This site uses cookies to improve your experience. To help us insure we adhere to various privacy regulations, please select your country/region of residence. If you do not select a country, we will assume you are from the United States. Select your Cookie Settings or view our Privacy Policy and Terms of Use.
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Used for the proper function of the website
Used for monitoring website traffic and interactions
Cookie Settings
Cookies and similar technologies are used on this website for proper function of the website, for tracking performance analytics and for marketing purposes. We and some of our third-party providers may use cookie data for various purposes. Please review the cookie settings below and choose your preference.
Strictly Necessary: Used for the proper function of the website
Performance/Analytics: Used for monitoring website traffic and interactions
ST-elevation myocardial infarction (STEMI) is a critical cardiovascular emergency characterized by acute coronary artery occlusion and subsequent myocardial injury. However, despite successful revascularization, microvascular obstruction (MVO) remains a major challenge, contributing to adverse clinical outcomes.
Theres ST elevation in V3-4 which meets STEMI criteria, which could be present in either early repolarization, pericarditis or injury. Lets see what happens in the current STEMI paradigm. Emergency physician: STEMI neg but with elevated troponin = Non-STEMI The first ECG was signed off. What do you think?
Interpretation : diagnostic of acute anterior OMI with STE less than STEMI criteria in V1-V4, hyperacute T waves in V2-V4, and suspiciously flat isoelectric ST segments in III and aVF suspicious for reciprocal findings. Now it even meets STEMI criteria, and HATWs continue to inflate. The patient survived with unknown long term outcome.
This narrative review aims to evaluate strategies for reducing door-to-balloon (D2B) time in ST-elevation myocardial infarction (STEMI) patients, focusing on pre-hospital, in-hospital, and technological innovations, as well as addressing challenges to ensure sustainability.
What is the impact of complete revascularization versus culprit-only revascularization on outcomes in older patients with ST-segment elevation myocardial infarction (STEMI) and non–ST-segment elevation myocardial infarction (NSTEMI)?
Cath lab declined as it is not a STEMI." And now this finding is even formally endorsed as a "STEMI equivalent" in the 2022 ACC guidelines!!! Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mindset. Opiates are associated with worse outcomes in Myocardial Infarction. Cath attending is aware.
They concluded, "Our findings increase confidence in the normal automated GE Marquette 12 SL ECG software interpretation to predict a benign outcome. Smith comment: this is a very stupid outcome measure) What if we use that methodology for the ECG above? Despite serial ECGs being "STEMI negative", the cath lab was activated.
So while there’s no diagnostic STEMI criteria, there are multiple ischemic abnormalities in 11/12 leads involving QRS, ST and T waves, which are diagnostic of a proximal LAD occlusion. First trop was 7,000ng/L (normal 25% of ‘Non-STEMI’ patients with delayed angiography have the exact same pathology of acute coronary occlusion.
What are the outcomes of bivalirudin vs. heparin anticoagulation during percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI)?
Later it was shown that index of microvascular resistance which quantified the inability of microcirculation to vasodilate and improve coronary flow after primary PCI, was associated with worst outcomes independent of epicardial coronary flow. Immediate Microvascular Physiology After Mechanical Coronary Reperfusion of STEMI.
Doing so literally enables those of us who embrace the OMI Paradigm the ability to recognize within seconds that a patient with new CP ( C hest P ain ) — and — one or more hyperacute T waves — needs prompt cath regardless of potential absence of STEMI criteria.
Cardiogenic shock (CS)is the most feared event following STEMI. We tend to perceive CS as an exclusive complication of STEMI. The incidence is half of that of STEMI, i.e., 2.5-5%. might show little elevation with considerable overlap of left main STEMI vs NSTEMI ) 2.Onset ACS pathophysiology is not that simple.
Obvious infero-postero-lateral STEMI(+)OMI, regardless of context Now let’s put them in order: what was the sequence? With serial ECGs that are ‘STEMI negative’ the physician could have waited for serial troponin levels or referred the patient as “non-STEMI”. What was the outcome and final diagnosis?
Implementing and tracking quality improvement (QI) metrics may lead to improved outcomes in patient care after STEMI in low- and middle-income countries (LMIC), according to an analysis of data from the ACC's Global Heart Attack Treatment Initiative (GHATI).
(MedPage Today) -- ATLANTA -- Fractional flow reserve (FFR)-guided complete revascularization in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease did not result in better outcomes compared.
Methods and Results Patients with confirmed ST elevation myocardial infarction (STEMI) treated by emergency medical services were included in this retrospective cohort analysis of the AVOID study. And as we have shown before, morphine leads to slower times to treatment and worse outcomes. 414 patients were included in the analysis.
Background Hyperglycemia, characterized by elevated blood glucose levels, is frequently observed in patients with acute coronary syndrome, including ST-elevation myocardial infarction (STEMI). There are conflicting sources regarding the relationship between hyperglycemia and outcomes in STEMI patients. 3.45) and 4.47 (95% CI: 2.54–7.87),
7, 2024 — The Society for Cardiovascular Angiography & Interventions (SCAI) recently announced the publication of the Expert Consensus Statement on the Management of Patients with STEMI Referred for Primary PCI. It synthesizes the latest evidence-based practices and provides comprehensive suggestions to enhance patient care and outcomes.
Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. What do you think?
See my formula for differentiating anterior LV aneurysm (that is to say, persistent ST elevation after old MI) from acute anterior STEMI. Both support acute anterior STEMI. In fact, in our studies, the false negative cases for acute STEMI were due to prolonged occlusion (at least 6 hours). It is not chronic. 3.0 = 0.50
Posterior leads are unnecessary if anterior leads are diagnostic According to the STEMI paradigm an ECG has to have ST elevation to diagnose acute coronary occlusion, and if there’s no ST elevation on anterior leads you can look for it on posterior leads. Do you need posterior leads? If so, how will they change management?
STEMI remains a major cause of morbidity, mortality, disability, and high health care costs in Latin America and the rest of the world. New data assessing the impact of ACC's Global Heart Attack Initiative (GHATI) on patient care outcomes at the CEDIMAT Cardiovascular Center in Santo Domingo, Dominican Republic.
Jason was very skeptical of STEMI. This also argues against STEMI. What was the outcome? Outcome "I later found out that this is a patient who regularly calls paramedics to c/o chest pains and he had fooled many of them. He complained of 3 days of diarrhea and abdominal pain. What do you think? Jason, I agree.
A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. Is this acute STEMI? Is this an acute STEMI? -- Unlikely! He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin.
This patient could have very easily been overlooked, both because the ECG was STEMI negative and because the Q waves were attributed to an “old infarct”. Fortunately, Dr. Cho was not looking for STEMI ECG criteria but for an acute coronary occlusion. OMI or STEMI? As cardiology documented, “possible STEMI.
So this NSTEMI was likely a STEMI(-)OMI with delayed reperfusion. The patient was admitted as ‘NSTEMI’ which is supposed to represent a non-occlusive MI, but the underlying pathophysiology is analogous to a transient STEMI. See these posts: Chest Pain, ST Elevation, and an Elevated Troponin: Should we Activate the Cath Lab?
Background It is unclear how COVID-19 pandemic affected care and outcomes among patients who are diagnosed with ST-elevation myocardial infarction (STEMI) in the USA. Results There were 1 050 905 hospitalizations with STEMI, and there was an 8.2% Results There were 1 050 905 hospitalizations with STEMI, and there was an 8.2%
Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? This is the response he got: Interventionist: "No STEMI, no cath. After stabilizing the patient and recording more ECGs, he tried again: Interventionalist: "It isn't a STEMI." It is a STEMI equivalent. We don't know how many though.
He had an immediate ED ECG: There is artifact, but the findings appear to be largely gone now The diagnosis is acute MI, but not STEMI. Outcome : Was it RCA or LCX with inferior MI? His pain was intermittent and he was vague about when it was present and when it was resolved. Here is his prehospital ECG: Diagnosis?
The most common clinical presentation of ACS was STEMI in 47.4%. The prevalence of composite clinical outcomes including mortality, non-fatal MI and recurrent SCAD was 3.3% (95% CI: 1.4–5.1), The prevalence of composite clinical outcomes including mortality, non-fatal MI and recurrent SCAD was 3.3% (95% CI: 1.4–5.1),
Introduction:Elevated LDL cholesterol is linked to microvascular injury and adverse cardiac events in STEMI patients. This study examines the impact of prior statin use on LDL levels at the time of MI, focusing on NSTEMI and STEMI patients. For STEMI, the treated group had an average LDL level of 87.8 ± 42 mg/dL versus 103 ± 41.2
BackgroundThe pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Multivariable logistic regression models were used to assess the association between lysis-PCI timing and outcomes.
1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes. 4,5] We have now formally studied this question: Emergency department Code STEMI patients with initial electrocardiogram labeled ‘normal’ by computer interpretation: a 7-year retrospective review.[6]
Echo on the day after admission showed EF of 30-35% and antero-apical wall akinesis with an LV thrombus [these frequently form in complete or near complete (no early reperfusion) anterior STEMI because of akinesis/stasis] 2 more days later, this was recorded: ST elevation is still present. The LAD has reperfused early. This was recorded 2.5
Publication date: Available online 2 July 2024 Source: The American Journal of Cardiology Author(s): Sara J. King, Rajiv Patel, Sameer Arora, George A.
You can subscribe for news and early access (via participating in our studies) to the Queen of Hearts here: [link] queen-form This EMS ECG was transmitted to the nearby Emergency Department where it was remotely reviewed by a physician, who interpreted it as normal, or at least without any features of ischemia or STEMI.
Publication date: Available online 14 November 2024 Source: The American Journal of Cardiology Author(s): Aiham Albaeni, Shuang Li, Yong Shan, Ravi Thakker, Diann E. Gaalema, Ritika Saxena MPH, Yong-fang Kuo, Hani Jneid, James Goodwin
Here they are: Patient 1, ECG1: Zoll computer algorithm stated: " STEMI , Anterior Infarct" Patient 2, ECG1: Zoll computer algorithm stated: "ST elevation, probably benign early repolarization." He diagnosed anterior "STEMI" and activated the cath lab. 25 minutes later, EMS called back with this new ECG: Super obvious STEMI(+) OMI.
As a low-volume PCI centre in the Middle East, we wanted to find out if the outcomes of our PCI procedures are different from those of high-volume PCI centres in the UK and the Western world. Prospectively collected data of all comers for PCI (urgent and elective) were retrospectively analysed. and the average number of stents 2.6.
This was a machine read STEMI positive OMI. the investigators reviewed outcomes in 118 patients presenting with NSTEMI. The meaning of this quote is that at times, something as obvious as the dramatic anterior lead ST elevation that we see in today's tracing is not the result of an acute LAD STEMI. His ECG is shown below.
Objectives This study aimed to perform a meta-analysis of the short-term impact of ischaemic postconditioning (IPoC) on myocardial injury in ST elevation myocardial infarction (STEMI) using surrogate cardiac biomarkers. Few studies used troponin as an outcome, thus, a subanalysis of troponin dynamics was not performed.
Here it is: Obvious Inferior Posterior STEMI (+) OMI. Initial troponin was: 3 ng/L We showed that the first troponin in acute STEMI is often negative in at least 27%. Aside on ECG Research: 20% of Definite diagnostic STEMI (Cox et al.) The cath lab was activated prehospital But imagine if the patient had walked in.
We organize all of the trending information in your field so you don't have to. Join thousands of users and stay up to date on the latest articles your peers are reading.
You know about us, now we want to get to know you!
Let's personalize your content
Let's get even more personalized
We recognize your account from another site in our network, please click 'Send Email' below to continue with verifying your account and setting a password.
52 
Let's personalize your content