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Poor Prognosis For STEMI Patients With No Reperfusion

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Poor Prognosis For STEMI Patients With No Reperfusion

According to researchers, advanced age is the most common cause for no reperfusion in patients with STEMI ( ST segment elevation myocardial infarction).  There are multiple reasons for no reperfusion strategy, according to an article to be published in The American Journal of Cardiology. Researchers at William Beaumont Hospital in Royal Oak, Michigan, wanted to see the reasons underlying no reperfusion strategy in patients with STEMI. They analyzed hospital admissions for a period of five years (October 2006 to March 2011) and found that of 1126 patients, 139 did not receive reperfusion. The reasons behind this choice were related disease, advanced age, late presentation, acute or chronic renal failure, dementia, etc.. Researchers have noted that by far the most common reason was age. It should be mentioned that more than half of the 139 patients were presented to the hospital with other diagnoses  than STEMI, and that nearly 30% of them had STEMI within 24 hours of admission. The researchers also noted that the prognosis was poor for these patients.

EKG Nurse

EKG Nurse

STEMI means ST-elevation myocardial infarction, that is myocardial infarction with ST segment elevation on the electrocardiogram. There is also myocardial infarction without ST segment elevation, so-called NSTEMI, which is part of acute coronary syndromes, along with unstable angina. STEMI means the death of cardiac myocytes caused by prolonged ischemia. Ischemia occurs by reducing blood flow through coronary arteries. It should be mentioned that ischemia often occurs when there is  a plaque on one of the coronary arteries. It is known that the most dangerous plaques are those rich in fat and  with thin fibrous layer. These plaques are prone to rupture and thrombosis. When such plaque ruptures, heart attack occurs. Normally, if the patient goes to the hospital quickly the clogged coronary artery (one that caused myocardial infarction) can be reperfused.However, in some cases, even if there is artery patency, myocardial reperfusion does not occur due to microvascular obstruction. This complication is called no-reflow.

There are several prognostic factors that must be taken into account in patients with STEMI, such as patient age, associated diseases, infarct size, infarct location, hypotension, others diseases. Reperfusion therapy is indicated for all patients with STEMI that go to the hospital in less than 12 hours after stroke onset. Regarding the strategy of reperfusion, there are several options: primary PCI,  percutaneous coronary intervention, fibrinolysis, delayed PCI, surgery. PCI involves mounting a stent and is preferred for all patients, especially those in cardiogenic shock or those with contraindications to fibrinolysis.