Kardiol Pol
-
Reperfusion therapy is the primary treatment for acute myocardial infarction. Its infarct-limiting effectiveness is, however, limited by so called reperfusion-induced myocardial injury likely related to reperfusion-mediated opening of the mitochondrial permeability transition pore (mPTP). ⋯ In this context, a clinical exploitation of endogenous cardioprotective mechanisms, known as ischaemic preconditioning and ischaemic postconditioning, emerges as an attractive therapeutic alternative. This is particularly so because ischaemic pre- and post-conditionig seem to afford cardioprotection by preventing reperfusion-induced deleterious opening of mPTP.
-
Acute heart failure (HF) is an emerging problem in clinical practice, associated with high in-hospital mortality and a high short-term readmission rate. ⋯ In our registry, in-hospital mortality in patients admitted due to acute HF was slightly higher compared to other reports. Baseline values of some parameters (e.g. blood pressure, serum Na(+), renal function) as well as their changes during hospitalisation (e.g. serum K(+), renal function, plasma NT-proBNP) can help identify acute HF patients at a higher risk of in-hospital mortality.
-
Primary percutaneous coronary intervention (PPCI) is regarded as the treatment of choice for ST elevation myocardial infarction (STEMI) patients. It has been emphasised that only experienced centres with round-the-clock cathlab facilities should perform PPCI. Some investigators have doubted whether PPCI performed during 'off-hours' is as effective and safe as that performed during regular hours. Papers supporting both possibilities have been published. ⋯ The PPCI performed in high-volume, experienced invasive cardiology centres in Europe during off-hours is associated with a comparable outcome and safety profile as PPCI performed during regular working hours.
-
The effects of pre-existing anaemia on the occurrence and course of an acute coronary syndrome has recently become a topic of extensive research. The data on the significance of anaemia in patients with ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI) are less abundant and the conclusions equivocal. ⋯ Patients with anaemia who develop STEMI are, right from the admission, a separate, higher-risk population of patients with considerably increased risk of death and in-hospital cardiovascular complications. The unfavourable impact of anaemia on outcomes in patients with acute MI undergoing PCI is complex and cannot be explained by the increased extend of post-infarction myocardial damage. In patients with STEMI, anaemia on admission should be treated as an additional risk factor.