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Acute myocardial infarction in a patient with dextrocardia and successful angioplasty.

ABSTRACT: A 48-year-old man with dextrocardia presented with atypical chest pain for 2 hours. Right-side ECG showed convex upward ST elevations in leads V4 and V5. Coronary angiogram showed complete occlusion of mid portion of the left anterior descending artery (LAD). Several attempts at engaging the left main origin was successful and the LAD was opened with placement of a drug-eluting stent. The post-procedure course was uneventful, and he was discharged home two days later.

SUBMITTER: Subedi BH

PROVIDER: S-EPMC5738648 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Acute myocardial infarction in a patient with dextrocardia and successful angioplasty.

Subedi Bishnu H BH

Journal of community hospital internal medicine perspectives 20171214 6

A 48-year-old man with dextrocardia presented with atypical chest pain for 2 hours. Right-side ECG showed convex upward ST elevations in leads V4 and V5. Coronary angiogram showed complete occlusion of mid portion of the left anterior descending artery (LAD). Several attempts at engaging the left main origin was successful and the LAD was opened with placement of a drug-eluting stent. The post-procedure course was uneventful, and he was discharged home two days later. ...[more]

PMID: 29296253

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Project description:Preclinical data suggest that an acute inflammatory response following myocardial infarction (MI) accelerates systemic atherosclerosis. Using combined positron emission and computed tomography, we investigated whether this phenomenon occurs in humans.Overall, 40 patients with MI and 40 with stable angina underwent thoracic 18F-fluorodeoxyglucose combined positron emission and computed tomography scan. Radiotracer uptake was measured in aortic atheroma and nonvascular tissue (paraspinal muscle). In 1003 patients enrolled in the Global Registry of Acute Coronary Events, we assessed whether infarct size predicted early (?30 days) and late (>30 days) recurrent coronary events. Compared with patients with stable angina, patients with MI had higher aortic 18F-fluorodeoxyglucose uptake (tissue-to-background ratio 2.15±0.30 versus 1.84±0.18, P<0.0001) and plasma C-reactive protein concentrations (6.50 [2.00 to 12.75] versus 2.00 [0.50 to 4.00] mg/dL, P=0.0005) despite having similar aortic (P=0.12) and less coronary (P=0.006) atherosclerotic burden and similar paraspinal muscular 18F-fluorodeoxyglucose uptake (P=0.52). Patients with ST-segment elevation MI had larger infarcts (peak plasma troponin 32 300 [10 200 to >50 000] versus 3800 [1000 to 9200] ng/L, P<0.0001) and greater aortic 18F-fluorodeoxyglucose uptake (2.24±0.32 versus 2.02±0.21, P=0.03) than those with non-ST-segment elevation MI. Peak plasma troponin concentrations correlated with aortic 18F-fluorodeoxyglucose uptake (r=0.43, P=0.01) and, on multivariate analysis, independently predicted early (tertile 3 versus tertile 1: relative risk 4.40 [95% CI 1.90 to 10.19], P=0.001), but not late, recurrent MI.The presence and extent of MI is associated with increased aortic atherosclerotic inflammation and early recurrent MI. This finding supports the hypothesis that acute MI exacerbates systemic atherosclerotic inflammation and remote plaque destabilization: MI begets MI.URL: https://www.clinicaltrials.gov. Unique identifier: NCT01749254.

Project description:ImportanceBlack patients experience worse outcomes than white patients following acute myocardial infarction (AMI).ObjectiveTo examine the degree to which nonrace characteristics explain observed survival differences between white patients and black patients following AMI.Design, setting, and participantsThis cohort study used the extensive socioeconomic and clinical characteristics from patients recovering from an AMI that were prospectively collected at 31 hospitals across the contiguous United States between 2003 and 2008 for the Prospective Registry Evaluating Myocardial Infarction: Events and Recovery registry and the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status registry. Survival was assessed using data from the National Death Index. Data were analyzed from December 2016 to July 2018.Main outcomes and measuresPatient characteristics were categorized into 8 domains, and the degree to which each domain discriminated self-identified black patients from white patients was determined by calculating propensity scores associated with black race for each domain as well as cumulatively across all domains. The final propensity score was associated with 1- and 5-year mortality rates.ResultsAmong 6402 patients (mean [SD] age, 60 [13] years; 2127 [33.2%] female; 1648 [25.7%] black individuals), the 5-year mortality rate following AMI was 28.9% (476 of 1648) for black patients and 18.0% (856 of 4754) for white patients (hazard ratio, 1.72; 95% CI, 1.54-1.92; P?<?.001). Most categories of patient characteristics differed substantially between black patients and white patients. The cumulative propensity score discriminated race, with a C statistic of 0.89, and the propensity scores were associated with 1- and 5-year mortality rates (hazard ratio for the 75th percentile of the propensity score vs 25th percentile, 1.72; 95% CI, 1.43-2.08; P?<?.001). Patients in the lowest propensity score quintile associated with being a black individual (regardless of whether they were of white or black race) had a 5-year mortality rate of 15.5%, while those in the highest quintile had a 5-year mortality rate of 31.0% (P?<?.001). After adjusting for the propensity associated with being a black patient, there was no significant mortality rate difference by race (adjusted hazard ratio, 1.09; 95% CI, 0.93-1.26; P?=?.37) and no statistical interaction between race and propensity score (P?=?.42).Conclusions and relevanceCharacteristics of black patients and white patients differed significantly at the time of admission for AMI. Those characteristics were associated with an approximately 3-fold difference in 5-year mortality rate following AMI and mediated most of the observed mortality rate difference between the races.

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Acute myocardial infarction in a patient with dextrocardia and successful angioplasty.

Publications

Acute myocardial infarction in a patient with dextrocardia and successful angioplasty.

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