Update on ACC/ESC criteria for acute ST-elevation myocardial infarction

Disruption of vulnerable or high-risk plaques is the common pathophysiological mechanism of acute coronary syndromes with or without ST elevation. The reflection of the same pathophysiological mechanism differs in non-ST-elevation acute coronary syndromes and ST-elevation myocardial infarction (STEMI) in terms of clinical presentation, prognosis and therapeutic approach. Diagnostic and therapeutic evolution had come along together from the beginning of the acute myocardial infarction (MI) concept. Pathological appearance of acute MI is classified as acute, healing and healed phases as a time related phenomenon. Clinical presentation of STEMI, is different than the other ischaemic cardiac events with the sudden onset, the duration and the severity of chest pain or discomfort. Although the old markers creatine kinase and the MB fraction, lactate dehydrogenase are also used for the diagnosis of acute MI, cardiac troponins are very sensitive and specific, and myoglobin is an early marker for acute MI. In electrocardiogram; new or presumed new ST segment elevation at the J point in two or more contiguous leads or Q wave in established MI are typical changes. Echocardiographic or nuclear techniques have been used widely to rule out or confirm STEMI. In conclusion; all clinical, pathological, biochemical, electrocardiographic analysis methods and new imaging techniques have their own unique contribution for evaluating STEMI

Update on ACC/ESC criteria for acute ST-elevation myocardial infarction

34th International Congress on Electrocardiology/48th International Symposium on Vectorcardiography -- JUN 27-30, 2007 -- Istanbul, TURKEYWOS: 000254244300005PubMed ID: 17584670Disruption of vulnerable or high-risk plaques is the common pathophysiological mechanism of acute coronary syndromes with or without ST elevation. The reflection of the same pathophysiological mechanism differs in non-ST-elevation acute coronary syndromes and ST-elevation myocardial infarction (STEMI) in terms of clinical presentation, prognosis and therapeutic approach. Diagnostic and therapeutic evolution had come along together from the beginning of the acute myocardial infarction (MI) concept. Pathological appearance of acute MI is classified as acute, healing and healed phases as a time related phenomenon. Clinical presentation of STEMI, is different than the other ischaemic cardiac events with the sudden onset, the duration and the severity of chest pain or discomfort. Although the old markers creatine kinase and the MB fraction, lactate dehydrogenase are also used for the diagnosis of acute MI, cardiac troponins are very sensitive and specific, and myoglobin is an early marker for acute MI. In electrocardiogram; new or presumed new ST segment elevation at the J point in two or more contiguous leads or Q wave in established MI are typical changes. Echocardiographic or nuclear techniques have been used widely to rule out or confirm STEMI. In conclusion; all clinical, pathological, biochemical, electrocardiographic analysis methods and new imaging techniques have their own unique contribution for evaluating STEMI

The Highway Technique: a new stenting technique to treat coronary bifurcation lesions

WOS: 000294133900012PubMed ID: 20142197Aims: We report a new stenting technique which was employed in 12 patients to treat coronary bifurcation lesions. Methods and results: A stent is positioned in the main vessel together with a balloon in the side branch, which is positioned slightly proximal to the main vessel stent that also has enough length to cover the side branch ostium. Both the stent in the main vessel and the balloon in the side branch are inflated simultaneously. Following deflation, a double lumen is created in the main vessel, proximal to the bifurcation. The stent balloon is removed with the side branch balloon left deflated in its initial position. The main vessel is rewired with a third guidewire. The side branch balloon and guidewire are removed. The initial guidewire in the main vessel is directed to the side branch. A balloon is advanced and inflated in the side branch to dilate the struts of the main vessel stent that will provide the side branch entrance. The side branch balloon is left in place. A size matched balloon is advanced on the third guidewire that was advanced in the main vessel and inflated inside the stent with high pressure. Finally, kissing balloon inflation is performed at the bifurcation. Provisional stenting of the side branch can be performed when necessary. Final kissing balloon inflation is recommended after stenting of the side branch. Conclusions: As a new coronary bifurcation stenting method, the Highway Technique has some advantages in side branch protection, with favourable immediate and 30-day clinical outcomes

The interaction between endothelin-1 and C-reactive protein and their impact on long-term prognosis after percutaneous coronary interventions

WOS: 000267405600008Introduction: Previous studies have demonstrated unfavourable outcomes in coronary artery disease and percutaneous coronary intervention (PCI) patients with high endothelin-1 (ET-1) or high sensitivity C-reactive protein (hs-CRP) levels. The aim of our study was to investigate the impact of pre-procedural ET-1 and hs-CRP levels on major adverse coronary events (MACE) after PCI and to analyse a possible correlation between ET-1 and hs-CRP in this study population. Material and methods: Eighty consecutive PCI patients with a single de novo, non-occlusive coronary lesion were included. Blood samples were obtained immediately before the procedure. The study endpoint was the occurrence of MACE, which was defined as death (all causes), non-fatal myocardial infarction or repeat coronary revascularization (PCI or surgery). Results: At the end of the 24 months' follow-up, 28 patients (35%) reached an end-point. We could not observe any correlation between ET-1 and hs-CRP in the overall patient group (r = 0.141, p = 0.213). Neither ET-1 nor hs-CRP levels were found to be predictive for MACE after PCI in multivariate analyses (p = 0.605 and 0.757 respectively). Conclusions: We could not demonstrate a relationship between pre-procedural ET-1 or hs-CRP levels and MACE at 24 months after successful PCI with single stent implantation to single de novo lesions. This study also could not show any correlation between ET-1 and hs-CRP levels in PCI patients

The relationship of microalbuminuria with left ventricular functions and silent myocardial ischemia in asymptomatic patients with type 2 diabetes

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Son yıllarda, ilerleyici böbrek yetersizliğinin bir belirteci olan mikroalbüminürinin (MA) özellikle diyabetik hastalarda kardiyovasküler hastalıkla da ilişkili olduğu gözlenmiştir. Bu çalışmada, tip 2 diyabetli asemptomatik hastalarda MA ile sol ventrikül fonksiyonları ve efor testinde saptanan sessiz miyokart iskemisi arasındaki ilişki araştırıldı. Çalışma planı: Çalışmaya, kardiyak açıdan yakınmasız, tip 2 diyabet tanısı konan 50 hasta (36 kadın, 14 erkek; ort. yaş 63±7) alındı. Her hastaya transtorasik ekokardiyografik değerlendirmeyi takiben biyokimyasal değerlendirme ve egzersiz testi yapıldı. Her hastada iki ayrı günde 24 saatlik idrarda MA düzeyi ölçüldü. Hastalar MA miktarının 30 mg’nin üzerinde ve altında olmasına göre sırasıyla MA(+) ve MA(–) olarak gruplandırıldı.Objectives: Recently, microalbuminuria (MA), a marker of advanced renal failure, has been shown to be related with cardiovascular disease especially in diabetic patients. This study was designed to investigate the relationship between MA and left ventricular functions and silent myocardial ischemia documented by exercise test in patients with type 2 diabetes mellitus. Study design: The study included 50 asymptomatic patients (36 women, 14 men; mean age 63±7 years) with type 2 diabetes. All the patients underwent treadmill test and biochemical tests following transthoracic echocardiography. Microalbuminuria was diagnosed from a 24-hour urine sample on two different days and the patients were evaluated in two groups based on the presence (≥30 mg/dl) or absence (<30 mg/dl) of MA

The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Atriyal fibrilasyon (AF); açık kalp cerrahisi sonrasında en sık görülen komplikasyonlardan biridir. Açık kalp cerrahisini takiben sinüs ritmini sağlamak için kullanılan değişik antiaritmik ilaçların etkisinin karşılaştırılması ile ilgili yeterli veri yoktur. Biz çalışmamızda; farklı sınıflarda yer alan çeşitli antiaritmik ilaçların, operasyon öncesi başlanmasının, postoperatif AF sıklığına, hastanede yatış zamanına, gelişebilecek komplikasyonlara etkisini karşılaştırmayı planladık. Yöntemler: Bu ileriye dönük tek-kör çalışmaya açık kalp cerrahisi planlanan 180 hasta (130 erkek, 50 kadın, ortalama yaş: 58.13±11.7) alındı. Hastalar beş gruba ayrıldı. İlaçlar operasyondan 7 gün önce başlandı. Birinci gruba (G1) propafenon 300mg /gün, ikinci gruba (G2) sotalol 80mg /gün, üçüncü gruba (G3) amiodaron 400mg/gün, dördüncü gruba (G4) diltiazem 180mg /gün; oral olarak verildi. Beşinci gruba (G5) antiaritmik ilaç verilmedi. Operasyon sonrası tüm gruplarda tedaviye yatış süresince devam edildi. İstatistiksel analiz Ki-kare ve tek yönlü ANOVA testleri ile yapıldı.Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent’s usage to maintain sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13±11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 (G4) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests

The comparison between the efficiency of different anti-arrhythmic agents in preventing postoperative atrial fibrillation after open heart surgery

WOS: 000256807300006PubMed ID: 18524727Objective: Atrial fibrillation (AF) is one of the most frequent complications that may occur after open-heart surgery. Clinical reports regarding comparison of different anti-arrhythmic agent's usage to maintain,sinus rhythm after open-heart surgery are not conclusive. We examined the effects of different anti-arrhythmic agents administration before operation on postoperative AF incidence, duration of hospitalization and complications. Methods: Overall, 180 patients (130 men and 50 women, mean age 58.13 +/- 11.71 years) who were candidates for open-heart surgery, were included in this prospective, single-blind study. All patients divided into five different groups. All anti-arrhythmic drugs were administered approximately 7 days before the operation. Propafenone was given to Group 1 (G1); sotalol to Group 2 (G2); amiodarone to Group 3 (G3) and diltiazem to Group 4 IN) at doses of 300 mg/day, 80 mg/day, 400 mg/day and 180 mg/day orally respectively. The fifth group (G5) did not receive any of anti-arrhythmic drugs. The medication was continued for ten days postoperatively. Statistical analysis was performed using Chi-Square and one-way ANOVA tests. Results: Atrial fibrillation developed during postoperative period in 18.1% patients in G1, 9.1% patients in G2, 16.2% patients in G3, 28.6% patients in G4 and 38.1 % patients in G5. The prevalence of postoperative AF was significantly higher in G5 as compared with other groups (p=0.026). There were significant differences across groups in duration of hospitalization (p=0.033), with shortest mean duration of hospitalization in G2 (8.9 +/- 2.7 days). Conclusion: Any anti-arrhythmic agent started 7 days before the operation and continued for 10 days, may reduce the prevalence of postoperative AF, morbidity and duration of hospitalization. However, we found that sotalol and amiodarone were more effective than other anti-arrhythmic agents in our patient population

Multiple coronary thrombi with cisplatin

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Testicular cancer is the most common malignancy in young men (15-29 years old). Combination therapy with bleomycin, etoposide, and cisplatin has been the standard first-line treatment for testicular metastatic disease. We present a case of multicoronary thrombi causing acute inferior myocardial infarction in a patient who recently received chemotherapy for testicular tumor

Evaluation of left ventricular regional systolic functions in patients with coronary artery disease by two-dimensional strain imaging: a velocity vector imaging study

İstanbul Bilim Üniversitesi, Tıp Fakültesi.Amaç: Bu çalışmada, koroner arter hastalığında (KAH) sol ventrikül (SV) bölgesel sistolik fonksiyonları yeni bir gerilim (strain) görüntüleme yöntemi olan hız vektör görüntüleme (HVG) ile değerlendirildi. Çalışma planı: Çalışmaya KAH tanısı konan 69 hasta (51 erkek, 18 kadın; ort. yaş 59.2±10.3) ve 30 sağlıklı gönüllü (22 erkek, 8 kadın; ort. yaş 58.1±13.8) alındı. Hastaların 33’ünde geçirilmiş miyokart enfarktüsü (ME) vardı. Tüm hastalarda, Amerikan Kalp Birliği’nin 16 segment modeli kullanılarak SV bölgesel duvar hareketleri (akinetik, hipokinetik ve normokinetik) belirlendi. Ayrıca, HVG yöntemi kullanılarak, SV’ye ait tüm segmentlerin zirve sistolik gerilimi (strain), gerilim hızı (SRs) ve segmenterejeksiyon fraksiyonları (SEF) hesaplandı.Objectives: The aim of the study was to assess left ventricular (LV) regional systolic functions in coronary artery disease (CAD) using a novel strain imaging method, namely, velocity vector imaging (VVI). Study design: The study included 69 patients (51 men, 18 women; mean age 52.9±10.3 years) with CAD and 30 healthy volunteers (22 men, 8 women; mean age 58.1±13.8 years). Thirty-three patients had previous myocardial infarction (MI). In all the patients, LV wall motions were analyzed as akinetic, hypokinetic, or normokinetic using the 16-segment model of the American Heart Association. In addition, LV peak systolic strain, strain rate (SRs), and segmental ejection fraction (SEF) of all the segments were calculated by using VVI