STEMI vs NSTEACS management trends in non-invasive hospital

AbstractObjectivesTo compare the clinical features, management, and in-hospital outcomes of patients with ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTEACS), in the Western Region of Saudi Arabia.MethodsA total of 71 patients were enrolled in a longitudinal study at a tertiary hospital without cardiac catheterization facility. These data were collected from Saudi Project for Assessment of Coronary Events registry.ResultsTwenty-three patients with STEMI were compared to 48 patients with NSTEACS. Mean age for STEMI was younger, 57.4±13.7 years compared to 63.2±13.9 years respectively (p=0.19). Forty-four percent arrived at the hospital by ambulance. History of hypertension and hyperlipidemia were more frequent in NSTEACS (p=0.05), while both groups showed no difference in diabetes mellitus, 17% vs 22% and smoking, 30% vs 17%. In-hospital medications were: Aspirin (100%) both groups, Clopidogrel (91% vs 100%) (p=0.03). There was more aggressive use of beta-blockers (74% vs 95%) (p=0.01) and statins (87% vs 100%) (p=0.01) in NSTEACS.In-hospital outcomes showed one recurrent myocardial infarction and one death in NSTEACS group (2%). Other outcome in the two groups showed recurrent ischemia (13% vs 29%) (p=0.14) and cardiogenic shock (9% vs 2%) (p=0.17). No stroke or major bleeding was reported in both groups.ConclusionNSTEACS patients in western province of KSA present at an older age are mostly males and have higher prevalence of hypertension and hyperlipidemia compared with STEMI patients. It is therefore important to identify patients with high-risk profile and put implement measures to reduce these factors

Does Cardiac Exercise Stress Testing Still Exist?

Exercise Treadmill Testing to identify CAD is now a widely available and relatively low-cost examination that has been used for more than 60 years. The use of the ETT has expanded to include testing for functional capacity, chronotropic incompetence, assess the effects of therapy and also useful for risk stratification of patients with known CAD. The test sensitivity ranges from 61% to 73%, as reported by various analysts, and Specificity ranges from 59% to 81%, depending on the study or article referenced. Due to the various criteria set for the exercise stress test interpretation and reporting, we have outlined the criteria needed to support high quality exercise stress testing practice throughout Health facilities.</jats:p

Uncommon cause of complicated myocardial infarction with normal coronary arteries in a Saudi patient

A case of a young Saudi patient with a previous diagnosis of bronchial asthma, nasal polyps, and chronic smoker, presented with atypical chest pain, elevated serum troponin and borderline ischemic electrocardiogram (ECG) changes, with no significant regional wall motion abnormalities at bedside echocardiography is reported. The patient was admitted to the coronary care unit for continuous monitoring as possible acute coronary syndrome, non-ST elevation myocardial infarction (STEMI). One hour after admission, the patient had ventricular fibrillation (VF) cardiac arrest that required three DC shocks and amiodarone bolus before returning of spontaneous circulation, which followed the fourth shock. The resuscitation took 15 minutes of cardiopulmonary resuscitation (CPR). An immediate 12-leads ECG showed significant ST elevation in precordial leads that mandate an urgent coronary angiogram that revealed patent coronary arteries, therefore spasm of normal coronary arteries was postulated as the operative factor. The cardiac magnetic resonance image (MRI) showed a picture of transmural anterior myocardial infarction, which correlates with the follow up echocardiogram reporting hypokinetic anterior wall. A complete history was taken and no use of illicit drugs or alcohol was found. The unusual presentation in such a patient with evidence of extensive anterior STEMI and normal coronary arteries raise the thought of considering uncommon causes. In view of previous medical history and laboratory evidence of eosinophilia, Kounis syndrome was considered dominant in the differential diagnosis. Keywords: Coronary, Myocardial, infarction, Kouni