Myocardial Infarction and Thrombolysis

Enhancing microcirculation in STEMI patients: can intracoronary thrombolysis combined with thrombus aspiration provide an optimal strategy?

Frontiers in Cardiovascular Medicine

MARCH 28, 2025

ST-elevation myocardial infarction (STEMI) is a critical cardiovascular emergency characterized by acute coronary artery occlusion and subsequent myocardial injury. The current standard of care is primary percutaneous coronary intervention (PPCI), which aims to rapidly restore epicardial blood flow.

Thrombolysis

Thrombolysis STEMI Myocardial Infarction Article

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Heart BMJ

JULY 10, 2024

Background Despite restoration of epicardial blood flow in acute ST-elevation myocardial infarction (STEMI), inadequate microcirculatory perfusion is common and portends a poor prognosis. IC thrombolysis was associated with a significantly lower incidence of MACE (RR=0.65, 95% CI 0.51 to 2.67; I 2 =25%; p<0.0001).

Myocardial Infarction

Myocardial Infarction Thrombolysis STEMI Outcomes

Case Report: Fatal atrioesophageal fistula following atrial fibrillation ablation—critical reflections on prevention

Frontiers in Cardiovascular Medicine

FEBRUARY 24, 2025

This case report describes a unique instance of a patient developing AEF following AF ablation, accompanied by ischemic stroke and myocardial infarction. Upon admission, physical examination and laboratory tests revealed vital signs within abnormal ranges and indicators suggesting inflammation and potential myocardial injury.

Atrial Fibrillation

Atrial Fibrillation Ablation Cardiogenic Shock Myocardial Infarction

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Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Frontiers in Cardiovascular Medicine

JANUARY 7, 2024

Introduction Differences in pathophysiology, clinical presentation, and natural course of ST-elevation myocardial infarction in female patients due to either spontaneous dissection (SCAD-STEMI) or atherothrombotic occlusion (type 1 STEMI) have been discussed. vs. 1.8 ± 5.1%, p = 0.002).

Myocardial Infarction

Myocardial Infarction SCAD STEMI Thrombolysis

Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Circulation: Cardiovascular Interventions

JANUARY 23, 2024

BACKGROUND:It is uncertain whether adjunctive thrombolysis is beneficial for patients with ST-segment–elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) within 120 minutes of presentation. The infarct size was detected by cardiac magnetic resonance 5 days after randomization. versus 29.0%;P<0.001)

Myocardial Infarction

Myocardial Infarction Thrombolysis Academic Cardiovascular Interventions

Influence of Trichosanthes pericarpium extract on improving microcirculation and outcomes of patients with acute myocardial infarction after percutaneous coronary intervention

Frontiers in Cardiovascular Medicine

JANUARY 3, 2024

Background Microcirculatory dysfunction is an independent risk factor for a poor prognosis after percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). Cardiac function was measured by echocardiography during hospitalization and follow-up.

Myocardial Infarction

Myocardial Infarction Outcomes Cardiac Function Thrombolysis

Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillationâ€“Thrombolysis in Myocardial Infarction 48

American College of Cardiology

JULY 12, 2024

The ENGAGE AF-TIMI 48 trial sought to study the safety and efficacy of edoxaban, an oral direct factor Xa inhibitor, as compared with warfarin in the treatment of atrial fibrillation.

Myocardial Infarction

Myocardial Infarction Thrombolysis Atrial Fibrillation Article

Culprit Lesion Vessel Size and Risk of Reperfusion Injury in ST?Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Journal of the American Heart Association

JANUARY 31, 2024

BackgroundMicrovascular obstruction (MVO) and intramyocardial hemorrhage (IMH) are well‐established imaging biomarkers of failed myocardial tissue reperfusion in patients with ST‐segment elevation–myocardial infarction treated with percutaneous coronary intervention. MVO and IMH were found in 299 (58%) and 182 (35%) patients.

Myocardial Infarction

Myocardial Infarction Thrombolysis Biomarkers Hemorrhage

Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Frontiers in Cardiovascular Medicine

MAY 24, 2024

BackgroundST-segment elevation myocardial infarction (STEMI) persists to be prevalent in the elderly with a dismal prognosis. We assessed the Thrombolysis in Myocardial Infarction (TIMI) and Global Registry of Acute Coronary Events Risk (GRACE) scores in two groups.

Myocardial Infarction

Myocardial Infarction STEMI Thrombolysis

Relation of Thrombolysis in Myocardial Infarction Frame Count to Invasively Measured Coronary Physiologic Indexes

The American Journal of Cardiology

DECEMBER 13, 2023

Publication date: 15 January 2024 Source: The American Journal of Cardiology, Volume 211 Author(s): Tatsuro Yamazaki, Yuichi Saito, Daichi Yamashita, Hideki Kitahara, Yoshio Kobayashi

Myocardial Infarction

Myocardial Infarction Thrombolysis Physiology

Determinants and Prognostic Value of Early Gadolinium Enhancement-Derived Myocardial Salvage Index in STEMI

Circulation: Cardiovascular Imaging

MARCH 24, 2025

BACKGROUND:T2-weighted imaging is commonly used to measure myocardial salvage in reperfused myocardial infarction but is hindered by poor reproducibility and indistinct boundaries. The median MSI was 35.0% (interquartile range, 22.959.5%), with smaller MSI observed in patients with larger infarcts (P<0.001).

Myocardial Infarction

Myocardial Infarction STEMI Thrombolysis Cardiovascular Imaging

Until “Pre-hospital PCI” becomes a reality …this is not possible.

Dr. S. Venkatesan MD

MARCH 3, 2025

Is primary PCI superior to thrombolysis in the first hour of STEMI ? The fact of the matter is, at best, pPCI fights for equipoise in the first hour, but thrombolysis is a clear winner in moral, scientifc & holistic perspective, as it can be administered very early, at a fraction of cost ,independent of expertise and infrastructure.

Hospital

Hospital Angioplasty Myocardial Infarction Thrombolysis

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Dr. S. Venkatesan MD

SEPTEMBER 1, 2024

In this context, we need a movement to revive the pre-hospital thrombolysis. Efficiency of thrombolysis is highly reproducible. Strategy to Reduce Mortality Rates of ST-elevation Acute Myocardial Infarction Using Prehospital Thrombolysis: A Meta-analysis. This is what CAPTIM told us. DOI: 10.4103/rcm.rcm_1_24 2.Nallamothu

Thrombolysis

Thrombolysis Myocardial Infarction Academic STEMI

Inclusivity in randomised clinical trials: myth or reality?

Heart BMJ

MARCH 12, 2024

The study aims to evaluate the applicability in the real world of randomised clinical trials (RCT) on antithrombotic treatment in patients with cardiovascular disease (CVD) and peripheral artery disease (PAD).

Peripheral Arterial Disease

Peripheral Arterial Disease Myocardial Infarction Heart Attack Heart attacks

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. 2000;139:430–436. Am J Cardiol.

Chest Pain

Chest Pain Myocardial Infarction Anatomy Angina

An elderly male with shortness of breath

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

Timing of revascularization in patients with transient ST segment elevation myocardial infarction: a randomized clinical trial. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Lemkes et al. Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Pericarditis

Study Finds Olezarsen Cuts Triglyceride Levels by About Half

DAIC

APRIL 7, 2024

Brian Bergman, MD “Treatments to reduce high triglycerides are an unmet clinical need,” said Brian Bergmark, MD , of the Thrombolysis in Myocardial Infarction (TIMI) Study Group at Brigham and Women’s Hospital and Harvard Medical School and the study’s principal investigator.

Cholesterol

Cholesterol Heart Attack Heart attacks Myocardial Infarction

TIMI Thrombus Grade

All About Cardiovascular System and Disorders

MARCH 21, 2024

These are the grade, TIMI grades, named after the landmark Thrombolysis In Myocardial Infarction trial. Grade 0 is no thrombus, while grade 5 is total occlusion of the vessel due to thrombus formation. Grade 0, no angiographic evidence of thrombus.

Myocardial Infarction

Myocardial Infarction Thrombolysis General Cardiology

Abstract WMP27: Strategies to Mitigate Tenecteplase (TNK) Dosing Errors in Acute Ischemic Stroke

Stroke Journal

FEBRUARY 1, 2024

Tenecteplase (TNK) is currently being used for IV thrombolysis in acute ischemic stroke. This off-label use can lead to dosing errors related to the TNK packaging, which only states dosing for myocardial infarction. The dosing for myocardial infarction is 0.5 Genetech, 2023). Bach, 2023; Campbell et al.,

Myocardial Infarction

Myocardial Infarction Stroke Strokes Nursing

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Dr. Smith's ECG Blog

MARCH 9, 2013

In my experience, all Wellens' with significant myocardial infarction have evolution from type A waves to type B waves over 6-24 hours' time , so that the presence of type A or type B waves, I believe, are simply a matter of the timing of recording and the rapidity of evolution. Am Heart J (1989) 117 : pp 657-665. de Zwaan C.,

Chest Pain

Chest Pain Myocardial Infarction Ischemia Angina

Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD

Circulation

OCTOBER 18, 2023

The primary efficacy outcome was a composite of acute limb ischemia, major amputation of a vascular pathogenesis, myocardial infarction, ischemic stroke, or cardiovascular death. The principal safety end point was Thrombolysis in Myocardial Infarction major bleeding. 2.59]) with an absolute risk increase of 0.9%

Peripheral Arterial Disease

Peripheral Arterial Disease Myocardial Infarction Thrombolysis Ischemia

Random Survival Forest Machine Learning for the Prediction of Cardiovascular Events Among Patients With a Measured Lipoprotein(a) Level: A Model Development Study

Circulation: Genomic and Precision Medicine

JANUARY 23, 2025

The end point of interest was time to first myocardial infarction, stroke/TIA, or coronary revascularization. We included patients with an Lp(a) measured between 1989 and 2022 and who had at least 1 year of electronic health record data before measurement of an Lp(a) level. mg/dL, of whom 23.7% had a prior cardiovascular event).

Myocardial Infarction

Myocardial Infarction Risk Factors Thrombolysis Circulation

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

Electrocardiographic Manifestations: Acute posterior wall myocardial infarction. Posterior myocardial infarction: the dark side of the moon. New electrocardiographic criteria for posterior wall myocardial ischemia validated by percutaneous transluminal coronary angioplasty model of acute myocardial infarction.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Dr. Smith's ECG Blog

MARCH 11, 2016

Appearance of abnormal Q waves early in the course of acute myocardial infarction: implications for efficacy of thrombolytic therapy. Patients who received CPR or experienced reinfarction or very small infarcts due to thrombolysis also displayed Type II T-wave evolution. These do NOT indicate late, subacute MI.

Myocardial Infarction

Myocardial Infarction Pericarditis STEMI Angina

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Circulation

NOVEMBER 11, 2024

Methods:STEMI patients who underwent coronary revascularization therapy and cardiac magnetic resonance (CMR) at about 4 days and 6 months between 2017 and 2023 were included.

STEMI

STEMI Myocardial Infarction Kidney Disease Thrombolysis

Abstract 4119169: Navigating Complexity: The Carlino Technique in Multivessel Percutaneous Coronary Intervention for Chronic Total Occlusion

Circulation

NOVEMBER 11, 2024

She was diagnosed with NSTEMI with a thrombolysis in myocardial infarction (TIMI) score of 5. Her EKG showed marked left-axis deviation, ST depressions in V2-V4, and RBBB.

Coronary Artery Disease

Coronary Artery Disease Chest Pain Myocardial Infarction Thrombolysis

Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease

Heart BMJ

MARCH 12, 2024

Methods Inclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA), Prevention of Cardiovascular events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background (..)

Cardiovascular Disease

Cardiovascular Disease Peripheral Arterial Disease Coronary Artery Disease Myocardial Infarction

A Tough ECG, But Learn From It!

Dr. Smith's ECG Blog

JUNE 18, 2013

Acute Myocardial Infarction Due to Left Circumflex Artery Occlusion and Significance of ST-Segment Elevation. Incidence Incidence, angiographic features and outcomes of patients presenting with subtle ST-elevation myocardial infarction. From AM, Best PJM, Lennon RJ, Rihal CS, Prasad A. Sorajja P, Gersh BJ, Cox DA, et al.

STEMI

STEMI Chest Pain Myocardial Infarction Webinar

If you had recorded an ECG during chest pain, what would it have shown?

Dr. Smith's ECG Blog

JUNE 28, 2018

Characteristic electrocardiographic pattern indicating a critical stenosis high in left anterior descending coronary artery in patients admitted because of impending myocardial infarction. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J. Am Heart J.

Chest Pain

Chest Pain Myocardial Infarction STEMI Article

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Details cannot be shared here, but suffice it to say that inability to recognize acute occlusive myocardial infarction in the presence of ventricular paced rhythm contributed to a poor outcome. Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analys is.

Chest Pain

Chest Pain Myocardial Infarction STEMI Ischemia

The “open data” movement runs aground on FOURIER

Dr. Anish Koka

JANUARY 18, 2023

The TIMI (Thrombolysis in Myocardial Infarction) Study Group is a Division of Cardiovascular Medicine at the esteemed Brigham and Women’s Hospital and Harvard Medical School. Anish Koka, MD @anish_koka This was driven almost entirely by myocardial infarction / need for revascularization.

Document

Document Academic Heart Attack Heart attacks

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

This has been termed a “STEMI equivalent” and included in STEMI guidelines, suggesting this patient should receive dual anti-platelets, heparin and immediate cath lab activation–or thrombolysis in centres where cath lab is not available. Incidence of an acute coronary occlusion. Am J Med 2019, 132(5):622-630. link] Harhash AA et al.

Ischemia

Ischemia STEMI Stenosis Chest Pain

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients. In the setting of evolving infarction — development of AIVR often heralds the onset of reperfusion ( following thrombolysis, acute angioplasty, or spontaneous reperfusion ).

Chest Pain

Chest Pain SCAD STEMI Blog

Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations

Open Heart

AUGUST 3, 2024

Background Guidelines recommend the use of risk scores to select patients for further investigation after myocardial infarction has been ruled out but their utility to identify those with coronary artery disease is uncertain. The negative predictive value (NPV) varied from 77.3% –100%).

Coronary Artery Disease

Coronary Artery Disease Myocardial Infarction Chest Pain Thrombolysis

Successful pharmaco-mechanical treatment of a subtotally occluded venous bypass graft in a patient presenting with acute coronary syndrome: a case report and review of the current literature on the role of local thrombolysis

Frontiers in Cardiovascular Medicine

MARCH 17, 2025

Initial diagnostics indicated non-ST-elevation myocardial infarction, leading to immediate intervention. A combination of balloon angioplasty, stent implantation, and intra-arterial thrombolysis with recombinant tissue plasminogen activator (rt-PA) was employed, resulting in significant thrombus reduction and improved coronary flow.

Coronary Artery Bypass Graft

Coronary Artery Bypass Graft Thrombolysis Coronary Artery Disease Myocardial Infarction

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

Dr. Smith's ECG Blog

MARCH 14, 2025

ECG #3 is easily recognized as OMI and the AI model recommends immediate revascularization The patient in today's case received suboptimal care and suffered a substantial myocardial infarction. Here is evidence for this: Opiates are associated with worse outcomes in Myocardial Infarction. Abstract 556.

Chest Pain

Chest Pain STEMI Myocardial Infarction Ischemia

What is Wellens' syndrome? And what conditions mimic it?

Dr. Smith's ECG Blog

APRIL 2, 2025

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Electrocardiographic diagnosis of reperfusion during thrombolytic therapy in acute myocardial infarction. Am Heart J 2000;139(3):4306.

Chest Pain

Chest Pain STEMI Myocardial Infarction Stents

Cardiovascular Update

Enhancing microcirculation in STEMI patients: can intracoronary thrombolysis combined with thrombus aspiration provide an optimal strategy?

Intracoronary thrombolysis in ST-elevation myocardial infarction: a systematic review and meta-analysis

Case Report: Fatal atrioesophageal fistula following atrial fibrillation ablation—critical reflections on prevention

Webinars

Differences in left ventricular myocardial function and infarct size in female patients with ST elevation myocardial infarction and spontaneous coronary artery dissection

Single Bolus r-SAK Before Primary PCI for ST-Segment–Elevation Myocardial Infarction

Influence of Trichosanthes pericarpium extract on improving microcirculation and outcomes of patients with acute myocardial infarction after percutaneous coronary intervention

Effective Anticoagulation With Factor Xa Next Generation in Atrial Fibrillationâ€“Thrombolysis in Myocardial Infarction 48

Culprit Lesion Vessel Size and Risk of Reperfusion Injury in ST?Segment Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study

Age-associated declined function of endothelial progenitor cells and its correlation with plasma IL-18 or IL-23 concentrations in patients with ST-segment elevation myocardial infarction

Relation of Thrombolysis in Myocardial Infarction Frame Count to Invasively Measured Coronary Physiologic Indexes

Determinants and Prognostic Value of Early Gadolinium Enhancement-Derived Myocardial Salvage Index in STEMI

Until “Pre-hospital PCI” becomes a reality …this is not possible.

The pseudo-superiority of pPCI is exposed one more time … but it will thrive!

Inclusivity in randomised clinical trials: myth or reality?

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

An elderly male with shortness of breath

Study Finds Olezarsen Cuts Triglyceride Levels by About Half

TIMI Thrombus Grade

Abstract WMP27: Strategies to Mitigate Tenecteplase (TNK) Dosing Errors in Acute Ischemic Stroke

First ED ECG is Wellens' (pain free). What do you think the prehospital ECG showed (with pain)?

Rivaroxaban Plus Aspirin Versus Aspirin Alone After Endovascular Revascularization for Symptomatic PAD: Insights From VOYAGER PAD

Random Survival Forest Machine Learning for the Prediction of Cardiovascular Events Among Patients With a Measured Lipoprotein(a) Level: A Model Development Study

Right precordial ST depression in a patient with chest pain

Initial Reperfusion T-waves, Followed by Pseudonormalization. Diagnosis?

Abstract 4141279: Catch me if you flow slow: The temporal filter slow flow fact

Abstract 4119169: Navigating Complexity: The Carlino Technique in Multivessel Percutaneous Coronary Intervention for Chronic Total Occlusion

Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease

A Tough ECG, But Learn From It!

If you had recorded an ECG during chest pain, what would it have shown?

Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

The “open data” movement runs aground on FOURIER

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Risk scores and coronary artery disease in patients with suspected acute coronary syndrome and intermediate cardiac troponin concentrations

Successful pharmaco-mechanical treatment of a subtotally occluded venous bypass graft in a patient presenting with acute coronary syndrome: a case report and review of the current literature on the role of local thrombolysis

What happens when you give morphine for chest pain in ACS? And what is pseudo-normalization of T-waves?

What is Wellens' syndrome? And what conditions mimic it?

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