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Islam, Syed Aminul, Md Faruque, Fazlur Rahman, Harisul Hoque, and Nilufar Fatema. "Clinical Impacts of ST- Segment Non-Resolution after Thrombolysis for Myocardial Infarction." University Heart Journal 15, no. 1 (2019): 3–7. http://dx.doi.org/10.3329/uhj.v15i1.41439.
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Streptokinase therapy for acute myocardial infarction reduces early mortality and improves outcomes. Failure of reperfusion after streptokinase therapy for acute myocardial infarction is common and indicates a poor prognosis. We investigated the clinical consequences of non-resolution of the ST segment after thrombolytic therapy for acute ST-elevation myocardial infarction, in 80 consecutive patients admitted to a coronary care unit. Failed thrombolysis was defined as <50% ST-segment resolution at 90 minutes after the start of thrombolytic treatment. Outcomes were measured in terms of in hospital adverse events and mortality at 6 weeks. Thrombolysis was successful, in terms of ST-segment resolution, in 59 patients (73.75%). After adjustment for other factors, ST resolution was the only independent predictor of an uncomplicated recovery in hospital. ST-segment resolution is a useful marker of successful thrombolysis and relates to clinical outcome. Average hospital stay was 2 days greater in non resolved ST-segment group than in ST-segment resolved group. At 6 weeks overall early mortality was much lower in the ST segment resolution group (1.7% versus 57.1% with P value of <0.001). So, non resolution of ST-segment in electrocardiogram following thrombolytic therapy in acute STEMI has paramount importance. If assessed routinely it might assist, along with other clinical markers, in the identification of high risk patients.
 University Heart Journal Vol. 15, No. 1, Jan 2019; 3-7
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Ahmad, Munir, Muhammad Yasir, and Asif Rahmat. "ACUTE ST ELEVATION MYOCARDIAL INFARCTION." Professional Medical Journal 25, no. 05 (2018): 777–83. http://dx.doi.org/10.29309/tpmj/18.4763.
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Uddin, Md Faruque, and AK Fazlul Hoque. "Impact of Diabetic Mellitus on the Effect of Streptokinase in Acute Myocardial Infarction Patients." Medicine Today 24, no. 1 (2013): 16–19. http://dx.doi.org/10.3329/medtoday.v24i1.14108.
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A prospective interventional study was carried out to compare the thrombolytic effect of streptokinase between diabetic and non-diabetic myocardial infarction patients. Out of 187 study subjects with acute ST segment elevation myocardial infarction (STEMI), admitted at coronary care unit, 126 patients were non-diabetic and 61 patients were diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration. Successful reperfusion (=70% ST-resolution) was significantly higher in non-diabetic than diabetic (p<0.001), while failed reperfusion (<30% ST resolution) was significantly higher in diabetic patients (p<0.001). It may be concluded that diabetes mellitus might affect the thrombolytic outcome of acute myocardial infarction patients with diabetes mellitus. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.14108 Medicine TODAY Vol.24(1) 2012 pp.16-19
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Ahmad, Aamir, Syed Muhammad Adnan Shah, Raza Ullah, Syed Muhammad Salman Shah, Syed Mujeeb Ur Rahman, and Muhammad Zuhaid. "Post Thrombolytic St-Segment Resolution Outcome in Acute Myocardial Infarction Patients." Journal of Gandhara Medical and Dental Science 9, no. 2 (2022): 38–42. http://dx.doi.org/10.37762/jgmds.9-2.177.
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OBJECTIVES: The main objective of this study was to assess post thrombolytic resolution of ST-segment and its outcome in patients with acute myocardial infarction. METHODOLOGY: This Prospective Comparative Study was carried out at the Cardiology Unit of Ayub Teaching Hospital, Abbottabad. All patients irrespective of gender and age with ST-Segment elevation myocardial infarction (STEMI), having no immediate access to angioplasty and thrombolysed with streptokinase, were included in this study. ECG was taken at the beginning and 90 minutes after the administration of streptokinase. Based on ST-segment resolution on ECG taken at 90 minutes these patients were classified into group A and B. Group A included patients with ST-segment resolution while group B showed no resolution of ST-segment after streptokinase administration. These patients were followed during their hospital stay for complications such as arrhythmias, cardiogenic shock, acquired ventricular septal defects (VSD) aneurysm and death. RESULTS: Among 115 patients, 94 were male and 21 female. Group A included 102 (89%) patients and group B included 13 (11%). In group A, only 1 (0.98 %) patient developed complications and in group B, 13 patients (100%) developed complications. Arrhythmias were the most common complication among MI patients in group A while cardiogenic shock was the commonest complication in group B. CONCLUSION: ST-segment resolution is a practical and applicable indicator of successful thrombolysis and has a significant correlation with clinical outcome in acute myocardial patients after thrombolysis with streptokinase.
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Ahmad, Zeeshan, Noor Ul Sabah Shah, Abdul Latif, and Anas Shakir. "Frequency of Successful Resolution of ST T Changes after Thrombolysis with Streptokinase in Patients of Acute St Segment Elevated Myocardial Infarction." Pakistan Journal of Medical and Health Sciences 16, no. 3 (2022): 790–92. http://dx.doi.org/10.53350/pjmhs22163790.
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Objective: To determine the frequency of successful resolution of ST T changes after thrombolysis with streptokinase in patients of acute ST Segment elevated myocardial infarction Design of the Study: Cross sectional study Study Settings: The study was conducted at Cardiology Department, Lady Reading Hospital, Peshawar from 22/10/2019 to 22/4/2020. Material and Methods: Over the course of the investigation, researchers kept tabs on 165 patients. FBC, ECG (cardio fax), and echocardiography (Siemens' Acuson cv-70) are all included in the evaluation and investigations. Every patient had an ECG done 90 minutes following the initiation of SK injection to see if the ST segment abnormalities had gone down. Results of the Study: 35 patients (20%) were between the ages of 30 and 45, while 130 patients (79%), were between the ages of 46 and 60. The average age was 57, with a standard deviation of 12.11. There were 72% male patients and 28% female participants in the study. Seventy-three percent of patients had successful resolution of ST T alterations, while 27 percent of patients did not. Conclusion: Our study concludes that the frequency of successful resolution of ST T changes after thrombolysis with streptokinase was 73% in patients of acute ST Segment elevated myocardial infarction Keywords: successful, resolution of ST T changes, thrombolysis, streptokinase, acute ST segment elevated myocardial infarction
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Aslan, Burhan, and Mehmet Zülküf Karahan. "The Relationship Between ST-Segment Depression in Lead aVR and Coronary Microvascular Function in Acute Inferior Myocardial Infarction." Acta Medica 53, no. 1 (2022): 53–58. http://dx.doi.org/10.32552/2022.actamedica.681.
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Aim: The aim of this study was to investigate the relationship between ST-segment depression in the aVR lead and coronary microvascular function in acute inferior myocardial infarction undergoing primary percutaneous intervention.
 Methods: 287 patients with inferior myocardial infarction confirmed by coronary angiography were divided into two groups with and without ST-segment depression in lead aVR ≥ 0.1 mV on the 12 lead ECG. Electrocardiographic recordings were made for the evaluation of ST-segment resolution before and after primary PCI. Angiographic assessment in the infarct-related artery was performed by using the myocardial blush grade and thrombolysis in myocardial infarction flow. 
 Results: Overall, 51 of 287 patients had ST-segment depression in lead aVR. The number of patients with RCA-induced infarction was higher in the group with ST-segment depression in lead aVR. RCA involvement was present in 44 patients. Peak troponin was higher in the group with ST-segment depression in lead aVR compare to the other group (P <0.001). The MBG was more impaired, and the STR was less regressed in patients with ST depression in lead aVR (p<0,001). The ejection fraction of patients with ST-segment depression in lead aVR was lower.
 Conclusion: We found that ST-segment depression in lead aVR was associated with impaired myocardial perfusion in patients with inferior myocardial infarction.
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AHMAD, SHIEKH NADEEM, SYED SAUD HASAN, and MUHAMMAD YOUSUF SALAT. "MYOCARDIAL INFARCTION." Professional Medical Journal 18, no. 04 (2011): 671–77. http://dx.doi.org/10.29309/tpmj/2011.18.04.2667.
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Thrombolytic therapy for Acute Myocardial Infarction has been one of the most potent treatment ever developed for condition that kill more patients worldwide than any other. Objective: To evaluate the benefit and efficacy or observational studies of streptokinase therapy on ST-segment elevation resolution in different types of myocardial infarction that focus especially on the younger age group less than forty years. Study design: To observe the streptokinase therapy, in ST-segment elevation resolution, in age less than 40 years and in different types of myocardial infarction. Place & duration of study: The study was conducted at national institute of cardiovascular diseases (NICVD) of Pakistan, Karachi. Subject and Methods: All patients fulfilling the inclusion criteria for thrombolytic therapy were included. Baseline ECG recorded before streptokinase infusion and repeated at completion of infusion i.e. 90 minutes, day 1 and day 2. Results: Streptokinase therapy on blood pressure, CKMB, and ST-segment resolution at 90 minutes, day 1, and Day2 in less than 40-year of age patient. The mean systolic blood pressure was 124+ 3.32 and 112+3.00 pre and post SK therapy reflecting a percentage decrease of 6.67 and highly significant (P<0.001). The Diastolic blood pressure was decrease to 6.25% with a mean value of 76.80+ 2.70 and 72+1.91 before and after the Streptokinase therapy’s, segment resolution at 90 minutes was decreased to 52.01 percent from the baseline and continued to decrease at Day-1 and Day-2 with a percentage reduction of 70.65 and 83.69 % respectively. The P values were highly significant (P<0.001). Conclusions: Thrombolysis improves survival when given within 12 hours of the onset of symptoms. The magnitude of benefit is greatest when reperfusion is established early. Age itself should not be considered a contraindication for fibronolysis
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Gandhi, Viral, and Vicky Gandhi. "Prognostic Value of ST-segment Deviation in Lead aVR in Electrocardiogram in Acute Myocardial Infarction." Journal of the Practice of Cardiovascular Sciences 10, no. 2 (2024): 88–92. http://dx.doi.org/10.4103/jpcs.jpcs_35_24.
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Background: Acute myocardial infarction (AMI) remains a significant cause of morbidity and mortality worldwide, necessitating effective risk stratification tools for improved management. ST-segment deviation in lead augmented vector right (aVR) has emerged as a potential prognostic marker in AMI, but its clinical relevance in the Indian context requires further investigation. Materials and Methods: We conducted a single-center prospective observational study among patients admitted with AMI to assess the prognostic value of ST-segment deviation in lead aVR. Patients were categorized based on the presence or absence of ST-segment deviation in lead aVR, and demographic, clinical, and angiographic characteristics were compared between groups. Follow-up evaluations were performed to assess left ventricular ejection fraction (LVEF) and the incidence of ventricular tachycardia (VT). Results: The study enrolled 110 patients, categorizing them by ST-segment deviation in lead aVR. Patients with ST elevation in lead aVR showed higher moderate LVEF dysfunction (31%–40%) than those with isoelectric ST segments (P = 0.0058). Conversely, patients with ST depression in lead aVR had increased preserved ejection fraction compared to those with an isoelectric ST segment (P = 0.0414). <50% ST-segment resolution postpercutaneous coronary intervention (PCI) was more common among non-ST-segment elevation myocardial infarction (NSTEMI) patients. The incidence of VT was higher in ST elevation in lead aVR (P = 0.0045). Significant differences in ST-segment resolution after PCI (P = 0.0117) between STEMI and NSTEMI patients were noted. Conclusion: ST-segment deviation in lead aVR serves as a valuable prognostic marker in AMI, correlating with adverse outcomes such as moderate LVEF dysfunction and increased risk of VT. Furthermore, its association with ST-segment resolution post-PCI highlights its role in assessing reperfusion success and guiding management strategies. These findings underscore the importance of ST-segment deviation in lead aVR for risk stratification and personalized management in AMI patients.
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Mukesh, Shandilya, and Prasad Ravivishnu. "Assessing Resolution of ST-Elevation on Treatment with Streptokinase and Also to Predict Short Term Outcome." International Journal of Current Pharmaceutical Review and Research 16, no. 2 (2024): 276–80. https://doi.org/10.5281/zenodo.12739744.
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Aim: The aim of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, withrespect to resolution of ST-elevation on treatment with streptokinase and also to predictshort term outcome duringhospital stay in terms of adverse events and mortality.Methods: This study was done by analysing the ECG of patients with diagnosis of acute ST segment elevationbefore and after thrombolysis with Streptokinase, admitted to Department of Cardiology, IGIMS, PATNA, Bihar,India for the period of 2 years. 150 Acute STEMI patients who had received thrombolytic therapy withstreptokinase were studied in three groups namely Category A, Category B and Category C based on ST segmentresolution after administration of thrombolytic therapy.Results: In the present study, the minimum age of the patient was 30years, maximum age was 75 years. Maximumnumbers of patients in between 40-59 years constitute 55%. Mean age of present study was 52.8±9.6. Male wassignificantly increased (P<0.000) when compared with female patients. In this study chest pain was the mostcommon mode of presentation, present in 116 (96.66%) patients associated withsweating in 104 (86%) patients,breathlessness seen in 30 (25%) patients. Syncope wasseen in 12 (10%) patients and palpitation in 6 (5%) patients.In this study anterior wall Myocardial infarction was not significant compared with inferior wall myocardialinfarction. Thrombolysis time of <3 hours, 3-5 hours and more than5 hours was noted in a, b and c categoriespatients. B and c categories patients were significantly increased when compared with categories of patients.Conclusion: In this present study we conclude that the efficacy of IV streptokinase for thrombolysis in acuteSTEMI and patients with no ST segment resolution at 90 minutes following thrombolysis were associated withmore frequent adverse events and increased mortality compared to partial and complete resolution group.Percentage of resolution of ST segment following 90 minutes of thrombolysis as a diagnostic test helps in riskstratification of patients.
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Ahmad, Munir, Muhammad Yasir, and Asif Rahmat. "ACUTE ST ELEVATION MYOCARDIAL INFARCTION." Professional Medical Journal 25, no. 05 (2018): 777–83. http://dx.doi.org/10.29309/tpmj/2018.25.05.325.
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Objective: To determine the frequency of in-hospital outcomes in patients ofacute ST elevation myocardial infarction (STEMI) within five days of hospitalization with .70ST segment resolution 90 minutes post thrombolysis. Study Design: Case series. Place andDuration of Study: Department of Cardiology, Faisalabad Institute of Cardiology, Faisalabad,from April, 2016 to October, 2016. Methodology: In 370 patients fulfilling the inclusion andexclusion criteria a baseline 12 lead electrocardiogram was recorded before initiation ofthrombolysis and at 90 minutes thereafter. Conventional contraindications to thrombolysis wereobserved and streptokinase 1.5 mu was administered by intravenous infusion over 60 minutes.Successful thrombolysis was taken as 70% or more ST elevation resolution at 90 minutes frombaseline electrocardiogram measured 80ms from J-point. Patients with successful thrombolysiswere observed for in-hospital clinical outcomes of recurrent angina, congestive cardiac failure,ventricular arrhythmia and death within five days of hospitalization. Results: Out of 370 cases,51.35 %( n=190) were male while 48.65 %( n=180) were female, 25.14 %( n=93) were between30-50 years of age while 74.86 %( n=277) were between 51-65 years of age, the mean agewas 54.98+5.96 years. Frequency of in-hospital outcome was recorded as 10.67 %( n=38) forcongestive cardiac failure, 14.59 %( n=54) for ventricular arrhythmia, 5.40 %( n=20) for mortalitywhile no case had recurrent angina. Conclusion: In-hospital outcome is better in patients of.70% ST resolution at 90 minutes post thrombolysis .This might assist in identification of lowrisk patients who can be discharged early and should not be considered for early invasivestrategy.
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Iqbal, Shahriar, M. Saiful Bari, MA Bari, et al. "A Comparative Study of St Segment Resolution between Diabetic and Non-Diabetic ST Segment Elevation Myocardial Infarction Patients following Streptokinase Thrombolysis." Cardiovascular Journal 11, no. 2 (2019): 118–22. http://dx.doi.org/10.3329/cardio.v11i2.40411.
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Background: One of the most effective and used (in our settings) methods of reperfusion of ST elevation myocardial infarction (STEMI) is administration of streptokinase (SK) infusion. This study was conducted with the aim to compare ST segment resolution between diabetic and non-diabetic patients with ST segment elevation myocardial infarction after thrombolysis by streptokinase.
 Methods: A total of 100 patients with ST elevation myocardial infarction with or without diabetes mellitus were studied from December 2016 to November 2017. Among these half of patients were diabetic while rests were non-diabetic. Streptokinase was administered to all patients. Resolution (reduction) of elevated ST segment was evaluated after 90 min of streptokinase administration.
 Results: Failed reperfusion (<30% ST resolution) was significantly higher in diabetic as compared to nondiabetic patients (42% vs. 12%, p <0.001). In hospital complications were more in diabetic patients who has failed reperfusion following streptokinase thrombolysis. Cardiogenic shock occurred in 44% and acute LVF in 30% patients and EF (46.54%) was significantly lower in diabetic patients and higher number of diabetic patients had prolong hospital stay than non-diabetic patients with STEMI.
 Conclusion: The outcome of thrombolytic therapy is adversely affected by diabetes mellitus in patients with ST-elevation myocardial infarction.
 Cardiovasc. j. 2019; 11(2): 118-122
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Tomasevic, Miloje, Tomislav Kostic, Svetlana Apostolovic, et al. "Comparative effect of streptokinase and alteplase on electrocardiogram and angiogram signs of myocardial reperfusion in ST segment elevation acute myocardial infarction." Srpski arhiv za celokupno lekarstvo 136, no. 9-10 (2008): 481–87. http://dx.doi.org/10.2298/sarh0810481t.
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INTRODUCTION Modern pharmacological reperfusion in ST segment elevation acute myocardial infarction means the application of fibrin specific thrombolytics combined with modern antiplatelets therapy dual antiplateles therapy, acetylsalicylic acid and clopidogrel, and enoxaparin. The contribution of each agent has been widely examined in large clinical studies, but not sufficiently has been known about the effects of a combined approach, where the early angiography and percutaneous coronary intervention is added during hospitalization, if necessary. OBJECTIVE The aim of the paper is to compare the effects of streptokinase and alteplase, together with the standard modern adjuvant antiplatelets and anticoagulation therapy (aspirin, clopidogrel, enoxaparin) in patients with ST segment elevation acute myocardial infarction, on electrocardiographic and angiographic signs of the achieved myocardial reperfusion. METHOD The prospective study included 127 patients with the first ST segment elevation acute myocardial infarction who were treated with a fibrinolytic agent in the first 6 hours from the chest pain onset. The examined group included 40 patients on the alteplase reperfusion therapy, while the control 87 patients were on the streptokinase therapy. All the patients received the same adjuvant therapy and all were examined by coronary angiography on the 3rd to 10th day of hospitalization. Reperfusion effects were estimated on the basis of the following: ST segment resolution at 60, 90 and 120 minutes, the appearance of reperfusion arrhythmias at the electrocardiogram, percentage of residual stenosis at the 'culprit' artery, TIMI coronary flow at the 'culprit' artery and the appearance of new major adverse coronary events in the 6-month-follow-up period. RESULTS By analysing the resolution of the sum of ST segment elevation in infarction leading 60 minutes after the beginning of the medication application, we received a statistically significantly higher resolution of ST segment in the group of patients who received alteplase (p<0.05). 60 minutes after the application of thrombolytics, 64% of patients at streptokinase showed the absence of ST segment resolution (<30%), and 32% of patients at alteplase (p<0.0001). Reperfusion arrhythmias as the sign of successful myocardial reperfusion were present in 62.5% of patients at alteplase and in 57.4% of patients at streptokinase, but the difference is not statistically significant. There was no statistically significant difference in the degree of residual stenosis at the 'culprit' artery in the compared groups of patients. TIMI 3 flow was achieved in 75% of patients at alteplase and in 38% of patients at streptokinase (p<0.0001). There was no statistically significant difference in the frequency of major adverse coronary events in the 6-month-follow-up period after acute myocardial infarction. CONCLUSION Alteplase with modern adjuvant therapy of ST segment elevation acute myocardial infarction shows the earlier achievement of coronary perfusion as well as better coronary flow compared to streptokinase. There is no statistically significant difference in the frequency of reperfusion arrhythmias, degree of residual stenosis at the 'culprit' artery and the frequency of new coronary events in the 6-month-follow-up period after acute myocardial infarction.
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Z Alshibani, Mazin. "Effectiveness of t-PA in Patients with Acute Myocardial Infarction." AL-QADISIYAH MEDICAL JOURNAL 13, no. 24 (2018): 46–54. http://dx.doi.org/10.28922/qmj.2017.13.24.46-54.
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Tissue plasminogen activator (t-PA) had improve the treatment of ST elevation myocardial infarction (STEMI). The aims considered assessment the response of patients with STEMI to t-PA (Alteplase) infusion by estimate the frequency of selected parameters. This is study that included 62 patients with STEMI who had been treated with t-PA infusion as a thrombolytic therapy. They had been selected from those who had been admitted to the Coronary Care Unit at Al-Diwaniya Teaching Hospital, Diwaniya city, Iraq during the period between 1st of March 2014 to the 31st of August 2015. Specific selected parameters used to assess effectiveness of t-PA. Parameters including: resolution of ST segment elevation (reduction in the ST elevation ? 50%), relieve of chest pain, occurrence of accelerated idioventricular rhythm (AIVR) and positive response for three parameters (simultaneously), observe within 90 minutes after t-PA infusion. After t-PA infusion, 59.6% of the patients had resolution of ST segment elevation, 56.4% getting relieve of chest pain, AIVR occur in 30.6% and positive response of all parameters in 9.6%. Patients less than 60 years old age constitutes 45.1% of patients who had ST segment resolution, 30.6% of patients who had relieve of chest pain, patients with AIVR in 22.5%, and patients with positive response of all three parameters in 9.6%, (significant p.value). Smokers patients getting ST segment resolution in 41.3% of patients, relieve of chest pain in 38.7%, AIVR in 16.12% and positive response for all selected parameters in 8.06% of patients, (significant p.value). 1.61% of patients with ST segment resolution and 11.29% of patients with relieve of chest pain seen with time to perfusion more than 6 hours. This study indicated that increasing age, obesity, diabetes mellitus (DM), and delay in reaching hospital after onset of ischemic chest pain considered as predictors for poor response to t-PA infusion among patients with STEMI. BMI has no significant consideration but smokers patients had been associated with better response to t-PA.
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S., Karthik, Satchi A. Surendran, and Mohamed Kasim A. "Efficacy of thrombolytic therapy with IV streptokinase in acute ST elevation myocardial infarction patients." International Journal of Advances in Medicine 6, no. 4 (2019): 1121. http://dx.doi.org/10.18203/2349-3933.ijam20193257.
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Background: Acute Myocardial Infarction is one of the leading causes of mortality and morbidity. Now there are a number of drugs for Thrombolysis but still Streptokinase is used in many of the centers because of the ease of availability and less cost. ST segment elevation resolution following thrombolysis is simple, non-invasive, accessible tool for the assessment of coronary reperfusion. Objective of the present study was to assess the efficacy of thrombolysis in Acute STEMI patients, with respect to resolution of ST-elevation on treatment with streptokinase and also to predict short term outcome during hospital stay in terms of adverse events and mortality.Methods: 60 Acute STEMI patients who had received thrombolytic therapy with streptokinase were studied in three groups namely Category A, Category B and Category C based on ST segment resolution after administration of thrombolytic therapy.Results: Of 60 patients, 9 patients (15%) had <30% ST resolution (no STR), 26 patients (43.3%) had 30-70% ST resolution (partial STR), 25 patients (41.7%) had >70% ST resolution (complete STR).Conclusions: In the present study we conclude that the efficacy of IV streptokinase for thrombolysis in acute STEMI is 41.7%. Patients with no resolution of ST segment 90 minutes following thrombolysis associated with more frequent adverse events and increased mortality compare to partial and complete resolution group.
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Khalid, Muhammad Rahman, Muhammad Adeel Qamar, Ashok Kumar, et al. "Frequency of Failure of St-Segment Resolution after Primary Percutaneous Coronary Intervention in Patients with St-Segment Elevation Acute Myocardial Infarction." Pakistan Journal of Medical and Health Sciences 16, no. 3 (2022): 417–20. http://dx.doi.org/10.53350/pjmhs22163417.
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Objective: To determine the frequency of failure of ST-segment resolution after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation acute myocardial infarction (MI). Methodology: This cross-sectional study was carried out at the CCU department of the National Institute of Cardiovascular Diseases (NICVD) Karachi, during six months from January 2017 to July 2017. All patients with ST elevation myocardial infarction admitted at CCC and undergoing primary PCI, the onset of typical pian of chest and related presentation in the last 12 hours that persists at least > 20 minutes, without the previous administration of fibrinolytic therapy assessed with history and previous reports, platelet glycoprotein IIb/IIIa inhibitors without prior administration and of either gender were included. All study subjects were shifted to Angiography department, the arterial sheath was inserted only through to the femoral route to prevent bias, and the interventional cardiologist with a minimum 05 years of professional experience was chosen. Angiography was performed, and the identified occlusion area was by interventional cardiologist ballooned/stented. ST resolution failure was seen after/within 30 minutes of primary angioplasty. All the information was collected via study proforma and SPSS version 26 was used for the data analysis. Results: Mean age of the patients was 56.18±8.70 years, average BMI was 25.56±4.76 kg/m2. Females were 25% and males were 77%. Complete resolution was achieved in 73% patients, while 22% patients Failure of ST-segment resolution post PPCI. Conclusion: Our findings show that ST-segment resolution in the ECG within 30 minutes, as opposed to the traditional 90-min successful PPCI, is a significant predictive predictor. The intriguing discovery that ST-segment resolution has limited predictive value in a cohort of STEMI cases managed by the PPCI deserves additional exploration, especially as it is already widely used as the surrogate end point in trials. Keywords: St-Segment Resolution; Failure; ST-segment elevation myocardial infarction; primary percutaneous coronary intervention; electrocardiogram.
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Matte, Bruno da Silva, and Alexandre Damiani Azmus. "Acute Myocardial Infarction Caused by an Anomalous Right Coronary Artery Occlusion Presenting with Precordial ST Elevation." Case Reports in Cardiology 2017 (2017): 1–4. http://dx.doi.org/10.1155/2017/3972830.
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Acute coronary syndrome with precordial ST segment elevation is usually related to left anterior descending artery occlusion, although isolated right ventricular infarction has been described as a cause of ST elevation in V1–V3 leads. We present a case of a patient with previous inferior wall infarction and new acute ST elevation myocardial infarction (STEMI) due to proximal right coronary thrombotic occlusion resulting in right ventricular infarction with precordial ST elevation and sinus node dysfunction. The patient was treated with successful rescue angioplasty achieving resolution of acute symptoms and electrocardiographic abnormalities.
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Hassan, Zeeshan, Nabeegh Rana, Bakhtawar Rana, Asif Iqbal, and Ali Javaid Chughtai. "A Comparative Study to Assess the Efficacy of Streptokinase in Diabetic Versus Non-Diabetic Acute ST Elevation Myocardial Infarction Patients." Esculapio 17, no. 1 (2021): 88–92. http://dx.doi.org/10.51273/esc21.2517118.
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Objective: Prominent resolution in the ST segment elevation on electrocardiogram(ECG), thrombolysis at the infarction site restoring perfusion determines the effectiveness of the streptokinase therapy. Hyper- coagulable states and lack of efficacy with streptokinase is seen in diabetics. This study aimed to assess the thrombolytic efficacy of streptokinase in diabetic vs non-diabetics patients. Methods: A cross-sectional study was conducted at Cardiology Department of Allama Iqbal Memorial Teaching Hospital, Sialkot from 1st September 2019 to 30th April, 2020. Total 504 patients of which 185 diabetics and 319 non-diabetic were selected. All the patients presenting with first episode of acute ST- elevation myocardial infarction were thrombolysed with 1.5million units of streptokinase within 12hours from the onset of their typical chest pain symptoms. A complete record of ECG changes was kept before and 90 min after thrombolysis with streptokinase. Chi- square test was applied and p value <0.05 was considered significant. Results: 89.19% diabetic patients had >70% resolution of ST segment changes in comparison to 95.61% non-diabetics. 16.76% of the diabetic patients had increased ST-segment elevation post thrombolysis (P- value 0.001). 8.11% and 10.81% reinfarction rates during hospital stay and at one month post-thrombolysis were recorded in diabetics. Reduced left ventricle Ejection Fraction was seen in 62.16% and 58.62% of the diabetic and non-diabetic patients(P-value<0.005). Conclusion: Comparatively decreased efficacy of streptokinase is seen in diabetic patients with reduced resolution of ST-segment. In correspondence with reduced left ventricle EF, re-infarction and stroke episodes. Key Words: Streptokinase, acute myocardial infarction, STEMI, diabetes mellitus, hypercoagulability, atherosclerosis. How to Cite: Hassan Z., Rana N., Rana B., Iqbal I., Chughtai J.I. A comparative study to assess the efficacy of streptokinase in diabetic versus non-diabetic acute ST elevation myocardial infarction patients. Esculapio 2021;17(01):88-92
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Ramaniuk, Aliaksandr, Semiramis Carbajal-Mamani, Susheela Hadigal, and Basma Ricaurte. "850 REM Sleep and ST Deviation in Acute Myocardial Infarction." Sleep 44, Supplement_2 (2021): A330—A331. http://dx.doi.org/10.1093/sleep/zsab072.847.
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Abstract Introduction Sleep stage architecture and amount of REM sleep have been associated with mortality and clinical recovery, without clear etiology. Patients recovering from critical illness frequently experience sleep disturbances, episodic arrhythmogenesis, EKG changes. This case aims to add to current field of study and describes an unusual pattern of sleep stage dependent, hypoxia independent, ST segment variation, which may benefit from further exploration and utilization of polysmongoraphy (PSG) in the immediate post acute MI period. Report of case(s) 46 year old female with history of smoking, obesity, and diabetes presented for a sleep medicine evaluation, four days following a hospitalization for non ST elevation myocardial infarction (NSTEMI) and percutaneous coronary intervention. Her split night PSG data revealed severe obstructive sleep apnea (OSA) with apnea hypopnia index (AHI) of 131. Patient did not report acute cardiac symptoms during overnight sleep evaluation. On close observation of PSG data, the patient had grossly evident baseline ST segment depression during wake period. The ST depression persisted through stages 1 and 2 with unchanged morphology. During Stage 3, the ST segment showed progressive elevation to near the isoelectric line. During REM sleep without positive airway pressure (PAP), ST segment was noted at or near isoelectric line, even in the setting of hypoxia with saturation (Sao2) of 75%. During REM Sleep with PAP, the ST segment remained at the isoelectric line, and returning to baseline depression during wake phase while on BiPAP. Conclusion Residual ST segment deviation, and its resolution, are strong predictors of prognosis in patients with MI. Prior studies focused on hypoxic tolerance and sleep disordered breathing, with limited attention on specific sleep stage evaluation. REM sleep has been described as potentially having restorative effect on ischemic myocardium. Additionally, the transition period from non REM to REM sleep was reported to provide potential for myocardial restoration. PSG with cardiac monitoring remains a unique tool in further assessment of a possible association. This case aims to bring attention to the potential association of EKG ST segment variation with sleep stages, especially REM and S3, independent of hypoxia. Support (if any):
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Dregoesc, Ioana, Adrian Iancu, Simona Manole, and Şerban Bălănescu. "Microvascular Obstruction in Acute Myocardial Infarction." Journal Of Cardiovascular Emergencies 3, no. 4 (2017): 197–202. http://dx.doi.org/10.1515/jce-2017-0026.
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Abstract Introduction: The no-reflow phenomenon has been described in 20–40% of patients with acute ST-segment elevation myocardial infarction, despite restoration of TIMI 3 myocardial flow. It is associated with adverse left ventricular remodeling and an unfavorable long-term prognosis. Case presentation: A 45-year-old gentleman was admitted one hour after the onset of an acute anterior ST-segment elevation myocardial infarction. Emergency coronary angiography was performed, and a severe stenosis of the left anterior descending artery was identified. The lesion was crossed with a pressure-wire, and a drug-eluting stent was directly implanted, with restoration of TIMI 3 epicardial flow. Predilatation was not performed. Coronary wedge pressure was measured during stent deployment. The mean pressure value was 27 mmHg. However, a tall systolic wave was identified in the morphology of the pressure curve. Myocardial blush grade and ST-segment resolution were concordant with early micro-vascular obstruction. Similarly, at transthoracic Doppler echocardiography, the flow in the left anterior descending artery revealed the same pattern. An apical left ventricular aneurysm was echocardiographically detected. The MRI described extensive interstitial edema that affected the anterior, septal, and apical regions of the left ventricle. Areas of intramyocardial hemorrhage and microvascular obstruction were also detected. According to recent literature data, the morphology of the coronary wedge pressure wave suggested at least the presence of pre-procedural distal embolization. Conclusions: In the setting of acute myocardial infarction, the integrity of coronary microvasculature is an important issue. The distal coronary pressure wave pattern before primary percutaneous revascularization can be a deciding factor for an early therapeutic approach.
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Nugraha, Raka Aldy, Auliya Husen, Hary Sakti Muliawan, and Dian Zamroni. "Hyperkalemia Mimicking Anteroseptal Myocardial Infarction." Indonesian Journal of Cardiology 44, no. 1 (2023): 28–32. http://dx.doi.org/10.30701/ijc.1297.
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Background: Hyperkalemia often results in cardiac emergency associated with fatal cardiac arrhythmias. However, the presence of ST segment elevation in hyperkalemia is rare and could potentially subject the patients to unnecessary risk of intervention. Most commonly, ST elevation in hyperkalemia presents in a down-sloping fashion compared to the typical convex or upsloping pattern in myocardial infarction. However, in some cases, the ST elevation morphology can be very identical and difficult to distinguish. Herein, we describe a hyperkalemic patient presenting with non-ischemic ST segment elevation that resolved spontaneously following therapy.
 Case illustration: A 77-year-old, bed-ridden, inarticulate woman was admitted to emergency department with acute dyspnea perceived for 1.5 hours. The patient’s past clinical history included craniotomy for subdural hematoma, poorly controlled hypertension, hypertensive heart disease, rheumatoid arthritis, and dementia and was under candesartan, amlodipine, nebivolol, spironolactone, and atorvastatin treatment. The 12-lead electrocardiography (ECG) recording showed wide QRS complex with left bundle branch block pattern, slow atrial fibrillation with total atrioventricular block, ST segment elevation and Q wave in anteroseptal leads, and peaked T wave (Figure 1A). The pattern of ST elevation was indistinguishable from that of myocardial infarction which necessitated further laboratory confirmation. Laboratory results showed severe hyperkalemia (K+ 7.93 mmol/L) and normal troponin level (45.0 ng/L). The patient was given serial insulin-based therapy and calcium gluconate immediately. The follow-up ECG pictured normal sinus rhythm with no sign of bundle branch block, resolution of ST segment elevation, and reduction in T wave amplitude (Figure 1B). However, the reduction in potassium level was not significant and the patient also experienced an acute kidney injury. The patient was transferred to intensive care unit and was prepared for hemodialysis.
 Conclusion: ST segment elevation is a rare feature of hyperkalemia that could mislead the patient’s treatment. Thorough ECG evaluation is the key to narrow down the differential diagnosis. Every deviant feature should not be interpreted separately. Laboratory tests could help confirm the diagnosis, particularly in patients with atypical presentation and could help avoid unnecessary risk of intervention.
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Prabhakaran, Sunil Prasobh, and Abhilash Kannan. "Prognostic significance of troponin T in acute myocardial infarction." International Journal of Research in Medical Sciences 5, no. 10 (2017): 4363. http://dx.doi.org/10.18203/2320-6012.ijrms20174559.
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Background: Cardiac markers traditionally have been used only to establish the diagnosis in patients with acute coronary syndromes. In those with suspected acute STEMI, markers have been deemed to have little value, although smaller studies have suggested that troponin T may be valuable for risk stratification. Study aim was to study the prognostic significance of admission Troponin T in acute STEMI and also the relation between Troponin positivity and ST segment resolution after thrombolysis and also relationship with ejection fraction by echocardiogram.Methods: This was a descriptive study conducted in 50 patients admitted with acute STEMI within eight hours in the department of medicine in a tertiary care centre in South Kerala. A blood sample was sent for assessing troponin T. All Patients underwent thorough clinical examination and investigations including echocardiogram was done and were managed with thrombolysis. They were closely followed up for in hospital and 30 days mortality and complications. ST segment resolution after thrombolysis with streptokinase was also assessed.Results: In present study 48% of the patients were troponin T positive. Total six patients died of which all were Troponin T positive. There was a significant increase in the complications in troponin T positive group (46% vs 16%). 44% of the patients had an anterior wall myocardial infarction of which 46% had complications. ST segment resolution after thrombolysis was below 30% in 66.7% of the troponin T positive patients. Ejection fraction was below 50% in 80% of troponin T positive patients.Conclusions: There was a statistically significant correlation between admission troponin T levels and in hospital complications and also mortality rates at 30 days. Troponin T positivity at admission was significantly associated with lower rates of reperfusion after thrombolysis with streptokinase and also lower rate of ejection fraction on echocardiogram. Troponin T positive anterior wall myocardial infarction was associated with more complications than non-anterior wall myocardial infarction.
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Separham, Ahmad, Soudabeh Dinparvar, Safa Savadi-Oskouei, Leili Pourafkari, Aidin Baghbani-Oskouei, and Nader D. Nader. "Association of ABO blood types with ST resolution following thrombolysis in acute ST elevation myocardial infarction." Journal of Cardiovascular and Thoracic Research 12, no. 2 (2020): 106–13. http://dx.doi.org/10.34172/jcvtr.2020.18.
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Introduction : There is paucity of data about the possible role of ABO antigen in response to pharmacologic reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) and its relationship with ST segment recovery; thus, we aimed to evaluate the association of ABO antigen with ST-segment resolution in STEMI patients treated with thrombolysis. Methods: This prospective and observational study was conducted between March 2016 and September 2017 on patients with first acute STEMI within the first 12 hours after onset of symptoms treated with thrombolysis. Myocardial reperfusion success was determined by single-lead ST-segment recovery in 12-lead ECG. Patients were considered as responders if ST-segment resolved ≥50% or were assigned as non-responders if ST-segment resolution was <50%. Univariable and multivariable analyses were performed to examine the contribution of "A" and "B" blood group antigens to ST-segment resolution and the occurrence of major adverse cardiovascular or cerebrovascular event (MACCE). Odds ratio (OR) with 95% confidence interval (CI) were reported for each variable. Results: In this study 303 patients (187 males and 116 females) with a mean age of 56.6 ± 16.8 (ranging from 39 to 87 years) were enrolled. 184 patients (60.7%) were responders and 119 patients (39.2%) were non-responders. The presence of either A (4.5 folds increase) or B (5.4 folds increase) antigen was associated with a higher likelihood of a response to thrombolytic therapy, while had not effect on the occurrence of MACCE. Conclusion: We conclude that the presence of A or B blood group antigens is associated with a better response to thrombolytic therapy in patients with acute STEMI. This finding may imply a higher likelihood for thrombotic occlusion of coronary arteries in patients who have either A or B antigen in their blood.
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Haji Sobhani, Sepas, Mohammad Mahdi Daei, Samira Dodangeh, Majid Hajikarimi, and Navid Mohammadi. "Impact of Metabolic Syndrome in Patients With Acute Myocardial Infarction After Thrombolytic Therapy." Journal of Inflammatory Diseases 25, no. 4 (2022): 217–22. http://dx.doi.org/10.32598/jid.25.4.3.
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Background: Metabolic syndrome (MetS) comprises a group of conditions that happen together and increase the risk of heart disorders. MetS has known characteristic diagnostic criteria and is diagnosed through physical examination and blood tests. This syndrome is extremely prevalent in patients with acute myocardial infarction. We aimed to determine the prevalence of MetS and its relationship with myocardial infarction and response to treatment in patients suffering from acute myocardial infarction under fibrinolytic treatment. Methods: In this cross-sectional study, 145 patients with acute ST-elevation myocardial infarction (STEMI) were enrolled. They were referred to Bu-Ali Sina Hospital in Qazvin, Iran, between January 2018 and January 2019 and were candidates for thrombolytic therapy. The patients were divided into two groups with and without MetS according to the NCEP ATP III definition (the National Cholesterol Education Program-Adult Treatment Panel III). In each group, the ST resolution of more than 50% in electrocardiogram was evaluated 90 minutes after thrombolytic administration. In addition, angiographic information and left ventricular ejection fraction (LVEF) were compared between the two groups. Results: Overall, the prevalence of MetS was 57.2% in the study population. After treatment, ST-segment resolution of more than 50%, the number of involved coronary vessels, the thrombolysis in myocardial infarction flow grade, mean LVEF, and type of myocardial infarction were similar in both study groups. Conclusion: Our study indicates that MetS does not affect the response rate to thrombolytic treatment.
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Lefèvre, Thierry, Eulegio Garcia, Bernhard Reimers, et al. "X-Sizer for Thrombectomy in Acute Myocardial Infarction Improves ST-Segment Resolution." Journal of the American College of Cardiology 46, no. 2 (2005): 246–52. http://dx.doi.org/10.1016/j.jacc.2005.04.031.
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Farah, Alejandro, and Alejandro Barbagelata. "Unmet goals in the treatment of Acute Myocardial Infarction: Review." F1000Research 6 (July 27, 2017): 1243. http://dx.doi.org/10.12688/f1000research.10553.1.
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Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities. To administer thrombolytic therapy during transport to the catheterization laboratory could reduce time to reperfusion in cases with expected prolonged transport time to a percutaneous coronary intervention center or to a center without primary percutaneous coronary intervention capabilities with additional expected delay, known as pharmaco-invasive strategy. Myocardial reperfusion is known to produce damage and cell death, which defines the reperfusion injury. Lack of resolution of ST segment is used as a marker of reperfusion failure. In patients without ST segment resolution, mortality triples. It is important to note that, until recently, reperfusion injury and no-reflow were interpreted as a single entity and we should differentiate them as different entities; whereas no-reflow is the failure to obtain tissue flow, reperfusion injury is actually the damage produced by achieving flow. Therefore, treatment of no-reflow is obtained by tissue flow, whereas in reperfusion injury the treatment objective is protection of susceptible myocardium from reperfusion injury. Numerous trials for the treatment of reperfusion injury have been unsuccessful. Newer hypotheses such as “controlled reperfusion”, in which the interventional cardiologist assumes not only the treatment of the culprit vessel but also the way to reperfuse the myocardium at risk, could reduce reperfusion injury.
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Ndrepepa, Gjin, Patricia Alger, Sebastian Kufner, Julinda Mehilli, Albert Schömig, and Adnan Kastrati. "ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction." Cardiology Journal 19, no. 1 (2012): 61–69. http://dx.doi.org/10.5603/cj.2012.0009.
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Park, So Ra, Young Ran Kang, Myeng Ki Seo, et al. "Clinical Predictors of Incomplete ST-Segment Resolution in the Patients With Acute ST Segment Elevation Myocardial Infarction." Korean Circulation Journal 39, no. 8 (2009): 310. http://dx.doi.org/10.4070/kcj.2009.39.8.310.
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Ishmael, Leah, and Joseph Zalocha. "ST-Elevation Myocardial Infarction in the Presence of Septic Shock." Case Reports in Critical Care 2020 (August 18, 2020): 1–3. http://dx.doi.org/10.1155/2020/8879878.
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Elevated cardiac enzymes are often seen in the setting of sepsis. The mechanism involves hypoperfusion and possible compromise to myocardial tissue. Electrocardiogram (ECG) changes in the setting of septic shock are less common and can vary widely. Rarely, ST-segment elevations can occur. This case describes a 54-year-old female who presented with septic shock secondary to pyelonephritis and Escherichia coli bacteremia. The patient was admitted to the intensive care unit on norepinephrine and required mechanical ventilation. A significant rise in troponin I (peak 19.8 ng/mL) was seen and ECG showed ST-segment elevations in leads I and aVL with reciprocal ST depressions in leads II, III, and aVF. The patient was taken urgently for left cardiac catheterization, which showed no evidence of obstructive coronary artery disease. When distinguishing between septic shock and cardiogenic shock, insertion of a pulmonary artery catheter may help with diagnosis and treatment of cardiogenic shock. Catheter hemodynamic monitoring can also confirm the diagnosis. In our patient’s case, hemodynamic monitoring was initiated and was not consistent with cardiogenic shock. ST-segment elevations in the high lateral leads and elevated cardiac markers were likely due to severe transmural ischemia secondary to increased oxygen demand. The patient was continued on intravenous antibiotics for treatment of her septic shock. She was extubated and weaned off of norepinephrine within 48 hours. Repeat ECG performed after resolution of the infection showed normal sinus rhythm with no ST-segment changes. Cardiac dysfunction in the setting of septic shock is well described in medical literature; however, the mechanisms of dysfunction are not explicitly understood. Transient hypoperfusion, coronary vasospasm, and localized endothelial damage are possible components. It is important to think of varying etiologies, other than acute coronary syndrome when approaching patients in septic shock with acute ST-segment changes and elevated cardiac markers.
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KHAN, N., A. ULLAH, R. ULLAH, U. IQBAL, and M. MAGSI. "ROLE OF ST SEGMENT RESOLUTION ALONE AND IN COMBINATION WITH THROMBOLYSIS IN MYOCARDIAL INFARCTION (TIMI) FLOW IN PRIMARY PERCUTANEOUS CORONARY INTERVENTION FOR ST SEGMENT ELEVATION MYOCARDIAL INFARCTION." Biological and Clinical Sciences Research Journal 2023, no. 1 (2023): 510. http://dx.doi.org/10.54112/bcsrj.v2023i1.510.
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This study aimed to assess the effect of ST-segment resolution (STR) alone and in combination with TIMI flow after primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI). The study was conducted at the Department of Cardiology, Peshawar Institute of Cardiology, Hayatabad Peshawar, KPK, from August 2022 to July 2023. Ninety patients with acute myocardial infarction were enrolled, and STR was considered successful if it reached 50% or complete STR (ST-segment back to the equipotential line). TIMI flow was evaluated after PPCI, and the primary outcome was two-year all-cause mortality. Results showed that each STR <50%, STR ≥50%, and complete STR occurred in 33.3% of the patients. Successful STR was the only independent predictor of 2-year death among all clinical factors. Combining TIMI flow and STR showed different 2-year mortality rates in subgroups; the lowest was seen in successful STR and TIMI 3 flow, the middle when either of these measures was decreased, and the greatest when both were abnormal. The study concluded that analyzing both STR and TIMI flow provides additional prognostic information beyond what either measure could provide. Therefore, it can be used as a reliable and convenient surrogate endpoint for determining successful PPCI. Additionally, the study found that post-PPCI STR is a strong long-term prognosticator for ST-segment elevation myocardial infarction.
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Kim, Byung Gyu, Sung Woo Cho, Jongkwon Seo, et al. "Effect of direct stenting on microvascular dysfunction during percutaneous coronary intervention in acute myocardial infarction: a randomized pilot study." Journal of International Medical Research 50, no. 9 (2022): 030006052211278. http://dx.doi.org/10.1177/03000605221127888.
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Objective Whether direct stenting (DS) without predilatation during primary percutaneous coronary intervention (PPCI) reduces microvascular dysfunction in patients with ST-elevation myocardial infarction is unclear. We performed a randomized study to assess the effect of DS on microvascular reperfusion. Methods Seventy-two patients undergoing PPCI were randomly assigned to the DS or conventional stenting (CS) with predilatation groups. The primary endpoint was the post-PPCI index of microcirculatory resistance (IMR). We compared thrombolysis in myocardial infarction myocardial perfusion (TMP) grades, ST-segment resolution, and long-term clinical outcomes between the groups. Results Microvascular reperfusion parameters immediately after PPCI (e.g., the IMR, TMP grade, and ST-segment resolution) were not different between the groups. However, significantly fewer patients in the DS group had the IMR measured because of no-reflow or cardiogenic shock during PPCI than those in the CS group. No differences were found in left ventricular functional recovery or clinical outcomes between the groups. Conclusions This trial showed no effect of DS on the IMR. However, our finding should be interpreted with caution because the number of patients who could not have the IMR measured was higher in the CS group than in the DS group. A larger randomized trial is required (Research Registry number: 8079).
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Akbari, Behnaz, Samad Ghaffari, Naser Aslanabadi, et al. "The impact of oral nicorandil pre-treatment on ST resolution and clinical outcome of patients with acute ST-segment elevation myocardial infarction undergoing primary coronary angioplasty: A randomized placebo controlled trial." Journal of Cardiovascular and Thoracic Research 12, no. 2 (2020): 90–96. http://dx.doi.org/10.34172/jcvtr.2020.16.
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Introduction : Literature has shown the effects of intravenous/intracoronary nicorandil on increased myocardial salvage in patients with ST-segment elevation myocardial infarction (STEMI) treated with mechanical reperfusion. However, the possible cardioprotective effect of oral nicorandil on the clinical outcome prior to primary coronary angioplasty is not well documented. Our aim was to assess the effect of oral nicorandil on primary percutaneous coronary intervention (PPCI). Methods: A total of 240 patients with acute STEMI undergoing PPCI were randomly assigned to oral nicorandil (Intervention, n=116) and placebo (Control, n=124) groups. The intervention group received 20 mg oral nicorandil at the emergency department and another 20 mg oral nicorandil in the catheterization laboratory just before the procedure. The control group received matched placebo. Our primary outcome was ST-segment resolution ≥50% one hour after primary angioplasty. Secondary outcome was in-hospital major adverse cardiovascular events (MACE), defined as a composite of death, ventricular arrhythmia, heart failure and stroke. Results: In the patients of intervention and control groups, the occurrence of ST-segment resolution ≥ 50% were 68.1% and 62.9% respectively, (P=0.27). In-hospital MACE occurred less frequently in the intervention group, compared to placebo group (11.2% vs. 22.5%, P=0.012). Conclusion: Although the administration of oral nicorandil before primary coronary angioplasty did not improve ST-segment resolution in patients with acute STEMI, its promoting effects was remarkable on in-hospital clinical outcomes.
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Ilia, Reuben, Guy Amit, Carlos Cafri, et al. "Reperfusion arrhythmias during coronary angioplasty for acute myocardial infarction predict ST-segment resolution." Coronary Artery Disease 14, no. 6 (2003): 439–41. http://dx.doi.org/10.1097/00019501-200309000-00004.
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Chen, Yuefeng, Michael Amponsah, and Cyril Nathaniel. "Simultaneous Multi-Vessel Very Late Stent Thrombosis in Acute ST-Segment Elevation Myocardial Infarction." Case Reports in Cardiology 2021 (December 30, 2021): 1–3. http://dx.doi.org/10.1155/2021/2658094.
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Simultaneous multi-vessel very later stent thrombosis (VLST) is a very rare complication of percutaneous coronary intervention (PCI). We present a case of simultaneous multi-vessel VLST as the cause of acute ST-segment elevation myocardial infarction (STEMI). PCI of the culprit vessel was performed at acute presentation. Resolution of in-stent thrombosis in non-culprit vessels was noted on coronary angiography 2 days later. Our case suggests that PCI for culprit lesion in acute setting may be a reasonable option for simultaneous multi-vessel VLST.
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Tanveer, Hayat, Arzu Jahanara, Walidur Rahman Mohammad, et al. "Association between ST-Segment Resolution Following Thrombolysis and Reperfusion of Infarct Related Artery in Coronary Angiogram in Patients with ST-Segment Elevation Myocardial Infarction." International Journal of Medical Science and Clinical Research Studies 04, no. 06 (2024): 1261–67. https://doi.org/10.5281/zenodo.12581027.
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<strong>Background:</strong> ST-segment elevation myocardial infarction (STEMI) is the most critical form of acute coronary syndrome as having the worst overall prognosis. Following thrombolysis, if it is possible to reliably predict about the reperfusion status by means of a non-invasive, readily available tool like ECG, it will help the clinicians to determine the quality of reperfusion and select the next strategy of management. The aim of the study was to assess angiographic findings of TIMI flow in infarct related artery (IRA), compared to the ranges of ST-segment resolution, and determine their association to predict reperfusion in IRA. <strong>Methods:</strong> Thiscross-sectional observational study was conducted in the department of Cardiology at National Institute of Cardiovascular Diseases (NICVD), Dhaka, for 12-months following ethical approval. A total of 116 adult patients with acute STEMI who underwent thrombolysis with streptokinase were enrolled by convenient sampling method after taking written informed consent. The percent resolution of ST-segment deviation from baseline to 60 minutes following thrombolysis was compared with angiographic IRA TIMI flow grade in index hospitalization. Detailed history, thorough clinical examination and necessary investigations were carried out in each patient and recorded in predesigned structured questionnaire. Data were analyzed by SPSS 26.0. <strong>Results: </strong>The mean age of the patients was 50.8 ± 8.8 years with male predominance (77.6%). Among all, 45.7% had >70% ST resolution followed by 29.3% had 30-70% and 25% had <30% ST resolution. Regarding TIMI grade flow, 59.1% had grade-3, 22.7% had grade-2 and 18.2% had grade 0 or 1. TIMI grade flow significantly increased with the increased ST-segment resolution. A cut off value of ST-segment resolution ≥57.5% (AUC=0.771, 95% CI=0.684-0.858, p<0.001) in the prediction of TIMI grade flow 3 showed 67.69% sensitivity, 66.67% specificity, 74.58% PPV, 58.82% NPV and 67.27% accuracy. Multivariate logistic regression shows that timing of thrombolysis, >70% ST resolution showed higher odds ratio and >70% ST resolution showed statistically significant p-value for predicting TIMI grade flow 2 or 3. <strong>Conclusion: </strong>ST-segment resolution in electrocardiogram following thrombolysis has significant positive association with TIMI flow of infarct related artery in coronary angiogram. However, further larger study is recommended.
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Heavener, T., M. Jepson, B. Bushe, S. Thotakura, and Ch Chiles. "A concurrent presentation of nonspecific colitis as well as likely myocarditis." Progress in Health Sciences 8, no. 1 (2018): 225–30. http://dx.doi.org/10.5604/01.3001.0012.1334.
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An ST-segment elevation myocardial infarction represents a time-sensitive cardiac pathology with utmost importance placed upon timely coronary angiography with percutaneous coronary intervention. While emphasis is placed on atherosclerotic or thrombotic coronary occlusion, it is important to recognize other etiologies which may present in a similar fashion. This case demonstrates a 71-year-old female patient with prior coronary artery disease and stenting who presented with acute abdominal pain and elevated cardiac biomarkers as well as ST-segment elevation on initial EKG. Coronary angiography revealed only mild to moderate coronary lesions and patent stents while echocardiography was essential unchanged from prior evaluation. Computed tomography of the abdomen would show findings suggestive of infectious colitis and empiric antibiotics led to full resolution of symptoms. While no definitive cause for her cardiac manifestations was discovered, the authors propose coronary vasospasm or myo-pericarditis as likely etiologies in response to an overwhelming inflammatory state. The case underscores the importance of formulating a comprehensive differential diagnosis during the initial workup of a ST-segment elevation myocardial infarction.
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Abdel, Raouf Fahmy, Taema Khaled, Mashhour Karim, El Naggar Ayman, and Khaled Hassan. "Impact of manual thrombus extraction on improving myocardial tissue level perfusion and left ventricular remodeling in ST segment elevation myocardial infarction: a prospective comparative study." Biolife 5, no. 4 (2022): 484–92. https://doi.org/10.5281/zenodo.7389934.
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<strong>ABSTRACT</strong> Background: Despite restoration of epicardial blood flow with primary PCI, microvascular obstruction with diminished myocardial perfusion occurs in large proportion of patients. Thrombus manual-aspiration seems to be practical for resolving these issues. Objective: Evaluate the effect of the Diver TMC.E., aspiration thrombectomy catheter as an adjunct to primary PCI on myocardial perfusion and left ventricular functional recovery and remodeling. Methods: We included 40 patients [57.8±9.3 year, 31 (77.5 %) males] with acute STEMI eligible for primary PCI. Patients were assigned to undergo either standard PCI (standard PCI group=control group) or PCI with thrombus aspiration (DiverCE thrombus-aspiration group=study group).Results: Both groups were comparable with no significant differences regarding demographic, clinical, echocardiographic, and angiographic parameters. The percent of thrombus burden reduction was significantly higher in study group (73.50 ± 19.13 %) compared to control group (50.75 ± 23.75 %) (P = 0.002). TIMI flow grade 3 was achieved in 100 % of the DiverCE group patients compared to 50% in control group, P = 0.001). Myocardial Blush Grading improved to 3 in 11 of study group compared to only 2 of control group patients (P=0.01). Complete ST segment resolution was achieved in 70% of study group compared to 35% of the control group patients (P = 0.047). The six months left ventricular end diastolic dimension and wall motion score index were significantly lower in the study group (4.97 ± 0.55 cm and 1.41 ± 0.20) compared to control group (5.49 ± 0.36 cm and 1.66 ± 0.16) (P = 0.001 and 0.044 respectively). Six months left ventricular ejection fraction was significantly higher in study group (56.95 ± 6.15 % Vs 52.10 ± 7.57 %) (P = 0.032). Conclusions: We concluded that manual thrombus extraction with Diver C.E. catheter as an adjunct therapy in primary PCI for STEMI is a simple, easy-to-use, non-time consuming, procedure which is effective in preventing distal embolization and microvascular obstruction improving myocardial tissue level perfusion and left ventricular remodeling at six months. <strong>Key words: </strong>STEMI, Primary PCI, Manual thrombus aspiration, Diver CE. <strong>REFERENCES</strong> Ito H, Maruyama A, Iwakura K, et al. Clinical implications of the 'no reflow' phenomenon. A predictor of comp-lications and left ventricular remodeling in reperfused anterior wall myocardial infarction. Circulation 1996;93:223-8. Stone GW, Peterson MA, Lansky AJ, Dangas G, Mehran R, Leon MB. Impact of normalized myocardial perfusion after successful angioplasty in acute myocardial infarction. Journal of the American College of Cardiology 2002; 39:591-7. Topol EJ, Yadav JS. 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Tsuchida, Keiichi, Norihito Nakamura, Satoshi Soda, et al. "Relationship Between Glucose Fluctuations and ST-Segment Resolution in Patients With ST-Elevation Acute Myocardial Infarction." International Heart Journal 58, no. 3 (2017): 328–34. http://dx.doi.org/10.1536/ihj.16-250.
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Deshmukh, Anand, Paul Turner, Suman Pasupuleti, et al. "Prognostic significance of reciprocal ST segment depression resolution in patients with acute ST elevation myocardial infarction." Cardiovascular Revascularization Medicine 13, no. 2 (2012): e7-e8. http://dx.doi.org/10.1016/j.carrev.2012.01.024.
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Boulos, Mariana, Yasmine Sharif, Nimer Assy, and Dawod Sharif. "Significance of Smoking in Patients with Acute ST Elevation Myocardial Infarction (STEMI) Undergoing Primary Percutaneous Coronary Intervention: Evaluation of Coronary Flow, Microcirculation and Left Ventricular Systolic Function." Hearts 5, no. 1 (2024): 182–95. http://dx.doi.org/10.3390/hearts5010012.
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In the thrombolytic care era, myocardial infarction in cigarette smokers was associated with better six-month outcomes compared to non-smokers. Aims: We tested the hypothesis that in patients with anterior myocardial infarction with ST-segment elevation (STEMI) treated with primary percutaneous coronary intervention (PPCI), cigarette smoking is associated with better coronary artery flow, myocardial perfusion, and left ventricular systolic function. Methods: Ninety-nine patients (sixty-six smokers) with anterior STEMI treated with PPCI were studied. Angiographic coronary artery flow TIMI grades, myocardial blush grades (MBGs) before and after PPCI, ST-segment elevation resolution, maximal troponin I and creatine phosphokinase blood levels, left ventricular echocardiographic systolic function as well as left anterior descending coronary artery (LAD) velocity parameters at admission and at discharge were evaluated. Results: Smokers and non-smokers were treated similarly. In smokers, the age was significantly younger, 54 ± 10, compared to non-smokers, 71.8 ± 10 years, p < 0.05, and had a lower prevalence of women, 13.6% compared to 36.6%. TIMI and MBG before and after PPCI were similar between smokers and non-smokers. Smokers had a lower prevalence of complete ST elevation resolution, 33% compared to 50% in non-smokers. Diastolic LAD velocity and integral were lower in smokers, p < 0.05. Maximal biomarker blood levels as well as LV systolic function at admission and on discharge were similar. Conclusions: Cigarette smokers with anterior STEMI treated with PPCI were younger with a lower prevalence of women and of complete ST elevation resolution and had lower LAD diastolic velocity and integral late after PPCI. However, angiographic parameters and LV systolic function parameters were similar.
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Shah, Rahman, Scott J Duncan, and Kodangudi B Ramanathan. "ST-Segment Elevation in Patients With Cocaine Abuse and Chest Pain." Acute Medicine Journal 13, no. 2 (2014): 72–73. http://dx.doi.org/10.52964/amja.0347.
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Use of cocaine may complicate the diagnosis of myocardial infarction (MI) and may influence treatment strategy. Patients with symptoms suggestive of acute coronary syndrome (ACS) should be questioned about the use of cocaine. Initial management of cocaine users presenting with chest pain and ST segment elevation should include administration of glyceryl trinitrate (GTN). Assessment for resolution of chest discomfort and ECG changes should be undertaken before fibrinolytic therapy or angiography is considered. We present a case of patient with chest pain (CP) and ST elevation after cocaine use, whose symptoms and ST changes promptly resolved after medical therapy. Our case highlights the importance of medical therapy in patient with CP and ST elevation after cocaine abuse, before activating cardiac catheterization laboratory for emergent angiography.
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Reingardienė, Dagmara, Jolita Vilčinskaitė, and Diana Bilskienė. "Brugada-Like Electrocardiographic Patterns Induced by Hyperkalemia." Medicina 49, no. 3 (2013): 24. http://dx.doi.org/10.3390/medicina49030024.
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Brugada syndrome was described in 1992 as a new clinical and electrocardiographic syndrome involving susceptibility to ventricular arrhythmias and sudden cardiac death in patients with no obvious structural heart disease. Brugada syndrome is characterized by a hereditary anomaly in the sodium ion channel (mutation of the SCN5A gene) identified by a wide QRS associated with the ST-segment elevation and the T‑wave inversion in the right precordial leads. The Brugada-like electrocardiographic pattern can be caused by sodium channel-blocking drugs and electrolyte disorders. Hyperkalemia may produce multiple ECG abnormalities, including the ST-segment elevation and pseudomyocardial infarction with a resolution of these abnormalities after the correction of hyperkalemia. This article describes 8 cases of pseudoanteroseptal myocardial infarction in acute renal insufficiency with hyperkalemia. The ST-segment elevation related to hyperkalemia is resolved by the reduced serum potassium level. Clinicians should recognize that hyperkalemia is one of the etiologies of the Brugada-like electrocardiographic pattern.
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Ben Hamda, Khaldoun, Walid Jomaa, F. Moatemeri, Sonia Hamdi, M. Amine Majdoub, and Faouzi Maatouk. "063 Predictive factors of ST-Segment resolution after primary angioplasty for acute myocardial infarction." Archives of Cardiovascular Diseases Supplements 3, no. 1 (2011): 20–21. http://dx.doi.org/10.1016/s1878-6480(11)70065-9.
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Nicolau, José C., Lilia N. Maia, J. oão Vítola, et al. "ST-segment resolution and late (6-month) left ventricular remodeling after acute myocardial infarction." American Journal of Cardiology 91, no. 4 (2003): 451–53. http://dx.doi.org/10.1016/s0002-9149(02)03245-9.
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Adlbrecht, Christopher, Diana Bonderman, Christian Plass, et al. "Active endothelin is an important vasoconstrictor in acute coronary thrombi." Thrombosis and Haemostasis 97, no. 04 (2007): 642–49. http://dx.doi.org/10.1160/th06-08-0479.
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SummaryAcute coronary syndrome is characterized by compromised blood flow at the epicardial and microvascular levels. We have previously shown that thrombectomy in ST-elevation myocardial infarction (STEMI) accelerates ST-segment resolution, possibly by preventing distal embolization. We hypothesized that thrombus constituents contribute to microcirculatory dysfunction. Therefore, we analyzed the molecular and cellular composition of acute coronary thrombi, and correlated vasoconstrictive mediators with the magnitude of ST-segment resolution within one hour of percutaneous coronary intervention (PCI). Fresh coronary thrombi were retrieved in 35 consecutive STEMI patients who were treated with the X-Sizer thrombectomy catheter, and thrombus cell counts and vasoconstrictor concentrations were assessed. Twelve-lead ECG recordings were analyzed prior to and one hour after PCI. Concentration of endothelin (ET) was 20.0 (7.9–52.2) fmol/ml in thrombus compared with 0.1 (0.1–0.3) fmol/ml in corresponding peripheral plasma (p<0.0001), representing a selective 280 (70.0–510.0)- fold enrichment, exceeding enrichment of noradrenaline, angiotensin II and serotonin. Human coronary thrombus homogenates exerted vasoconstriction of porcine coronary artery rings that was inhibited by the dual ET receptor blocker tezosentan. Extracted ET (r=0.523 p=0.026) and number of leukocytes (r=0.555 p=0.017) were correlated with the magnitude of STsegment resolution. In conclusion, the amount of active ET and white blood cells aspirated from STEMI target vessels correlated with improvement of territorial microcirculatory function as illustrated by enhanced ST-segment resolution.
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Li, Chun-Mei, Xing-Hua Zhang, Xiao-Jing Ma, and Xing-Lei Zhu. "Relation of corrected thrombolysis in myocardial infarction frame count and ST-segment resolution to myocardial tissue perfusion after acute myocardial infarction." Catheterization and Cardiovascular Interventions 71, no. 3 (2008): 312–17. http://dx.doi.org/10.1002/ccd.21376.
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M. S., Ravishankar, and Harish Kumar S. "ST elevated myocardial infarction: clinical manifestation and outcomes of thrombolysis in a tertiary care hospital." International Journal of Advances in Medicine 5, no. 4 (2018): 1003. http://dx.doi.org/10.18203/2349-3933.ijam20183137.
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Background: Acute myocardial infarction has reached enormous proportion in the developing countries and it is speculated that atherosclerotic heart disease will replace infectious disease as the leading cause of death in India. It has been shown that the thrombolytic therapy is underutilized. So, the study was taken to study the clinical manifestations and outcome of thrombolytic therapy in STEMI.Methods: The study was conducted for a period of 18 months in a tertiary care centre during which 100 cases of STEMI admitted to ICCU were included in the study, after fulfilling the inclusion criteria for thrombolysis, data related to clinical profile and outcome of thrombolysis was collected. SPSS 16 was used to analyse the data. Descriptive statistics like proportions mean and SD were computed.Results: Incidence of STEMI was high among subjects in the age group 51-60 years. Males were more affected (72%). Smoking, hypertension, hyperlipidemia and diabetes mellitus were the most common risk factors. Chest pain (92%) was the most common symptom. Majority (56%) were admitted within 6 hours of onset of symptoms. Anterior wall infarction was most common type of myocardial infarction. Majority (82%) were admitted in either Killips I/II class. Left Ventricular failure and Arrhythmias were most common complication. 64% patients had objective evidence in a form of ECG with ST-T resolution (>50%) between 1-6 hours, 18% between 6-24 hours and 18% patients had no significant resolution even after 24 hours. Echocardiography showed good left ventricle function (LVEF >45%) in 70% and 30% of the patients showed reduced ejection fraction (LVEF<45%). Mortality was seen in 8% of cases.Conclusions: Smoking, hyperlipidemia, diabetes mellitus and hypertension were most important risk factors for MI in the study. Coronary pain relief was most frequent and early marker of reperfusion. The ST segment elevation resolution has been widely accepted as most reliable objective criteria of coronary reperfusion. Hence ST segment resolution is regarded as a marker of salvaged myocardium by post-thrombolytic reperfusion. Early reperfusion of the ischaemic myocardial tissue with thrombolytic therapy decreases the morbidity and mortality.
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Gibson, C. Michael, Juhana Karha, Robert P. Giugliano, et al. "Association of the timing of ST-segment resolution with TIMI myocardial perfusion grade in acute myocardial infarction." American Heart Journal 147, no. 5 (2004): 847–52. http://dx.doi.org/10.1016/j.ahj.2003.11.015.
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Masci, Pier Giorgio, Javier Ganame, Elisabetta Strata, et al. "Myocardial Salvage by CMR Correlates With LV Remodeling and Early ST-Segment Resolution in Acute Myocardial Infarction." JACC: Cardiovascular Imaging 3, no. 1 (2010): 45–51. http://dx.doi.org/10.1016/j.jcmg.2009.06.016.
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Rahman, Md Hasanur, Syeda Fahmida Afrin, Md Aminul Islam, Md Saqif Shahriar, Md Abu Zahid, and Mohammad Badiuzzaman. "Comparison of ST-segment resolution influencing in hospital outcome after primary percutaneous coronary intervention and fibrinolysis (with streptokinase) in patients with acute ST-segment elevation myocardial infarction." Bangladesh Journal of Medical Science 15, no. 2 (2016): 252–56. http://dx.doi.org/10.3329/bjms.v15i2.28794.
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Background: Coronary artery disease (CAD) is the most common cause of mortality & morbidity in all over the world. Reperfusion therapy is the cornerstone for treating acute ST-segment elevation myocardial infarction. Effective reperfusion in STEMI can be achieved by either fibrinolysis or primary percutaneous coronary intervention (PPCI). PPCI generally produces better outcomes than fibrinolysis but is not widely available. ST-segment abnormalities play a fundamental role in assessment and decision making for patients with STEMI. Methods: This quasi-experimental study was conducted in the Department of Cardiology, National Heart Foundation Hospital and Research Institute. Group I underwent primary PCI and group II received fibrinolytic therapy as reperfusion therapy for acute STEMI.Results: The mean ST-segment resolutions were significantly more in group I than group II at 60 minutes (63.54±20.98 vs 33.97±15.88%, p<0.001) and at 90 minutes (73.15±18.76 vs 60.06±23.33%, p<0.015). However the difference is not significant at 180 minutes after procedure (74.48±18.09 vs 65.33±21.20%, p=0.064). In our study we observed that significantly higher number of patients of group II developed acute LVF (33.3% vs 6.1%, p=0.005) and cardiogenic shock (18.2% vs 3.0%, p=0.046) than group I and Rescue PCI was needed in 5 (15.2%% vs 0%, p=0.020) patients of group II than group I. Conclusion: ST-segment resolution occurs earlier and more completely after Primary percutaneous coronary intervention than fibrinolysis (with Streptokinase) with better in hospital outcome in patients with acute STEMI.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.252-256
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Cao, Mingkun, Zhiyong Wang, Xiujie Meng, et al. "Effects of intracoronary low-dose prourokinase administration on ST-segment elevation in patients with myocardial infarction and a high thrombus burden: a randomized controlled trial." Journal of International Medical Research 50, no. 12 (2022): 030006052211397. http://dx.doi.org/10.1177/03000605221139723.
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Objective To evaluate the efficacy and safety of low-dose prourokinase (pro-UK) administration during primary percutaneous coronary intervention (PCI) for the treatment of acute ST-segment elevation myocardial infarction (STEMI) in patients with a high thrombus burden. Methods A prospective, randomized controlled trial was conducted at the Inner Mongolia People’s Hospital, China. Patients with STEMI and a high thrombus burden who underwent thrombus aspiration and primary PCI were randomly allocated to pro-UK administration or control groups. The primary endpoint was corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Results There were no significant differences in the baseline demographics or clinical characteristics of the two groups. The CTFC, tissue myocardial perfusion grade, ST-segment resolution, and myocardial blush grade of the pro-UK group were significantly better than those of the control group. In addition, after 30 days of follow-up, the pro-UK group had better cardiac function and perfusion than the control group. There were no differences in the clinical outcomes or incidence of hemorrhage. Conclusions Intracoronary low-dose pro-UK improves myocardial perfusion and cardiac function in patients with a high thrombus burden. Major hemorrhages still occur in patients administered pro-UK, but are no more frequent. Study registration: Chinese Clinical Trial Registry (ChiCTR1900022290).