Conduction Disorders in the Setting of Acute STEMI

Nikus, Kjell; Birnbaum, Yochai; Fiol‐Sala, M.; Rankinen, Jani; Luna, Antoni Bayés de

doi:10.2174/1573403x16666200702121937

Cited by 17 publications

(10 citation statements)

References 43 publications

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“…The high incidence of LAFB in LM occlusion indicated significant ischemia of the anterior wall, especially in the absence of collateral circulation. Since RBBB and LAFB receive essentially the same blood supply from the proximal LAD, LM occlusion may result in the coexistence of LAFB and RBBB ( 29 ). Bifascicular block (LAFB + RBBB) was reported to be one of the two main ECG features in LM occlusion ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Combining electrocardiographic criteria for predicting acute total left main coronary artery occlusion

Liu

Yang

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPrediction of left main artery (LM) occlusion may contribute to the administration of early reperfusion. We sought to identify electrocardiographic (ECG) features associated with acute total LM occlusion and explore the relationship between ECG features and collateral circulation.MethodsWe retrospectively studied ECGs in 84 consecutive patients with LM occlusion between January 2001 and April 2022. The ECG findings in these patients were compared with those in 468 consecutive patients with LM subtotal occlusion and non-LM occlusion.ResultsThree main ECG patterns were described according to the characteristics of ST elevation (STE) in LM occlusion: ST-segment elevation myocardial infarction (STEMI), STE in aVR with diffuse ST depression, and STE in both aVR and aVL. These ECG patterns were associated with different collateral filling territories. One-third STEMI in LM occlusion showed STE in the precordial leads including V1, while 2/3 STEMI showed STE in the precordial leads from V2 to V5 without STE in V1. The following ECG characteristics predicted LM occlusion: STE in both aVR and aVL; STE in I, aVL, and V2–V5 without V1; left anterior fascicular block (LAFB); right bundle branch block (RBBB) + LAFB; and prolongation of the QRS interval. The incidences of STE in aVR and STE in aVR and V1 were higher in LM subtotal occlusion than in LM occlusion. The combination of two different STE criteria (STE in aVR and aVL and STE in I, aVL, V2-V5 without V1) predicted LM occlusion with 62% sensitivity and 95% specificity. The combination of the STE criteria and fascicular block criteria (LAFB and LAFB + RBBB) further improved the specificity to 99% but reduced the sensitivity to 39%.ConclusionThe combination of STE criteria predicted LM occlusion with high specificity and moderate sensitivity, and the addition of fascicular block criteria further improved the specificity with some loss of sensitivity.

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Section: Discussionmentioning

confidence: 99%

Combining electrocardiographic criteria for predicting acute total left main coronary artery occlusion

Liu

Yang

et al. 2022

Front. Cardiovasc. Med.

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“…However, indirect evidence, such as myocardial ischemia, has been suggested to cause heart block. 35 Further studies are still warranted to clarify the effect of PreRASi on heart block in the HF population.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Renin–Angiotensin System Inhibitors Improve Major Outcomes of Heart Failure Patients Undergoing Cardiac Surgery

et al. 2022

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The aim of this study was to study the association of perioperative administration of renin angiotensin system inhibitors (RASi) and clinical outcomes of patients with heart failure (HF) undergoing cardiac surgery. Summary Background Data: It is controversial whether the perioperative RASi should be administered in HF patients undergoing cardiac surgery. Methods: A total of 2338 patients with HF and undergoing CABG and/ or valve surgeries at multiple hospitals from 2001 to 2015 were identified from STS database. After adjustment using propensity score and instrumental variable, logistic regression was conducted to analyze the influence of preoperative continuation of RASi (PreRASi) on short-term in-hospital outcomes. Independent risk factors of 30-day mortality, major adverse cardiovascular events (MACE), and renal failure were analyzed by use of stepwise logistic regression. The effects of pre-and postoperative use of RASi (PostRASi) on long-term mortality were analyzed using survival analyses. Stepwise Cox regression was conducted to analyze the independent risk factors of 6-year mortality. The relationships of HF status and surgery type with perioperative RASi, as well as PreRASi-PostRASi, were also evaluated by subgroup analyses. Results: PreRASi was associated with lower incidences of 30-day mortality [P < 0.0001, odds ratio (OR): 0.556, 95% confidence interval (CI) 0.405−0.763], stroke (P =0.035, OR: 0.585, 95% CI: 0.355−0.962), renal failure (P =0.007, OR: 0.663, 95% CI: 0.493-0.894). Both PreRASi (P =0.0137) and PostRASi (P =0.007) reduced 6-year mortality compared with the No-RASi groups. Conclusions: Pre-and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/ or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.

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“…Nos infartos inferiores também surgirão ondas S empastadas ou entalhadas em D2, D3 e aVF. 116 Os desnivelamentos do segmento ST podem permitir a identificação de infarto do miocárdio recente, de acordo com os critérios definidos por Sgarbossa e cols. A partir de 5 pontos observa-se elevada acurácia no reconhecimento do infarto do miocárdio com supradesnivelamento do segmento ST.…”

Section: Infarto Do Miocárdio Na Presença De Bloqueio De Ramo Esquerd...unclassified

Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022

Samesima¹,

God²,

Kruse³

et al. 2022

Arquivos Brasileiros De Cardiologia

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Conduction Disorders in the Setting of Acute STEMI

Cited by 17 publications

References 43 publications

Combining electrocardiographic criteria for predicting acute total left main coronary artery occlusion

Combining electrocardiographic criteria for predicting acute total left main coronary artery occlusion

Perioperative Renin–Angiotensin System Inhibitors Improve Major Outcomes of Heart Failure Patients Undergoing Cardiac Surgery

Diretriz da Sociedade Brasileira de Cardiologia sobre a Análise e Emissão de Laudos Eletrocardiográficos – 2022

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