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Sequential thromboembolic events after primary angioplasty in a patient with acute anterior myocardial infarction.

ABSTRACT: A 65 year old man was transferred to our cath lab for primary PCI about two hours after the onset of pain in the context of acute, anterior myocardial infarction. Thrombus aspiration of the proximal LAD and balloon angioplasty with a DES implantation were performed. After a few days, although the patient was under treatment with unfractioned heparin, he sustained a transient ischemic attack. The echocardiographic study revealed a large, mobile, protruding thrombus in the apex. Four days later, the patient complained of mild abdominal pain with a gradual deterioration. Abdominal CT scan revealed embolism of the superior mesenteric artery and urgent embolectomy was scheduled.

SUBMITTER: Aggeli C

PROVIDER: S-EPMC3760563 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

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Sequential thromboembolic events after primary angioplasty in a patient with acute anterior myocardial infarction.

Aggeli Constantina C Pietri Panagiota P Vavouranakis Manolis M Felekos Ioannis I Tatsis Hraklis H Stefanadis Christodoulos C

European heart journal. Acute cardiovascular care 20121201 4

A 65 year old man was transferred to our cath lab for primary PCI about two hours after the onset of pain in the context of acute, anterior myocardial infarction. Thrombus aspiration of the proximal LAD and balloon angioplasty with a DES implantation were performed. After a few days, although the patient was under treatment with unfractioned heparin, he sustained a transient ischemic attack. The echocardiographic study revealed a large, mobile, protruding thrombus in the apex. Four days later, t ...[more]

PMID: 24062925

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Project description:BackgroundThis study aimed to investigate the hypothesis that specific pattern of myocardial work (MW) distribution in patients with acute anterior ST-segment elevation myocardial infarction (STEMI) could provide prognostic value for predicting left ventricular (LV) remodeling.MethodsA total of 98 first anterior wall STEMI patients treated with primary percutaneous coronary intervention [85 men (86.7%), mean age: 58 ± 12 years] were enrolled. Transthoracic echocardiography was performed 24-72 h after angioplasty and during 3-month follow-up. MW was estimated from the left ventricular pressure-strain loop derived from speckle tracking echocardiography and simultaneous noninvasive brachial artery cuff pressure. The primary endpoint was early LV remodeling, defined as an increase in LV end-diastolic volume ≥20% compared with baseline at 3 months after STEMI. Major adverse cardiac events and combined clinical outcomes were recorded.ResultsLV remodeling was present in 32 patients (33%), who exhibited lower global and culprit-regional work index (WI), constructive work (CW), work efficiency (WE), and specifically, greater differences of WE (delta-WE) and CW (delta-CW) between the culprit and non-culprit region than those without LV remodeling both at the acute phase and follow-up (all P < 0.0125). During follow-up, all global and regional WI, CW, and WE were improved (P < 0.0125 compared with baseline), with less improvement in patients with LV remodeling. In multivariate analysis, baseline delta-WE (odds ratio: 2.304; 95% CI: 1.093-4.856, P = 0.028) and peak troponin I level (odds ratio: 1.035; 95%CI: 1.008-1.063, P = 0.010) were independently associated with early LV remodeling. Patients with greater delta-WE at baseline were associated with a higher incidence of heart failure and combined clinical outcomes during follow-up.ConclusionAfter reperfused acute anterior STEMI, patients with LV remodeling presented with more inhomogeneous MW distribution. The absolute difference of WE between culprit and non-culprit territory at the acute phase is an independent predictor for early LV remodeling.Clinical trial registrationwww.ClinicalTrials.gov, identifier: NCT05107102.

Dataset Information

Sequential thromboembolic events after primary angioplasty in a patient with acute anterior myocardial infarction.

Publications

Sequential thromboembolic events after primary angioplasty in a patient with acute anterior myocardial infarction.

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