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Complicating Acute Myocardial Infarction—Etiologies, Management and Outcome

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 July 2022) | Viewed by 10602

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Special Issue Editor

Dr. Jarosław Zalewski

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Guest Editor

1. Department of Coronary Disease and Heart Failure, Institute of Cardiology, Jagiellonian University, Medical College, Krakow, Poland
2. John Paul II Hospital, Krakow, Poland
Interests: acute coronary syndromes; myocardial infarction; pharmacotherapy; primary percutaneous coronary intervention; imaging; left ventricular assist device

Special Issue Information

Dear Colleagues,

Mechanical reperfusion with primary angioplasty is currently the treatment of choice in acute myocardial infarction. This therapy is associated not only with a high percentage of full epicardial and myocardial reperfusion and immediate clinical effectiveness, but also with a very good long-term clinical outcome. The critical weakness of treatment of myocardial infarction including reperfusion therapy is associated with complications such as cardiogenic shock, pulmonary oedema, perforation of the left ventricular free wall, and papillary muscle rupture with acute mitral regurgitation or ventricular septal rupture. Although such complications are not common, each of them is associated with an increased or sometimes extremely high mortality rate, and therefore they determine the overall mortality in a population of patients with myocardial infarction. The therapeutic management of complications of myocardial infarction often has to be individualized. In this Special Issue, we would like to present the latest research on complications of myocardial infarction, including innovative solutions as well as contemporary approaches to the most challenging clinical scenarios.

Dr. Jarosław Zalewski
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

myocardial infarction
cardiogenic shock
acute heart failure
pulmonary oedema
left ventricular septal rupture
left ventricular free wall rupture
mitral regurgitation
left ventricular aneurysm
arrhythmias
left ventricular assist device

Published Papers (3 papers)

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Research

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15 pages, 890 KiB

Open AccessArticle

New-Onset Atrial Fibrillation in Acute Myocardial Infarction Is a Different Phenomenon than Other Pre-Existing Types of That Arrhythmia

by Monika Raczkowska-Golanko, Krzysztof Młodziński, Grzegorz Raczak, Marcin Gruchała and Ludmiła Daniłowicz-Szymanowicz

J. Clin. Med. 2022, 11(15), 4410; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11154410 - 28 Jul 2022

Cited by 2 | Viewed by 1331

Abstract

(1) Background: Atrial fibrillation (AF) in acute myocardial infarction (AMI) could worsen the prognosis. Yet, there is no definitive answer to whether new-onset AF (NOAF) is a more aggravating diagnosis than other types of that arrhythmia. The purpose of our study was to compare in-hospital clinical course and outcomes of NOAF patients contrary to patients with other pre-existing types of AF. (2) Methods: AMI patients hospitalized in the high-volume cardiological center within 2017–2018 were included in the study. NOAF was noticed in 106 (11%) patients, 95 (10%) with an AF history and AF during AMI formed the AF group, 60 (6%) with an AF history but without AF during AMI constituted the Prior-AF group, and 693 (73%) patients were without an AF before and during AMI. Medical history, routinely monitored clinical parameters, and in-hospital outcomes were analyzed between the groups. (3) Results: NOAF patients, contrary to others, initially had the highest high-sensitivity troponin I (hsTnI), B-type natriuretic peptide (BNP), C-reactive protein (CRP), and glucose levels, and the lowest potassium concentration, with the worst profile of changes for that parameter within the first four days of hospitalization. NOAF patients had the highest rate of ST-elevated AMI (40%), the longest hospitalization (p < 0.001), and the highest in-hospital mortality (p < 0.001). Not NOAF, but other AF groups (AF and Prior-AF groups) were more burdened with the previous comorbidities. (4) Conclusions: NOAF could be a distinct phenomenon in AMI patients, identifying those with the worst clinical in-hospital course and outcomes as compared to other types of AF. Full article

(This article belongs to the Special Issue Complicating Acute Myocardial Infarction—Etiologies, Management and Outcome)

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14 pages, 1238 KiB

Open AccessArticle

Real-World Long-Term Clinical Outcomes of Ultrathin Strut Biodegradable Polymer Drug-Eluting Stents in Korean ST-Segment-Elevation Myocardial Infarction (STEMI) Patients with or without Acute Heart Failure Undergoing Primary Percutaneous Coronary Intervention

by Albert Youngwoo Jang, Jongwook Yu, Pyung Chun Oh, Minsu Kim, Soon Yong Suh, Kyounghoon Lee, Seung Hwan Han and Woong Chol Kang

J. Clin. Med. 2021, 10(24), 5898; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245898 - 15 Dec 2021

Cited by 2 | Viewed by 1893

Abstract

Biodegradable polymers (BDPs) and ultrathin struts were recently introduced to drug-eluting stents (DES) to further improve outcomes. In this study, we analyzed and compared the effect of the ultrathin strut BDP-DES (UBDP-DES) with the conventional durable polymer-DES (DP-DES) in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). A total of 356 STEMI patients (n = 160 in the UBDP-DES group and n = 196 in the DP-DES group) were enrolled. The primary endpoint was target lesion failure (TLF), including cardiac death, target vessel myocardial infarction, and ischemic-driven, target lesion revascularization (ID-TLR). The mean age was 60.3 ± 12.7 years (male 81.7%), and the median follow-up duration was 63.8 months. TLF was numerically more frequent in the UBDP-DES group (8.1% vs. 4.1%; HR 2.14; 95% CI 0.89–5.18; p = 0.091). Propensity score matching (PSM) was performed to balance discrepancies in the baseline characteristics due to patients in the UBDP-DES group initially having more unstable vital signs. However, after PSM (n = 116 in each group), there was no significant difference in TLF (5.3% vs. 5.3%; HR 1.04, 95% CI 0.34-3.22; p = 0.947) or other secondary endpoints including ID-TLR. In the subgroup analysis, subjects with initial acute heart failure (AHF), defined as Killip class ≥ 3, were associated with 13.6% chance of 30-day mortality (9-fold of those without AHF), although chances of repeat revascularization were low (3.0%). Among patients with AHF, the UBDP-DES group was associated with a numerically higher chance of TLF compared with the DP-DES group. There was no difference in TLF between groups in patients without AHF. This study showed that UBDP-DES has long-term clinical outcomes similar to those of conventional DP-DES in real-world Korean STEMI patients receiving PPCI, especially in those without initial AHF. Full article

(This article belongs to the Special Issue Complicating Acute Myocardial Infarction—Etiologies, Management and Outcome)

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Review

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20 pages, 3015 KiB

Open AccessReview

Complicating Acute Myocardial Infarction. Current Status and Unresolved Targets for Subsequent Research

by Jaroslaw Zalewski, Karol Nowak, Patrycja Furczynska and Magdalena Zalewska

J. Clin. Med. 2021, 10(24), 5904; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245904 - 16 Dec 2021

Cited by 5 | Viewed by 6566

Abstract

Mechanical reperfusion with primary angioplasty, as the treatment of choice in acute myocardial infarction (MI), is associated not only with a high percentage of full epicardial and tissue reperfusion but also with a very good immediate and long-term clinical outcome. However, the Achilles heel of MI treatment is its ensemble of complications, such as cardiogenic shock due to severe systolic and/or diastolic dysfunction or MI mechanical complications, including perforation of the left ventricular free wall, papillary muscle rupture with acute mitral regurgitation and ventricular septal rupture. They are associated with an increased or, sometimes, with an extremely high mortality rate, determining the overall mortality in an MI patient population. In this review we summarize the mechanisms of MI complications, current therapeutic management and alternative directions for overcoming their devastating consequences. Moreover, we have sought to indicate gaps in the evidence on current treatments as the potential targets for further clinical research. From the perspective of mortality trends that are not improving, the forthcoming therapeutic management of complicated MI will require an individualized and novel approach based on their thorough pathobiology. Full article

(This article belongs to the Special Issue Complicating Acute Myocardial Infarction—Etiologies, Management and Outcome)

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