Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents.

BACKGROUND: In patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary interventions (pPCI), longer door-to-balloon (DTB) time is known to be associated with an unfavorable outcome. A percentage of patients with acute coronary occlusion present with atypical electrocardiographic (ECG) findings, known as STEMI-equivalents. We investigated whether DTB time for STEMI-equivalent patients was delayed. METHODS: This is a retrospective study including patients arriving at an emergency department with the acute coronary syndrome in whom emergent pPCI was performed. ECGs were classified into STEMI and STEMI-equivalent groups. We compared DTB time, with its components, between the groups. We also investigated whether STEMI-equivalent ECG was an independent predictor of DTB time delayed for more than 90 min. RESULTS: A total of 180 patients were included in the present study, and 23 patients (12.8%) presented with STEMI-equivalent ECGs. DTB time was significantly delayed in patients with STEMI-equivalent ECGs (89 (80-122) vs. 81 (70-88) min, p = 0.001). Multivariable logistic regression analysis showed that STEMI-equivalent ECG was an independent predictor of delayed DTB time (odds ratio: 4.692; 95% confidence interval: 1.632-13.490, p = 0.004). CONCLUSIONS: DTB time was significantly delayed in patients presenting with STEMI-equivalent ECGs. Prompt recognition of STEMI-equivalent ECGs by emergency physicians and interventional cardiologists might reduce DTB time and lead to a better clinical outcome.

Artificial neural network approach for acute poisoning mortality prediction in emergency departments.

OBJECTIVE: The number of deaths due to acute poisoning (AP) is on the increase. It is crucial to predict AP patient mortality to identify those requiring intensive care for providing appropriate patient care as well as preserving medical resources. The aim of this study is to predict the risk of in-hospital mortality associated with AP using an artificial neural network (ANN) model. METHODS: In this multicenter retrospective study, ANN and logistic regression models were constructed using the clinical and laboratory data of 1,304 patients seeking emergency treatment for AP. The ANN model was first trained on 912/1,304 (70%) randomly selected patients and then tested on the remaining 392/1,304 (30%). Receiver operating characteristic curve analysis was used to evaluate the mortality prediction of the two models. RESULTS: Age, endotracheal intubation status, and intensive care unit admission were significant predictors of mortality in patients with AP in the multivariate logistic regression model. The ANN model indicated age, Glasgow Coma Scale, intensive care unit admission, and endotracheal intubation status were critical factors among the 12 independent variables related to in-hospital mortality. The area under the receiver operating characteristic curve for mortality prediction was significantly higher in the ANN model compared to the logistic regression model. CONCLUSION: This study establishes that the ANN model could be a valuable tool for predicting the risk of death following AP. Thus, it may facilitate effective patient triage and improve the outcomes.

Cerebellar infarction following accidental inhalation of toluene-mixed paint.

We report a case of atypical cerebellar infarction following accidental inhalation of toluene mixed paint. An unconscious 57-year-old housewife with hypertension arrived at our emergency department by ambulance. She had been rescued from a basement (30 m3) 12 h after exposure to paint containing toluene (34%). On arrival, she was comatose (E1V1M1) with a mild fever (37.4 °C). Physical examination showed chemical burns on her buttocks and rales on the left lung. Initial arterial blood gas with 15 L/min of oxygen showed a pH of 7.142, PCO2 of 47.3 mmHg, and PaO2 of 204.7 mmHg. She received endotracheal intubation and mechanical ventilation. Laboratory tests showed elevated white blood cells (26.86 × 109/L), C-reactive protein (0.18 mg/dL), glucose (238 mg/Dl), and CPK (1389 U/L). At 5.5 h after arrival, she became responsive to verbal commands. On day 3, after removal of the endotracheal tube, she began to complain of an occipital headache without neurologic abnormalities. Brain magnetic resonance angiography (MRA) performed on day 6 showed a tiny acute infarction on the right cerebellar hemisphere. We serially measured urinary hippuric acid concentrations (reference range, ≤2.5 g/g creatinine) from 74 h (3.88) after hospital arrival to 218 h (0.5). She was discharged on day 14. Herein we presented a near fatal toluene intoxication (>45,000 mg/m3 estimated based on the basement volume and quantity of paint used) with atypical cerebellar infarction, compared with prior findings of bilateral involvement or reversibility.