myocardial infarction

Post Infarction Ventricular Septal Rupture (PIVSR) is a rare condition of mechanical complication of myocardial infarction (MI) with a high mortality rate. Deterioration of hemodynamics is inevitable during both its progression while waiting for a timely surgery and after the surgery itself. Continuous vigilance of hemodynamic may improve hemodynamic status observation, enable timely interventions that target specific problems, and ultimately improve patient prognosis.

Case Illustration: 

65-year-old man with dyspnea, following 19 days after onset of MI. He was referred to our hospital with a presentation of acute heart failure, with pansystolic murmur grade IV/VI heard at the apex area. Echocardiogram showed a 14 mm IVS gap at the apex area, with left to right shunt. The patient was then stabilized in the CVCU and planned to undergo VSR closure and CABG. Procedure was done at 16th day of hospitalization. Post operative period, he developed shock due to bleeding and cardiac tamponade that required him to underwent 2x redo surgery. After tremendous efforts for stabilizing the patient, he ultimately survived.

Hemodynamic monitoring and stabilization play a pivotal role in determining the prognosis in the case of PIVSR. Prompt diagnosis of post-operative complications that deteriorate hemodynamics, along with an interdisciplinary team approach, can improve treatment strategy and significantly reduce fatal complications and morbidity, which ultimately will improve the patient’s chances of survival.

Myocardial infarction (MI) presents one of the most common cardiovascular disorders and a progressive debilitating condition. Patients with MI experience low quality of life (QoL) mainly due to the devastating complications of this condition, and it is necessary to upgrade QoL and self-care among these patients. Self-care training is one of the ways to improve QoL in these patients. Therefore, the present study aimed to investigate the effects of implementing Orem’s self-care model on the QoL of patients experiencing MI hospitalized in the intensive care unit (ICU).

The present research employed a quasi-experimental randomized pre-post design conducted from February 2021 to August 2022. The research population included 70 patients with MI hospitalized in the ICU of the Shahid Mostafa Khomeini Hospital of Ilam City, Eligible patients according to entry and exit criteria were divided into the intervention and control groups. Data were gathered using a questionnaire consisting of three parts: 1-demographic information, 2- needs assessment based on the Orem model, and 3- the MacNew Heart Disease Health-related Quality of Life. The intervention group received 4 sessions of self-care training (30-45 minutes each session) via in-person, virtual, and phone-based methods and handed a self-care training booklet. Participants in both groups filled out the QoL and self-care questionnaires before and two weeks and two months after the intervention by face-to-face visits or phone/virtual interviews. The data collected were analyzed using SPSS v.26 software by calculating frequencies, means, and standard deviations. The repeated-measure analysis of covariance was utilized to compare the two study groups before and after the intervention.

The results showed no significant difference in the mean QoL score between the intervention and control groups before the intervention (P-value = 0.05); however, after the intervention, the two groups showed a significant difference in terms of the mean score of QoL (P-value = 0.001).

The results of the present study showed that Orem self-care training could effectively improve the QoL of patients with MI, suggesting this approach as an effective non-pharmaceutical approach to upgrade QoL in these patients.

To provide a detailed understanding and apply a comprehensive strategy, this study examines the association between COVID‑19 vaccination and cardiovascular events. We conducted a Bayesian multivariate meta‑analysis using summary data across multiple outcomes including myocardial infarction, stroke, arrhythmia, and CAD, considering potential dependencies in the data. Markov chain Monte Carlo (MCMC) methods were detected for easy implementation of the Bayesian approach. Also, the sensitivity analysis of the model was done by using different priors.

Fifteen studies were included in the systematic review, with eleven studies comparing the results between the vaccine group and the unvaccinated group. Additionally, six studies were used for further analysis to compare mRNA COVID‑19 Vaccines (Pfizer‑BioNTech and Moderna).

Bayesian meta‑analysis revealed a link between vaccines and CAD risk (OR, 1.70; 95% CrI: 1.11–2.57), particularly after BNT162b2 (OR, 1.64; 95% CrI: 1.06–2.55) and second dose (OR, 3.44; 95% CrI: 1.99–5.98). No increased risk of heart attack, arrhythmia, or stroke was observed post‑COVID‑19 vaccination. As the only noteworthy point, a protective effect on stroke (OR, 0.19; 95% CrI: 0.10–0.39) and myocardial infarction (OR, 0.003; 95% CrI: 0.001–0.006) was observed after the third dose of the vaccine.

Secondary analysis showed no notable disparity in cardiovascular outcomes between BNT162b2 and mRNA vaccines. The association of COVID‑19 vaccination with the risk of coronary artery disease should be considered in future vaccine technologies for the next pandemic.

Acute myocardial infarction causes the heart to lose its proper function due to contractile dysfunction within the damaged ischemic cardiac tissue. Different studies have presented various cardiac patches based on different biomaterials to support the infarcted myocardium to recover cardiac function. 

In this study, we developed a nanofiber cardiac patch with antioxidant and antibacterial properties. Polycaprolactone (PCL) nanofibers were enriched with chitosan-coated selenium nanoparticles (Cs-SeNPs) using an electrospinning technique. 

The PCL/Cs-SeNPs nanofibers, with an average diameter of 648.36±259.19 nm, displayed antioxidant properties in the DPPH assay. Additionally, viable cell count assessment demonstrated the antibacterial effects of PCL/Cs-SeNPs nanofibers against Staphylococcus aureus and Escherichia coli bacteria. MTT assay results revealed improved proliferation for the PCL/Cs-SeNPs nanofibers compared to the PCL nanofibers scaffold, with no significant cell toxicity. The SEM imaging and DAPI/Phalloidin staining supported the improved cell adhesion with well-expanded cytoskeleton of 3T3 cells on PCL/Cs-SeNPs nanofibers. In the rat model of myocardial infarction, improved cardiac function and reduced post-surgical adhesion were observed 28 days after surgery. 

The results of this study suggest that the PCL/Cs-SeNPs nanofibers cardiac patch can be considered a potent supportive strategy for myocardial rehabilitation after myocardial infarction.

Red blood cell Distribution Width (RDW) can help diagnose blood diseases and predict mortality in heart disease. Fatigue is one of the common symptoms of Acute Myocardial Infarction (AMI) and can affect the quality of life of patients. This study aimed to investigate the link between RDW at admission and fatigue severity 2 weeks after AMI.

This cross‑sectional study examined 250 consecutive patients with AMI during 2023–2024. The patients were assessed for RDW and other laboratory and demographic variables within 24 h of admission. The Fatigue Severity Scale (FSS), which is a 9‑item and 7‑point scale, was completed for patients. A score >36 was considered as Post‑AMI Fatigue (PAF) and lower as non‑PAF. Data analysis was performed by SPSS version 22 and R version 4.2.2 software.

Our findings indicated that 71.20% of patients experienced fatigue after AMI. There were no significant differences between age, gender, laboratory parameters, past medical history, underlying diseases, and blood pressure of patients with and without fatigue (p > 0.05). RDW distribution for non‑PAF and PAF was 13.30% [12.50, 14.60%] and 13.30% [12.80, 14.00%], respectively, (p = 0.726). Multivariable regression results based on three models did not show any significant findings.

The present study is the first study, designed to determine the predictive value of RDW on post‑AMI fatigue, as far as we searched the recent literature. We did not find any significant relation between RDW and PAF. Therefore, it cannot be used to predict fatigue in patients with AMI until definitive results are found.

Acute myocardial infarction (AMI) often leads to pain. The use of complementary medicine can serve as an effective alternative approach to alleviate the pain of these patients.

The present study aimed to compare the effects of hand and foot reflexology on chest pain in patients after primary percutaneous coronary intervention (PPCI) in the Coronary Care Unit (CCU) in Zanjan, Iran.

A parallel-group randomized controlled design was used. A total of 80 participants were randomly allocated to three groups: The hand reflexology group (n = 26), the foot reflexology group (n = 27), and the control group (n = 27). After removing the arterial sheath, patients were given a 15-minute session of hand and foot reflexology. Participants’ pain levels were assessed using Visual Analog Scales (VASs) at four time points: Baseline, 15 minutes, three hours, and six hours after the intervention.

According to the results, there was no statistically significant variation in the levels of chest pain between the hand reflexology group, the foot reflexology group, and the control group (P < 0.05).

The results of this study determined that hand and foot reflexology did not effectively alleviate chest pain in patients who underwent PPCI. Therefore, the effectiveness of reflexology in acute pain conditions should be assessed in patients undergoing alternative therapeutic interventions, rather than PPCI, for several reasons.

The reopening of occluded arteries in myocardial infarction can be achieved through invasive and non-invasive methods.

This study aimed to determine treatment factors and outcomes comparison in acute myocardial infarction patients.

This cross-sectional and retrospective study examined the hospitalization data of 252 myocardial infarction patients referred to Ayatollah Mousavi Hospital from April 2021 to March 2022. The patient's demographic and clinical data, factors influencing treatment intervention selection, and clinical outcomes were assessed. Data were analyzed using the Chi-square test/Fisher's exact test, multiple logistic regression analysis, and ANOVA in SPSS v.22 software.

Primary percutaneous coronary intervention (PPCI) comprised 45.6% of treatments, with thrombolytic therapy comprising 35.3%. Multiple regression analysis revealed that the availability of a 24/7 operational catheterization lab and immediate access to an on-call interventional cardiologist were significant predictors of treatment selection (P< 0.05).
(P<0.05). The success rate of PPCI was 87.2% and thrombolytic therapy was 58.9%. Outcomes such as hospitalization length, analgesia dose, rehospitalization, and mortality rate over a year showed no significant statistical difference between the PPCI and thrombolytic groups (P>0.05).

Access to equipment and specialized manpower is essential for PPCI. There were no complications or clinical outcomes that differed between patients treated with PPCI and thrombolytic therapy. Thrombolytic therapy remains a viable alternative to PPCI when timely intervention is not feasible.

Myocardial infarction (MI) is one of the most common causes of death globally. Since a comprehensive study on the relationship between coagulation factors in AMI patients and opium consumption has not been done, in this study the effect of opium consumption on the number of coagulation factors I, II, VII, IX, and XI in patients with myocardial infarction and ST-elevated (STEMI) was investigated. Furthermore, our results shed light on the relationship between opium and coagulation factors with thrombosis grades.

In this case-control study, 80 STEMI patients referred to Razi Birjand Hospital, Iran, between years 2021 to 2022 were divided into two groups of opium addicts and non-addicts based on opium consumption and non-addict use, and the levels of the mentioned coagulation factors in their plasma were measured and compared with the corresponding values in 80 healthy people. Collected data was analyzed using SPSS software. The significance level of all tests was 5%.

The number of coagulation factors I, II, VII, and IX, unlike factor XI, in the opium addict group was significantly higher than the other two groups. While there was no statistically significant relationship between these coagulation factors with different degrees of thrombosis, most of the studied population were classified as Grade 5. Results also suggest no significant correlation between biochemical parameters and opium consumption.

Opium consumption can cause thrombosis by increasing the level of some coagulation factors. The findings from this study could have implications for clinical practice and public health interventions related to opium addiction and its impact on cardiovascular outcomes.

Treatment adherence refers to the degree to which an individual’s behavior complies with health or treatment recommendations. 

This study aims to determine treatment adherence and the related factors among patients with myocardial infarction (MI) admitted to selected hospitals in Hilla, Iraq.

In this cross-sectional study, 264 patients over 18 years of age diagnosed with MI for at least six months from three hospitals in Hilla, Iraq, were selected by a convenience sampling method. A demographic form and the coronary artery disease treatment adherence scale (CADTAS) were used to collect data. Pearson correlation test, Independent t-test, analysis of variance, multivariable general linear model (GLM) and Wilk’s lambda statistic was used for data analysis.

Most of the participants were male (72.7%), married (72.3%), worker (44.3%) with a middle school education (28%) and a mean age of 60.87±8.25. The mean total CADTAS score was 92.28±8.01( From 35 to 175 possible scores). The CADTAS score had significant and negative relationship with age (r=-0.225, P=0.001) and age at the onset of diagnosis (r=-0.239, P=0.001). The results of the GLM showed the significant and negative association of the history of heart attack (B=-2.645; 95% CI, -5.106, -0.184, P=0.035) and the history of underlying diseases (B=-2.828, 95% CI, -5.463, -0.193, P=0.036) with the CADTAS score. Also, the medication use duration was positively and significantly associated with the CADTAS score (B=1.145; 95%CI, 0.069, 2.222, P=0.037). Also, Wilks’ Lambda values showed a significant difference in the CADTAS score in terms of gender (Wilks’ Lambda =0.933, P=0.002), occupation (Wilks’ Lambda =0.845, P=0.001), history of heart attack (Wilks’ Lambda =0.950, P=0.013), history of underlying diseases (Wilks’ Lambda =0.953, P=0.018), and medication use duration (Wilks’ Lambda =0.938, P=0.003) 

The results of this study showed that the mean score obtained by the study samples was higher than the mean score of the tool used to determine the level of adherence. Given the MI patients’ treatment adherence scores, more studies are needed to determine the reasons for non-adherence to treatment in Iraqi patients with MI. Planning education for these patients and their families can be helpful to increase their treatment adherence.

In this investigation, the protective effects of hydroxytyrosol (HT) administered prior to myocardial infarction in rats were examined, with a particular focus on its potential roles within the Notch pathway.

The animals were categorized into seven groups (n=7): control, myocardial infarction (MI) 6th hour, MI 24th hr, MI 7th day, MI+HT 6th hr, MI+HT 24th hour, MI+HT 7th day. In order to create infarction, the rats received a subcutaneous injection of isoproterenol at a dose of 200 mg/kg. Rats were given 4 ml/kg/day liquid containing HT orally for six weeks before infarction. Histopathological examination was conducted on heart tissue to assess Notch1, Hes1, and DLL4. Biochemical parameters were analyzed in serum using the ELISA method.

The study revealed an increase in Notch1 and DLL4 levels, particularly at the 24th hr and 7th day after the occurrence of myocardial infarction. DLL4 increased at 24 hr and 7 days of infarction after HT administration compared to control. Hes1 levels increased towards the seventh day after infarction and following HT application before infarction. It was noted that the severity of histopathological damage in heart tissue was reduced at the 24th hr of infarction in rats treated with HT prior to infarction. A significant decrease in fibrosis was observed on the seventh day of infarction in rats given HT before infarction. The levels of biochemical parameters decreased with the administration of HT before the occurrence of infarction.

HT is thought to exert a cardioprotective effect in MI, potentially mediated through the Notch pathway.

The SYNTAX score is a strong predictor of adverse cardiovascular events such as cardiac death, myocardial infarction, and lesions with revascularization. This rating was also confirmed for patients with left ventricular problems and all the patients referred for percutaneous coronary interventions Percutaneous Coronary Interventions (PCI).

This study was conducted on 107 patients with ST-Elevation Myocardial Infarction (STEMI) who underwent thrombolytic treatment and then angiography. SYNTAX score was calculated in all the patients. Finally, the short-term and long-term prognoses were examined. Finally, the STR values were compared in two groups of people with high syntax and low syntax.

Eighteen patients (16.8%) suffered Congestive Heart Failure (CHF), one (0.9%) experienced GI bleeding, and one (0.9%) suffered ReMI. The patients’ mean±standard deviation, maximum, and minimum SYNTAX scores were 12.82±7.19, 35, and 3, respectively. Twelve patients (11.2%) had SYNTAX scores higher than 22 (high risk), and 95 (88.8%) had scores lower than 22 (low risk).

Results of the present study indicated that patients with SYNTEX scores >22 had STR lower than 50. CHF incidence rate in patients with SYNTAX scores higher than 22 (high risk) was higher. There was also a significant relationship between the patients’ prognosis and SYNTAX scores.

 Plasma proteins play essential roles in myocardial infarction (MI) and atrial fibrillation (AF) ; however, it remains unknown whether the two disorders share causal plasma proteins.

 The present study utilizes cis-protein quantitative trait loci (cis-pQTLs) for 4,719 plasma proteins to assess their causality on MI and AF.

 Two-sample Mendelian randomization (MR) identifies 21 and 9 plasma proteins for MI and AF, respectively (FDR P<0.05), with plasminogen (PLG) being a commonly protective factor against both diseases. Multi-trait MR suggests that PLG is also protective against coronary atherosclerosis. PheWAS analysis identifies associations of six cis-pQTLs with both MI and AF, i.e., rs11751347 (PLG), rs11591147 (PCSK9), rs77347777 (ITIH4), rs936228 (ULK3), rs2261033 (AIF1V), and rs2711897 (BDH2). Furthermore, interactions exist among the causal plasma proteins, with PLG directly interacting with multiple others. Drug-gene databases suggest that PLG activators, such as Urokinase, Reteplase, Streptokinase, Alteplase, Anistreplase, Tenecteplase, Desmoteplase, and Defibrotide sodium may serve as common therapeutic drugs for MI and AF.

 Our study provides a causal inference of human plasma proteins in MI and AF. Several of the identified proteins and single nucleotide polymorphisms (sNPs) exert pleiotropic effects on other cardiometabolic phenotypes, indicating their crucial roles in the pathology of cardiovascular disease (CVD). Our study provides new insights into the shared causality and drugs for MI and AF.

ST-segment elevation myocardial infarction (STEMI) continues to be a significant
global health issue, necessitating ongoing monitoring of care processes to enhance quality. This
study aimed to examine time to treatment delay and clinical indicators in patients with STEMI
undergoing primary percutaneous coronary intervention (PPCI).

This descriptive cross-sectional study was conducted with the recruitment of 313
patients with STEMI treated with PPCI Tabriz (Iran) in 2023. Data were analyzed using descriptive
statistics, the Mann-Whitney U test, the Kruskal-Wallis test, the chi-square test, and regression
analysis in SPSS v.13 software.

Most of the patients were men and half of them were 60 years old or younger. The
median door-to-balloon time [IQR] was 80 [49-140] minutes. The pre-PCI center delay time and
treatment delay time were 191 and 310 minutes, respectively. There was a statistically significant
association between the patient’s place of residence, the admission type in the PCI center,
and the pre-PCI center delay time. In addition, there was a statistically significant association
between treatment delay time, left ventricular ejection fraction (LVEF), baseline troponin I level,
angioplasty outcome, and receiving acute coronary syndrome (ACS) drugs at the pre-PCI center.

The longer pre-PCI center delay time resulted in a longer total treatment delay. To
reduce delays, it is proposed to improve the logistics surrounding these procedures for patients
with STEMI and to provide appropriate education about the STEMI management program to all
stockholders.

Acute myocardial infarction (MI) occurs less frequently in younger individuals compared to older ones. The development of atherosclerotic plaque is primarily linked to oxidized low-density lipoprotein cholesterol (Ox-LDL).

This study aimed to investigate circulating Ox-LDL levels in individuals with premature MI and compare them to controls without a history of ischemic heart disease.

In this case-control study, 35 patients who experienced a premature MI within 24 hours of symptom onset and met the age criteria (men ≤ 55 years and women ≤ 65 years) were recruited as cases. For comparison, 35 age and sex-matched individuals without a history of ischemic heart disease were selected as controls.

Analysis of circulating Ox-LDL levels revealed a significant elevation in patients with premature MI compared to controls (2.25 ± 1.78 vs. 1.04 ± 1.17 µg/dL; P = 0.002). Elevated Ox-LDL levels were associated with a 1.70-fold increased risk of premature MI compared to healthy individuals (95% CI: 1.16 - 2.49; P = 0.007).

This study demonstrates an association between elevated Ox-LDL levels and premature MI, particularly in younger individuals. Measuring Ox-LDL levels may help predict heart attack risk, and interventions aimed at reducing these levels could potentially prevent atherosclerosis.

Cardiogenic shock (CS) is a severe complication of ST-Elevation Myocardial Infarction (STEMI) and is associated with high mortality rates. This study aimed to identify predictors of in-hospital mortality in patients experiencing cardiogenic shock following STEMI.

A retrospective cohort study was conducted at Afshar Hospital in Yazd from 2018 to 2023, analyzing clinical data from 62 STEMI patients diagnosed with CS. The mean age of the cohort was 64.9 ± 13.5 years, with a male predominance of 69.5%. Key variables assessed included left ventricular ejection fraction (LVEF), comorbidities, and treatment interventions. Survival analysis and Cox regression were employed to evaluate mortality outcomes.

LVEF less than 30% emerged as a significant predictor of in-hospital mortality, with a hazard ratio of 11.1 (95% CI: 2.6–47.4; p < 0.001). The mean survival time was 7.0 days (95% CI: 5.8–8.3). Additionally, hyperlipidemia was associated with increased mortality, presenting an odds ratio of 11.3 (95% CI: 1.1–114.1; p = 0.040). The prevalence of chronic kidney disease was notably higher in the deceased cohort (28.0% vs. 8.1%; p = 0.042). Although urgent percutaneous coronary intervention (PCI) was performed in the majority of cases, mortality remained significant.

This study highlights that LVEF and hyperlipidemia are critical predictors of in-hospital mortality in patients with cardiogenic shock following STEMI. Other studies also suggest the prognostic value of LVEF in various cardiac conditions, particularly in the context of acute coronary syndromes [14, 15]. Also, the combination of renal dysfunction left ventricular ejection fraction, and advanced age has been proposed as a predictor of in-hospital mortality [18]. These findings underscore the importance of early identification and targeted management strategies to improve patient outcomes in this high-risk population.

 During COVID-19 pandemic, the emergency department (ED) was challenged to treat patients with COVID-19-related symptom. Therefore, the aim of this study was to investigate treatment delay and prognostic outcomes in ST-segment elevation myocardial infarction (STEMI) patients during COVID-19 pandemic due to isolation or precaution and compare it with pre-COVID-19 period.

This was a retrospective observation study using multicenter data with different case mix. Anonymized data were collected through each center’s electronic medical data of common case report form. Primary outcomes were number and rate of in-hospital mortality within 28 days. Secondary outcomes were door-to-balloon time and length of stay in the ED. Kaplan-Meier estimation and Cox proportional hazard regression analysis were performed to determine impact of predictors on 28-day in-hospital mortality.

Door-to-balloon time was longer in STEMI patients with COVID-19-related symptom(s) than those without symptom during the COVID-19 period (97.0 [74.8, 139.8] vs. 69.0 [55.0, 102.0] minutes, P<.001). However, there was no significant statistical difference in door-to-balloon time between STEMI patients with and without COVID-19-related symptom(s) during the pre-COVID-19 period (73.0 [61.0, 92.0] vs. 67.0 [54.5, 80.0] minutes, P=.2869). The 28-day mortality rate did not show a statistically significant difference depending on symptoms suggestive of COVID-19 during the pre-COVID-19 period (15.4% vs. 6.8%, P=.1257). However, it was significantly higher during the COVID-19 period (21.1% vs. 6.7%, P=.0102) in patients with COVID-19 suggestive symptoms than in patients without the symptoms.

 In Korea, symptoms suggestive of COVID-19 during the pandemic had a significant effect on the increase of door-to-balloon time and 28-day mortality in STEMI patients. Thus, health authorities need to make careful decision in designating symptoms indicated for isolation in ED based on opinions of various medical field experts.

ST-segment elevation myocardial infarction (STEMI) is a critical form of acute coronary syndrome that requires immediate myocardial reperfusion to reduce infarct size and enhance patient outcomes. Despite improvements in the management of STEMI, it continues to be a global contributor to mortality. This study aimed to evaluate the long-term prognosis and outcomes of STEMI patients by investigating the incidence of major adverse cardiac and cerebrovascular events. (MACCE).

This prospective cohort study enrolled 305 patients diagnosed with STEMI between March 2016 and February 2017 in Afshar Hospital, a tertiary cardiac hospital in central Iran. The researchers performed Primary percutaneous coronary intervention (PCI) using drug-eluting stents (DES), and patients received standard medical therapy. Data on major adverse cardiac and cerebrovascular events (MACCE), demographic characteristics, clinical factors, and procedural details were collected through patient interviews, medical records, and the myocardial infarction registry database.

The overall success rate of primary PCI was 92.8%. Hypertension was the most prevalent risk factor for coronary artery disease (41.1%). During the one-year follow-up, the incidence of MACCE was 15.1% (46 patients), with death being the most common occurring in 33 patients (10.8%). Mortality rates were highest within the first six months. The multivariate logistic regression analysis revealed that age (P=0.001) and stent length exceeding 30 mm (P=0.036) were significant predictors of mortality.

This study provides important insights into primary PCI outcomes in STEMI patients in central Iran. The findings indicate a high success rate for PCI and emphasize the necessity for timely and appropriate management. MACCE incidence, especially mortality, highlights the importance of ongoing surveillance and comprehensive follow-up care.