Humans ; Myocardial Infarction ; complications ; therapy ; Myocardial Reperfusion Injury ; etiology ; therapy

Acute myocardial infarction (AMI) in pregnant women is a rare but potentially lethal occurrence that should be carefully managed, especially in consideration of cardiac conditions being a rising cause of maternal deaths. Risk factors for AMI occurrence, in addition to typical cardiac-related risk factors, include medical conditions such as (pre) eclampsia, blood transfusions, thrombophilia and postpartum infections. Being older, multigravida or in the third trimester of pregnancy is also associated with an increased risk. The pathophysiological causes underlying AMI in pregnancy are diverse but generally associated with the coagulative and physiological changes related to the pregnancy. The selection of diagnostic modality and treatment options require careful consideration for pregnancy-related changes as well as risk of harm to the patient and fetus. This paper serves to review available literature regarding an extensive range of management issues that directly impact on maternal and fetal outcomes.
Adult ; Female ; Humans ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Pregnancy ; Pregnancy Complications, Cardiovascular ; physiopathology ; therapy ; Young Adult

Emergency Treatment ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; complications ; therapy ; Myocardial Infarction ; complications ; therapy ; Pancreatitis ; complications ; therapy ; Treatment Outcome

OBJECTIVETo investigate the clinical implications of reperfusion arrhythmias during primary percutaneous coronary intervention (PCI) for patients with acute myocardial infarction (AMI).

METHODSData from 228 AMI patients in whom the infarct-related artery (IRA) were successfully recanalized by primary PCI were retrospectively analyzed. The 228 patients were divided into 2 groups: myocardial ischemia-reperfusion injury (MIRI) group (n=119) in whom MIRI events occurred within minutes after successful recanalization of IRA, and non-MIRI group (n=109). The 119 patients in MIRI group were further divided into 3 subgroups: severe bradycardia with hypotension (brady-arrhythmia subgroup), lethal ventricular arrhythmias requiring electrical cardioversion (tachy-arrhythmia subgroup), and IRA antegrade flow less than or equal to TIMI 2 grade without angiographic evidence of abrupt closure (no-reflow subgroup).

RESULTS(1) Clinical and angiographic data: Compared with non-MIRI group, MIRI group was characterized by more inferior infarct location, shorter ischemic duration, more frequently right coronary artery as IRA, more diseased vessels, more often TIMI 0 grade of initial antegrade flow in IRA, less pre-infarction angina, more renal insufficiency, and higher in-hospital mortality (13.4% vs. 4.6%, P=0.021). (2) The peak CK level was remarkably lower in brady-arrhythmia subgroup than that in non-MIRI group (2010 IU/L vs. 2521 IU/L, P=0.039). The peak CK or CK-MB level was notably higher in no-reflow subgroup than in non-MIRI group (4573 IU/L, 338 IU/L, respectively, P=0.000). (3) Left ventricular ejection fraction in no-reflow subgroup was significantly lower than in non-MIRI group (38.7% +/- 8.3% vs. 51.2% +/- 8.1%, P=0.000), left ventricular end-diastolic volume in no-reflow subgroup was greater than that in tachy-arrhythmia subgroup [(135 +/- 32) ml vs. (105 +/- 19) ml, P=0.029].

CONCLUSIONReperfusion arrhythmias may imply the existence of much survived myocardium and do not enhance myocardial damage, while no-reflow increases myocardial injury and induces permanent impairment of cardiac function.

Arrhythmias, Cardiac ; complications ; Cell Survival ; Humans ; Myocardial Infarction ; therapy ; Myocardial Reperfusion ; Myocardial Reperfusion Injury ; etiology ; Myocardium ; enzymology ; Retrospective Studies

BACKGROUND: Preliminary studies have indicated that Shexiang Baoxin Pill (MUSKARDIA) has a coronary artery dilation effect and increases the coronary blood flow, relieving the symptoms of angina. This study aimed to evaluate the benefit of MUSKARDIA on patients with stable coronary artery disease (CAD) and diabetes mellitus (DM). METHODS: This was a subgroup analysis of a multicenter, randomized, placebo-controlled phase IV trial. CAD patients with a medical history of DM or baseline fasting blood glucose (FBG) ≥7.0 mmol/L were grouped according to the treatment (standard therapy plus MUSKARDIA or placebo). The primary outcome was major adverse cardiovascular events (MACEs), which was the composite outcome of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. The secondary outcome was the composite outcome of all-cause death, non-fatal myocardial infarction, non-fatal stroke, hospitalization for unstable angina or heart failure, and coronary angioplasty. RESULTS: MACEs occurred in 2.6% (9/340) and 4.8% (18/376) of patients in the MUSKARDIA and placebo groups, respectively ( P  = 0.192). Secondary composite outcome was significantly less frequent with MUSKARDIA than with placebo (15.3% [52/340] vs . 22.6% [85/376], P  = 0.017). Risk of MACEs (hazard ratio [HR] = 0.69, 95% confidence interval [CI]: 0.31-1.57) was comparable between two groups. In patients with uncontrolled DM (≥4 measurements of FBG ≥7 mmol/L in five times of follow-up), the risk of secondary outcome was significantly lower with MUSKARDIA (5/83, 6.0%) than with placebo (15/91, 16.5%) (HR = 0.35, 95%CI: 0.13-0.95). CONCLUSION: As an add-on to standard therapy, MUSKARDIA shows a trend of reduced MACEs in patients with stable CAD and DM. Furthermore, MUSKARDIA may reduce the frequency of all-cause death, hospitalization, and coronary angioplasty in this population, especially in those with uncontrolled DM. TRIAL REGISTRATION ChiCTR.org.cn, ChiCTR-TRC-12003513.
Humans ; Coronary Artery Disease/complications* ; Diabetes Mellitus, Type 2/drug therapy* ; Myocardial Infarction/complications* ; Stroke/epidemiology*

OBJECTIVESTo investigated the prognosis of primary percutaneous coronary intervention (PCI) in acute myocardial infarction patients with or without diabetes mellitus (DM) in terms of myocardial blush grade (MBG) and ST-segment elevation resolution (STR).

METHODSMBG and STR were measured in AMI patients with (n = 95) and without (n = 192) diabetes mellitus after successful primary PCI.

RESULTSPost-procedural TIMI grade 3 flow (>95%) were similar between two groups. Compared to non-DM patients, DM patients were more likely to have absent myocardial perfusion (MBG 0/1, 56.0% vs. 41.1%, P = 0.019) and absent STR (43.2% vs. 30.7%, P = 0.038). MACE rate was also higher in DM patients than that in non-DM patients during follow-up (27.4% vs. 16.1%, P = 0.025). Multivariate analysis showed DM was an independently factor related to the risk of poor prognosis (RR 1.83, 95% CI 1.04 - 3.36], P = 0.01).

CONCLUSIONDespite similar TIMI-3 flow after primary PCI, DM patients are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG and poor prognosis compared to non-DM patients. Poor prognosis in DM patients with AMI post PCI might be related to more disturbed micro-vascular perfusion.

Aged ; Angioplasty, Balloon, Coronary ; Diabetes Complications ; Female ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; complications ; physiopathology ; therapy ; Myocardial Reperfusion ; Prognosis

Aged ; Angioplasty, Balloon, Coronary ; Anterior Wall Myocardial Infarction ; complications ; therapy ; Dextrocardia ; complications ; Female ; Humans ; Situs Inversus ; complications ; Stents

OBJECTIVETo study the effect of continuous hemofiltration (CH) on the prognosis of multiple organ dysfunction syndrome (MODS) after acute myocardial infarction (AMI) in elderly patients.

METHODSThirty-four elderly patients with MODS after AMI admitted to intensive care unit (ICU) were grouped into continuous hemofiltration (CH) group and non-CH (NCH) group. The Acute Physiology and Chronic Health Evaluation (APACHEII) scores and Marshall scores were assessed upon admission in ICU and 7 days after the admission. The mortality rates of the patients within 28 and 90 days after admission to ICU were calculated, and the changes in APACHEII scores and Marshall scores were compared between the two groups.

RESULTSThe APACHEII scores and Marshall scores showed no significant difference between the two upon admission to the ICU, but significantly decreased in CH group 7 days after the admission (P<0.05 and P<0.01 respectively). The APACHEII scores increased significantly in NCH group (P<0.01) 7 days after the admission while the Marshall scores remained unchanged (P>0.05). The overall mortality rates at 28 and 90 days were 41.18% and 61.76%, respectively. A significant difference was noted in the mortality rate at 28 days between the two groups (P<0.05), but not in the rate at 90 days (P>0.05).

CONCLUSIONCH can improve the organic functions and the short-term outcome of elderly patients with MODS after AMI, but has no positive effect on their long-term outcomes.

Aged ; Aged, 80 and over ; Female ; Hemofiltration ; Humans ; Male ; Multiple Organ Failure ; complications ; therapy ; Myocardial Infarction ; complications ; therapy ; Prognosis

No abstract available.
*Drug-Eluting Stents ; Female ; Humans ; Male ; Myocardial Infarction/*etiology/*therapy ; Renal Insufficiency, Chronic/*complications

Accreditation ; Chest Pain ; etiology ; China ; Humans ; Myocardial Infarction ; complications ; therapy ; Pain Clinics