BACKGROUND: Influenza vaccination early after myocardial infarction (MI) improves prognosis but vaccine effectiveness may differ dependent on type of MI. METHODS: A total of 2,571 participants were prospectively enrolled in the Influenza vaccination after myocardial infarction (IAMI) trial and randomly assigned to receive in-hospital inactivated influenza vaccine or saline placebo. The trial was conducted at 30 centers in eight countries from October 1, 2016 to March 1, 2020. Here we report vaccine effectiveness in the 2,467 participants with ST-segment elevation MI (STEMI, n = 1,348) or non-ST-segment elevation MI (NSTEMI, n = 1,119). The primary endpoint was the composite of all-cause death, MI, or stent thrombosis at 12 months. Cumulative incidence of the primary and key secondary endpoints by randomized treatment and NSTEMI/STEMI was estimated using the Kaplan-Meier method. Treatment effects were evaluated with formal interaction testing to assess for effect modification. RESULTS: Baseline risk was higher in participants with NSTEMI. In the NSTEMI group the primary endpoint occurred in 6.5% of participants assigned to influenza vaccine and 10.5% assigned to placebo (hazard ratio [HR], 0.60; 95% CI, 0.39-0.91), compared to 4.1% assigned to influenza vaccine and 4.5% assigned to placebo in the STEMI group (HR, 0.90; 95% CI, 0.54-1.50, P = .237 for interaction). Similar findings were seen for the key secondary endpoints of all-cause death and cardiovascular death. The Kaplan-Meier risk difference in all-cause death at one year was more pronounced in participants with NSTEMI (NSTEMI: HR, 0.47; 95% CI 0.28-0.80, STEMI: HR, 0.86; 95% CI, 0.43-1.70, interaction P = .028). CONCLUSIONS: The beneficial effect of influenza vaccination on adverse cardiovascular events may be enhanced in patients with NSTEMI compared to those with STEMI.
- MeSH
- Influenza, Human * complications prevention & control MeSH
- Non-ST Elevated Myocardial Infarction * complications MeSH
- ST Elevation Myocardial Infarction * therapy complications MeSH
- Myocardial Infarction * complications MeSH
- Humans MeSH
- Risk Factors MeSH
- Influenza Vaccines * MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
Journal of the American College of Cardiology, ISSN 0735-1097 vol. 41, no. 4, suppl. S, February 2003
vi, 131S s. : tab., grafy ; 28 cm
- MeSH
- Biomarkers MeSH
- Myocardial Infarction MeSH
- Coronary Disease MeSH
- Coronary Thrombosis MeSH
- Troponin diagnostic use MeSH
- Publication type
- Collected Work MeSH
- Conspectus
- Patologie. Klinická medicína
- NML Fields
- kardiologie
- angiologie
- hematologie a transfuzní lékařství
Akutní koronární syndrom bez ST elevací je diagnózou, která skrývá mnoho klinických stavů stejné etiopatogenezy, avšak s rozmanitým klinickým projevem závislým na mnoha faktorech. Riziko další progrese v dokonaný infarkt myokardu, jeho recidivu nebo úmrtí nemocného se liší u jednotlivých pacientů. Bylo rozpoznáno mnoho rizikových faktorů, které ukazují na zhoršenou prognózu individuálního pacienta a zároveň identifikují nemocné, kteří budou mít prospěch z aplikace agresivnějších diagnostických a léčebných postupů. Dnes jsou vypracovány i systémy určení rizika jednotlivce, které zohledňují kumulaci více rizikových faktorů. Některé jsou jednoduché a lze je běžně použít u lůžka pacienta, jiné počítají riziko nemocného podle složitějších algoritmů. V klinické praxi je možno využít jednodušší skórovací systém, je ale nutno mít na paměti i další rizika, která v něm nejsou obsažena a u nemocného jsou známa. V nemocnici bez katetrizačního zázemí by stanovení rizika nemocného s AKS bez ST elevací mělo pomoci k vystupňování medikamentózní léčby a k optimálnímu časování intervenčního vyšetření, kde u nemocných s vysokým rizikem je nutno přistoupit ke koronarografii co nejdříve, maximálně do 24 hodin a na základě jejího výsledku je nutno stanovit optimální léčebný postup.
Acute coronary syndrome without ST segment elevation is a diagnosis covering a wide range of clinical conditions of the same aetiopathogenesis, but with very different manifestations depending on numerous factors. The risk of continuing progression into myocardial infarction or recurrent myocardial infarction or into death differs in each patient. Many risk factors have been discovered which show worsened prognosis of an individual patient and at the same time identify patients who will benefit most from the application of aggressive diagnostic and therapeutic approaches. Nowadays, risk score systems are available which determine a patient’s risk and take into account cumulation of more factors. Some of them are simple and can be used at the bedside, others use more complicated algorithms for calculating the risk. In clinical routine, a simple scoring system can be used, but also other risks must be kept in mind which are not included in the scoring system used, but the patient is known to have them. Risk stratification in a patient suffering from acute coronary syndrome without ST segment elevation in a hospital without an interventional facility should help intensify medical treatment and optimise the timing of invasive examination. In high risk patients, angiography of coronary arteries should be done as soon as possible, within a 24-hour time frame, and, based on its result, an optimal treatment approach should be determined.
Elektrokardiogram zůstává nejdůležitějším nástrojem v diagnóze infarktu myokardu s elevací ST segmentu. Je okamžitě k dispozici, je snadné jej opakovat a ekonomicky je velice výhodný. Pro trénovaného odborníka je rovněž vysoce citlivý a specifický. Časná diagnóza a následná léčba infarktu myokardu s elevací ST segmentu závisí na rychlém provedení a správné interpretaci EKG. Mimo akutního infarktu myokardu existuje u pacienta s probíhající bolestí na hrudi mnoho dalších příčin elevace ST segmentu. Lékař musí mít tyto diferenciální diagnózy na zřeteli a musí být schopen rychle potvrdit nebo vyvrátit alternativní příčiny elevace ST segmentu. Cílem tohoto článku je přezkoumání nálezů na EKG u akutního infarktu myokardu v porovnání s ostatními alternativními diagnózami, u kterých může docházet k elevaci ST segmentu. Tato diskuse je ukončena třemi kazuistickými příklady atypických příčin elevace ST segmentu u pacienta s bolestí na hrudi.
The electrocardiogram remains the most crucial tool in the diagnosis on ST-segment elevation myocardial infarction. It is rapidly available, easily reproducible, and highly cost effective. To the trained interpreter it is also highly sensitive and specific. Early diagnosis and subsequent treatment of ST-segment myocardial infarction relies on rapid performance and correct interpretation of the electrocardiogram. In addition to acute myocardial infarction, there are multiple other causes of ST-segment elevation in the patient with active chest pain. The clinician must be aware of these differential diagnoses, and be able to quickly confirm or exclude alternative causes of ST-segment elevation. The purpose of this article is to review the electrocardiographic findings in acute myocardial infarction in comparison to other alternative diagnoses that may present with ST-segment elevation. This discussion concludes with three case based examples of atypical causes of ST-segment elevation in the patient with chest pain.
- Keywords
- elektrokardiogram, elevace ST segmentu,
- MeSH
- Acute Coronary Syndrome diagnosis MeSH
- Chest Pain * diagnosis etiology MeSH
- Diagnosis, Differential * MeSH
- Electrocardiography * methods utilization MeSH
- Myocardial Infarction * diagnosis MeSH
- Myocardial Ischemia diagnosis MeSH
- Coronary Angiography utilization MeSH
- Publication type
- Review MeSH
- MeSH
- Algorithms MeSH
- Anticoagulants therapeutic use MeSH
- Myocardial Infarction drug therapy therapy MeSH
- Platelet Aggregation Inhibitors therapeutic use MeSH
- Cardiovascular Agents therapeutic use MeSH
- Humans MeSH
- Angina, Unstable drug therapy therapy MeSH
- Myocardial Revascularization MeSH
- Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use MeSH
- Check Tag
- Humans MeSH
- MeSH
- Angina Pectoris etiology drug therapy MeSH
- Angiography MeSH
- Electrocardiography MeSH
- Myocardial Infarction * diagnosis etiology drug therapy MeSH
- Coronary Vessels * pathology MeSH
- Humans MeSH
- Aged MeSH
- Spasm * diagnosis drug therapy MeSH
- Check Tag
- Humans MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Diagnostic Errors MeSH
- Demography MeSH
- Adult MeSH
- Electrocardiography methods MeSH
- Myocardial Infarction diagnosis mortality pathology MeSH
- Humans MeSH
- Arrhythmias, Cardiac diagnosis mortality pathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Multicenter Study MeSH
- Comparative Study MeSH
- Geographicals
- Slovakia MeSH
OBJECTIVES: We evaluated impact of timing of coronary artery bypass grafting (CABG) and prasugrel pretreatment in patients with non-ST-segment elevation myocardial infarction undergoing CABG in the ACCOAST study. METHODS: Of 4033 enrolled patients, 314 (7.8%) underwent isolated CABG through 30 days. Primary efficacy end point for this analysis was any cardiovascular death, myocardial infarction, stroke, urgent revascularization, or glycoprotein IIb/IIIa inhibitor bailout through 30 days. RESULTS: More CABG versus percutaneous coronary intervention or medically managed patients were men, diabetic, or had peripheral arterial disease. Per randomization, 157 of 314 patients received a 30-mg prasugrel loading dose before CABG, and 157 of 314 received placebo. Patients were stratified by tertile of time from randomization to CABG: <2.98 days (n = 104), ≥2.98 and <6.95 days (n = 106), and ≥6.95 days (n = 104). Primary end point occurred in 12.5%, 4.7%, and 4.8%, respectively (<2.98 days vs other tertiles, hazard ratio [HR] = 2.80; P = .011). Similarly, the rate of all TIMI major bleeding was highest in the lowest tertile (26.0% vs 10.4% and 4.8%; P < .001), but no difference in all-cause death was observed through 30 days (3.9% vs 1.9% and 1.9%; P = .30). Time from randomization to CABG (HR = 0.84 for each day delay), left main disease (HR = 1.76), region of enrollment (Non-Eastern Europe vs Eastern Europe; HR = 3.83), but not prasugrel pretreatment and baseline troponin ≥3× upper limit of normal, were independent predictors of combined 30-day end point of all-cause death/myocardial infarction/stroke/TIMI major bleeding. CONCLUSIONS: In ACCOAST, early (<2.98 days) surgical revascularization carried increased risk of bleeding and ischemic complications without affecting all-cause mortality through 30 days. Baseline troponin and prasugrel pretreatment did not impact ischemic clinical outcomes.
- MeSH
- Electrocardiography * MeSH
- Myocardial Infarction diagnosis therapy MeSH
- Percutaneous Coronary Intervention methods MeSH
- Coronary Artery Bypass methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Prasugrel Hydrochloride administration & dosage MeSH
- Preoperative Care methods MeSH
- Aged MeSH
- Treatment Outcome MeSH
- Dose-Response Relationship, Drug MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
