2018 Vol. 15, No. 3
Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction (STEMI), are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide registry. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early (30 days) and late (12 months) mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women (vs. 2.5%, P vs. 2.6%, P vs. 3.1%, P > 0.001; unadjusted OR: 2.33, 95% CI: 2.08–2.61) were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ? 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer related to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ? 3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for younger women should be performed.
Objective Cardiovascular complications contribute to postoperative morbidity and mortality in elderly hip fracture patients. Limited data are available regarding which preoperative risk factors predict cardiovascular course following hip fracture surgery (HFS). We used high sensitive troponin I (hs-TnI) assays and clinical parameters to identify preoperative risk factors associated with major adverse cardiac events (MACE) in elderly hip fracture patients. Method From August 2014 to November 2016, 575 patients with hip fracture were enrolled in a retrospective, single-center registry. A total of 262 of these patients underwent HFS and hs-TnI assays. MACE was defined as postoperative all-cause deaths, heart failure (HF), new-onset atrial fibrillation (AF), myocardial infarction (MI) and cardiovascular re-hospitalization that occurred within 90 days postoperative. Results Of 262 HFS patients, MACE developed following HFS in 65 (24.8%). Patients with MACE were older and had higher rates of renal insufficiency, coronary artery disease, prior HF, low left ventricular ejection fraction and use of beta blockers; higher levels of hs-TnI and N-terminal pro-brain natriuretic peptide (NT-proBNP) and higher revised cardiac risk index. A preoperative hs-TnI ≥ 6.5 ng/L was associated with high risk of postoperative HF, new-onset AF and MACE. In multivariable analysis, preoperative independent predictors for MACE were age > 80 years [adjusted hazard ratio (HR): 1.79, 95% confident interval (CI): 1.03–3.13, P = 0.04], left ventricular ejection fraction (LVEF) P 6.5 ng/L (adjusted HR: 3.75, 95% CI: 2.09–6.17, P Conclusion In elderly patients with hip fracture who undergo HFS, a preoperative assessment of hs-TnI may help the risk refinement of cardiovascular complications.
Hypertension has been found to be increased a risk of stroke in atrial fibrillation (AF). Both the European and U.S. guidelines ad-vocate the use of the CHA2DS2-VASc (congestive heart failure, hypertension, age > 75 years, diabetes mellitus, stroke/transient is-chemic attack, vascular disease, age 65–74 years, sex category) scheme for risk stratification. Although vitamin K antagonists is more effective than acetylsalicylic acid at preventing ischaemic stroke, its benefit is offs by an increased haemorrhage risk. The risk of is-chemic stroke in patients with AF and a CHA2DS2-VASc score of 1 are considered to be low risk and may be not expected to benefit from anticoagulation therapy. Hypertension carries an increased risk of ischemic stroke, however, it is also a clear risk factor for hem-orrhage in AF. Therefore, the optimal antithrombotic management is highlighted in patients with AF with only one risk factor espe-cially hypertension.
Letter to the Editor: Iatrogenic aortic dissection (IAD) is a rare complication of percutaneous coronary intervention. The mortality of IAD is high and urgent surgery is usually recommended. This case illustrated a severe IAD that was managed conservatively with good clinical outcome.
Background: Patients with Diabetic Ketoacidosis are prone to various life-threatening complications. This case presents a rare presentation of pseudoinfarction in a patient presenting with DKA. Case: 47-year old female with diabetes presented to the hospital with a three-day course of worsening nausea and vomiting. Initial electrocardiogram demonstrated ST elevations on leads V1-V3 concerning for anterior myocardial infarction. She underwent emergent left heart catheterization. During the procedure, the patient was found to have a blood glucose of 985 mg/dL, potassium of 6.7mmol/L, bicarbonate of 8 mmol/L, anion gap of 35 and the diagnosis of diabetic ketoacidosis was made. Cardiac catheterization demonstrated non-obstructive coronary artery disease. Left ventricular end-diastolic pressure obtained concerning for severe dehydration and left vetriculogram noted preserved ejection fraction. She later underwent management for DKA in the medical intensive care unit, including insulin therapy and fluid replacement. One hour afterwards, serum glucose level had improved (613 mg/dL) and the hyperkalemia had resolved (potassium 4.6 mmol/L). Repeat EKG showed normal sinus rhythm with no ST elevations. Decision-Making: Early detection of myocardial infarction is imperative to reduce mortality from this entity. ST segment elevation does not always equal myocardial infarction as demonstrated in this case. An EKG pattern mimicking myocardial infarction with worrisome confounding co-morbid condition such as diabetic ketoacidosis can subject patients to unnecessary invasive management. Conclusion: Hyperkalemia, metabolic acidosis or other metabolic abnormalities and hyperosmolar blood present in DKA can lead to ST segment elevations mimicking a myocardial infarction pattern on EKG. Diabetic Ketoacidosis in 4% of cases may predispose patients to developing acute myocardial infarction and should be considered as a confounding factor in medical or invasive management.
Simultaneous multiple coronary arteries thrombosis is a rare presentation of ST segment elevation myocardial infarctions (STEMI). It is associated with high incidence of complications including cardiogenic shock, ventricular arrhythmias, or sudden cardiac death. We report a case of 64-year-old male who was admitted to our hospital due to STEMI, and found to have thrombotic occlusion of two major coronary arteries
We present the case of a 71-year-old male who was transferred from a district hospital to our tertiary centre due to a large left atrial myxoma. Surgical removal of the myxoma was planned. The preoperative transesophageal echocardiogram demonstrated in detail the myxoma and its anatomical relation with the other cardiac structures. The mitral valve was intact, although severe mitral pseudostenosis was noted.
A 72-year-old female patient was admitted to hospital due to second degree and intermittent third degree atrioventricular block (AVB) . The DDD pacemaker was implanted successfully. After the procedure, the patient had chest pain and shortness of breath. Troponin T (TnT) was elevated gradually and the electrocardiography showed T wave inversion. The coronary angiography showed mild leisons and left ventriculography identified Takotsubo cardiomyopathy. Echocardiography showed reduced left ventricular ejection fraction (LVEF). It was confirmed eventually that the pain, nervousness and anxiety during the procedure of pacemaker implantation triggered the problem. After medical therapy, the left ventricular wall motion and LVEF was recovered normal.