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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
Fulltext Association of testosterone, inflammation with the severity of first acute ST-elevation myocardial infarction

Wickramatilake CM, Mohideen MR, Pathirana C

Indian Heart J, 2017 02 12;69(2):291.
PMID: 28460787 DOI: 10.1016/j.ihj.2017.02.002
Matched MeSH terms: ST Elevation Myocardial Infarction/diagnosis*
Acute myocarditis mimicking ST-elevation myocardial infarction: A diagnostic challenge for frontline clinicians

Ang KP, Quek ZQ, Lee CY, Lu HT

Med J Malaysia, 2019 12;74(6):561-563.
PMID: 31929492

The clinical presentation of acute myocarditis is highly variable ranging from no symptoms to cardiogenic shock. Despite considerable progress, it remains a challenge for frontline physicians to discriminate between acute myocarditis and myocardial infarction, especially in the early phase. Our case serves as a reminder that acute presentation of myocarditis could resemble ST elevation myocardial infarction potentially misdirecting the therapeutic decision. The clinical presentation, electrocardiographic and laboratory findings of the patient are not specific enough to distinguish acute myocarditis from myocardial infarction. The gold standard tests such coronary angiography and cardiovascular magnetic resonance (CMR) can reliably differentiate the two entities.

Matched MeSH terms: ST Elevation Myocardial Infarction/diagnosis*
Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis

Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, et al.

Heart, 2018 08;104(16):1362-1369.
PMID: 29437704 DOI: 10.1136/heartjnl-2017-312517

OBJECTIVE: This study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers.
METHODS: We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure.
RESULTS: 32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time-risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran's Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays.
CONCLUSION: Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time-risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA.
CLINICAL TRIAL REGISTRATION: PROSPERO (CRD42015026069).

Matched MeSH terms: ST Elevation Myocardial Infarction/diagnosis
Fulltext Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study

Foo CY, Andrianopoulos N, Brennan A, Ajani A, Reid CM, Duffy SJ, et al.

Sci Rep, 2019 12 27;9(1):19978.
PMID: 31882674 DOI: 10.1038/s41598-019-56353-7

Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with further consideration of the unobserved factors and reports the population average effect. Adults with ST-elevation myocardial infarction admitted to one of the six registry participating hospitals in Australia were included in this study. The exposure variable was patient-level door-to-balloon time. Primary outcomes assessed included in-hospital and 30 days mortality. 4343 patients fulfilled the study criteria. 38.0% (1651) experienced a door-to-balloon delay of >90 minutes. The absolute risk differences for in-hospital and 30-day deaths between the two exposure subgroups with balanced covariates were 2.81 (95% CI 1.04, 4.58) and 3.37 (95% CI 1.49, 5.26) per 100 population. When unmeasured factors were taken into consideration, the risk difference were 20.7 (95% CI -2.6, 44.0) and 22.6 (95% CI -1.7, 47.0) per 100 population. Despite further adjustment of the observed and unobserved factors, this study suggests a directionally consistent linkage between longer door-to-balloon delay and higher risk of adverse outcomes at the population level. Greater uncertainties were observed when unmeasured factors were taken into consideration.

Matched MeSH terms: ST Elevation Myocardial Infarction/diagnosis