G. Nelson

Effect of prehospital triage on revascularization times, left ventricular function, and survival in patients with ST-elevation myocardial infarction.

Shorter reperfusion times lead to better outcomes in patients with ST-elevation myocardial infarction (STEMI). We assessed the efficacy of prehospital triage with bypass of community hospitals and early activation of the cardiac catheterization team on revascularization times, left ventricular (LV) ejection fraction, and survival. Patients with STEMI (624) were divided into 3 groups determined by site of triage: ambulance field triage (163), interventional center emergency department (202), and 3 community hospital emergency departments (259). Compared with community hospital and interventional center triages, ambulance field triage resulted in a significant median decrease in door-to-balloon times of 68 and 27 minutes, respectively (p <0.001). LV ejection fraction was highest in the field triage group (52 +/- 13%) compared with the interventional center (49 +/- 12%) and community hospital (48 +/- 12%, p = 0.017) groups. Thirty-day mortality was lowest in the ambulance field group (3%) compared with the interventional facility (11%) and community hospital (4%, p = 0.007) groups. There was a significant difference in long-term survival with up to 30-month follow-up among the 3 triage groups (p = 0.041). With time-dependent Cox regression modeling the difference in survival was significant only during the first week after STEMI (p = 0.020). Every extra minute of symptom onset to reperfusion time was associated with a relative risk of long-term mortality of 1.003 (95% confidence interval 1.000 to 1.006, p = 0.027). In conclusion, field triage of patient with STEMI decreased revascularization times, which preserved LV function, and improved early survival.

Why do acute myocardial infarction patients not call an ambulance? An interview with patients presenting to hospital with acute myocardial infarction symptoms

Abstract

Cocaine-induced epicardial coronary artery thrombosis resulting in extensive myocardial injury assessed by cardiac magnetic resonance imaging

Cocaine causes myocardial injury through multiple mechanisms including vasoconstriction, adrenergic hyper-stimulation, and de novo thrombus formation. This report presents two cases of cocaine-induced coronary artery thrombosis with no underlying stenosis, resulting in substantial myocardial injury.nnA previously well 32-year-old man presented with chest pain which commenced 24 h after intranasal cocaine use. He denied use …

Impact of Multivessel Coronary Artery Disease on Serum Biochemical Markers and Clinical Outcomes Following Acute Myocardial Infarction Treated with Percutaneous Coronary Intervention

no disease. Future studies will investigate the underlying mechanisms of cytokines in CAD. http://dx.doi.org/10.1016/j.hlc.2013.05.102

Myocardial injury following Primary Percutaneous Coronary Intervention (PCI) is comparable in patients with multi-vessel disease compared to single vessel disease

Background: “Ischaemic Preconditioning” is a well-documented mechanism, which protects viable myocardium that is repeatedly exposed to ischaemic episodes. Patients with multi-vessel disease (MVD) should have been exposed to a higher level of ischaemic burden than similar patients with single vessel disease (SVD). If these patients subsequently present with acute myocardial infarction (AMI), our hypothesis suggests that there should be a reduction in their amount of myocardial injury compared to patients with SVD. Methods: We examined all patients who presented to our institutionwith suspectedAMI to identify (a) presence of MVD or SVD (b) myocardial injury (CK). Results: Between May 2005 and February 2009, 1297 patients underwent coronary angiography for suspected AMI. Complete data was missing in 108 patients. 264 Patients were found to have normal or minor disease in their coronary arteries andwere excluded from this study. Of the remaining925patients, PrimaryPCIwasperformed <6h from symptom onset in 564 patients, 283(SVD) and 281(MVD). The mean CK values for each group were 2020U/L (SVD) and 1915U/L (MVD). Conclusions: Myocardial injury following primary PCI for AMI is similar in patients irrespective of number of concomitant vessels diseased. Based on this result, there is no evidence to support our hypothesis, however a larger study may be needed to fully address this question.