RESUMO
To determine the serum levels of troponin-l in identifying left ventricular ejection fraction [LVEF] of = 40% in patients with first anterior ST Elevation Myocardial Infarction [STEMI]. Case series. At the Tabba Heart Institute, Karachi, from May to November 2008. Consecutive patients presenting with first anterior STEMI were studied. Troponin-l concentration was measured by MEIA [microparticle enzyme immunoassay] method and LVEF was visually assessed. Analysis of relation between troponin-l levels and LVEF by the Receiver-Operator Characteristic [ROC] curve was performed to determine the cut off values of troponin-l in identifying LVEF of <40% in patients, who had received streptokinase or undergone primary Percutaneous Coronary Intervention [PCI]. Out of the 90 patients studied, 50 patients received streptokinase and the remaining 40 patients underwent primary PCI. Mean age was 54.6 +/- 9 years and 82% were male. Troponin-l levels of > 63.5 ng/ml predicted LVEF of <40% with a sensitivity of 94% and specificity of 97% in patients receiving streptokinase, whereas in patients undergoing primary PCI, troponin-l levels of > 87.5 ng/ml predicted LVEF < /=40% with a sensitivity of 86% and specificity of 100%. Troponin-l concentration of > 63.5 ng/ml and > 87.5 ng/ml can predict LVEF = 40% in patients treated with either streptokinase or primary PCI respectively for first anterior STEMI. Troponin-l can be used as a non-imaging tool to identify patients with LVEF = 40% who need early aggressive therapy
Assuntos
Humanos , Masculino , Feminino , Troponina , Volume Sistólico , Infarto do Miocárdio , Eletrocardiografia , EstreptoquinaseRESUMO
We are reporting the case of a 48-year-old man hypertensive, and smoker presenting with acute inferoposterior ST elevation myocardial infarction [STEMI] with right ventricular infarction. He underwent diagnostic angiogram which revealed total occlusion of mid right coronary artery [RCA] by thrombus. Multiple runs of aspiration were performed using Export Aspiration Catheter-6F and thrombus was aspirated from RCA. Postaspiration stenting was deferred due to absence of any significant obstructive lesion. Some thrombus had migrated to distal right posteriolateral branch [RPLB]. He was started on glycoprotein [GP] IIb IIIa inhibitors which had to stopped after a few hours due to upper gastrointestinal bleed. After 48 hours a re-look angiogram demonstrated good flow in RCA with resolution of the residual thrombus