scholarly journals Acute myocardial infarction in non-cardiac critically ill patients: a clinical-pathological study

2015 ◽  
Vol 74 (4) ◽  
Author(s):  
Giorgio Berlot ◽  
Antonella Vergolini ◽  
Cristina Calderan ◽  
Rossana Bussani ◽  
Lucio Torelli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Correct Diagnosis ◽  
Post Mortem ◽  
Post Mortem Examination ◽  
Group 2 ◽  
Clinical Records ◽  
Group 1

Background: in patients admitted to the Intensive Care Unit (ICU) for non cardiac disease, the diagnosis of acute coronary syndromes can be challenging. The aim of the study was to define the rate of discrepancies concerning the diagnosis of acute myocardial infarction and to evaluate the presence of risk factors that could be helpful in identifying patients at higher risk of missed diagnosis. Methods: we compared clinical and autopsy records of 600 critically ill patients who died in our ICU in a 10-years period. We identified patients in whom acute myocardial infarction was reported as the cause of death on the clinical records or was discovered only at post-mortem examination. These subjects were subsequently divided into two Groups: patients in Group 1 underwent diagnostic evaluation for acute myocardial infarction whereas those in Group 2 were not investigated for. Results: In Group 1, a definite clinical diagnosis was reached in 11 patients (14,7%) but remained undetermined in 37 patients (48%). The diagnosis was totally missed in 8 patients in Group 1 (10,6%) and in 20 patients of Group 2 (26,6%). The diagnostic discrepancy was higher in septic patients, in whom the correct diagnosis of acute myocardial infarction was established at a rate lower than 50% in respect to non-septic patients. Conclusions: Our experience strengthens the role of post-mortem examination as a source of feed-back of the overall diagnostic and therapeutic approach especially in septic patients, where the diagnostic error is more frequent.

scholarly journals Can the cytokine adsorber CytoSorb® help to mitigate cytokine storm and reduce mortality in critically ill patients? A propensity score matching analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Christina Scharf ◽  
Ines Schroeder ◽  
Michael Paal ◽  
Martin Winkels ◽  
Michael Irlbeck ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Wilcoxon Test ◽  
Relative Reduction ◽  
Cytokine Storm ◽  
Saps Ii ◽  
Significant Difference ◽  
Group 2 ◽  
Group 1

Abstract Background A cytokine storm is life threatening for critically ill patients and is mainly caused by sepsis or severe trauma. In combination with supportive therapy, the cytokine adsorber Cytosorb® (CS) is increasingly used for the treatment of cytokine storm. However, it is questionable whether its use is actually beneficial in these patients. Methods Patients with an interleukin-6 (IL-6) > 10,000 pg/ml were retrospectively included between October 2014 and May 2020 and were divided into two groups (group 1: CS therapy; group 2: no CS therapy). Inclusion criteria were a regularly measured IL-6 and, for patients allocated to group 1, CS therapy for at least 90 min. A propensity score (PS) matching analysis with significant baseline differences as predictors (Simplified Acute Physiology Score (SAPS) II, extracorporeal membrane oxygenation, renal replacement therapy, IL-6, lactate and norepinephrine demand) was performed to compare both groups (adjustment tolerance: < 0.05; standardization tolerance: < 10%). U-test and Fisher’s-test were used for independent variables and the Wilcoxon test was used for dependent variables. Results In total, 143 patients were included in the initial evaluation (group 1: 38; group 2: 105). Nineteen comparable pairings could be formed (mean initial IL-6: 58,385 vs. 59,812 pg/ml; mean SAPS II: 77 vs. 75). There was a significant reduction in IL-6 in patients with (p < 0.001) and without CS treatment (p = 0.005). However, there was no significant difference (p = 0.708) in the median relative reduction in both groups (89% vs. 80%). Furthermore, there was no significant difference in the relative change in C-reactive protein, lactate, or norepinephrine demand in either group and the in-hospital mortality was similar between groups (73.7%). Conclusion Our study showed no difference in IL-6 reduction, hemodynamic stabilization, or mortality in patients with Cytosorb® treatment compared to a matched patient population.

scholarly journals Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

2018 ◽  
Vol 26 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Victoria Tea ◽  
Marc Bonaca ◽  
Chekrallah Chamandi ◽  
Marie-Christine Iliou ◽  
Thibaut Lhermusier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Secondary Prevention ◽  
High Risk Patients ◽  
Risk Patients ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

scholarly journals Effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients: A randomized clinical trial

2018 ◽  
Vol 5 (7) ◽  
pp. 2528-2537
Author(s):  
Akram Kooshki ◽  
Zaher Khazaei ◽  
Azam Zarghi ◽  
Mojtaba Rad ◽  
Hadi Gholam Mohammadi ◽  
...  
Keyword(s):  
Enteral Nutrition ◽  
Clinical Outcomes ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Routine Care ◽  
Fenugreek Seeds ◽  
Mechanically Ventilated ◽  
Fenugreek Seed ◽  
Group 2 ◽  
Group 1

Background: Enteral nutrition (EN) intolerance is a common complication in critically ill patients that contributes to morbidity and mortality. Based on the evidence of curing effects of fenugreek seeds in some gastrointestinal disorders, this study aimed to determine the effects of fenugreek seed powder on enteral nutrition tolerance and clinical outcomes in critically ill patients. Materials & Methods: A randomized, double-blinded clinical trial of 5-day duration was conducted on 60 mechanically ventilated patients divided in 2 groups (n=30). Group 1 was given fenugreek seed powder by gavage, twice a day in addition to routine care, while Group 2 received only routine care. Enteral nutrition tolerance and clinical outcomes were measured throughout the study. Demographic and clinical data were recorded and clinical responses to the primary outcome (enteral nutrition tolerance) and secondary outcome (other clinical factors) were interpreted. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis, and repeated measure ANOVA via SPSS statistical software (v. 20); statistical significance was set at p< 0.05. Results: Patients who were fed with the fenugreek seed powder showed a significant improvement in enteral nutrition tolerance, as well as some complications of mechanical ventilation for Group 1, as compared with Group 2. The mortality rates were not different between the two groups. Conclusion: This study shows the beneficial effects of fenugreek seeds on food intolerance in critically ill patients and that the seed powder can be used as an add-on therapy with other medications. Thus, the use of fenugreek seeds to treat mechanically ventilated patients is recommended.

scholarly journals Prospectively Validated Dosing Nomograms for Maximizing the Pharmacodynamics of Vancomycin Administered by Continuous Infusion in Critically Ill Patients

2009 ◽  
Vol 53 (5) ◽  
pp. 1863-1867 ◽  
Author(s):  
Federico Pea ◽  
Mario Furlanut ◽  
Camilla Negri ◽  
Federica Pavan ◽  
Massimo Crapis ◽  
...  
Keyword(s):  
Continuous Infusion ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Dosage Calculation ◽  
Cohort Group ◽  
Increased Risk ◽  
Dependent Activity ◽  
Group 2 ◽  
Vancomycin Treatment ◽  
Group 1

ABSTRACT The efficacy of vancomycin against methicillin-resistant Staphylococcus aureus (MRSA)-related infections has been called into question by recent findings of higher rates of failure of vancomycin treatment of infections caused by strains with high MICs. Continuous infusion may be the best way to maximize the time-dependent activity of vancomycin. The aim of this study was to create dosing nomograms in relation to different creatinine clearance (CLCr) estimates for use in daily clinical practice to target the steady-state concentrations (C sss) of vancomycin during continuous infusion at 15 to 20 mg/liter (after the administration of an initial loading dose of 15 mg/kg of body weight over 2 h). The correlation between vancomycin clearance (CLv) and CLCr was retrospectively assessed in a cohort of critically ill patients (group 1, n = 70) to create a formula for dosage calculation to target C ss at 15 mg/liter. The performance of this formula was prospectively validated in a similar cohort (group 2, n = 63) by comparison of the observed and the predicted C sss. A significant relationship between CLv and CLCr was observed in group 1 (P < 0.001). The application of the calculated formula to vancomycin dosing in group 2 {infusion rate (g/24 h) = [0.029 × CLCr (ml/min) + 0.94] × target Css × (24/1,000)} led to a significant correlation between the observed and the predicted C sss (r = 0.80, P < 0.001). Two dosing nomograms based on CLCr were created to target the vancomycin C ss at 15 and 20 mg/liter in critically ill patients. These nomograms could be helpful in improving the vancomycin treatment of MRSA infections, especially in the presence of borderline-susceptible pathogens and/or of pathophysiological conditions which may enhance the clearance of vancomycin, while potentially avoiding the increased risk of nephrotoxicity observed with the use of high intermittent doses of vancomycin.

scholarly journals Predictors of Left Ventricular Remodeling after Revascularized Acute Myocardial Infarction

2016 ◽  
Vol 1 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Sorin Pop ◽  
Roxana Hodaş ◽  
Edvin Benedek ◽  
Diana Opincariu ◽  
Nora Rat ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Ventricular Remodeling ◽  
Left Ventricular Remodeling ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Group 2 ◽  
Group 1

AbstractBackground:The acute loss of myocardium, following an acute myocardial infarction (AMI) leads to an abrupt increase in the loading conditions that induces a pattern of left ventricular remodeling (LVR). It has been shown that remodeling occurs rapidly and progressively within weeks after the AMI.Study aim:The aim of our study was to identify predictors for LVR, and find correlations between them and the cardiovascular (CV) risk factors that lead to remodeling.Material and methods:One hundred and five AMI patients who underwent primary PCI were included in the study. A 2-D echocardiography was performed at baseline (day 1 ± 3 post-MI) and at 6 months follow-up. The LV remodeling index (RI), was defined as the difference between the Left Ventricular End-Diastolic diameter (LVEDD) at 6 months and at baseline. The patients were divided into 2 groups, according to the RI: Group 1 – RI >15% with positive remodeling (n = 23); Group 2 – RI ≤15% with no remodeling (n = 82).Results:The mean age was 63.26 ± 2.084 years for Group 1 and 59.72 ± 1.267 years for Group 2. The most significant predictor of LVR was the female gender (Group 1 – 52% vs. Group 2 – 18%, p <0.0001). Men younger than 50 years showed a lower rate of LVR (Group1 – 9% vs. Group 2 – 20%, p = 0.0432). In women, age over 65 years was a significant predictor for LVR (Group 1 – 26% vs. Group 2 – 9%, p = 0.0025). The CV risk factors associated with LVR were: smoking (p = 0.0008); obesity (p = 0.013); dyslipidemia (p = 0.1184). The positive remodeling group had a higher rate of LAD stenosis compared to the no-remodeling group (48% vs. 26%, p = 0.002). The presence of multi-vessel disease was shown to be higher in Group 1 (26% vs. 9%, p = 0.0025). The echocardiographic parameters that predicted LVR were: LVEF <45% (p = 0.048), mitral regurgitation (p = 0.022), and interventricular septum hypertrophy (p <0.0001).Conclusions:The CV risk factors correlated with LVR were smoking, obesity and dyslipidemia. A >50% stenosis in the LAD and the presence of multi-vessel CAD were found to be significant predictors for LVR. The most powerful predictors of LVR following AMI were: LVEF <45%, mitral regurgitation, and interventricular septum hypertrophy.

scholarly journals Leukocyte and platelet markers of blood in the dynamics of the hospital period in patients with acute myocardial infarction: the ability to predict the development of long-term adverse events

2022 ◽  
Vol 28 (5) ◽  
pp. 9-23
Author(s):  
O. M. Parkhomenko ◽  
V. O. Shumakov ◽  
T. V. Talayeva ◽  
I. V. Tretyak ◽  
O. V. Dovhan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Area Under The Curve ◽  
Limit Values ◽  
Branch Group ◽  
Group 2 ◽  
A Prospective Study ◽  
Complex Indicators ◽  
Group 1

The aim – to create a new method of assessing the development of long-term complications in STEMI patients by studying blood cell composition and its adaptation to practical application in general clinical practice.Materials and methods. The study was involved 148 patients with acute myocardial infarction (AMI) who was admitted from January 2014 to June 2020 to the intensive care unit. Some patients were evaluated retrospectively and were in group 1 (n=92). Group 2 – 56 patients, who were studied prospectively. The groups of patients did not differ in clinical and anamnestic characteristics and treatment. The study provided an annual observation period. The endpoint in group 1 was: death, stroke, exacerbation of coronary heart disease – including the need for revascularization, the developement or decompensation for heart failure, which led to hospitalization (in addition, group 2 was analyzed for onset of cardiac death).Results and discussion. There complex indicators were built, based on the analysis of the clinical profile and dynamics of laboratory parameters in patients with the onset of the endpoint – a modified leukocyte index (mLI), which contains the values ​​of the number and percentage of granulocytes, lymphocytes and monocytes on days 1, 3 and 10 of STEMI and leukocyte-platelet index (mLPI), which additionally includes indicators of platelet inhomogeneity in size (PDWc and P-LCR). These indices with their limit values ​​(mLI > 140 units and mLPI > 242 units) were more informative in predicting distant cardiovascular events than other laboratory markers (including neutrophil-leukocyte ratio, NLR). In a prospective study branch (group 2), the mLI and mLPI indicators also turned out to be more informative than other markers (in particular, the NLR indicator) in determining the propensity to occur as a combined endpoint (area under the curve 0.71 for both; p>0.0001), so and death (areas under the curve 0.78 and 0.84, respectively; p>0.0001). Based on the data obtained, a computer algorithm has been created that simplifies the risk assessment in AMI patients using the developed indicators.Conclusions. Created leukocyte and leukocyte-platelet indices are highly informative in predicting the risk of complications in patients within a year after AMI.

Abstract 901: Impact of Microvascular Dysfunction on Long-Term Cardiovascular Events after Primary Coronary Intervention for Acute Myocardial Infarction in Patients Achieving TIMI Grade 3 Reperfusion

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Koichi Tamita ◽  
Atsushi Yamamuro ◽  
Syuichiro Kaji ◽  
Minako Katayama ◽  
Tomoko Tani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Microvascular Dysfunction ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Timi Grade ◽  
Group 2 ◽  
Grade 3 ◽  
Group 1

It has been reported that even if TIMI 3 flow is achieved in epicardial coronary arteries after primary percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI), microvascular dysfunction results in insufficient reperfusion. Recent studies have shown that microvascular injury can be assessed from coronary flow velocity (CFV) pattern. The aim of this prospective study was to examine whether the CFV pattern predicts the long-term cardiovascular outcomes in AMI patients who achieved TIMI grade 3 reperfusion. The study population consisted of 161 consecutive patients with a first anterior AMI successfully treated with primary PCI (≤50% residual stenosis with TIMI grade 3). We examined the CFV pattern immediately after PCI using a Doppler guidewire. We defined microvascular dysfunction as a diastolic deceleration time ≤600 ms and the presence of systolic flow reversal. Patients were divided into two groups: those without microvascular dysfunction (n=126; group 1) and those with micriovascular dysfunction (n=35; group 2). We evaluated the association between the microvascular dysfunction and the long-term major adverse cardiovascular event (MACE) rates. The Kaplan-Meier survival curves showed that group 2 was poorer than group 1 in prognosis (p=0.0014). Risk-adjusted data by multivariate analysis showed that the microvascular dysfunction was the strongest predictor for long-term MACE (hazard ratio: 3.37; 95% CI, 1.59–7.15; p=0.0015). The CFV pattern immediately after PCI is an accurate predictor of the long-term cardiovascular outcomes in patients with AMI who achieved TIMI grade 3 reperfusion.

scholarly journals The higher the better? Defining the optimal beta-lactam target for critically ill patients to reach infection resolution and improve outcome

2020 ◽  
Vol 8 (1) ◽  
Author(s):  
Christina Scharf ◽  
Uwe Liebchen ◽  
Michael Paal ◽  
Max Taubert ◽  
Michael Vogeser ◽  
...  
Keyword(s):  
Liver Function ◽  
Hospital Mortality ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Beta Lactam ◽  
Target Attainment ◽  
Outcome Group ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Abstract Objectives Beta-lactam antibiotics are often subject to therapeutic drug monitoring, but breakpoints of target attainment are mostly based on expert opinions. Studies that show a correlation between target attainment and infection resolution are missing. This analysis investigated whether there is a difference in infection resolution based on two breakpoints of target attainment. Methods An outcome group out of 1392 critically ill patients treated with meropenem or piperacillin-tazobactam was formed due to different selection criteria. Afterwards, three groups were created: group 1=free drug concentration (f) was < 100% of the time (T) above the minimal inhibitory concentration (MIC) (< 100% fT >MIC), group 2=100% fT >MIC<4xMIC, and group 3=100% fT >4xMIC. Parameters for infection control, renal and liver function, and estimated and observed in-hospital mortality were compared between those groups. Statistical analysis was performed with one-way analysis of variance, Tukey post hoc test, U test, and bivariate logistic regression. Results The outcome group consisted of 55 patients (groups 1–3, 17, 24, and 14 patients, respectively). Patients allocated to group 2 or 3 had a significantly faster reduction of the C-reactive protein in contrast to patients allocated to group 1 (p = 0.033 and p = 0.026). Patients allocated to group 3 had a worse renal function, a higher Acute Physiology and Chronic Health Evaluation (APACHE II) score, were older, and had a significantly higher in-hospital mortality compared to group 1 (p = 0.017) and group 2 (p = 0.001). The higher mortality was significantly influenced by worse liver function, higher APACHE II, and higher Sequential Organ Failure Assessment (SOFA) score and norepinephrine therapy. Conclusion Achieving the target 100% fT >MIC leads to faster infection resolution in the critically ill. However, there was no benefit for patients who reached the highest target of 100% fT >4xMIC, although the mortality rate was higher possibly due to confounding effects. In conclusion, we recommend the target 100% fT >MIC<4xMIC for critically ill patients. Trial registration NCT03985605

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