ST elevation MI

ST-segment elevation A type of myocardial infarction (MI) that typically results in an injury that transects the thickness of the myocardial wall. Following an ST-elevation MI, pathologic Q waves are frequently seen on the electrocardiogram, indicating transmural myocardial infarction. 

The safety of G-CSF stimulation in patients with CAD has been questioned in two recent studies. Hill et al. [138] report the results of administration of 10 mcg/kg/day of G-CSF for 5 days in patients with chronic CAD n = 16). There was no clinical benefit as assessed by exercise stress testing and dobuta-mine cardiac MRI. Additionally two patients in the G-CSF group developed serious adverse events related to the therapy (one non-ST elevation MI one MI causing death). Zbinden et al. [139] also tested the efficacy of the same G-CSF dose in patients with chronic CAD ( = 7). The invasive endpoint collateral flow index was significantly better in the G-CSF treated patients when compared to the placebo group. However, two patients in the G-CSF treated group developed acute coronary syndrome during treatment. 

While the survival of older patients with ST elevation MI has improved in the last 20 years, it still remains much higher than in younger adults. Thus, the potential of treatments to improve outcomes in absolute terms is greater in older patients. Despite... 

In the hospital, ECG and laboratory tests are performed promptly to determine the subsequent treatment strategy. When car-diomyocytes die, contractile proteins (troponin) or myocardial enzymes (creatine kinase, CK-MB) are liberated and can be detected in blood for diagnostic purposes. Marked elevation of the ST segment in the ECG raises the strong suspicion of a complete occlusion of a coronary artery (ST elevation MI, STEMI). In these MI patients, reperfusion of the affected area as early and as completely as Luellmann, Color Atlas of Pharmacology All rights reserved. Usage subject to terms... 

Antman EM, Cohen M, Bernink PJ et al. The TIMI risk score for unstable angina/non-ST elevation MI a method for prognostication and therapeutic decision making. JAMA 2000 284 835. 

That genetic factors contribute to SCD has been supported by population studies which show that SCD risk is often familial (83,84). In one study (83), a parental history of SCD before age 65 was associated with a 2.7-fold increased risk of SCD, after adjustment for familial aggregation of common risk factors. However, this study included SCD patients who were both ischemic and nonischemic at the time of cardiac arrest. In a complementary study, a parental history of SCD was associated with a 1.8-fold increased risk of SCD, while a parental history of MI was not associated with SCD (85). If both parents had a history of SCD, the risk of SCD in the offspring was increased nine-fold. In another study of patients with ST elevation MI, patients were grouped into those with VF arrest versus a control group with ST elevations in the absence of VF (84). A family history of SCD occurred significantly more frequently among patients with VF versus the controls without VF (43.1% versus 25.1%, respectively OR 2.72, 95% Cl 1.84-4.03). 

Figure 6.9 Odds ratio plot with 95% confidence intervals comparing 30-day outcomes in acute ST elevation MI patients with TIMI 3 flow at 90 minutes who underwent PCI (adjunctive or delayed) versus those who did not undergo PCI (medical therapy) in the TEVII lOB and 14 trials. (From Ref. 30.)...

During recent years clinical trials have shown early or acute invasive coronary revascularization to be superior to medical stabilization or thrombolysis. The benefit has been demonstrated in patients with unstable angina or moderate infarction (non-ST elevation MI, non-STBMI) [31,32], as well as in patients with large ST elevation MI (STEMI)... 

Primary PCI should be performed for patients less than 75 years old with ST elevation or LBBB who develop shock within 36 h of MI and are suitable for revascularization that can be performed within 18 h of shock unless further support is futile because of the patient s wishes or contraindications/unsuitability for further invasive care. (Level of Evidence A)... 

Abbreviations D, death MI, myocardial infarction NNH, numbers needed to harm NNT, numbers needed to treat PCI, percutaneous coronary inteivention STEMI, ST-elevation myocardial infraction UR, urgent reintervention. 

In English literature, it is usually named STEMI (ST elevation myocardial infarction), but we consider the name STE-ACS better because currently with quick reperfusion treatment some of these cases present aborted MI. 

We express our gratitude to E. Antman, pioneer in many aspects of IHD, who has written a generous Foreword to this book, for his support and collaboration. We have written together a monograph related to the role of surface ECG in patients with acute thoracic pain and ST-segment elevation MI, which has been mostly included in this book, and for that he may also be considered co-author of the book. Also my thanks to Gunter Breithardt, an... 

Although the above agents have not demonstrated a clear benefit over UFH, several trials have defined a clear role of enoxaparin in ACS. The ESSENCE trial studied the effect of enoxaparin for two to eight days upon presentation with non-ST-elevation ACS, and showed a significant reduction in the combined endpoint of death, MI, or recurrent angina when compared with... 

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