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A systematic review of thromboembolic complications and outcomes in hospitalised COVID-19 patients

Othman HY, Zaki IAH, Isa MR, Ming LC, Zulkifly HH

BMC Infect Dis, 2024 May 10;24(1):484.
PMID: 38730292 DOI: 10.1186/s12879-024-09374-1

Thromboembolic (TE) complications [myocardial infarction (MI), stroke, deep vein thrombosis (DVT), and pulmonary embolism (PE)] are common causes of mortality in hospitalised COVID-19 patients. Therefore, this review was undertaken to explore the incidence of TE complications and mortality associated with TE complications in hospitalised COVID-19 patients from different studies. A literature search was performed using ScienceDirect and PubMed databases using the MeSH term search strategy of "COVID-19", "thromboembolic complication", "venous thromboembolism", "arterial thromboembolism", "deep vein thrombosis", "pulmonary embolism", "myocardial infarction", "stroke", and "mortality". There were 33 studies included in this review. Studies have revealed that COVID-19 patients tend to develop venous thromboembolism (PE:1.0-40.0% and DVT:0.4-84%) compared to arterial thromboembolism (stroke:0.5-15.2% and MI:0.8-8.7%). Lastly, the all-cause mortality of COVID-19 patients ranged from 4.8 to 63%, whereas the incidence of mortality associated with TE complications was between 5% and 48%. A wide range of incidences of TE complications and mortality associated with TE complications can be seen among hospitalized COVID-19 patients. Therefore, every patient should be assessed for the risk of thromboembolic complications and provided with an appropriate thromboprophylaxis management plan tailored to their individual needs.

Matched MeSH terms: Myocardial Infarction/complications; Myocardial Infarction/mortality; Myocardial Infarction/epidemiology
Fulltext Invasive and antiplatelet treatment of patients with non-ST-segment elevation myocardial infarction: Understanding and addressing the global risk-treatment paradox

Ahrens I, Averkov O, Zúñiga EC, Fong AYY, Alhabib KF, Halvorsen S, et al.

Clin Cardiol, 2019 Oct;42(10):1028-1040.
PMID: 31317575 DOI: 10.1002/clc.23232

Clinical guidelines for the treatment of patients with non-ST-segment elevation myocardial infarction (NSTEMI) recommend an invasive strategy with cardiac catheterization, revascularization when clinically appropriate, and initiation of dual antiplatelet therapy regardless of whether the patient receives revascularization. However, although patients with NSTEMI have a higher long-term mortality risk than patients with ST-segment elevation myocardial infarction (STEMI), they are often treated less aggressively; with those who have the highest ischemic risk often receiving the least aggressive treatment (the "treatment-risk paradox"). Here, using evidence gathered from across the world, we examine some reasons behind the suboptimal treatment of patients with NSTEMI, and recommend approaches to address this issue in order to improve the standard of healthcare for this group of patients. The challenges for the treatment of patients with NSTEMI can be categorized into four "P" factors that contribute to poor clinical outcomes: patient characteristics being heterogeneous; physicians underestimating the high ischemic risk compared with bleeding risk; procedure availability; and policy within the healthcare system. To address these challenges, potential approaches include: developing guidelines and protocols that incorporate rigorous definitions of NSTEMI; risk assessment and integrated quality assessment measures; providing education to physicians on the management of long-term cardiovascular risk in patients with NSTEMI; and making stents and antiplatelet therapies more accessible to patients.

Matched MeSH terms: Non-ST Elevated Myocardial Infarction/diagnosis; Non-ST Elevated Myocardial Infarction/mortality; Non-ST Elevated Myocardial Infarction/therapy*
Overlapping technique for hybrid percutaneous coronary intervention strategy utilising drug eluting stent and ABSORB bioresorbable vascular scaffold

Yew KL

Int J Cardiol, 2015 Jan 15;178:e8-e10.
PMID: 25205484 DOI: 10.1016/j.ijcard.2014.08.085
Matched MeSH terms: Myocardial Infarction/diagnosis*; Myocardial Infarction/surgery*
Fulltext Severe Plasmodium falciparum infection mimicking acute myocardial infarction

Sulaiman H, Ismail MD, Jalalonmuhali M, Atiya N, Ponnampalavanar S

Malar J, 2014;13:341.
PMID: 25176417 DOI: 10.1186/1475-2875-13-341

This case report describes a case of presumed acute myocardial infarction in a returned traveler who was later diagnosed to have severe malaria. Emergency coronary angiography was normal and subsequent peripheral blood film was positive for Plasmodium falciparum.

Matched MeSH terms: Myocardial Infarction/diagnosis*; Myocardial Infarction/pathology*
Fulltext Contribution of diet and major depression to incidence of acute myocardial infarction (AMI)

Yary T, Soleimannejad K, Abd Rahim F, Kandiah M, Aazami S, Poor SJ, et al.

Lipids Health Dis, 2010;9:133.
PMID: 21087475 DOI: 10.1186/1476-511X-9-133

BACKGROUND: Despite significant improvements in the treatment of coronary heart disease (CHD), it is still a major cause of mortality and morbidity among the Iranian population. Epidemiological studies have documented that risk factors including smoking and the biochemical profile are responsible for the development of acute myocardial infarction (AMI). Psychological factors have been discussed as potential risk factors for coronary heart disease. Among emotional factors, depression correlates with coronary heart disease, particularly myocardial infarction.
METHODS: This case-control study was conducted on 120 cases (69 males and 51 females) of acute myocardial infarction (AMI) and 120 controls, with a mean age of 62.48 ± 15.39 years. Cases and controls were matched by age, residence and sex.
RESULTS: The results revealed that severe depression was independently associated with the risk of AMI (P = 0.025, OR = 2.6, 95% CI 1.1-5.8). The analysis of variables indicated that risk factors for developing depression were unmarried, low levels of polyunsaturated fatty acids (PUFAs), total dietary fiber (TDF) and carbohydrates. The levels of these dietary factors were lowest in severely depressed patients compared to those categorised as moderate or mild cases. Furthermore, severely depressed subjects were associated with higher levels of total cholesterol, high systolic blood pressure (SBP) and WHR. Age, income, a family history of coronary heart disease, education level, sex, employment and smoking were not associated with severe depression.
CONCLUSION: The present study demonstrated that severe depression symptoms are independent risk factors for AMI. Furthermore, severe depression was associated with an unhealthy diet and AMI risk factors.
Study site: Mostafa Hospital, Ilam Province, Iran

Matched MeSH terms: Myocardial Infarction/etiology*; Myocardial Infarction/epidemiology*
Association of ABO blood group B with myocardial infarction

Sheikh MK, Bahari MB, Yusoff NM, Knight A

J Coll Physicians Surg Pak, 2009 Aug;19(8):514-7.
PMID: 19651016 DOI: 08.2009/JCPSP.514517

The purpose of this study was to find out the association between blood group B and Myocardial Infarction (MI) in sample population in Malaysia.

Matched MeSH terms: Myocardial Infarction/blood*; Myocardial Infarction/epidemiology
Diagnostics on acute myocardial infarction: Cardiac troponin biomarkers

Fathil MF, Md Arshad MK, Gopinath SC, Hashim U, Adzhri R, Ayub RM, et al.

Biosens Bioelectron, 2015 Aug 15;70:209-20.
PMID: 25841117 DOI: 10.1016/j.bios.2015.03.037

Acute myocardial infarction or myocardial infarction (MI) is a major health problem, due to diminished flow of blood to the heart, leads to higher rates of mortality and morbidity. Data from World Health Organization (WHO) accounted 30% of global death annually and expected more than 23 million die annually by 2030. This fatal effects trigger the need of appropriate biomarkers for early diagnosis, thus countermeasure can be taken. At the moment, the most specific markers for cardiac injury are cardiac troponin I (cTnI) and cardiac troponin T (cTnT) which have been considered as 'gold standard'. Due to higher specificity, determination of the level of cardiac troponins became a predominant indicator for MI. Several ways of diagnostics have been formulated, which include enzyme-linked immunosorbent assay, chemiluminescent, fluoro-immunoassays, electrical detections, surface plasmon resonance, and colorimetric protein assay. This review represents and elucidates the strategies, methods and detection levels involved in these diagnostics on cardiac superior biomarkers. The advancement, sensitivity, and limitations of each method are also discussed. In addition, it concludes with a discussion on the point-of care (POC) assay for a fast, accurate and ability of handling small sample measurement of cardiac biomarker.

Matched MeSH terms: Myocardial Infarction/blood*; Myocardial Infarction/diagnosis*
Ethnic differences in acute myocardial infarction in Singapore

Mak KH, Chia KS, Kark JD, Chua T, Tan C, Foong BH, et al.

Eur Heart J, 2003 Jan;24(2):151-60.
PMID: 12573272

AIMS: We compare the myocardial infarction (MI) event and mortality rates among Chinese, Malay and Indian residents of Singapore.
METHODS: Residents, aged 20 to 64 years, with an MI event were identified from hospital discharge listings, postmortem reports, and the Registry of Births and Deaths. All pathology laboratories flagged patients with elevated creatine phosphokinase (CPK) levels. Modified MONICA (multinational monitoring of trends and determinants in cardiovascular disease) criteria were used for determining MI events.
RESULTS: From 1991 to 1999, 12 481 MI events were identified. Chinese patients were older and less likely to have typical symptoms or previous MI. Malays had the highest peak CPK level. Among all three ethnic groups, MI event and age-adjusted case-fatality rates declined. Compared with Chinese, MI event rates were >2-fold and >3-fold higher, and age-standardized coronary mortality rates were 2.4 and 3.0 higher times for Malays and Indians, respectively. Malays have the highest 3.1-year case-fatality, with an adjusted hazard ratio of 1.26 (95% confidence interval, 1.14 to 1.38) compared with Chinese.
CONCLUSION: We found strong ethnic differences in MI event, case-fatality and coronary mortality rates among the three ethnic groups in Singapore. While Indians have the greatest MI event rates, Malays have the highest case-fatality.

Matched MeSH terms: Myocardial Infarction/ethnology*; Myocardial Infarction/mortality
Fulltext Mortality in the early phase of acute myocardial infarction: a 3 year experience in the coronary care unit

Ng WH

Med J Malaysia, 1982 Mar;37(1):66-9.
PMID: 7121350

Mortality in the early phase of acute myocardial infarction occurs both during the pre-hospital period and after admission to the Coronary Care Unit. This report is an analysis of deaths that occurred in the Coronary Care Unit within a 3 year period. Forty percent of 304 patients (13 percent) unth. acute myocardial infarction died in the Coronary Care Unit, Fifty percent of the deaths were due to cardiac arrhythmias and 45 percent attributable to myocardial pump failure. Mean delay in hospital admission from onset of symptoms was 15 hours. Factors affecting early mortality and their prevention are discussed.

Matched MeSH terms: Myocardial Infarction/complications; Myocardial Infarction/mortality*
Fulltext A profile of acute myocardial infarction in urban Malays

Bakar R, Ng WH, Kew ST, Mohan A

Med J Malaysia, 1982 Mar;37(1):62-5.
PMID: 7121349

This is a retrospectioe study of epidemiological and riskfactors ofischaemic heart disease in Malay patients admitted into the Coronary Care Unit, General Hospital, Kuala Lumpur between October 1977 and December 1979 unth. proven myocardial infarction. Ofthe 116patients (M/F sex ratio 9.5 : 1), the incidence of various risk factors were smoking 82 percent, hypertension 42 percent, hypercholesterolemia 23 percent, diabetes mellitus 20 percent and family history 9 percent. Anterior infarctions were more common than inferior. Hyperuricemia was detected in 19 percent and 96 percent had at least one major riskfactor. In terms ofoccupation, a majorproportion ofthose afflicted were pensioners, security personnel and businessmen.

Matched MeSH terms: Myocardial Infarction/etiology; Myocardial Infarction/epidemiology*
Fulltext Cigarette smoking and the risk of myocardial infarction, and acute non-infarct coronary events among Malaysian women

Quek DK, Lim LY, Ong SB

Med J Malaysia, 1989 Sep;44(3):210-23.
PMID: 2626136

In a prospective case-control study over a two-year period involving 1006 women, 264 women with acute myocardial infarction (AMI), 305 with non-infarct acute coronary syndromes (CAD) were compared with 437 women with no coronary heart disease (Controls), to determine the relationship between cigarette smoking and other risks factors with coronary heart disease. A history of current cigarette smoking was strongly associated with the risk of coronary events for both AMI And CAD (p less than 0.001). 23.9% of patients with acute coronary syndromes were current smokers, compared with only 12.8% among controls. Overall, women smokers had about a two-fold increase in risk for all coronary events. Younger women smokers (less than 40 years) and those between 61-70 years had particularly higher risks (10.3 and 2.7 times respectively (p less than 0.01, p less than 0.02). A dose-response pattern of increased AMI risks (from 2.0 to 2.9 times) among women smokers was also found, corresponding to the number of cigarettes smoked per day (p less than 0.05). Other significant coronary risk factors established were: postmenopausal status (OR 6.5), diabetes mellitus (OR 5.1), hypertension (OR 1.6), family history of premature coronary heart disease less than 50 years (OR 1.3) and use of oral contraceptive pills (OR 1.4). Our results thus emphasize that cigarette smoking is an important determinant of acute coronary events even among Malaysian women.

Matched MeSH terms: Myocardial Infarction/etiology; Myocardial Infarction/epidemiology*
Kounis syndrome following solenopsis (fire ant) bite

Ng BH, Tan HX, Vijayasingham S

Med J Malaysia, 2019 08;74(4):344-346.
PMID: 31424048

Anaphylaxis is rarely associated with the vasospastic acute coronary syndrome with or without the presence of underlying coronary artery disease. We report here a case of Kounis syndrome in a man with no known cardiovascular risk developed acute ST-elevation myocardial infarction complicated with complete heart block following Solenopsis (fire ant) bite.

Matched MeSH terms: ST Elevation Myocardial Infarction/diagnosis; ST Elevation Myocardial Infarction/etiology*
Fulltext Inverse changes in plasma tetranectin and titin levels in patients with type 2 diabetes mellitus: a potential predictor of acute myocardial infarction?

Rahim MAA, Rahim ZHA, Ahmad WAW, Bakri MM, Ismail MD, Hashim OH

Acta Pharmacol Sin, 2018 Jul;39(7):1197-1207.
PMID: 29417940 DOI: 10.1038/aps.2017.141

An early intervention using biomarkers to predict acute myocardial infarction (AMI) will effectively reduce global heart attack incidence, particularly among high-risk patients with type 2 diabetes mellitus (T2DM). This study attempted to identify potential biomarkers by detecting changes in the levels of plasma proteins in T2DM patients following onset of AMI in comparison with those without AMI. Volunteer T2DM patients without AMI (control; n=10) and T2DM patients with AMI (n=10) were recruited. Plasma samples from these patients were evaluated via two-dimensional gel electrophoresis (2DE) to screen for proteins with level changes between the two groups. The abundance of spots on gel images was analyzed using Progenesis SameSpots and subjected to false discovery rate (FDR) analysis. Protein spots with statistically significant changes of at least 1.5 fold were selected for mass spectrometry (MS) analysis. Due to strong cardiac connections, tetranectin and titin were evaluated by enzymelinked immunosorbent assay (ELISA). The adjusted P-values and fold changes between the two groups resulted in identification of 34 protein spots with significantly altered abundance. Upon MS analysis, 17 plasma proteins were identified: tetranectin, titin, clusterin, haptoglobin, myosin-13, zinc fnger protein 445, DNA repair protein RAD50, serum albumin, apolipoprotein A-IV, caspase-6, aminoacyl tRNA synthase complex-interacting multifunctional protein 1, serotransferrin, retinol-binding protein 4, transthyretin, alpha-1-antitrypsin, apolipoprotein A-I and serum amyloid A. Comparable patterns of changes in tetranectin and titin between the control and AMI groups were confirmed using ELISA. In summary, tetranectin and titin in plasma appeared to be closely associated with the onset of AMI among T2DM patients and can be used as potential biomarkers for prediction of a cardiac event, though this requires validation in a prospective cohort study.

Matched MeSH terms: Myocardial Infarction/blood*; Myocardial Infarction/diagnosis
Reference value for cardiac troponin I in a multi-ethnic group

Sthaneshwar P, Jamaluddin FA, Fan YS

Pathology, 2010;42(5):454-6.
PMID: 20632822 DOI: 10.3109/00313025.2010.493861

The aim of this study was to evaluate the distribution of cardiac troponin I (cTnI) values, measured by the ADVIA TnI-Ultra method in a multi-ethnic group and to determine the imprecision of the assay.

Matched MeSH terms: Myocardial Infarction/blood*; Myocardial Infarction/ethnology*
Quantitative analysis of intraventricular flow-energetics and vortex in ischaemic hearts

Chan BT, Yeoh HK, Liew YM, Dokos S, Al Abed A, Chee KH, et al.

Coron Artery Dis, 2018 06;29(4):316-324.
PMID: 29261521 DOI: 10.1097/MCA.0000000000000596

OBJECTIVE: This study investigated the intraventricular flow dynamics in ischaemic heart disease patients.
PATIENTS AND METHODS: Fourteen patients with normal ejection fraction and 16 patients with reduced ejection fraction were compared with 20 healthy individuals. Phase-contrast MRI was used to assess intraventricular flow variables and speckle-tracking echocardiography to assess myocardial strain and left ventricular (LV) dyssynchrony. Infarct size was acquired using delayed-enhancement MRI.
RESULTS: The results obtained showed no significant differences in intraventricular flow variables between the healthy group and the patients with normal ejection fraction group, whereas considerable reductions in kinetic energy (KE) fluctuation index, E' (P<0.001) and vortex KE (P=0.003) were found in the patients with reduced ejection fraction group. In multivariate analysis, only vortex KE and infarct size were significantly related to LV ejection fraction (P<0.001); furthermore, vortex KE was correlated negatively with energy dissipation, energy dissipation index (r=-0.44, P=0.021).
CONCLUSION: This study highlights that flow energetic indices have limited applicability as early predictors of LV progressive dysfunction, whereas vortex KE could be an alternative to LV performance.

Matched MeSH terms: ST Elevation Myocardial Infarction/physiopathology*; ST Elevation Myocardial Infarction/diagnostic imaging
Deep Deterministic Learning for Pattern Recognition of Different Cardiac Diseases through the Internet of Medical Things

Iqbal U, Wah TY, Habib Ur Rehman M, Mujtaba G, Imran M, Shoaib M

J Med Syst, 2018 Nov 05;42(12):252.
PMID: 30397730 DOI: 10.1007/s10916-018-1107-2

Electrocardiography (ECG) sensors play a vital role in the Internet of Medical Things, and these sensors help in monitoring the electrical activity of the heart. ECG signal analysis can improve human life in many ways, from diagnosing diseases among cardiac patients to managing the lifestyles of diabetic patients. Abnormalities in heart activities lead to different cardiac diseases and arrhythmia. However, some cardiac diseases, such as myocardial infarction (MI) and atrial fibrillation (Af), require special attention due to their direct impact on human life. The classification of flattened T wave cases of MI in ECG signals and how much of these cases are similar to ST-T changes in MI remain an open issue for researchers. This article presents a novel contribution to classify MI and Af. To this end, we propose a new approach called deep deterministic learning (DDL), which works by combining predefined heart activities with fused datasets. In this research, we used two datasets. The first dataset, Massachusetts Institute of Technology-Beth Israel Hospital, is publicly available, and we exclusively obtained the second dataset from the University of Malaya Medical Center, Kuala Lumpur Malaysia. We first initiated predefined activities on each individual dataset to recognize patterns between the ST-T change and flattened T wave cases and then used the data fusion approach to merge both datasets in a manner that delivers the most accurate pattern recognition results. The proposed DDL approach is a systematic stage-wise methodology that relies on accurate detection of R peaks in ECG signals, time domain features of ECG signals, and fine tune-up of artificial neural networks. The empirical evaluation shows high accuracy (i.e., ≤99.97%) in pattern matching ST-T changes and flattened T waves using the proposed DDL approach. The proposed pattern recognition approach is a significant contribution to the diagnosis of special cases of MI.

Matched MeSH terms: Myocardial Infarction/diagnosis*; Myocardial Infarction/pathology
Molecular understanding of the protective role of natural products on isoproterenol-induced myocardial infarction: A review

Wong ZW, Thanikachalam PV, Ramamurthy S

Biomed Pharmacother, 2017 Oct;94:1145-1166.
PMID: 28826162 DOI: 10.1016/j.biopha.2017.08.009

Modern medicine has been used to treat myocardial infarction, a subset of cardiovascular diseases, and have been relatively effective but not without adverse effects. Consequently, this issue has stimulated interest in the use of natural products, which may be equally effective and better tolerated. Many studies have investigated the cardioprotective effect of natural products, such as plant-derived phytochemicals, against isoproterenol (ISO)-induced myocardial damage; these have produced promising results on the basis of their antioxidant, anti-atherosclerotic, anti-apoptotic and anti-inflammatory activities. This review briefly introduces the pathophysiology of myocardial infarction (MI) and then addresses the progress of natural product research towards its treatment. We highlight the promising applications and mechanisms of action of plant extracts, phytochemicals and polyherbal formulations towards the treatment of ISO-induced myocardial damage. Most of the products displayed elevated antioxidant levels with decreased oxidative stress and lipid peroxidation, along with restoration of ionic balance and lowered expression of myocardial injury markers, pro-inflammatory cytokines, and apoptotic parameters. Likewise, lipid profiles were positively altered and histopathological improvements could be seen from, for example, the better membrane integrity, decreased necrosis, edema, infarct size, and leukocyte infiltration. This review highlights promising results towards the amelioration of ISO-induced myocardial damage, which suggest the direction for future research on natural products that could be used to treat MI.

Matched MeSH terms: Myocardial Infarction/chemically induced*; Myocardial Infarction/drug therapy*
Fulltext Acute myocardial infarction in young Asian women: a comparative study on Chinese, Malay and Indian ethnic groups

Xie CB, Chan MY, Teo SG, Low AF, Tan HC, Lee CH

Singapore Med J, 2011 Nov;52(11):835-9.
PMID: 22173254

There is a paucity of data on acute myocardial infarction (AMI) in young Asian women and of comparative data among various ethnic groups with respect to risk factor profile and clinical outcomes. We present a comprehensive overview of the clinical characteristics of young Asian women with AMI and a comparative analysis among Chinese, Malay and Indian women in a multi-ethnic Asian country.

Matched MeSH terms: Myocardial Infarction/ethnology*; Myocardial Infarction/epidemiology*
Fulltext Tall precordial T waves with depressed ST take-off: an early sign of acute myocardial infarction?

Soo CS

Singapore Med J, 1995 Apr;36(2):216, 236-7.
PMID: 7676272
Matched MeSH terms: Myocardial Infarction/diagnosis*; Myocardial Infarction/physiopathology
Fulltext Acute myocardial infarction after blunt chest injury

Kannan P, Saradha N, Jeyamalar R

Singapore Med J, 1992 Feb;33(1):86-8.
PMID: 1598616

A 20-year-old male sustained an inferior myocardial infarction following blunt chest trauma, after a motor vehicle accident. Though coronary arteriograms 9 months later were normal, LV angiography revealed severe hypokinesia of the inferobasal and diaphragmatic segments. The literature is reviewed with respect to mechanisms of injury, autopsy and angiographic findings and clinical outcome in this condition.

Matched MeSH terms: Myocardial Infarction/etiology*; Myocardial Infarction/radiography

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