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1.
J Investig Med ; 70(4): 892-898, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1784873

ABSTRACT

The aim of the study was to evaluate the diagnostic significance of ST-segment re-elevation episodes registered with telemetric ECG monitoring in patients with ST-segment elevation myocardial infarction (STEMI) treated with thrombolytic therapy (TLT). The study included 117 patients with STEMI following effective TLT. The elective coronary angiography followed by percutaneous coronary interventions was performed in the interval from 3 to 24 hours after a successful systemic TLT. Before and after cardiac catheterization, the telemetric ECG monitoring was performed using AstroCard Telemetry system (Meditec, Russia). During the study, two groups of patients were formed. Group 1 included 85 patients (72.6%) without new ST-segment deviations on telemetry. 77 patients (90.6%) had no recurrent coronary artery thrombosis at angiography. Eight patients (9.4%) from group 1 were diagnosed with thrombosis of the infarct-related coronary artery. Group 2 included 32 patients (27.4%) who underwent TLT and then had ST-segment re-elevation episodes of 1 mV or more in the infarct-related leads, lasting for at least 1 minute. In group 2, in 27 of 32 patients (84.4%), thrombosis of the infarct-related coronary artery was confirmed (p<0.01 compared with group 1). In 71.9% cases, the recurrent ischemic episodes were asymptomatic ('painless myocardial ischemia') (p<0.01). Thus, in patients with STEMI and successful TLT, re-elevation of ST-segment during remote ECG monitoring is strongly related to angiographically documented coronary artery thrombotic reocclusion. The absence of chest pain during recurrent myocardial ischemia requires continuous ECG telemetry to select patients for the rescue percutaneous coronary interventions at an earlier stage.


Subject(s)
Coronary Artery Disease , Myocardial Infarction , Myocardial Ischemia , ST Elevation Myocardial Infarction , Coronary Angiography , Coronary Artery Disease/etiology , Electrocardiography , Fibrinolytic Agents/therapeutic use , Humans , Myocardial Ischemia/diagnosis , Myocardial Ischemia/drug therapy , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/drug therapy , Thrombolytic Therapy/adverse effects
2.
Am Heart J ; 247: 33-41, 2022 May.
Article in English | MEDLINE | ID: covidwho-1652480

ABSTRACT

BACKGROUND: Activation of inflammatory pathways during acute myocardial infarction contributes to infarct size and left ventricular (LV) remodeling. The present prospective randomized clinical trial was designed to test the efficacy and safety of broad-spectrum anti-inflammatory therapy with a mammalian target of rapamycin (mTOR) inhibitor to reduce infarct size. DESIGN: Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS, clinicaltrials.gov NCT01529554) is a phase II randomized, double-blind, multi-center, placebo-controlled trial on the effects of a 5-day course of oral everolimus on infarct size, LV remodeling, and inflammation in patients with acute ST-elevation myocardial infarction (STEMI). Within 5 days of successful primary percutaneous coronary intervention (pPCI), patients are randomly assigned to everolimus (first 3 days: 7.5 mg every day; days 4 and 5: 5.0 mg every day) or placebo, respectively. The primary efficacy outcome is the change from baseline (defined as 12 hours to 5 days after pPCI) to 30-day follow-up in myocardial infarct size as measured by cardiac magnetic resonance imaging (CMRI). Secondary endpoints comprise corresponding changes in cardiac and inflammatory biomarkers as well as microvascular obstruction and LV volumes assessed by CMRI. Clinical events, laboratory parameters, and blood cell counts are reported as safety endpoints at 30 days. CONCLUSION: The CLEVER-ACS trial tests the hypothesis whether mTOR inhibition using everolimus at the time of an acute STEMI affects LV infarct size following successful pPCI.


Subject(s)
Acute Coronary Syndrome , Anterior Wall Myocardial Infarction , Myocardial Infarction , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Acute Coronary Syndrome/drug therapy , Arrhythmias, Cardiac , Double-Blind Method , Everolimus/therapeutic use , Humans , Magnetic Resonance Imaging , Myocardial Infarction/drug therapy , Prospective Studies , ST Elevation Myocardial Infarction/drug therapy , TOR Serine-Threonine Kinases/therapeutic use , Treatment Outcome , Ventricular Remodeling
3.
Curr Cardiol Rep ; 23(10): 152, 2021 09 28.
Article in English | MEDLINE | ID: covidwho-1442178

ABSTRACT

PURPOSE OF REVIEW: The purpose of this review is to offer a discussion on the existing data for the use of thrombolytic therapy for the treatment of ST-elevation myocardial infarction (STEMI) as well to present an evidence-based approach regarding the treatment for STEMI patients presenting to non-percutaneous coronary intervention (PCI)-capable hospitals during the ongoing COVID-19 pandemic. RECENT FINDINGS: There have been tremendous advances in the care of STEMI patients over the past two decades with primary (PCI) being the standard of care. However, many hospitals do not have interventional cardiology services available, and either have to expeditiously transfer patients for primary PCI, or use the strategy of fibrinolysis therapy with facilitated or rescue PCI. The current COVID-19 crisis has created an unprecedented paradigm shift with regard to the decision-making algorithm for STEMI patients especially in non-PCI-capable hospitals. Depending on regional transfer systems and potential delay in primary PCI, a strategy of thrombolysis first could be entertained at certain regional systems of care. The COVID-19 pandemic has caused a dramatic decline in the number of patient seeking care for myocardial infarction as well as a reduction in the accessibility of cardiac catheterization services. Regardless, professional societies continue to recommend PCI as the primary means of treatment for STEMI through the COVID-19 pandemic, and early multicenter data suggests the benefit of this therapy remains. Future research will be necessary and holds the key to proving this benefit persists beyond the immediate hospitalization time period both in the current era and in the context of possible future pandemics.


Subject(s)
COVID-19 , Percutaneous Coronary Intervention , ST Elevation Myocardial Infarction , Humans , Multicenter Studies as Topic , Pandemics , SARS-CoV-2 , ST Elevation Myocardial Infarction/drug therapy , Thrombolytic Therapy , Treatment Outcome
6.
J Investig Med High Impact Case Rep ; 8: 2324709620963567, 2020.
Article in English | MEDLINE | ID: covidwho-1223701

ABSTRACT

The incidence of mechanical valve thrombosis (MVT) is around 0.4 per 100 patient-years. Mitral valve thrombosis has a higher incidence than aortic valve thrombosis with a nearly 5-fold increase. Various factors contribute to MVT. The most common cause of valve thrombosis is poor adherence/disruption of anticoagulation therapy. Low cardiac output is known to increase the risk of prosthetic valve thrombosis. Other factors such as diabetes, hypertension, and other patient comorbidities might also play a role. Decreased flow promotes hypercoagulability. Lower pressure in the left atrium (and higher velocities in the left ventricle) can partially contribute to the higher incidence of mitral MVT versus aortic MVT. The presenting symptoms usually depend on the severity of the valve thrombosis; nonobstructive valve thrombosis patients have progressive dyspnea, signs of heart failure, and systemic embolization with strokes being the most common complication. In this article, we present a case of a middle-aged woman with a history of mitral and aortic mechanical prosthesis who presented with an ST-segment elevation myocardial infarction and pulmonary edema due to mechanical aortic valve prosthesis thrombosis. She had an isolated mechanical aortic valve prosthesis thrombosis with intact mitral valve, which, to the best of our knowledge, has not yet been described. We performed a literature review by searching PubMed and Embase using the keywords "mechanical valve," "thrombosis," "aortic," and "mitral," our search did not show similar cases.


Subject(s)
Aortic Valve , Heart Valve Prosthesis/adverse effects , Mitral Valve , ST Elevation Myocardial Infarction/etiology , Thrombosis/drug therapy , Cardiac Output, Low , Coronary Angiography , Echocardiography , Female , Fibrinolytic Agents/therapeutic use , Humans , Middle Aged , Platelet Aggregation Inhibitors/therapeutic use , Pulmonary Edema/diagnosis , Pulmonary Edema/drug therapy , ST Elevation Myocardial Infarction/drug therapy , Thrombosis/diagnosis
7.
BMJ Case Rep ; 14(1)2021 Jan 25.
Article in English | MEDLINE | ID: covidwho-1048665

ABSTRACT

Primary percutaneous coronary intervention is the recommended modality of treatment for acute ST-elevation myocardial infarction (STEMI). However, different countries now have different consensus about treatment of patients with STEMI during the COVID-19 pandemic. In this report, we describe a case of SARS-CoV-2-positive patient admitted with pneumonia. During hospital stay in COVID-19 designated special care, the patient developed inferoposterior wall myocardial infarction (MI) without haemodynamic instability and was treated successfully with thrombolytics (streptokinase) without any severe complications. To decrease the risk of in-hospital exposure to COVID-19 infection among the staff, in circumstances where there is no negative-pressure catheterisation laboratory and there is shortage in medical staff, thrombolytics can be used as a modality of treatment in low-risk, haemodynamically stable MI during this pandemic, as recommended by different cardiac societies. However, this needs further studies in order to reach local and international consensus.


Subject(s)
COVID-19/complications , Fibrinolytic Agents/therapeutic use , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/etiology , Streptokinase/therapeutic use , Aged , Female , Humans
9.
J Med Case Rep ; 14(1): 246, 2020 Dec 18.
Article in English | MEDLINE | ID: covidwho-992552

ABSTRACT

BACKGROUND: In December 2019, a new coronavirus (named severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) spread from China, causing a pandemic in a very short time. The main clinical presentation of SARS-CoV-2 infection (COVID-19, coronavirus disease-2019) is pneumonia, but several cardiovascular complications may also occur (e.g., acute coronary syndromes, pulmonary embolism, stroke, arrhythmias, heart failure and cardiogenic shock). Direct or indirect mechanisms induced by SARS-CoV-2 could be implicated in the pathogenesis of these events. CASE PRESENTATION: We report herein the third case of COVID-19 autoimmune haemolytic anaemia (AIHA) reported so far, which occurredwithout any other possible explanations in a Caucasian patient. The patient also suffered from ST-elevation myocardial injury. CONCLUSIONS: Both complications occurred quite late after COVID-19 diagnosis and were probably precipitated by systemic inflammation, as indicated by a significant delayed increase in inflammatory markers, including interleukin-6 (IL-6).


Subject(s)
Anemia, Hemolytic, Autoimmune/blood , Asymptomatic Infections , C-Reactive Protein/immunology , COVID-19/blood , Interleukin-6/immunology , ST Elevation Myocardial Infarction/diagnosis , Aged, 80 and over , Anemia, Hemolytic, Autoimmune/drug therapy , Anemia, Hemolytic, Autoimmune/etiology , Anti-Bacterial Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/complications , COVID-19/drug therapy , COVID-19/immunology , Coombs Test , Electrocardiography , Enzyme Inhibitors/therapeutic use , Female , Glucocorticoids/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Prednisolone/therapeutic use , SARS-CoV-2 , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/etiology
10.
J Int Med Res ; 48(10): 300060520966151, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-894958

ABSTRACT

OBJECTIVE: No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era. METHODS: Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period. RESULTS: In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic. CONCLUSION: Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.


Subject(s)
Coronavirus Infections/epidemiology , Fibrinolytic Agents/therapeutic use , Pandemics , Pneumonia, Viral/epidemiology , ST Elevation Myocardial Infarction/drug therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Aged , Aspirin/therapeutic use , COVID-19 , Clopidogrel/therapeutic use , Female , Fibrinolysis , Heparin/therapeutic use , Humans , Male , Middle Aged , Myocardial Reperfusion/methods , Percutaneous Coronary Intervention/methods , Recombinant Proteins/therapeutic use , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/physiopathology , ST Elevation Myocardial Infarction/surgery , Stents , Survival Analysis , Treatment Outcome
11.
Clin Med (Lond) ; 20(4): 437-439, 2020 07.
Article in English | MEDLINE | ID: covidwho-874911

ABSTRACT

We describe a case of an 82-year-old man who developed an anterior ST-elevation myocardial infarction (STEMI) and left ventricular thrombus while an inpatient following a diagnosis of severe COVID-19 infection (SARS-CoV-2). His D-dimer was significantly elevated at 12,525 ng/mL (normal range <243). He unfortunately died despite management with thrombolysis, warfarin and non-invasive ventilation. This case provides an example of a likely arterial thrombotic complication of severe COVID-19 infection. Clinicians should be aware of this possibility in such patients, with a severely prothrombotic state as a possible underlying aetiology. Further research is required to establish any causative link, pathophysiological mechanisms and whether modification to existing venous thromboembolism prophylaxis strategies may also reduce arterial thrombotic complications of severe COVID-19 infection.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , ST Elevation Myocardial Infarction/virology , Thrombosis/virology , Aged, 80 and over , COVID-19 , Continuous Positive Airway Pressure , Coronavirus Infections/therapy , Fatal Outcome , Fibrinolytic Agents/therapeutic use , Humans , Male , Noninvasive Ventilation , Pandemics , Pneumonia, Viral/therapy , ST Elevation Myocardial Infarction/drug therapy , Thrombosis/drug therapy
13.
Med Sci Monit ; 26: e927061, 2020 Sep 17.
Article in English | MEDLINE | ID: covidwho-771194

ABSTRACT

BACKGROUND The efficacy of telemedicine in reducing delay times and short-term adverse clinical outcomes in patients with ST segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic is unclear. This study compared outcomes in patients with STEMI who had percutaneous coronary intervention (PCI) and the use of a telemedicine app from August 2019 to March 2020 at a single center in Beijing, China. MATERIAL AND METHODS A total of 243 patients with STEMI who underwent PCI were consecutively enrolled and divided into 2 groups according to the date, before or after the pandemic. The 2 groups were further divided into patients who used the app for consulting and those who did not. RESULTS The time from symptom onset to calling an ambulance (SCT), door to balloon time (DTB), and total ischemia time (TIT) were significantly prolonged in patients after the pandemic. Patients who used the app had shorter SCT, DTB, and TIT before and after the pandemic compared to those who did not. Adverse clinical outcomes were significantly higher after compared with before the pandemic, despite the incidence rate of stroke, any revascularization, and stent thrombosis. However, there was no significant difference in short-term adverse clinical outcomes between patients who used the app and those who did not before and after the pandemic. CONCLUSIONS Telemedicine reduced the delay time of STEMI patients during the COVID-19 pandemic. The difference in short-term adverse clinical outcomes was not statistically significant between patients who used the app and those who did not.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Mobile Applications , Pandemics , Percutaneous Coronary Intervention , Pneumonia, Viral/epidemiology , ST Elevation Myocardial Infarction/therapy , Telemedicine , Aged , COVID-19 , China/epidemiology , Combined Modality Therapy , Comorbidity , Coronary Angiography , Female , Hospital Mortality , Humans , Male , Middle Aged , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnostic imaging , ST Elevation Myocardial Infarction/drug therapy , ST Elevation Myocardial Infarction/epidemiology , Smartphone , Telemedicine/methods , Time Factors , Time-to-Treatment , Treatment Outcome
14.
Circ Cardiovasc Interv ; 13(9): e009622, 2020 09.
Article in English | MEDLINE | ID: covidwho-744903

ABSTRACT

The ongoing coronavirus disease 2019 pandemic has resulted in additional challenges for systems designed to perform expeditious primary percutaneous coronary intervention for patients presenting with ST-segment-elevation myocardial infarction. There are 2 important considerations: the guideline-recommended time goals were difficult to achieve for many patients in high-income countries even before the pandemic, and there is a steep increase in mortality when primary percutaneous coronary intervention cannot be delivered in a timely fashion. Although the use of fibrinolytic therapy has progressively decreased over the last several decades in high-income countries, in circumstances when delays in timely delivery of primary percutaneous coronary intervention are expected, a modern fibrinolytic-based pharmacoinvasive strategy may need to be considered. The purpose of this review is to systematically discuss the contemporary role of an evidence-based fibrinolytic reperfusion strategy as part of a pharmacoinvasive approach, in the context of the emerging coronavirus disease 2019 pandemic.


Subject(s)
Fibrinolytic Agents/therapeutic use , ST Elevation Myocardial Infarction/drug therapy , COVID-19 , Coronavirus Infections , Humans , Pandemics , Patient Selection , Percutaneous Coronary Intervention , Pneumonia, Viral , ST Elevation Myocardial Infarction/surgery , Time Factors
15.
Zhonghua Xin Xue Guan Bing Za Zhi ; 48(6): 472-476, 2020 Jun 24.
Article in Chinese | MEDLINE | ID: covidwho-683960

ABSTRACT

Objective: To evaluate the efficacy and safety of fibrinolysis strategy in patients with acute ST-segment elevation myocardial infarction (STEMI) during the COVID-19 epidemic, and to provide reference value for optimization of fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff. Methods: The efficacy and safety of fibrinolysis were retrospectively analyzed in 7 patients with acute STEM, who hospitalized from February 29, 2020 to April 3, 2020 in the Department of Cardiology, Wuhan Union Hospital of Tongji Medical College, Huazhong University of Science and Technology. To optimize the fibrinolytic process on the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, a full-time medical team in charge of fibrinolysis under third-grade protection was established. The acute STEMI patients were treated immediately in a fixed and isolated area in emergency department before receiving green channel fibrinolysis. Blood samples for complete blood count, COVID-19 antibody test and nasopharyngeal swab samples for COVID-19 nucleic acid test were made before fibrinolysis, while the chest CT examination was accomplished after fibrinolysis. By comparing differences of time from the first electrocardiogram (ECG) to fibrinolysis before and after the improvement of fibrinolytic process, the effect of optimization of the fibrinolytic process was evaluated. Results: In the present study, seven patients with acute STEMI received fibrinolysis therapy, 6 of them achieved reperfusion and no bleeding was observed in all of the patients. Five out of the 7 patients were hospitalized after fibrinolysis, and the hospitalization days were 19.6 days on average. By following up to April 14, 2020, none of the 7 patients died. The first 2 patients were treated according to the routine medical procedure and the time from the first ECG to fibrinolysis were 201 and 106 minutes, respectively. After the optimization of the fibrinolytic process, the time from the first ECG to fibrinolysis of the last 5 patients were 42, 46, 51, 43 and 54 minutes, respectively,which was significantly shorter than that before optimization. Conclusions: During the COVID-19 epidemic, fibrinolysis in patients with acute STEMI is safe, effective and easy to implement. Therefore, it is recommended as the top priority for the patients with acute STEMI with indications for fibrinolysis. On the premise of prevention and control of COVID-19 transmission, including self-protection of medical staff, the duration of myocardial ischemia can be shortened by optimization of the fibrinolytic process.


Subject(s)
Betacoronavirus , Coronavirus Infections , Fibrinolytic Agents/therapeutic use , Pandemics , Pneumonia, Viral , ST Elevation Myocardial Infarction , COVID-19 , Coronavirus Infections/epidemiology , Epidemics , Humans , Pneumonia, Viral/epidemiology , Retrospective Studies , SARS-CoV-2 , ST Elevation Myocardial Infarction/drug therapy , Thrombolytic Therapy , Time Factors , Treatment Outcome
17.
Cardiovasc Revasc Med ; 21(8): 946-949, 2020 08.
Article in English | MEDLINE | ID: covidwho-276533

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cardiovascular manifestations of COVID-19 are diverse and complex and include acute coronary syndrome, myocarditis masquerading as ST-segment elevation myocardial infarction, pericarditis and pericardial effusion. We present 2 cases of COVID-19 infection with myocardial involvement with distinct mechanistic pathways and outcomes. Important decision strategies such as the timing of cardiac catheterization (when indicated) and requirement of early hemodynamic support in critically ill patients are discussed.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Glucocorticoids/therapeutic use , Myocarditis/etiology , Pandemics , Pneumonia, Viral/complications , ST Elevation Myocardial Infarction/etiology , Thrombolytic Therapy/methods , Adult , COVID-19 , Coronary Angiography , Coronavirus Infections/epidemiology , Echocardiography , Electrocardiography , Female , Humans , Male , Middle Aged , Myocarditis/diagnosis , Myocarditis/drug therapy , Pneumonia, Viral/epidemiology , SARS-CoV-2 , ST Elevation Myocardial Infarction/diagnosis , ST Elevation Myocardial Infarction/drug therapy
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