneous coronary revascularization for multivessel disease ST-segment elevation myocardial infarction

Objectives: The purpose of this study was to evaluate the event-free survival from major adverse cardiac events for ST-segment elevation myocardial infarction (STEMI) patients with multivessel disease (MVD) as a function of whether they underwent infarct-related artery (IRA)- only percutaneous coronary intervention (PCI) or complete revascularization at index admission. Background: The optimal management of patients with STEMI and MVD while undergoing primary PCI (P-PCI) is uncertain. Methods and Results: STEMI patients with MVD undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent complete revascularization during index admission (n = 150) and IRA-only revascularization (n = 156). Complete revascularization was performed at index admission of P-PCI. The primary endpoint was a composite of all-cause death, recurrent MI, heart failure (HF), and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of HF. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus in 23% of the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34–0.93; P = 0.039). There was a significant reduction in death; a nonsignificant reduction in all primary endpoint components was seen. Conclusions: In patients presenting for P-PCI with MVD, complete revascularization at index admission significantly lowered the rate of the primary composite endpoint at 24 months compared with treating IRA-only

Phased Reopening during COVID-19 in a nut shell

As the COVID-19 pandemic is rapidly progressing, most countries have implemented physical distancing measures community-wide. As transmission dynamics begin to decline, along with incidence of COVID-19 cases, there will be a need for decisions at the country level about how to transition out of strict physical distancing and into a phased reopening.</p

Comparative Effectiveness of Complete Revascularization Versus Infarct Related Artery-only Percutaneous Coronary Revascularization for Multivessel Disease After ST-Segment Elevation Myocardial Infarction

Objectives: The purpose of this study was to evaluate the event free survival from major adverse cardiac events (MACE) for STsegment elevation myocardial infarction (STEMI) patients with multivessel disease as a function of whether they underwent infarctrelated artery (IRA) only percutaneous coronary intervention (PCI) or complete revascularization at index admission. Background: The optimal management of patients with STEMI and multivessel disease while undergoing primary percutaneous coronary intervention (P-PCI) is uncertain. Methods and Results: STEMI patients with multivessel disease undergoing P-PCI between April 1, 2012, and March 31, 2014, were subdivided into those who underwent in-hospital complete revascularization (n= 150) or IRA-only revascularization (n = 156). Complete revascularization was performed during the index admission of P-PCI. The primary endpoint was a composite of allcause death, recurrent myocardial infarction (MI), heart failure, and ischemia-driven revascularization within 24 months. Patient groups were differed at baseline by gender and prevalence of heart failure. The average door-to-balloon time was significantly higher in the complete revascularization group. The primary endpoint occurred in 11.0% of the complete revascularization group versus 23% in the IRA-only revascularization group (hazard ratio: 0.51; 95% confidence interval: 0.34 to 0.93; p =0.039). There was a significant reduction in death, a non-significant reduction in all primary endpoint components was seen. Conclusions: In patients presenting for P-PCI with multivessel disease, index admission complete revascularization significantly lowered the rate of the primary composite endpoint at 24 months compared with treating only the IRA