Patients with transient ST-elevation myocardial infarction (STEMI) or spontaneous resolution (SpR) of the ST-segment elevation on electrocardiogram could potentially represent a unique group of patients posing a therapeutic management dilemma. In this review, we discuss the potential mechanisms underlying SpR, its relation to clinical outcomes and the proposed management options for patients with transient STEMI with a focus on immediate versus early percutaneous coronary intervention. We performed a structured literature search of PubMed and Cochrane Library databases from inception to December 2020. Studies focused on SpR in patients with acute coronary syndrome were selected. Available data suggest that deferral of angiography and revascularisation within 24-48 hours in these patients is reasonable and associated with similar or perhaps better outcomes than immediate angiography. Further randomized trials are needed to elucidate the best pharmacological and invasive strategies for this cohort.
Introduction: Atrial fibrillation (AF) is frequent after any cardiac surgery, but evidence suggests it may have no significant impact on survival if sinus rhythm (SR) is effectively restored early after the onset of the arrhythmia. In contrast, management of preoperative AF is often overlooked during or after cardiac surgery despite several proposed protocols. This study sought to evaluate the impact of preoperative AF on mortality in patients undergoing isolated surgical aortic valve replacement (AVR).Methods: We performed a retrospective, single-center study involving 2628 consecutive patients undergoing elective, primary isolated surgical AVR from 2008 to 2018. A total of 268/2628 patients (10.1%) exhibited AF before surgery. The effect of preoperative AF on mortality was evaluated with univariate and multivariate analyses.Results: Short-term mortality was 0.8% and was not different between preoperative AF and SR cohorts. Preoperative AF was highly predictive of long-term mortality (median follow-up of 4 years [Q1-Q3 2-7]; hazard ratio [HR]: 2.24, 95% confidence interval [CI]: 1.79-2.79, p < .001), and remained strongly and independently predictive after adjustment for other risk factors (HR: 1.54, 95% CI: 1.21-1.96, p < .001) compared with preoperative SR. In propensity score-matched analysis, the adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI: 1.04-1.99, p = .03) compared with the SR cohort.Conclusions: Preoperative AF was independently predictive of long-term mortality in patients undergoing isolated surgical AVR. It remains to be seen whether concomitant surgery or other preoperative measures to correct AF may impact longterm survival.
Conclusions First study investigating FMD in patients with permanent AF and hypertension together to assess whether presence of AF worsens the endothelial dysfunction seen in patients with hypertension. Endothelium-dependent FMD is impaired in patients with AF and hypertension. The presence of AF does not incrementally worsen endothelial dysfunction, nor was AF an independent predictor of endothelial dysfunction on multivariate analysis.
What is the reason for angina in this patient with a functionally single ventricle (Figure )? A patient in their 40s with background situs inversus, a functionally single ventricle with large ventricular septal defect, and transposed great arteries presented with chest pain and breathlessness. Surgery in childhood involved bilateral Blalock-Taussig shunts and pulmonary artery banding, performed via thoracotomies. Computed tomography coronary angiography showed proximal occlusion of a large coronary artery branch (Figure , A) and calcified masses within the epicardium with extrinsic compression of the anterior coronary artery. Magnetic resonance imaging showed features consistent with a completed infarct (Figure , B; Video), and tissue characterization favoured classification as a fibroma, myofibroma, or tuberculoma. Heart failure treatment and anticoagulation (given a high risk of apical thrombus) were implemented.Three percent of patients with acute myocardial infarction have no evidence of atherosclerotic disease on angiography. 1 Causative mechanisms include external compression of epicardial coronary arteries 2 secondary to muscle bridging, sinus of Valsalva aneurysms, and neoplasms. 3,4
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