Search

Unlabelled: The aim of the study was to assess plasma B-type natriuretic peptide (BNP) levels in patients after myocardial infarction (MI) with intraventricular conduction defects (IVCD) and to define relationship between BNP level, treatment strategy and left ventricular performance., Material and Methods: Four types of IVCD were noted: left bundle branch block (LBBB), right bundle branch block (RBBB), left anterior hemiblock (LAH) and left posterior hemiblock (LPH). A total of 158 patients six months after MI treated either invasively or conservatively were included. Of them 126 had IVCD (group A): LBBB-31, RBBB-36, LAH-130, LPH-29, whereas 32 patients without IVCD served as controls (group B). Plasma BNP levels were measured using an immunoenzymatic method. All subjects underwent echocardiography to evaluate left ventricular function., Results: In group A significantly lower plasma BNP levels (186.3 vs 355.3 pg/mL; p < 0.01) and significantly higher left ventricular ejection fraction (EF) (48.4 vs 42.4%; p < 0.05) were noted in favour of invasive treatment. In group B differences between plasma BNP level and echocardiographic parameters of left ventricle function were insignificant. In patients with LBBB plasma BNP levels were significantly lower in those treated invasively (163.9 vs 528.9; p < 0.01). Also, left ventricular EF and myocardial performance index (MPI) were comparable, whereas E/A value was lower as compared with patients treated conservatively (p < 0.05). There were no significant differences in BNP levels in groups with RBBB, LAH and LPH. Multifactorial regression analysis showed that BNP levels were most strongly correlated with magnitude of the ejection fraction EF (p < 0.001). Other parameters which affect significantly BNP level were MPI: OR 9.07 (95% CI 1.03-79.58; p < 0.05) and E/A: OR 6.58 (95% CI 1.01-42.76; p < 0.05)., Conclusions: Invasive strategy in MI with IVCD, especially with LBBB, correlates with lower plasma BNP levels six months after index procedure. In patients with IVCD post MI plasma BNP level is better marker of dysfunction of the left ventricle than its ejection fraction.

Muscle bridge with concomitant sclerotic lesions may cause myocardial infarction (MI). We present a case of 70 year-old woman, who suffered from MI due to sclerotic lesion located within the anterior descending artery, right above the muscle bridge. Implanting two drug eluting stents resulted in restoration of proper flow through the vessel, widening the sclerotic lesion and the area of muscle bridge.

In-stent thrombosis is a rare but devastating complication of coronary stent implantation, occurring in 0.5% to 1.9% of patients with bare metal stents (BMS). The most frequent clinical manifestation of stent thrombosis is ST elevation myocardial infarction (STEMI) and 30 day mortality is 50%. In-stent thrombosis can present as acute (within 24 h), subacute (within 30 days), late or very late after stent placement. We describe a case of a patient presented with STEMI due to subacute stent thrombosis, which occurred simultaneously in BMS, 3 days after implantation. The patient was successfully treated with balloon coronary angioplasty and discharged from a hospital in good condition.

Acute myocardial infarction (MI) in the postpartum period is rare. We present a case of a 37-year-old women with acute MI which occurred 15 days after delivery. Coronary angiography revealed multivessel coronary artery disease and she underwent successful surgical revascularisation.

A case of a 27-year-old female, who developed acute myocardial infarction is presented. The first ECG revealed T-waves changes. Coronary angiography revealed a critical stenosis of the left descending coronary artery and a successful angioplasty was performed. A five-year follow-up was uneventful.

A case of acute severe mitral regurgitation with serious hemodynamic impairment in the setting of an inferior ST-elevation myocardial infarction is presented. Both transthoracic and transesophageal echocardiography demonstrated a posteriorly directed eccentric jet of severe mitral regurgitation with flail anterior mitral valve leaflet. The rupture of the postero-medial papillary muscle attached via chords to the anterior mitral valve leaflet was found. The direction and eccentricity of the mitral regurgitant jet on transthorasic and transesophageal echocardiography helped to point the leaflet involved, but not necessarily the coexisting papillary muscle pathology.

Successful delivery of progenitor cells to the injury zone is a prerequisite for any effect of myocardial regeneration therapy. This key issue, however, has received far less attention than, for instance, a potential need for cell type selection or ex-vivo expansion, the optimal timing of cell application or multimodal functional evaluation after cellular transplantation. By combining myocardial perfusion scintigraphy, magnetic resonance imaging and 99Tc-HMPAO-labelled autologous bone marrow-derived CD34+ cells visualisation, we show in a 63-year-old man with a large anterior myocardial infarction that transcoronary applied cells (via the central lumen of an inflated over-the-wire balloon positioned in the stent implanted in primary PCI) graft preferentially to the infarct border zone. This is consistent with the idea that the area of myocardial 'irreversible' injury (i.e. the no-perfusion zone on perfusion scintigraphy or late enhancement zone on magnetic resonance) remains largely inaccessible to transcoronary-applied cells; thus other techniques need to be considered if the cell delivery is aimed at the zone of irreversible injury. The potency of such combined high-resolution visualisation provides grounds for comparing the efficacy of different methods of cell delivery after a recent myocardial infarction in man.

We present a patient with myocardial infarction and normal coronary angiogram. The patient had no classical coronary risk factors, but had thyrotoxicosis, which was taken into consideration as a possible cause of myocardial infarction.

There is a group of rare but serious complications of acute myocardial infarction (AMI), including free wall rupture (FWR) and, less frequent, ventricular septal rupture (VSR). Urgent surgery combined with simultaneous CABG is usually a treatment of choice. We present a case of a 65-year-old male with AMI, who developed cardiogenic shock due to cardiac tamponade as a result of FWR. The patient was successfully resuscitated and operated. During postoperative treatment parasternal systolic murmur was audible and VSR diagnosis was confirmed. Three months after AMI the AMPLAZER Muscular VSD Occluder was successfully implanted. The follow-up period was uneventful.

A case of a 60 year old female with angina and remote myocardial infarction is presented. Coronary angiography revealed an extreme curvature of the right coronary artery which was the most probable cause of infarction. A coronary stent was implanted which resulted in clinical improvement.

Introduction: The immediate and complete restoration of perfusion in patients with acute myocardial infarction (MI) leads to the survival of myocardial cells in the initially ischaemic risk area and makes the recovery of left ventricular contractile function possible., Aim: The goal of the study was to assess the utility of contrast echocardiography (CE) in the prediction of left ventricular function recovery in patients with AMI treated by percutaneous coronary intervention (PCI)., Methods: Eighty six patients (aged 58.4+/-11.2) with anterior AMI, treated by PCI of the left anterior descending coronary artery, were included in the study. Two-dimensional and contrast (Optison) echocardiography were performed immediately before and after PCI, and three days post-PCI. Myocardial contrasting was assessed using the following criteria: 0 -- lack of perfusion; 0.5 -- partial perfusion; 1 -- normal perfusion. On the third day post-PCI, the regional myocardial contrast index was evaluated as the mean value in dyssynergic left ventricular segments (LVRCstI). After three months, the left ventricular regional contractility index (LVRCtrctI) was calculated as the sum of points in the segments which were dyssynergic in the initial study, divided by their number., Results: 90% of segments with perfusion defects three days post-PCI demonstrated contractility defects (hypokinesia or akinesia) three months post-PCI. LVRCstI three days post-PCI correlated strongly with LVRCtrctI three months post-PCI (R2=0.7696). The sensitivity, specificity and accuracy of EC three days post-PCI in the prediction of recovery of left ventricular function were 88%, 80% and 86%, respectively., Conclusions: The presence of myocardial perfusion in the region supplied by the infarct-related artery three days post-MI is indicative of myocardial survival and predicts the recovery of contractile function in this region in long-term observation.

Introduction: Pathological left ventricular remodelling is considered the main cause of heart failure in patients after myocardial infarction., Aim: The purpose of this study was to evaluate correlations between the degree of coronary microvascular reperfusion assessed by means of the angiographic myocardial blush grade (MBG) scale and adverse left ventricular remodelling in patients with acute myocardial infarction treated with primary coronary angioplasty., Methods: This study involved 92 consecutive patients, hospitalised because of their first anterior wall myocardial infarction, who underwent successful (TIMI-3 grade flow) primary coronary angioplasty. Angiographic myocardial reperfusion parameters (MBG, corrected TIMI Frame Count) were assessed. Three days and 6 months after the index PCI all patients underwent an echocardiographic examination and such parameters as end-diastolic volume (EDV), left ventricular ejection fraction (EF) and contractility index (WMSI) were calculated., Results: The patients were divided into two groups: group 1 with impaired myocardial reperfusion (MBG 0-1) (n=32) and group 2 with adequate tissue reperfusion (MBG 2-3) (n=60). Negative left ventricular remodelling was observed more frequently in group 1 than in group 2 (28.1% vs 10%, p=0.029). More patients in group 1 presented heart failure symptoms (56.3% vs 25%, p=0.013)., Conclusions: Failure of tissue reperfusion assessed by means of angiographic indices (MBG 0-1) in patients with myocardial infarction treated with primary coronary angioplasty is associated with a higher rate of adverse myocardial remodelling and heart failure at 6 months after myocardial infarction.

Unlabelled: The myocardial perfusion assessment in myocardial infarction is crucial to proper therapeutical decisions and patient's prognosis. The aim of the study to assess the efficacy of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute myocardial infarction compared with 99mTc MIBI SPECT study., Material and Methods: 86 patients (mean age 58.4 +/- 11.2) underwent primary percutaneous coronary (PCI) for acute anterior myocardial infarction. TIMI grade flow, myocardial blush grade (TMPG), corrected TIMI frame count (cTFC) and segmental contractility and segmental perfusion were estimated in real time before and immediately after PCI, using injections of intravenous Optison. MCE performed before PCI described the risk area as the sum of segments with the lack of perfusion. A MCE perfusion defect size after PCI < 25% of the MCE perfusion defect size before PCI was used to define myocardial reperfusion. MCE was repeated on the third day after PCI. All patients underwent a rest 99mTc MIBI SPECT study (SPECT) on the third day after PCI., Results: Based on MCE, 54 patients had reperfusion ("reflow" group) and 32 had non-reperfusion ("no-reflow" group). Patients from the non-reperfusion group showed a higher creatine kinase peak (p = 0.0034), higher kinase-MB (p = 0.0033) and higher troponine level (p = 0.0629), longer time span between the onset of pain and reperfusion (p = 0.003), and worse baseline regional contractile function (p = 0.0022). All angiographic parameters were worse in this group before as well as after PCI: more often TIMI 0 or 1, TMPG 0 or 1 in patients from "no-reflow" group was observed. These patients had higher cTFC than ones from "reflow" group. The agreement between MCE and SPECT for detecting perfusion abnormality was 87%., Conclusions: MCE facilitated identification of myocardial perfusion abnormalities in patients with acute myocardial infarction, whereas serial MCE facilitated identification of patients with early and late improvement of myocardial perfusion. MCE correlated very well with SPECT images in assessing perfusion defect.

Introduction: Combined therapy with fibrinolytic agent and platelet GPIIb/IIIa inhibitor not followed by an interventional procedure does not improve prognosis in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) when compared to fibrinolysis alone. On the other hand, in the past percutaneous coronary interventions (PCI) performed after fibrinolysis were associated with low angiographic efficacy, a high risk of bleeding and a high rate of early cardiovascular events., Aim: Evaluation of angiographic and clinical outcomes in patients with STEMI treated with PCI following combined fibrinolytic therapy., Methods and Results: Complete angiographic and clinical data of 187 patients who underwent PCI immediately after combined fibrinolytic therapy were obtained from a survey of 669 consecutive patients with STEMI <12 hours, at age <75 years, without cardiogenic shock, who were transferred from regional hospitals to the catheterisation laboratory within 90 minutes and after the initiation of combined fibrinolytic therapy (alteplase 15 mg iv as a bolus followed by an infusion of 35 mg over 60 minutes; abciximab iv bolus of 0.25 mg/kg followed by a 12 h infusion of 0.125 microg/kg per minute; unfractionated heparin). At baseline angiographic examination revealed no flow (TIMI 0+1) in the infarct-related artery in 17.1% of patients, impaired flow (TIMI 2) in 17.1% and normal (TIMI 3) in 65.8% of cases. After immediate PCI, a significant improvement in epicardial perfusion (TIMI 2+3, 99.5%) and in microcirculation was achieved. This favourable effect was seen only in the group of patients with baseline TIMI 0+1 flow, whereas PCI in the group with baseline TIMI 3 flow did not cause any further improvement in microcirculatory perfusion. The rate of cardiovascular events within the first 30 days and 12 months after the procedures were similar in the studied subgroup of patients., Conclusions: PCI performed after combined fibrinolytic therapy in STEMI patients is associated with high efficacy and improvement in indices of epicardial perfusion and microcirculation. These benefits are confined mainly to patients with primarily impaired flow in the infarction-related artery (TIMI 0+1). However, the clinical results of this strategy, particularly in patients undergoing PCI following successful combined fibrinolytic therapy, must still be proved in further randomised trials.

Although in patients with interventricular septum rupture complicating acute myocardial infarction urgent cardiac surgery is suggested as a method of choice by current ESC and ACC/AHA guidelines, mortality is high. In some patients, intra-aortic counterpulsation and optimisation of medical therapy may stabilise patients condition and increased the safety of elective cardiac surgery which can be performed a few weeks later. In this report we describe two patients with this condition who were successfully treated using a conservative approach and subsequent elective surgery.

Background: Circulating endothelial microparticles (EMPs), the small vesicles released from altered endothelial cells, have been established as markers of endothelial injury. The elevated count of EMPs has been described in different conditions involving endothelial injury, including acute myocardial infarction (AMI)., Aim: To assess the presence of EMP in patients with acute MI in relation to early clinical outcome and coronary angiography results., Materials and Methods: EMPs counts were determined in 66 patients pts (23 women, 43 men) with documented ST elevation AMI and in 10 control patients with no evidence of coronary artery disease. All pts with AMI underwent coronary angiography with attempted primary angioplasty. EMPs were assayed by flow cytometry in platelet-poor plasma with combinations of fluorescent antibodies (anti CD31, -51, -42) allowing distinction of EMPs from platelet microparticles. Clinical and angiography results were compared with EMP levels., Results: Three kinds of EMPs were measured: CD31+, CD51+ and CD31+/51+. The percentage of EMPs CD31+/CD51 was significantly (p=0,042) higher in patients with AMI in comparison with control subjects. However, a marker, which distinguished both groups the most, was the level of EMPs CD51+. It was significantly (p=0,024) higher in pts with AMI than in control pts. The levels of CD31+ were similar in both groups. There was no correlation between EMP levels, clinical and angiography results., Conclusion: The presence of circulating EMPs provides direct evidence of endothelial injury in AMI. The clinical and practical value of these results, however, needs further exploration.

Primary Percutaneous Transluminal Coronary Angioplasty (PTCA) is increasingly common method of treatment patients with acute myocardial infarction. The aim of the study was to assess the left ventricular function in patients with myocardial infarction subjected to thrombolysis or primary PTCA. Gated Single Photon Emission Computed Tomography was performed in 40 patients 6 months after myocardial infarction treated either with thrombolysis or primary PTCA. Left ventricular ejection fraction (LVEF), left ventricular enddiastolic (LVED) and systolic (LVES) volumes were analysed both at rest and after stress. Six months after myocardial infarction LVEF was significantly greater and LVED, LVES volumes smaller in patients treated with primary PTCA in comparison to patients treated with thrombolysis. The above observation suggests that patients subjected to primary PTCA might have better functional outcome in comparison to matched patients treated with thrombolysis after 6 months post myocardial infarction.

Acute myocardial infarction complicated by cardiogenic shock in a patient with Leriche syndrome - a case report. A 46-year-old male with atherosclerosis obliterans was admitted to the hospital due to chest pain lasting for two hours and signs of cardiogenic shock. ECG revealed postero-inferior myocardial infarction. The patient was successfully treated with primary angioplasty of RCA. Due to atherosclerosis obliterans angioplasty was performed by transulnar approach. After 22 days of treatment and rehabilitation he was discharged home.

Elektrocardiographic signs of anterior myocardial infarction caused by the occlusion of the right ventricular branch. A case of a 72-year-old male with electrocardiographic symptoms of anterior myocardial infarction resulting from the right ventricular branch occlusion is presented. The mechanisms of eliscrepancy between angiographic and electrocardiographic findings are discussed and diagnostic as well as therapeutic procedures are described.

Background: Thrombus containing lesions (TCL) are often associated with unfavourable immediate results of invasive procedures thus influencing long-term outcome. Early invasive treatment strategy employed in patients (pts) with acute coronary syndromes without sustained ST segment elevation (ACS) may be crucial for improvement of immediate and in-hospital results., Objective: The aim of this study was to find out whether the presence of thrombi in lesions related to instability may negatively affect the results of early invasive treatment strategy and long-term outcome of patients with acute coronary syndromes., Materials and Methods: We analyzed coronary angiograms of 364 consecutive pts with ACS who were assigned to early invasive treatment strategy. Pts with angiographically recognizable thrombus containing lesions (group A) were compared with remaining ones (group B) with regard to immediate results of percutaneous intervention (PCI), in-hospital outcome and 12-month follow up., Results: The study group consisted of 84 patients with TCL and 280 without thrombus. Pts with TCL were younger (58 +/- 9,9 vs 61 +/- 10,8; p<0,03) and less frequently had impaired LV function (EF<35%; 5% vs 13% p<0,04). Cardiac enzymes at admission were positive in 49% and 35% of pts in group A and B respectively (p<0,04). Baseline TIMI flow was 2,7 +/- 0,8 in group A and 2,5 +/- 0,9 in group B (NS) and TIMI 3 flow before PCI was observed in 54,8% and 69,3% of pts respectively (p<0,01). Type B and C lesions were observed in 100% and 91% culprit lesions respectively (p<0.05). TIMI flow after PCI was 2,9 +/- 0,4 in group A and 2,9+/-0,5 in group B and TIMI 3 flow after PCI was observed in 95,2% and 95,9% respectively (NS). GP IIB/IIIA antagonists were used in 4,8% pts of group A and 6,4% patients of group B. Frequency of stent implantation was 96,5% and 96,7% respectively (NS). One (1,2%) in-hospital death occurred in group A and 4 (1,4%) in group B (NS). Myocardial infarction was observed in 4 (4,8%) pts in group A and 12 (4,3%) in group B (NS). In 12-month follow up 2 (2,4%) deaths in group A and 10 (3,6%) in group B were observed (NS). No difference between groups was noted in myocardial infarction rate: 7,14% (group A) vs 2.84% (group B), NS. More pts in group B had episodes of unstable angina during follow up (19,5% vs 9,5%; p<0,04)., Conclusions: Thrombus containing lesions in patients with ACS assigned to early invasive strategy do not negatively influence the immediate, in-hospital and 1-year results of percutaneous intervention.

Cardiac arrest (CA) refers to abrupt cessation of cardiac pump function. Most sudden deaths in young people are of cardiac origin, at the same time most patients have unrecognised prior heart disease. We report a case of a 17-year-old boy with cardiac arrest induced by ventricular fibrillation. Sinus rhythm was restored after one hour's resuscitation. Based upon elevated necrotic markers, ECG changes and echocardiographic examinations the diagnosis of anterolateral myocardial infarction was established. Coronary angiography revealed only a small myocardial bridge. The patient in a poor general and unconscious state was transferred to the Coronary Care Unit of the Department of Coronary Disease. The patient improved after treatment and without neurological deficit or circulatory insufficiency continued cardiac rehabilitation in a spa hospital. The paper reviews differential diagnosis of cardiac arrest, treatment modalities and describes the course of hospitalisation.

Background: Percutaneous coronary interventions (PCI) in acute myocardial infarction with ST segment elevation (STEMI) are associated with distal coronary embolisation. It may be speculated that percutaneous thrombectomy preceding stent implantation may prevent coronary microcirculation from embolisation., Aim: To assess safety and efficacy of percutaneous thrombectomy in patients with STEMI., Methods: Seventy two patients with STEMI were randomised to PCI with stent implantation alone (n=32) or percutaneous thrombectomy with the RESCUE system, followed by stent implantation (n=40). Coronary flow in infarct related artery before and after the procedure was assessed using TIMI scale and corrected TIMI frame count - cTFC. Myocardial blood flow was measured using TIMI myocardial perfusion grade - tMPG. The degree of ST segment resolution 60 min after PCI was also assessed. Left ventricular ejection fraction (LVEF) was measured in hospital and three months later., Results: The two groups did not differ with respect to the time from the onset of symptoms to the procedure (236+/-162 min vs 258+/-198 min, NS) or the baseline TIMI, cTFC and tMPG values. An effective thrombectomy procedure was performed in 35 (87%) patients from group B. After the procedure, the number of patients with TIMI 3 grade as well as cTFC values and the proportion of patients with tMPG 3 were similar in both groups (86% vs 85%, NS; 19 vs 21, NS; and 38% vs 54%, NS). The sum of ST segment elevations after the procedure was significantly greater in patients who underwent PCI only compared with patients who had thrombectomy and PCI (6.8+/-5.2 mm vs 3.6+/-2.9 mm, p=0.004). Complete normalisation of ST segment was achieved in 68% of patients treated with thrombectomy and PCI compared with 25% of patients who had PCI only (p=0.005). CK-MB peak values occurred significantly earlier in patients treated with thrombectomy (92.1% vs 66.7% up to 360 min, p=0.01). After 3 months of follow-up, LVEF tended to be greater in patients treated with thrombectomy and PCI than in those who underwent PCI only (55.3+/-14.7% vs 60.3+/-9.2%, NS)., Conclusions: Thrombectomy with the RESCUE system in patients with STEMI is safe and effectively restores patency of infarct related artery. Thrombectomy better improves myocardial perfusion than standard PCI.

Myocardial infarction in a 24-year-old woman with secondary antiphospholipid syndrome - a case report. A case of a 24-year-old female patient with a secondary antiphospholipid syndrome is described. She had a history of pulmonary embolism occurring after miscarriage. One month later she was admitted to the hospital due to acute myocardial infarction. Coronary angiography revealed distal occlusions in the left anterior descending and left circumflex coronary arteries. Angioplasty was not effective. She received thrombolysis, heparin and finally improved after administration of high doses of corticosteroids. She was discharged from hospital, however, died four weeks later. The treatment and complications of the antiphospholipid syndrome are discussed.

Aims: In patients with acute myocardial infarction (MI), low serum triiodothyronine (T3) concentration is commonly associated with a severe clinical course. The aim of this prospective study was to investigate whether a severe clinical course in patients with low T3 is related to the magnitude of myocardial injury assessed by echocardiography., Methods and Results: Out of 635 patients with MI we enrolled 100 consecutive patients. They were divided in two subgroups: group A, 81 patients without clinical hard events (death, resuscitation following ventricular tachycardia/vertricular fibrillation, new MI) and group B, 19 patients in whom at least one of the above hard events occurred during hospital stay. Thyroid function tests were performed on day 1, 4 and 7, echocardiographic examinations measuring asynergic area (AA), and wall motion score index (WMSI) between day 1 and 5 (median 3). A negative correlation was found between plasma free triiodothyronine (FT3), concentration and AA (p<0.001), FT3 and WMSI (p<0.001) values at all time points. FT3 concentration was lower in group B than group A at all time points (p<0.001)., Conclusions: In patients with acute MI, low FT3 state is related to the extent of myocardial damage.

Background: Modern therapy of acute myocardial infarction (AMI) is aimed at rapid and persisting restoration of blood flow in an infarct-related artery (IRA). However, in some patients myocardial reperfusion is not achieved in spite of effective IRA recanalisation. Myocardial Blush Grade (MBG) is one of the angiographic markers useful for the detection of this phenomenon., Aim: To assess the prognostic value of MBG in patients with anterior AMI treated with primary angioplasty., Methods: The study group consisted of 104 patients (74 males, 30 females, mean age 62+/-13 years) treated with primary angioplasty due to anterior ST-segment elevation AMI. MBG was assessed after the procedure. The mortality and major cardiovascular event (MACE) rates were analysed one and six months after AMI., Results: Patients with preserved myocardial reperfusion following angioplasty (MBG 2-3, n=64 (61.5%)) had a trend towards lower one-month mortality and significantly reduced six-month mortality compared with 40 (38.5%) patients with an impaired (MBG 0-1) myocardial reperfusion (3% vs 12.5%, NS; and 6.25% vs 20%, p<0.05, respectively). The rate of MACE was significantly lower in patients with rather than without reperfusion both after one and six months of follow-up (9.4% vs 27.5%, p=0.027 and 12.5% vs 42.5%, p<0.001, respectively). Compared with patients with a high MBG score, patients with altered reperfusion more frequently had diabetes (30% vs 12.5%, p=0.04), hypertension (67.5% vs 45%, p=0.043), longer time from the onset of symptoms to balloon inflation (355.9+/-199 min vs 215.5+/-113 min, p<0.001) and lower left ventricular ejection fraction, measured 3 days after AMI (43.3%+/-8 vs 47.4%+/-9, p=0.02)., Conclusions: MBG has a significant prognostic value in patients with anterior AMI treated with primary angioplasty. Diabetes, hypertension and long delay of treatment are associated with the impairment of myocardial reperfusion.

We describe a case of a 55-year-old male with anterior myocardial infarction, treated in the acute phase with thrombolysis. Transthoracic echocardiography showed hypokinetic apical segments, ejection fraction of 55% and reduced coronary flow reserve in the left anterior descending (LAD) coronary artery. Elective coronary angiography revealed a borderline (40-50%) lesion in LAD. The patient underwent successful angioplasty of LAD with stent implantation. Non-invasive coronary flow reserve measurements were repeated 3 days, 6 weeks and 6 months after angioplasty showing continuous improvement in this parameter. The role of non-invasive echocardiographic assessment of coronary flow reserve in the selection for angioplasty and monitoring of the effects of treatment is discussed.

By using classical thrombolytic treatment in acute myocardial infarction, reperfusion can be obtained in 60-80% of patients. However, in only 30-55% of cases TIMI grade 3 flow is achieved. Primary percutaneous coronary intervention (PCI) offers the potential for a higher rate of reperfusion and a lower rate of bleeding events. Recently, advances in platelet inhibition and PCI procedures have led to the combination of all the approaches. Facilitated PCI or the use of elective PCI after pharmacological reperfusion therapy can combine the best aspects of thrombolysis and mechanical revascularization in acute myocardial infarction. We report two cases with acute myocardial infarction successfully treated with PCI following thrombolytic treatment combined with platelet receptor IIb/IIIa inhibitor.

A case of a 72-year-old female who was admitted for elective dual-chamber pacemaker implantation, is presented. A few hours after the procedure the patient developed chest pain with ST-segment elevation in ECG and a significant increase in the troponin I level. An acute myocardial infarction was diagnosed. Urgent coronary angiography revealed normal coronary arteries without spasm. Possible causes of acute myocardial infarction following pacemaker implantation are discussed.

Background: Microvasculature damage after myocardial infarction (MI), known as "no-reflow" phenomenon, may occur in some patients with acute MI in spite of invasive treatment and opened infarct-related coronary artery. There are several non-invasive and invasive methods used for the coronary flow assessment at the tissue level., Aim: To compare the value of intravenous contrast echocardiography (MCE) in detecting myocardial perfusion defects in patients with acute MI with (99m)Tc MIBI SPECT study., Methods: Sixteen patients (11 males, 5 females, mean age 55.4+/-10.2 years) underwent primary coronary angioplasty or facilitated angioplasty (with reduced dose of a fibrinolytic drug and glycoprotein IIb/IIIa inhibitor) (PCI) for acute anterior MI. TIMI grade flow, TIMI Myocardial Perfusion Grade (TMPG), corrected TIMI frame count (cTFC), wall motion score index (WMSI) and segmental perfusion by myocardial contrast echocardiography (MCE) were estimated in real time before and immediately after PCI. MCE was repeated on the third day after PCI. All patients underwent (99m)Tc MIBI SPECT study (SPECT) while at rest on the third day after PCI. The area at risk was defined as the number of segments with no perfusion before angioplasty. Reflow was defined as an increase in contrast score in the same segments after angioplasty., Results: Baseline MCE showed 95 segments with perfusion defects. Immediately after PCI, 77 segments were found with perfusion defect; in 10 patients improvement of myocardial perfusion was observed whereas in 6 patients perfusion defect remained unchanged. On the third day further improvement was observed in 8 patients. The number of segments with perfusion defect decreased to 53. SPECT detected perfusion defect in 54 segments. The agreement between MCE and SPECT for detecting perfusion abnormality was 98% (kappa 0.94)., Conclusions: MCE is a safe technique for detecting myocardial perfusion in patients with acute MI. MCE proves that both primary and facilitated angioplasty improve myocardial perfusion in two thirds of patients with acute MI. Serial MCE allows identification of patients with both early and late improvement of myocardial perfusion. There is a very strong correlation between MCE and SPECT in the assessment of perfusion defects.