Frequency of Non-ST-Elevation Myocardial Infarction (NSTEMI) among Patients Presenting with Atypical Presentation
NSTEMI among Patients with Atypical Presentation
DOI:
https://doi.org/10.54393/pjhs.v4i05.776Keywords:
Non-ST-Elevation Myocardial Infarction, Atypical Symptoms, ElectrocardiogramAbstract
Non-ST-Elevation Myocardial Infarction (NSTEMI) occurs when there is a partial or complete blockage of blood flow to the heart muscle. Atypical symptoms may also be more commonly observed in patients with non-obstructive coronary artery disease, which is characterized by the presence of plaque but without significant stenosis. Objective: To find the incidence of Non-ST-Elevation Myocardial Infarction (NSTEMI) among the patients with atypical presentation. It was a cross-sectional study conducted at Tabba Heart Institute, Karachi for the duration of six months from 19th December 2019 to 18th June 2020. Methods: The study was carried out on 257 patients. The average age of patients was 56.33 ± 8.07 years; mean height was measured as 162.89 ± 7.75 cm, mean weight was 72.51 ± 15.26 kg and average BMI of patients was 27.2 8 ± 5.25 kg/m2. In distribution of gender, out of 257 patients, 155 (60.3%) were male while 102 (39.7%) were female
Results: Hypertension was noted in 155 (60.3%) patients, diabetes mellitus was documented in 109 (42.4%) patients. Positive family history of premature CAD was found to be in 31(12.1%) while 226 (87.9%) had negative family history. Non-ST elevation myocardial infraction was noted in 77 (30%) patients. Conclusions: As NSTEMI is linked with high chance of mortality and severe medical issues therefore, it was vital to study the underlying risk factors so that the burden of diseases can be lowered and optimization of the management strategies can be made for this already compromised cohort of patient.
References
Negrea MO, Zdrenghea D, Teodoru M, Neamțu B, Cipăian CR, Pop D. Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome. Journal of Cardiovascular Development and Disease. 2022 Mar; 9(3): 84. doi: 10.3390/jcdd9030084.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 2018 Jan; 39(2): 119-77.
Tziakas D, Chalikias G, Al-Lamee R, Kaski JC. Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice? International Journal of Cardiology. 2021 Apr; 329: 1-8. doi: 10.1016/j.ijcard.2020.12.082.
Lawesson SS, Isaksson RM, Thylén I, Ericsson M, Ängerud K, Swahn E, et al. Gender differences in symptom presentation of ST-elevation myocardial infarction–an observational multicenter survey study. International Journal of Cardiology. 2018 Aug; 264: 7-11. doi: 10.1016/j.ijcard.2018.03.084.
Cha JJ, Bae S, Park DW, Park JH, Hong SJ, Park SM, et al. Clinical outcomes in patients with delayed hospitalization for non–ST-segment elevation myocardial infarction. Journal of the American College of Cardiology. 2022 Feb; 79(4): 311-23. doi: 10.1016/j.jacc.2021.11.019.
Baumann AA, Mishra A, Worthley MI, Nelson AJ, Psaltis PJ. Management of multivessel coronary artery disease in patients with non-ST-elevation myocardial infarction: a complex path to precision medicine. Therapeutic Advances in Chronic Disease. 2020 Jun; 11: 2040622320938527. doi: 10.1177/2040622320938527.
Tisminetzky M, Gurwitz JH, Miozzo R, Nunes A, Gore JM, Lessard D, et al. Age Differences in the Chief Complaint Associated With a First Acute Myocardial Infarction and Patient's Care-Seeking Behavior. The American Journal of Medicine. 2020 Sep; 133(9): e501-7. doi: 10.1016/j.amjmed.2020.02.018.
Cohen M and Visveswaran G. Defining and managing patients with non‐ST‐elevation myocardial infarction: Sorting through type 1 vs other types. Clinical Cardiology. 2020 Mar; 43(3): 242-50. doi: 10.1002/clc.23308.
Kim I, Kim MC, Park KH, Sim DS, Hong YJ, Kim JH, et al. Prognostic significance of non-chest pain symptoms in patients with non-ST-segment elevation myocardial infarction. The Korean Journal of Internal Medicine. 2018 Nov; 33(6): 1111. doi: 10.3904/kjim.2017.071.
Chen H, Li M, Liu L, Dang X, Zhu D, Tian G. Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction. Medicine. 2019 Jun; 98(26): e16267. doi: 10.1097/MD.0000000000016267.
Michaels J, Parfrey S, Mozid AM, Veerasamy M, Bulluck H, Tayebjee MH. Incidence and Clinical Predictors of Non-Obstructive Coronary Arteries in Patients with Suspected Non-ST Elevation Myocardial Infarction Undergoing Invasive Coronary Angiography. Heart, Lung and Circulation. 2022 Aug; 31(8): e115-6. doi: 10.1016/j.hlc.2022.03.009.
Ahmed S, Khan A, Ali SI, Saad M, Jawaid H, Islam M, et al. Differences in symptoms and presentation delay times in myocardial infarction patients with and without diabetes: A cross-sectional study in Pakistan. Indian Heart Journal. 2018 Mar; 70(2): 241-5. doi: 10.1016/j.ihj.2017.07.013.
Steiro OT, Aakre KM, Tjora HL, Bjoerneklett RO, Skadberg OS, Bonarjee VV, et al. Chest pain characteristics and their ability to predict NSTEMI according to gender and age in patients presenting with suspected ACS. European Heart Journal. 2021 Oct; 42(Supplement_1): 724-1477. doi: 10.1093/eurheartj/ehab724.1477.
Ängerud KH, Sederholm Lawesson S, Isaksson RM, Thylén I, Swahn E. Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST-and non-ST-elevation myocardial infarction. European Heart Journal: Acute Cardiovascular Care. 2019 Apr; 8(3): 201-7. doi: 10.1177/2048872617741734.
Oz TK, Özbilgin N, Sungur A, Bas EG, Zengin A, Gürol T, et al. Prevalence of metabolic syndrome in young patients with ST-elevation myocardial infarction. International Journal of the Cardiovascular Academy. 2018 Jul; 4(3): 53. doi: 10.4103/IJCA.IJCA_10_18.
Wu CC, Hsu WD, Islam MM, Poly TN, Yang HC, Nguyen PA, et al. An artificial intelligence approach to early predict non-ST-elevation myocardial infarction patients with chest pain. Computer Methods and Programs in Biomedicine. 2019 May; 173: 109-17. doi: 10.1016/j.cmpb.2019.01.013.
Kitahara S, Fujino M, Honda S, Asaumi Y, Kataoka Y, Otsuka F, Nakanishi M, Tahara Y, Ogata S, Onozuka D, Nishimura K. COVID-19 pandemic is associated with mechanical complications in patients with ST-elevation myocardial infarction. Open Heart. 2021 Feb; 8(1): e001497. doi: 10.1136/openhrt-2020-001497.
Ram E, Sternik L, Klempfner R, Iakobishvili Z, Peled Y, Shlomo N, et al. Outcomes of different revascularization strategies among patients presenting with acute coronary syndromes without ST elevation. The Journal of Thoracic and Cardiovascular Surgery. 2020 Oct; 160(4): 926-35. doi: 10.1016/j.jtcvs.2019.08.130.
Chien DK, Lee SY, Hung CL, Sun FJ, Lin MR, Chang WH. Do patients with non-ST-elevation myocardial infarction without chest pain suffer a poor prognosis? Taiwanese Journal of Obstetrics and Gynecology. 2019 Nov; 58(6): 788-92. doi: 10.1016/j.tjog.2019.09.010.
Fu R, Li SD, Song CX, Yang JA, Xu HY, Gao XJ, et al. Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction—an analysis from China Acute Myocardial Infarction (CAMI) registry. Journal of Geriatric Cardiology: JGC. 2019 May; 16(5): 395.
Harrington DH, Stueben F, Lenahan CM. ST-elevation myocardial infarction and non-ST-elevation myocardial infarction: medical and surgical interventions. Critical Care Nursing Clinics. 2019 Mar; 31(1): 49-64. doi: 10.1016/j.cnc.2018.10.002.
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