Volume 2 Issue 2

Research Article: 70% of OHCA Receiving PAD Has Cardiac Arrest EGC Waveform - An Analysis of the Initial Electrocardiogram upon EMS Arrivals

Shintaro Furukawa, Hideharu Tanaka*, Toru Shirakawa, Ryo Sagisaka, Shota Tanaka and Hiroshi Takyu

Background: Importance of bystander Cardiopulmonary Resuscitation (CPR) and Automated External Defibrillator (AED) has been illuminated and over decays. But, it is little known about Electrocardiogram (ECG) change after Public Access Defibrillation (PAD) by citizens.
Aim: We evaluated the relationship between the initial Electrocardiography (ECG) rhythm on the EMS arrival and outcomes who received PAD.
Methods: In this retrospective nationwide observational study, a total of 61,838 witnessed cardiogenic OHCA with bystander CPR between 2005 and 2012 were used. Patients were divided into two groups and compared as follows: PAD group (n=2,643) and No-PAD group (n=59,195). The primary outcomes were return of spontaneous circulation (ROSC) on the field and favorable neurological outcomes (CPC1or2) at one month sorted by ECG waveform on the EMS arrivals. Odds ratio and multiple logistic regression were used for multivariate analysis.
Results: We found that 31.2% of the PAD group reached field ROSC and remained 68.8 % manifested cardiac arrest ECG waveform (Ventricular Fibrillation, pulseless Ventricular Tachycardia, Pulseless Electrical Activity, and Asystole) upon EMS arrival. Therefore, the delivery of PAD was strongly related to increased rates of favorable neurological outcomes at one month (PAD group: AOR, 6.01; 95% CI, 5.55 to 6.51: No-PAD group: AOR, 8.10; 95% CI, 7.44 to 8.81).
Conclusion: The delivery of PAD positively affects field ROSC and favorable neurological outcome, though 68.8 % of patients are still in cardiac arrest on the arrival of EMS. Not only continuous bystander CPR and AED, but also prompt EMS arrival and ALS treatment are extremely important for improve the chances of survival.
Keywords: PAD; Initial ECG; Favorable neurological outcom

Cite this Article: Furukawa S, Tanaka H, Shirakawa T, Sagisaka R, Tanaka S, et al. 70% of OHCA Receiving PAD Has Cardiac Arrest EGC Waveform - An Analysis of the Initial Electrocardiogram upon EMS Arrivals. Int J Cardiovasc Dis Diagn. 2017;2(2): 036-042

Published: 17 September 2017

Case Report: Double Territory Myocardial Infarction by Occlusion of Single Coronary Artery, Wrapped Left Anterior Descending Coronary Artery Phenomenon

Wassam el din Hadad Elshafey*

Acute occlusion of the Left Anterior Descending Coronary Artery (LAD) generally results in ST segment elevations in precordial leads and reciprocal ST segment depression in inferior leads. When ST segment elevation occurs in inferior leads, the culprit artery is either the Right Coronary Artery (RCA) or Left Circumflex Coronary Artery (LCX). Simultaneous anterior and inferior myocardial infarction has been described due to occlusion of "wrapped LAD" [1]. The occurrence of isolated inferior myocardial infarction due to occlusion of LAD is unknown. Here we describe an isolated acute inferior myocardial infarction due to occlusion of LAD which continues as the Posterior Descending Coronary Artery (PDA).

Cite this Article: Wassam el din Hadad Elshafey. Double Territory Myocardial Infarction by Occlusion of Single Coronary Artery, Wrapped Left Anterior Descending Coronary Artery Phenomenon. Int J Cardiovasc Dis Diagn. 2017;2(1): 033-035.

Published: 11 September 2017

Research Article : Protective Effect of Trimetazidine on Myocardial Injury in Patients with Non-ST Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention

Jiang-you Wang, Han Chen, Dan Song, Jian Peng, Xi Su and Hua Yan*

Background: To investigate the effects of loading dose of trimetazidine therapy on periprocedural myocardial injury in patients with Non-ST Segment Elevation (NSTE) acute coronary syndromes (unstable angina or NSTE acute myocardial infarction).
Method: The study included 82 patients who were undergoing PCI with the diagnosis of NSTACS. The patients were randomized into two groups. The first group (n=42) of the patients hospitalized with the diagnosis of NSTACS was given conventional therapy plus 60 mg TMZ just prior to PCI. Treatment with TMZ was continued for one month after the procedure. TMZ treatment was not given to the second group (n=40). The main end point was a 30-day incidence of major adverse cardiac events (cardiac death, nonfatal acute myocardial infarction, or revascularization with either PCI or coronary artery bypass grafting). Cardiac troponin I and high-sensitivity C-reactive protein levels were measured at the baseline and at 16-18h after the procedure.
Result: Major adverse cardiac events occurred in 10.0% of patients in the control group and 4.76% of those in the TMZ group (P<0.05). This difference was mostly because of reduction in the incidence of per procedural myocardial infarction (7.50 vs. 4.76%; P<0.05). Markers of the two groups were elevated after PCI; however, the serum levels of cardiac troponin I and high-sensitivity C-reactive protein in the TMZ group were significantly lower than those in the control group (P<0.01).
Conclusion: Short-term pretreatment with the TMZ administration prior to PCI can prominently reduce myocardial injury caused by PCI.
Keywords: Trimetazidine; Percutaneous Coronary Intervention; Ctni; Inflammatory Reaction

Cite this Article: Jiang-you Wang, Chen H, Song D, Peng J, Su X, et al. Protective Effect of Trimetazidine on Myocardial Injury in Patients with Non-ST Segment Elevation Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention. Int J Cardiovasc Dis Diagn. 2017;2(1): 029-032.

Published: 05 September 2017

Research Article : Usefulness of Moderate Intensity Daily Physical Activity As a Predictor of Left Ventricular Reverse Remodeling After ST-Elevation Myocardial Infarction

Akihiro Makino, Minako Yamaoka-Tojo*, Shuhei Yamamoto, Ryo Kameda, Shinichi Obara, Atsuhiko Matsunaga and Junya Ako

Left Ventricular (LV) reverse remodeling after ST-Segment Elevation Myocardial Infraction (STEMI) reduces the incidence of re-hospitalization or death from heart failure or cardiovascular disease. The present study aimed to clarify whether Physical Activity (PA) level may serve as a predictor of LV reverse remodeling in post-STEMI out patients. Subjects were stable 113 patients with old myocardial infarction who had successful reperfusion following STEMI. PA was assessed by an accelerometer, which measured average step count and light-moderate and vigorous-intensity activity time per day for 1 week at baseline. Single Photon Emission Computed Tomography (SPECT) was used to measure myocardial perfusion and LV function at baseline and at 12 months. LV reverse remodeling was defined as a >10% reduction in LV end-systolic volume at 12 months relative to baseline SPECT. Patients were divided into LV reverse remodeling group (n = 57) and no-LV reverse remodeling group (n = 56). After adjusting for age, PA index, and baseline LV function, logistic regression analysis showed that moderate-intensity activity time was a significant and independent predictor of LV reverse remodeling (odds ratio, 2.091; 95% Confidence Interval [CI]: 1.476-2.967; p = 0.0001). Receiver operating characteristic curve analysis identified a cut-off value of moderate-intensity activity for 29 minutes per day as a predictor of LV reverse remodeling, with a sensitivity of 74% and specificity of 89% (area under the curve, 0.860; 95% CI: 0.789-0.931; p = 0.0001). In conclusion, time spent performing moderate-intensity activity as measured by accelerometer was found to be an independent predictor of LV reverse remodeling in post-STEMI patients with maintenance phase..

Cite this Article: Makino A, Yamaoka-Tojo M, Yamamoto S, Kameda R, Obara S, et al. Usefulness of Moderate Intensity Daily Physical Activity As a Predictor of Left Ventricular Reverse Remodeling After ST-Elevation Myocardial Infarction. Int J Cardiovasc Dis Diagn. 2017;2(1): 022-028.

Published: 26 August 2017

Clinical image : Fat in the Coronary Arteries Isn't Always a Villain

Carlos A. Espinoza*, Syed Ali, Lavanya Alapati and Ashesh N. Buch

Coronary Artery Perforation (CAP) is an uncommon complication of coronary interventions; the probability of tamponade and death increases with the severity of the perforation. Patient and procedure risk factors have been identified: older age, female sex, intervention on chronic totally occluded arteries, and use of atherectomy device are the most important risk factors [1].

Cite this Article: Espinoza CA, Ali S, Lavanya A, Buch AN. Fat in the Coronary Arteries Isn't Always a Villain. Int J Cardiovasc Dis Diagn. 2017;2(1): 020-021.

Published: 10 August 2017

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