Prognostic significance of acute bundle branch block in patients with acute myocardial infarction

Background/Aim. Acute bundle branch block (ABBB) presence is associated with the increasing mortality of patients with acute myocardial infarction (AMI). The aim of this study was investigate ABBB influence with respect to in-hospital (IN) and long-term mortality in patients with AIM, as well as total mortality in follow-up, the presence of in-hospital congestive cardiac insufficiency (CCI) and the presence of CCI at follow-up. Methods. This study included 606 consecutive patients with AMI. A total of 415 (68.5%) were males and 191 (31.5%) females, mean age 64.0±11.9. After the dismissal the patients underwent 18-month follow-up period. Results. Acute bundle branch block was registered in 44 patients (7.2%), out of which 15 patients (2.4%) had the left (L) ABBB and 29 patients (4.8%) had the right (R) ABBB. The patients with ABBB showed higher proportion of IH CCI (Killip III and IV) and hypotension compared with the control group (patients without ABBB). In the group of patients with ABBB β-blockers, statins, aspirin and ACE-inhibitors were less applied. All the three ABBB groups exhibited an increased IH mortality (ABBB 47.7% vs 11.2%, p < 0.01, ARBBB 55.1% vs 11.2% p < 0.01, ALBBB 33.3% vs 11.2%, p < 0.01). Follow-up mortality of the patients with ABBB and ALBBB was higher in comparison with the control group (log-rank p = 0.046 and log-rank p = 0.01, respectively), whereas the group with ARBBB did not show any differences (log-rank, p = 0.59). Conclusion. The patients with ABBB AMI are a risk group of patients that commonly exhibit both early and remote CCI accompanied by high mortality. That is the reason why this sub-group of AMI patients should receive an urgent diagnostics followed by aggressive therapeutic treatment. <br><br><font color="red"><b> This article has been retracted. Link to the retraction <u><a href="http://dx.doi.org/10.2298/VSP0901074U">10.2298/VSP0901074U</a></u></b></font&gt

Upotreba reperfuzione terapije u zemljama tranzicije bez potpuno primenljive farmakoinvazivne strategije

Background/Aim.The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748-0.761)] were age (≥ 65 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p 360min). Kod bolesnika koji nisu bili lečeni RT, mortalitet je bio 15,7%, kod bolesnika lečenih fibrinolitičkom terapijom (FT) iznosio je 10,5%, a kod bolesnika lečenih p-PCI 6,2% ( p <0,000). U grupi bolesnika koji su do PMK stizali za 3 sata, mortalitet lečenih pomoću FT bio je veći od mortaliteta bolesnika lečenih p-PCI (FT 8,7% vs p-PCI 4,3%). Bolesnici lečeni pomoću FT bili su stariji, sa više komorbiditeta i sa učestalijim znacima srčane insuficijencije. Ipak, posle primenjenog propensity skora, sa ciljem da se izbegnu razlike između dve grupe bolesnika, mortalitet u FT grupi ostao je veći, alibez statistički značajne razlike u odnosu na bolesnike lečene p-PCI (FT 8,8%. vs p-PCI 6,4%). Zaključak. Primena RT, uz postignuti idealan balans potrošnje i koristi, teško je izvodljiva u zemljama u tranziciji. Mogućnosti za blagovremenu primenu p-PCI, kao i FIterapije, posebno su ograničene kod visoko rizičnih, starijih bolesnika, kod bolesnika sa znacima srčane insuficijencije, komorbiditetima i dijabetesom melitusom

Time-dependent changes of myeloperoxidase in relation to in-hospital mortality in patients with the first anterior ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention

Objectives: To analyze the prognostic value of myeloperoxidase (MPO) in relation to in-hospital mortality and to identify the optimum time point for sampling in patients with the first anterior ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Design and methods: A total of 100 consecutive patients with the first anterior STEMI undergoing pPCI were included. Blood samples were collected at baseline, 4, 8, 12, 18, 24,48 and 168 hours (h) after pPCI. Results: MPO concentrations have showed a biphasic pattern over time; the highest MPO levels were at 4 h and 2411 after pPCI. In-hospital mortality was 6%. MPO at 24 h significantly correlated with troponin I as well as heart failure. After multivariate adjustment, MPO at 24 h was an independent predictor of the in-hospital mortality (OR 3.34, 95% CI 1.13-9.86, P = 0.029). Conclusions: In patients with the first anterior STEMI treated by pPCI. MPO at 24 h after procedure was an independent predictor of the in-hospital mortality

Utility of Lipoprotein-Associated Phospholipase A(2) for Prediction of 30-day Major Adverse Coronary Event in Patients with the First Anterior ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Background: Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) has been suggested as an inflammatory marker of cardiovascular risk. The predictive value of Lp-PLA(2) in ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PCI) has not been established. The aim of this study was to determine whether plasma Lp-PLA(2) is a predictor of a major adverse cardiac event (MACE) in patients with the first anterior STEMI treated by primary PCI. Methods: This study consisted of 100 consecutive patients with first anterior STEMI who underwent primary PCI within 6 hours of the symptom onset. Plasma Lp-PLA(2) level was measured on admission using a turbidimetric immunoassay (diaDexus, Inc., USA). The Receiver Operating Characteristic analysis was performed to identify the most useful Lp-PLA(2) cut-off level for the prediction of MACE. The patients were divided into two groups according to the cut-off Lp-PLA(2) level: high Lp-PLA(2) group (>= 463 ng/mL, n = 33) and low Lp-PLA(2) group ( lt 463 ng/mL, n = 67). MACE was defined as cardiac death, non-fatal reinfarction, and target vessel revascularization. Results: Patients in the high Lp-PLA(2) group had significantly higher total-, LDL-cholesterol, apolipoprotein B levels, and significantly lower estimated glomerular filtration rates compared with the low Lp-PLA(2) group. The incidence of 30-day mortality was 18.2% (6/33) in high Lp-PLA(2) group, while in the low Lp-PLA(2) group no patient died (p lt 0.001). The 30-day MACE occurred in 24.2% of the high Lp-PLA(2) group and 3% of the low Lp-PLA(2) group (p = 0.001). Multiple logistic regression analysis identified the plasma Lp-PLA(2) level as an independent predictor of MACE (OR 1.011, 95%CI 1.001 - 1.013, p = 0.037). Conclusions: In patients with first anterior STEMI treated by primary PCI, the plasma Lp-PLA(2) level is an independent predictor of 30-day MACE. (Clin. Lab. 2012;58:1135-1144. DOI: 10.7754/Clin.Lab.2012.111102

The Usefulness of Myeloperoxidase in Prediction of In-Hospital Mortality in Patients with ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention

Background: The predictive value of myeloperoxidase (MPO) in ST-segment elevation myocardial infarction (STEM I) treated by primary percutaneous coronary intervention (PCI) has not been established. The aim of the present study was to investigate MPO as a predictor of in-hospital mortality in STEMI patients treated by primary PCI. Methods: Study population consisted of 189 STEMI patients having undergone primary PCI. Plasma MPO level was measured 24 hours after symptom onset using chemiluminescent microparticle immunoassay (Abbott Diagnostics, Germany). The Receiver Operating Characteristic analysis was performed to identify the most useful MPO cut-off level for the prediction of in-hospital mortality. The patients were divided into two groups according to the cut-off MPO level: high MPO group (>= 840 pmol/L, n = 65) and low M PO group ( lt 840 pmol/L, n = 124). Results: The high M PO group had significantly more frequent anterior wall infarctions (p lt 0.001) and Killip class >1 on admission (p=0.013) as well as lower left ventricular ejection fraction (LVEF) (p=0.011) and higher B-type natriuretic peptide (BNP) (p=0.029) than the low MPO group. The incidence of in-hospital mortality was 5.8% and was significantly higher in the high M PO group (13.8%) than in the low MPO group (1.6%) (p=0.001). Multiple logistic regression analysis identified the plasma MPO level as an independent predictor of in-hospital mortality (OR 3.88, 95%CI 1.13 - 13.34, p=0.031). Conclusions: Plasma M PO level independently predicts in-hospital mortality in STEMI patients treated by primary PCI. (Clin. Lab. 2012;58:125-131

Image1_Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection.jpeg

IntroductionDifferences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. Current knowledge on differences in left ventricular myocardial function and infarct size is limited. The aim of this study was to assess baseline clinical characteristics, imaging findings, and therapeutic approach and to compare differences in echocardiographic findings at baseline and 3-month follow-up in patients with SCAD-STEMI and type 1 STEMI.MethodsThis was a prospective multicenter study of 32 female patients (18–55 years of age) presenting with either SCAD-STEMI due to left anterior descending coronary artery (LAD) dissection or type 1 STEMI due to atherothrombotic LAD occlusion.ResultsThe two groups were similar in age, risk factors, comorbidities, and complications. SCAD-STEMI patients more often had Thrombolysis in Myocardial Infarction 3 flow, while type 1 STEMI patients were more often treated with percutaneous coronary intervention and dual antiplatelet therapy. Baseline mean left ventricular (LV) ejection fraction (LVEF) was similar in the two groups (48.0% vs. 48.6%, p = 0.881), but there was a significant difference at the 3-month follow-up, driven by an improvement in LVEF in SCAD-STEMI compared to type 1 STEMI patients (Δ LVEF 10.1 ± 5.3% vs. 1.8 ± 5.1%, p = 0.002). LV global longitudinal strain was slightly improved in both groups at follow-up; however, the improvement was not significantly different between groups (−4.6 ± 2.9% vs. −2.0 ± 2.8%, p = 0.055).ConclusionsThe results suggest that female patients with SCAD-STEMI are more likely to experience improvement in LV systolic function than type 1 STEMI patients.</p

Image3_Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection.jpeg

IntroductionDifferences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. Current knowledge on differences in left ventricular myocardial function and infarct size is limited. The aim of this study was to assess baseline clinical characteristics, imaging findings, and therapeutic approach and to compare differences in echocardiographic findings at baseline and 3-month follow-up in patients with SCAD-STEMI and type 1 STEMI.MethodsThis was a prospective multicenter study of 32 female patients (18–55 years of age) presenting with either SCAD-STEMI due to left anterior descending coronary artery (LAD) dissection or type 1 STEMI due to atherothrombotic LAD occlusion.ResultsThe two groups were similar in age, risk factors, comorbidities, and complications. SCAD-STEMI patients more often had Thrombolysis in Myocardial Infarction 3 flow, while type 1 STEMI patients were more often treated with percutaneous coronary intervention and dual antiplatelet therapy. Baseline mean left ventricular (LV) ejection fraction (LVEF) was similar in the two groups (48.0% vs. 48.6%, p = 0.881), but there was a significant difference at the 3-month follow-up, driven by an improvement in LVEF in SCAD-STEMI compared to type 1 STEMI patients (Δ LVEF 10.1 ± 5.3% vs. 1.8 ± 5.1%, p = 0.002). LV global longitudinal strain was slightly improved in both groups at follow-up; however, the improvement was not significantly different between groups (−4.6 ± 2.9% vs. −2.0 ± 2.8%, p = 0.055).ConclusionsThe results suggest that female patients with SCAD-STEMI are more likely to experience improvement in LV systolic function than type 1 STEMI patients.</p

Image2_Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection.jpeg

IntroductionDifferences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. Current knowledge on differences in left ventricular myocardial function and infarct size is limited. The aim of this study was to assess baseline clinical characteristics, imaging findings, and therapeutic approach and to compare differences in echocardiographic findings at baseline and 3-month follow-up in patients with SCAD-STEMI and type 1 STEMI.MethodsThis was a prospective multicenter study of 32 female patients (18–55 years of age) presenting with either SCAD-STEMI due to left anterior descending coronary artery (LAD) dissection or type 1 STEMI due to atherothrombotic LAD occlusion.ResultsThe two groups were similar in age, risk factors, comorbidities, and complications. SCAD-STEMI patients more often had Thrombolysis in Myocardial Infarction 3 flow, while type 1 STEMI patients were more often treated with percutaneous coronary intervention and dual antiplatelet therapy. Baseline mean left ventricular (LV) ejection fraction (LVEF) was similar in the two groups (48.0% vs. 48.6%, p = 0.881), but there was a significant difference at the 3-month follow-up, driven by an improvement in LVEF in SCAD-STEMI compared to type 1 STEMI patients (Δ LVEF 10.1 ± 5.3% vs. 1.8 ± 5.1%, p = 0.002). LV global longitudinal strain was slightly improved in both groups at follow-up; however, the improvement was not significantly different between groups (−4.6 ± 2.9% vs. −2.0 ± 2.8%, p = 0.055).ConclusionsThe results suggest that female patients with SCAD-STEMI are more likely to experience improvement in LV systolic function than type 1 STEMI patients.</p

Left atrial appendage closure with Watchman device in prevention of thromboembolic complications in patients with atrial fibrillation: First experience in Serbia

Introduction. Atrial fibrillation (AF) is the major cause ofstroke, particularly in older patients over 75 years of age. EuropeanSociety of Cardiology guidelines recommend chronic anticoagulationtherapy in patients with atrial fibrillation ifCHA2DS2-VASc score is ≥ 1 (CHA2DS2-VASc score for estimatingthe risk of stroke in patients with non-rheumatic AFconsisting of the first letters of patients condition: C – congestiveheart failure; H – hypertension; A2 – age ≥ 75 years; D –diabetes mellitus; S2 – prior stroke, transitory ischaemic attack(TIA) or thrombolism; V – vascular disease; A – age 65–74years; Sc – sex category). However, a significant number of patientshave a high bleeding risk, or are contraindicated forchronic oral anticoagulation, and present a group of patients inwhom alternative treatment options for thromboembolic preventionare required. Transcatheter percutaneous left atrial appendageclosure (LAAC) devices have been recommended inpatients with contraindications for chronic anticoagulanttherapy. Case report. We present our first three patients withnonvalvular AF and contraindications for chronic anticoagulanttherapy who were successfully treated with implantation ofLAAC Watchman device in Catheterization Laboratory of theClinic for Cardiology, Clinical Center of Serbia in BelgradeConclusion. Our initial results with Watchman LAAC deviceare promising and encouraging, providing real alternative in patientswith non-valvular AF and contraindication for chronicanticoagulant therapy and high bleeding risk

Decision-Making in Clinical Practice: Oral Anticoagulant Therapy in Patients with Non-valvular Atrial Fibrillation and a Single Additional Stroke Risk Factor

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