Rates Of Acute Coronary Events And All Cause Mortality In Patients With Stable Coronary Artery Disease (Cad) After Myocardial Infarction And Additional Cardiovascular Risk Factors
Shannon DeVoreCarl MellströmPhillip R. HuntDavid M. KernOzgur TunceliBingcao WuMogens WestergaardNiklas Hammar
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Stroke
Clinical endpoint
Acute coronary syndrome is a major cause of morbidity and mortality worldwide.Although acute coronary syndrome is usually the disease of people over 45 years old, a number of younger patients are also diagnosed with acute coronary syndrome.Besides atherosclerosis, non-atherosclerotic causes of acute coronary syndrome should also be considered during diagnosis.In this paper, we reviewed all causes of the acute coronary syndrome in the young adults.
Coronary disease
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Variations in the ratio of "definite" to "possible" myocardial infarction for non-fatal cases were examined in studies that used World Health Organization criteria. There were large variations in this ratio, variations which appeared to be due to differences in the ascertainment of non-fatal cases of "possible" myocardial infarction, which, in turn, contributed to reported differences in the incidence of myocardial infarction. A significant proportion of cases of "possible" myocardial infarction probably do not have ischemic heart disease at all, since, in our data, cases of "possible" myocardial infarction (non-fatal) with a hospital discharge diagnosis of chest pain (undiagnosed) had a risk of death that was no worse than that in the general population. Thus the most reproducible, and possibly most accurate estimates of the incidence of myocardial infarction may come from including only fatal cases of "possible" myocardial infarction with both fatal and non-fatal cases of "definite" myocardial infarction.
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Objective To analyze the clinical characteristics of atypical acute myocardial infarction,improve the diagnosis of myocardial infarction. Methods To analyze the main clinical characteristics of the patients with atypical acute myocardial infarction in our hospital in the past 3 years ,which compared to the typical acute myocardial infarction. Results Atypical acute myocardial infarction includes atypical symptom and atypical ECG, atypical symptoms is more prevail. Compared with typical acute myocardial infarction, the women, elderly people and hypertension patients is more common, fewer anterior myocardial infarction and poorer prognosis ( P ＜ 0.05 ). Conclusion To improve the understanding of atypical acute myocardial infarction,was benefit of reducing the misdiagnosis and mistreatment of acute myocardial infarction.
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Myocardial infarction
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Background/aims Acute coronary syndrome is a serious possible cause of chest pain, but detection rates at initial triage are low. This study evaluated the TRIGGER score as a tool for identifying patients with acute coronary syndrome who present to the emergency department with chest pain. Methods Data from 100 patients who presented to the emergency department with chest pain in February 2019 (before implementation of the TRIGGER score) were compared to 100 patients who presented in February 2020 (after implementation of the TRIGGER score). The proportion of patients with a final diagnosis of acute coronary syndrome was calculated and the predictive value of the TRIGGER score for acute coronary syndrome was evaluated. Results The majority of patients with a TRIGGER score of 9 or higher (actioning urgent referral) were found to have acute coronary syndrome or another cardiac condition. Overall, 50% of patients with a score of 10, 67% of patients with a score of 11 and 75% of patients with a score over 11 were found to have acute coronary syndrome. Overall, the TRIGGER score had 84.0% sensitivity and 81.7% specificity for acute coronary syndrome. The score was also associated with a decrease in average time to specialist review from 225 minutes to 112 minutes. Challenges associated with the tool included misclassification and increased workload. Conclusions The TRIGGER score is a useful tool for the rapid identification and referral of patients presenting with chest pain who have a high likelihood of acute coronary syndrome.
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Acute chest syndrome
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This thesis concerns the invasive and pharmacological treatment of acute coronary syndrome (ACS). In the last 30 years the development of the treatment of patients with an acute coronary syndrome has improved outcomes. In Part A we discuss care for ACS patients in the Netherlands. In Part B we describe the 10-year outcome of an early or selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome. Finally in Part C we report the use of pharmacological therapies during and after hospitalization for acute coronary syndrome. A national registry for acute coronary syndrome patients in the Netherlands remains highly warranted.
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Objective To investigate the clinical feature of painless myocardial infarction. Methods To retrospectively study the clinical data of 33 patients who suffered from painless myocardial infarction, and compare with that of typical acute myocardial infarction patients. Results There wash' t significant difference in gender(χ2 =1.63, P >0.05) and past history (χ2 = 4.88, P > 0.05) ,the time from visit to diagnosis (t = 1.44, P > 0.05) between painless myocardial infarction patients and typical acute myocardial infarction patients. But there was significant differ-ence in the age (χ2= 5.72, P < 0.05), the visit time (t = 30.98, P < 0.05), and the prognosis (χ2 = 32.17, P <0.0 ). Conclusion Patients with painless myocardial infarction have diverse clinical manifestations. They are usu-ally aged and delayed in seeking treatment and at last have a bad prognosis.
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Myocardial Infarction; Clinical feature
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It is often suggested that acute coronary syndrome (ACS) patients admitted during off-duty hours (OH) have a worse clinical outcome than those admitted during regular working hours (RH). Our objective was to compare the management and hospital outcomes of ACS patients admitted during OH with those admitted during RH.Prospective observational study of ACS patients enrolled in the Saudi Project for Assessment of Acute Coronary Syndrome study from December 2005 to December 2007.ACS patients with available date and admission times were included. RH were defined as weekdays, 8 AM-5 PM, and OH was defined as weekdays 5 PM-8 AM, weekends, during Eid (a period of several days marking the end of two major Islamic holidays), and national days.Of the 2825 patients qualifying for this analysis, 1016 (36%) were admitted during RH and 1809 (64%) during OH. OH patients were more likely to present with heart failure and ST elevation myocardial infarction (STEMI) and to receive fibrinolytic therapy, but were less likely to undergo primary percutaneous coronary interventions (PCI). The median door to balloon time was significantly longer (P<.01) in OH patients (122 min) than in RH patients. No differences were observed in hospital outcomes including mortality between the two groups, except for higher heart failure rates in OH patients (11.1% vs 7.2%, P<.001).STEMI patients admitted during OH were disadvantaged with respect to use and speed of delivery of primary PCI but not fibrinolytic therapy. Hospitals providing primary PCI during OH should aim to deliver it in a timely manner throughout the day.
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In 1,395 patients admitted to hospital between 1976 and 1981 due to suspected acute myocardial infarction, the 5-year mortality rate was related to whether they developed infarction or not during the first 3 days. In all, patients with definite myocardial infarction had a 5-year mortality rate of 33.4% as compared with 13.3% in patients not fulfilling the criteria for this diagnosis (p less than 0.001). When separately analyzing patients with no previous myocardial infarction before admission and discharged from hospital, the corresponding mortality rate was 24.1% for myocardial infarction patients versus 8.1% in nonmyocardial infarction patients (p less than 0.001). Among all patients with nonconfirmed myocardial infarction, those who partly fulfilled the criteria (possible myocardial infarction) had a 5-year mortality rate of 16.7% as compared with 12.0% in those in whom myocardial infarction was completely ruled out (p = 0.18). Independent risk factors for death among patients not developing early infarction were high age and a clinical history of previous myocardial infarction and smoking. We conclude that in this study the long-term prognosis among patients admitted to hospital due to suspected acute myocardial infarction was clearly related to whether they developed an infarction or not during the first 3 days in hospital.
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interconnection with the emergency room for structured concerted management and common systems.CAD (mainly acute coronary syndromes) remains the primary cause of admission but the population is, by far, more complex than generally considered.
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