Acute myocardial infarction

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A semiparametric Bayesian joint model for multiple mixed type outcomes: an application to acute myocardial infarction

A semiparametric Bayesian joint model for multiple mixed type outcomes: an application to acute myocardial infarction

Abstract We propose a Bayesian semiparametric regression model to represent mixed-type multiple outcomes concerning patients affected by Acute Myocardial Infarction. Our approach is motivated by data coming from the ST-Elevation Myocar- dial Infarction (STEMI) Archive, a multi-center observational prospective clinical study planned as part of the Strategic Program of Lombardy, Italy. We specifically consider a joint model for a variable measuring treatment time and in-hospital and 60-day survival indicators. One of our main motivations is to understand how the various hospitals differ in terms of the variety of information collected as part of the study. To do so we postulate a semiparametric random effects model that incorpo- rates dependence on a location indicator that is used to explicitly differentiate among hospitals in or outside the city of Milano. The model is based on the two parameter Poisson-Dirichlet prior, also known as the Pitman-Yor process prior. We discuss the
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TítuloIn hospital mortality due to acute myocardial infarction: relevance of type of hospital and care provided: RECALCAR study

TítuloIn hospital mortality due to acute myocardial infarction: relevance of type of hospital and care provided: RECALCAR study

The objective of the RECALCAR project is to investigate the relationship between organizational and administrative aspects of the cardiology units of the Spanish National Health Service (NHS) and patient outcomes. Among other activities, RECALCAR has analyzed the episodes of discharges from NHS hospitals recorded in the minimum basic data set in 2009-2010. In this article, we report the results obtained from the use of the minimum basic data set concerning the relationship between the characteristics of the hospital, the care provided (clinical services and procedures), and the in-hospital mortality due to acute myocardial infarction (AMI).
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EMMPRIN targeted magnetic nanoparticles for In vivo visualization and regression of acute myocardial infarction

EMMPRIN targeted magnetic nanoparticles for In vivo visualization and regression of acute myocardial infarction

Inhibition of extracellular matrix (ECM) degradation may represent a mechanism for cardiac protection against ischemia. Extracellular matrix metalloproteinase inducer (EMMPRIN) is highly expressed in response to acute myocardial infarction (AMI), and induces activation of several matrix metalloproteinases (MMPs), including gelatinases MMP-2 and MMP-9. We targeted EMMPRIN with paramagnetic/fluorescent micellar nanoparticles conjugated with the EMMPRIN binding peptide AP-9 (NAP9), or an AP-9 scrambled peptide as a negative control (NAPSC). We found that NAP9 binds to endogenous EMMPRIN in cultured HL1 myocytes and in mouse hearts subjected to ischemia/reperfusion (IR). Injection of NAP9 at the time of or one day after IR, was enough to reduce progression of myocardial cell death when compared to Control and NAPSC injected mice (infarct size in NAP9 injected mice: 32% ± 6.59 vs Control: 46% ± 9.04 or NAPSC injected mice: 48%±7.64). In the same way, cardiac parameters were recovered to almost healthy levels (LVEF NAP9 63% ± 7.24 vs Control 42% ± 4.74 or NAPSC 39% ± 6.44), whereas ECM degradation was also reduced as shown by inhibition of MMP-2 and MMP-9 activation. Cardiac magnetic resonance (CMR) scans have shown a signal enhancement in the left ventricle of NAP9 injected mice with respect to non-injected, and to mice injected with NAPSC. A positive corre- lation between CMR enhancement and Evans-Blue/TTC staining of infarct size was calculated (R:0.65). Taken together, these results point to EMMPRIN targeted nanoparticles as a new ap- proach to the mitigation of ischemic/reperfusion injury.
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Effects of Verapamil on Indexes of Heart Rate Variability After Acute Myocardial Infarction

Effects of Verapamil on Indexes of Heart Rate Variability After Acute Myocardial Infarction

In patients with previous myocardial infarction (MI), de- pressed heart rate variability (HRV) may reflect a reduc- tion in vagal activity and lead to cardiac electrical insta- bility. Interventions designed to increase HRV may be of clinical interest. Data on the effects of calcium antago- nists on HRV in post-MI patients are very limited. The aim of our study was to assess the effects of verapamil on HRV and on the sympathovagal balance after MI. Fifty consecutive patients with a first MI, stable sinus rhythm, and left ventricular ejection fraction >0.40 were studied. Each patient underwent two 24-hour Holter recordings, 1 at baseline and another after 4 days of treatment with verapamil retard (180 mg 2 times daily). Time and frequency domain parameters of HRV were analyzed. All time domain measurements increased sig- nificantly after verapamil: the standard deviation of all NN intervals (SDNN) from 87.1 6 31.4 to 98.1 6 30.3 ms (p <0.05) and the log-transformed percentage of pairs of adjacent NN intervals that differ >50 ms (pNN50) from 0.57 6 0.42 to 0.76 6 0.45 (p <0.01). The standard deviation of the averages of RR interevals (SDANN) (75.9 6 30.1 vs 86.3 6 29.4 ms, p <0.05),
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Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.

Initial complications and factors related to prehospital mortality in acute myocardial infarction with ST segment elevation.

Contributors FR-O and FJM-V conceived the study, designed the trial, obtained research funding and take responsibility for the paper as a whole. PFdV provided statistical advice on study analysis. JGdÁ y ÁG-A contributed substantially to progress of the global project, including the feasibility of the registry, and on the fi nal manuscript revision. All authors included in list of the Acute Cardiac Care Group of EPES* undertook supervision of recruitment of participating centres, patients and managed the data, including quality control and data collection. All authors approve the version submitted Acute Cardiac Care Group of EPES* MM-L (Málaga), IG-L(Cádiz), MdMR-M (Sevilla), IVD(Almería), FR-M ( Jaén).
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Myocardial Rupture in Acute Myocardial Infarction: Mechanistic Explanation Based on the Ventricular Myocardial Band Hypothesis

Myocardial Rupture in Acute Myocardial Infarction: Mechanistic Explanation Based on the Ventricular Myocardial Band Hypothesis

In all three cases, the ventricular rupture was correlated with the distribution of the segments of the VMB. In case 1 (60-year-old female) with anterior myocardial infarction and complex rupture of the IVS, the trans- esophageal echocardiogram (TEE) showed a separa- tion of the descending and ascending segments of the myocardial band due to a septal hemorrhagic dissec- tion. Figure 5 shows the correlation of the TEE with the segments of the VMB marked in a porcine specimen.

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Vitamin D, precocious acute myocardial infarction, and exceptional longevity

Vitamin D, precocious acute myocardial infarction, and exceptional longevity

2 Recent studies have reported low circulating levels of 25-hydroxyvitamin D (25(OH)D), the biologically active form of vitamin D, in patients with cardiovascular disease (CVD) [1], hypertension [2], carotid atherosclerosis [3], atrial fibrillation [4], and heart failure [5]. Moreover, vitamin D deficiency has been associated with all-cause mortality [6,7] and predicts adverse cardiac events in patients with established CVD [8] or after acute myocardial infarction (AMI) [9]. In turn, vitamin D supplementation improves the modulation of autonomic tone [10].
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Fibrilacin auricular isqumica

Fibrilacin auricular isqumica

Atrial fibrillation is the most common arrhythmia in the peri-acute myocardial infarc- tion period, although its presence associated only to the acute phase of ischemia and its immediate cessation after early and effective revascularization is anecdotal in the literature, with a consequent lack of evidence for further treatment. A clinical case in which early coronary intervention managed to achieve a cardioversion of atrial fibrillation to sinus rhythm during an acute myocardial infarction is reported. Subse- quently, it is discussed the strategy that must be followed with regard to arrhythmia in a patient with good clinical outcome after the event.
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Cierre percutneo primario del defecto del tabique  interventricular postinfarto con el dispositivo de Amplatzer: resultados inmediatos y seguimiento a largo plazo

Cierre percutneo primario del defecto del tabique interventricular postinfarto con el dispositivo de Amplatzer: resultados inmediatos y seguimiento a largo plazo

3. Crenshaw BS, Granger CB, Birnbaum Y, Pieper KS, Morris DC, Kleiman NS et al. Risk factors, angiographic patterns, and outcomes in patients with ventricular septal defect com- plicating acute myocardial infarction. GUSTO-I (Global utili- zation of streptokinase and TPA for occluded coronary arte- ries) trial investigators. Circulation. 2000; 101: 27-32. 4. Slater J, Brown RJ, Antonelli TA, Menon V, Boland J, Col J

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Antagonistas aldosterónicos en el tratamiento del ventrículo derecho sistémico. Estudio evedes: ensayo clínico aleatorizado y doble ciego

Antagonistas aldosterónicos en el tratamiento del ventrículo derecho sistémico. Estudio evedes: ensayo clínico aleatorizado y doble ciego

After one year of treatment, a trend toward reduction of CICP, NT- proMMP1, TIMP1 and galectin 3 levels and a lower increase in ICTP in patients under eplerenone when compared to placebo was observed. The sub-analysis excluding patients on ACEi strengthened this ten- dency with NT-proMMP1 reaching statistical significance. A reduction of markers of collagen synthesis in patients under treatment with eplerenone has been previously reported in patients with systemic left ventricle. In the previously mentioned sub-study of the EPHESUS trial [29] (in which the addition of eplerenone to optimal medical therapy re- duced morbidity and mortality among patients with acute myocardial infarction complicated by left ventricular dysfunction and heart failure), levels of aminoterminal propeptide of type I and type III procollagen were found to be significantly lower in the eplerenone group beginning at 6 months after the index hospitalization. In a recent trial on patients with heart failure with preserved ejection fraction, Deswal et al. [35] showed a reduction of procollagen type I aminoterminal peptide and ICTP along with an improvement in echocardiographic measures of diastolic function in the eplerenone group.
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El ndice leucoglucmico es un predictor de mortalidad por todas las causas al ao en pacientes cubanos con infarto agudo de miocardio con elevacin del segmento ST

El ndice leucoglucmico es un predictor de mortalidad por todas las causas al ao en pacientes cubanos con infarto agudo de miocardio con elevacin del segmento ST

The results from this work support the theoretical and practical basis of the leuko-glycaemic index as a predictor of adverse events per year, in the context of acute myocardial infarction. Its simplicity, wide availability, low cost and the fact of being part of the paraclinical routine examinations performed at ad- mission, in patients with acute coronary syndrome, further support its potential application in early risk stratification. Future larger samples multi-center studies are necessary to confirm our observations, as well as the prognostic capacity of the leucogly- caemic index in association with risk scales.
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Alteraciones de la perfusin miocrdica y marcadores de inflamacin en pacientes con infarto agudo al miocardio tratados con angioplasta primaria

Alteraciones de la perfusin miocrdica y marcadores de inflamacin en pacientes con infarto agudo al miocardio tratados con angioplasta primaria

Background: Microcirculatory dysfunction dur- ing acute myocardial infarction is mediated by various mechanisms including inflammation, thrombus, or plaque embolization. We hypothe- size that patients with acute myocardial infarc- tion and admission Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grade (TMP) < 2 had increased inflammatory status as measured by high sensitivity C-reactive protein (hs-CRP). Methods: From January 2002 to De- cember 2003, 166 patients (178 lesions) were referred for primary percutaneous coronary in- tervention. Patients were stratified based on pre- PCI TMP < 2 or TMP ³ 2. Univariate and multi- variate predictors of in-hospital and 30-day death were determined with logistic regression. Re- sults: Pre-PCI TMP < 2 was found in 66% vs 34% with TMP ³ 2 (P < .001). Hs-CRP levels were high in both groups but not significantly different (37.9 ± 6 vs 33.7 ± 6 mg/L, P = .63). Patients with TMP < 2 had higher WBC (12.83 ± 4.55 · 10 -3 vs 10.83 ± 3.00 · 10 -3 , P = .04), lower
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Fenómeno de no reflow, una complicación frecuente en la revascularización del infarto. Caso clínico

Fenómeno de no reflow, una complicación frecuente en la revascularización del infarto. Caso clínico

7. Jacquier A, Boussel L, Amabile N, Bartoli JM, Douek P, Moulin G, et al. Multidetector computed tomography in reperfused acute myocardial infarction. Assessment of infarct size and no-reflow in comparison with cardiac magnetic resonance imaging. Invest Radiol. 2008 Nov;43(11):773-81. 8. Sarwar A, Shapiro MD, Nasir K, Nieman K, Nomura CH, Brady TJ, et al. Evaluating global and regional left ventricular function in patients with reperfused acute myocardial infarction by 64- slice multidetector CT: a comparison to magnetic resonance imaging. J Cardiovasc Comput Tomogr. 2009;3(3):170-7.
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Hemorragia intramiocrdica en el infarto miocrdico con reperfusin espontnea

Hemorragia intramiocrdica en el infarto miocrdico con reperfusin espontnea

Objective. The presence of intramyocardial hemorrhage (IMH) is frequent in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary interven- tion (PPCI). We aim for the presence IMH using cMRI in pa- tients who presented AMI and did not undergo PPCI or thrombolysis. Cardiac magnetic resonance has proven to be a highly sensitive method for detect its presence in the ischemic damaged tissue. Material and methods. Patients admitted with diagnosis of ST elevation myocardial infarction > 24 h after initial presentation and without reperfusion therapy were enrolled in the study. All patients underwent cardiac magnetic resonance for detecting edema, microvascular ob- struction and intramyocardial hemorrhage, followed by coro- nary angiography. Results. Seven male patients, with median age of 53 years, were enrolled. Cardiac magnetic resonance showed that all patients had microvascular obstruction and edema. Two of them had intramyocardial hemorrhage in as- sociation with spontaneous reperfusion demonstrated by an- giography. Conclusion. The results of our study show that in patients with acute myocardial infarction, intramyocardial hemorrhage occurs not only after therapeutic, but also after spontaneous reperfusion. This is the first time that its pres- ence is demonstrated by cardiac magnetic resonance.
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Coronary thrombus: pathophysiology and consequences

Coronary thrombus: pathophysiology and consequences

Extensive research in vascular biology over the past few decades has substantially advanced our knowled- ge of the pathophysiology of atherosclerosis and athe- ro-thrombosis. Th e role of the endothelium in maintai- ning vascular health and the link between endothelial dysfunction and atherosclerosis has been verifi ed. Th e systemic nature of endothelial dysfunction leading to localized manifestations of atherosclerosis, exacerbated by infl ammation is now appreciated. Th e clinical mani- festations of acute coronary syndromes and chronic is- chemic coronary artery disease are ultimately a conse- quence of these processes. Th e evolution of the acute co- ronary syndromes is particularly related to the develop- ment of intravascular athero-thrombotic disease invol- ving the epicardial coronary vasculature. Th e recogni- tion of these thrombogenic processes and their sequelae is essential to the management of these syndromes.
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Anuario 2012: La terapia celular en la enfermedad cardiovascular  Las revistas de las Sociedades Nacionales presentan una seleccin de las investigaciones que han impulsado avances recientes en Cardiologa Clnica

Anuario 2012: La terapia celular en la enfermedad cardiovascular Las revistas de las Sociedades Nacionales presentan una seleccin de las investigaciones que han impulsado avances recientes en Cardiologa Clnica

differences between mammalian and fish hearts may not necessarily apply early in development. Using approaches from the zebrafish model, the authors resected the left ventricular (LV) apex of 1-day-old neonatal mice and observed a brisk regenerative res- ponse similar to that in the adult zebrafish. By 3 weeks after injury, the defect had been replaced by normal myocardial tissue, which showed normal contractile function by 8 weeks. Genetic fate-mapping studies indicated that this regeneration was mediated by the proliferation of pre-existing cardiomyocytes, again as in the zebrafish. Notably, this regenerative capacity was not observed in 7-day-old mice, suggesting that its loss may coincide with cardiomyocyte binu- cleation and reduced cell-cycle activity. Nonetheless, this study indicates that zebrafish-like regenerative mechanisms are latent in mammalian hearts. It also provides a genetically tractable model for dissecting the blocks to these mechanisms in the mammalian adult.
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Miocardiopatía takotsubo. Una entidad clínica con varios interrogantes

Miocardiopatía takotsubo. Una entidad clínica con varios interrogantes

Takotsubo cardiomyopathy(TCM) is a curious clinical entity characterized by tran- sient left ventricular dysfunction usually involving the antero apical and infero api- cal regions of the myocardium in the absence of signifi cant coronary artery disea- se. The syndrome often presents with chest pain and/or dyspnea, dynamic reversible ST-T segment abnormalities, and mildly increased cardiac enzymes disproportiona- te to the extent of wall motion abnormalities. Most patients are usually elderly wo- men and there is often a signifi cant mental or physical stress preceding the appea- rance of symptoms. Common triggers that have been identifi ed include the death of a loved one, becoming a victim of theft, the experience of a great loss such as with gambling, a surprise party or severe illness (hospitalization in an intensive care unit), etc. In others, an acute neurologic event, most commonly a subarachnoid hemorr- hage is the precipitating event. While elevated catecholamine levels have been sug- gested as a signifi cant pathophysiologic mechanism in most patients, in others, the pathophysiology is unknown as well as how elevated catecholamines alter left ven- tricular function. Since it was fi rst described in 1991, multiple articles have been pu- blished on this subject. However, several aspects of the disease remain unresolved. These revolve around its incidence, pathophysiology, the diagnostic criteria used to defi ne it and its appropriate management.
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Estado del arte de la tromblisis intracoronaria

Estado del arte de la tromblisis intracoronaria

Intracoronary thrombolisis was widely used to treat coronary thrombosis when coronary angioplasty was not yet a standard therapy. Later on, systemic thrombolysis proved to have the same effectiveness, besides easier to carry on, therefore the fi rst method was discontinued. Primary percutaneos coronary angioplasty was then established as the best treatment for patients with ST- myocardial infarction. Recently it has been determined that intracoronary thrombolysis is useful in some specifi c cases. It is also thought that it can have an important role in preventing and treating the no-refl ow phenomenon and other embolic complications.
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Experiencia con el uso del stent bioactivo cubierto con titanio xido ntrico comparado con stent liberador de zotarolimus en pacientes no diabticos portadores de cardiopata isqumica: anlisis comparativo y seguimiento a 12 meses

Experiencia con el uso del stent bioactivo cubierto con titanio xido ntrico comparado con stent liberador de zotarolimus en pacientes no diabticos portadores de cardiopata isqumica: anlisis comparativo y seguimiento a 12 meses

Objective: To compare clinical outcomes in terms of fre- quency of mayor adverse cardiovascular events (MACE) between bioactive stent (BAS) and drug eluting stent (DES) in nondiabetic patients (pts.) with ischemic heart disease at 12-months follow-up. Material and methods: We included 529 non-diabetic patients, with ischemic cardiopathy diagnosis, who underwent percutaneous coronary interventions. For analysis, they were divided into two arms: 233 patients in the DES groups, whilst 296 in the BAS group. Results: Analysis to 12 months reported no statistically signifi cant difference in no intervention of the lesion and / or vessel treated (TLR and TVR) between the two arms: 7.0 versus 2.6% and 2.3 versus 1.5% DES versus BAS respectively. The frequency of myocardial infarction (MI) was lower in DES 0.9 versus 1.9% BAS; p = NS. No case of stent thrombosis (ST) was observed in the DES and only 1 event in the BAS (0.33%); p = NS. Treatment of dual antigregation platelet therapy (DAPT) 3, 6 and 12 months BAS versus DES was 37.4 versus 0%, 62.6 versus 26.3%, 0 versus 73.7% respectively but with shorter periods of DAPT for BAS 7.1 ± 4.2 versus DES 11.1 ± 2.5 months; p = 0.0001. Conclusion: In this study, no differences were found in clinical outcomes at 12 months in nondiabetic patients who received DES or BAS. The overall risk of ST was very low in both groups demons- trating safety of bioactive stent in nondiabetic patients.
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Hiperglucemia como factor pronstico de complicaciones intrahospitalarias en el infarto agudo de miocardio con supradesnivel del segmento ST

Hiperglucemia como factor pronstico de complicaciones intrahospitalarias en el infarto agudo de miocardio con supradesnivel del segmento ST

ening of the QT interval, reduces ischemic precondi- tioning, increases non-reflux, depresses myocardial contractility and increases local and systemic in- flammatory degree. Even in STEMI patients referred to PCI, hyperglycemia also has a worse short-term prognostic significance, regardless of whether they have diabetes. The results of these and other studies allow us to assuredly state that hyperglycemia im- plies a worse outcome not only in patients with known diabetes, but also in those without a history of diabetes mellitus. Consequently, hyperglycemia has recently been considered as an independent risk factor in the prognostic assessment of patients with ACS 13 . In view of the above, it was decided to carry out the following study, essentially aimed at demonstrating the importance of hyperglycemia as a risk factor for in-hospital complications in patients with STEMI.
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