Background Shortening of the hospital stay in patients admitted with the diagnosis of acute myocardial infarction (AMI) has been observed within the last decades. Our center is the only cardiac center in the region providing tertiary care facility and hence receives all AMI patients deemed suitable for invasive assessment and management and this leads to huge required demand. Our aim is to assess feasibility and safety of the early discharge of selected proportion of AMI patients. Result Out of 557 of patients presented with AMI and treated with percutaneous coronary intervention (PCI), 310 (56%) were discharged early. Men patients and pilgrims were more prevalent among the early discharge group. Early discharged patients had significantly less comorbidities compared to the other group of patients. Moreover, they presented mainly with ST-elevation myocardial infarction (P = 0.04) and treated more with primary percutaneous coronary intervention (PPCI) (P = 0.04). They had favorable coronary anatomy (P = 0.01 and 0.02 for left main and multi-vessel coronary artery disease, respectively), better hospital course, and higher left ventricular ejection fraction compared to non-early discharged patients (P = 0.006 and < 0.001 for pulmonary edema and left ventricular ejection fraction post myocardial infarction). Follow-up of those early discharged patients were promising as majority of them were asymptomatic (95%) and did well post-discharge. Conclusion Our study demonstrated data that support safety of early discharge in a carefully selected group of AMI patients. Early but safe discharge may have a huge impact on increasing bed availability, reducing hospital costs, and improving patient’s satisfaction.
Background Patients with acute myocardial infarction (AMI) especially those with large MI (myocardial infarction) as identified by ST elevation in multiple contiguous ECG leads or anterior MI, may suffer significant myocardial damage leading to impaired wall motion and contractility which may lead to the formation of left ventricular thrombus (LVT) in the patient. This study was aimed to establish the incidence of LV thrombus and determine the predictors associated with the formation of LV thrombus in patients with AMI. Methods This retrospective study was held at the only cardiothoracic centre of Makkah, which provides tertiary level cardiac services. A total of 3084 consecutive patients with acute MI between 2016 and 2019 were identified and divided into two groups i.e. group I (with LVT) and group II (without LVT). The case notes, echocardiography data and cardiac catheterization lab records were reviewed to identify patients with LV thrombus. Regression analysis was employed to evaluate the predictors responsible for the formation of LV thrombus. Results The overall incidence for LV thrombus was determined as 8.4% (n = 260/3084), while in the subpopulation of pilgrims, it was 8.2% (83/1001). Mean age for patients with and without LVT was 54 ± 11 years vs 56 ± 12 years (p < 0.003), respectively. There was no significant difference between the two groups with respect to gender, diabetes, hypertension, smoking, Arabic speaking or BMI>30. Coronary thrombus aspiration was utilized in 17% vs 12% (p < 0.023) patients with LVT and without LVT, respectively. It was observed that the patients with cardiac arrest tend to develop more LVT i.e. 8.5% vs 5.2% (p < 0.033). However, LV thrombus formation was significantly associated with anterior STEMI with incidence of LVT reaching 13.4% and low ejection fraction (all MI types) i-e. 32 ± 9% vs 42 ± 11%, with p < 0.000 for both independent predictors. Conclusions LV thrombus is a relatively common occurrence in patients with acute MI, especially those with anterior STEMI and low ejection fraction<30%. Appropriate imaging studies are required for all acute MI patients in order to ascertain the presence or absence of LV thrombus as it has major influence on further management.
Background Cardiogenic Shock (CS) remains the most common cause of death in hospitalized acute ST-segment elevation myocardial infarction (STEMI) patients. Predictors of outcomes in those patients include clinical, laboratory, radiologic variables, and management strategies. The present study aimed to evaluate the incidence, characteristics, predictors of cardiogenic shock and mortality among acute ST-segment elevation myocardial infarction patients in our center. Methods This was a retrospective, single-center study conducted at KAMC, Makkah during 2015–2020. All acute ST-segment elevation myocardial infarction patients during this era were divided into two groups CS group and non-CS group. Results In this study total 3074 acute ST-segment elevation myocardial infarction patients of which 132(4.3%) patients had CS. CS group tended to have higher ages than non-CS group. Pilgrims were more complicated by CS than nonpilgrims. Subsequently, CS patients had a highly significant (p < 0.001 for all) increase in the incidence of in-hospital complications including pulmonary oedema, cardiac arrest and ventilation. There was a significant increase in hospital stay length and in-hospital mortality among CS patients. Renal impairment, peak troponin level, haemoglobin drop≥3 gm/dl, and Left ventricular ejection fraction (EF) were significant independent predictors of cardiogenic shock among our patients. However, STEMI type, left main disease, and EF was the independent predictors of CS among our patients with diabetes with EF cut-off value of 35% with a sensitivity of 74.6% and a specificity of 65.3%. Age was the only independent predictor of mortality among CS patients. Though age, female gender, and diabetes were found to be the independent predictors for in-hospital mortality among our patients. Conclusion High-income middle eastern countries have comparable outcomes to Europe and USA among patients with acute ST-segment elevation myocardial infarction patients with higher improvement of medical care in the last 2 to 3 decades. Renal impairment, peak troponin, severe bleeding and ejection fraction were significant independent predictors of CS in acute ST-segment elevation myocardial infarction patients. However, STEMI type, left main disease, and ejection fraction were the independent predictors of CS in acute ST-segment elevation myocardial infarction patients with diabetes. Age was the only independent predictor of mortality among CS patients.
Background Epidemiological related differences in patients presenting with ST-elevation myocardial infarction (STEMI) have not yet been fully characterized in the Middle East countries. The aim of this study was to assess gender, ethnic and racial variation in clinical profiles, presentation and treatment strategies with relation to the in-hospital outcomes. Method This is a retrospective, single center study reviewing the epidemiological details of STEMI patients who were admitted to our center during the period between October 2015 and August 2019. Result Out of 3079 patients presented with STEMI, 498 (16%) were women, 2170 (70%) were from Middle Eastern Countries and only 1200 (39%) were non- Arabic speakers. Women were older in age compared to men (60.04 ± 11.2 vs 55.35 ± 11.8; P < 0.001). They showed significantly higher rates of cardiovascular risk factors (P < 0.001 for diabetes mellitus (DM), hypertension (HTN) and obesity) and lower prevalence of smoking and old history of previous revascularization (P < 0.001 and 0.007, respectively). Middle Eastern Countries- STEMI patients were elderly, showed higher prevalence of DM, HTN, smoking and obesity compared to South Asian patients (p = 0.001, 0.057, <0.001, <0.001 respectively). Arabic speaking - STEMI patients showed more prevalence of DM, smoking and obesity compared to non-Arabic speaking patients (p < 0.001). Regarding STEMI localization, post myocardial infarction complications and in-hospital length of stay, there were no detected significant gender, ethnic or racial variation. Women showed higher rates of all in-hospital mortality compared to men (5% vs 3%; p = 0.027) however, no ethnic/racial mortality difference was recorded among STEMI patients. Being elderly, presence of multivessel coronary artery disease and left ventricular systolic dysfunction (LVEF < 30%) are the three independent predictors of mortality among our patients (p = 0.013, 0.048 and <0.0001 respectively). Conclusion Our study demonstrates that there are gender, ethnic/racial-related differences in the demographics and clustered cardiovascular risk factors. However, there were no significant detected variation between both genders and different ethnic groups regarding post MI complications, management provided, and hospital outcomes except for increased the mortality rates among women. Old age, presence of multi-vessel disease and severe left ventricular systolic dysfunction have the greatest effect on in-hospital mortality among STEMI patients.
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