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Guillain-Barré syndrome (GBS) usually develops after preceding infection, but cardiac surgery can also occasionally cause GBS. Currently, cardiac catheterizations have already become common therapeutic options for heart diseases, but there have been no reports of GBS occurrence after that. Herein, we present a rare case in which GBS occurred following catheterization. An 85-year-old-man with sudden onset chest pain was rushed to our hospital and diagnosed with ST-elevated myocardial infarction. He underwent emergent percutaneous coronary intervention (PCI) to left anterior descending artery, but he still had exertional chest pain. Echocardiography revealed severe aortic stenosis (AS) and our heart team considered AS was the cause of symptom and decided to perform and transcatheter aortic valve implantation (TAVI), 11 days after the PCI. However, 5 days after the TAVI procedure, he presented with symmetrical muscular weakness of extremities. Cranial magnetic resonance imaging showed no significant lesion. Based on several signs including albuminocytologic dissociation in cerebrospinal fluid examination, demyelinating polyneuropathy in nerve conduction study, positive anti-ganglioside antibody, and the lack of preceding infection, he was diagnosed with GBS triggered by cardiac catheterizations. We administered high-dose intravenous immunoglobulin therapy and his motor strength gradually improved, finally discharged with full motor strength after 7 months rehabilitation. • Cardiac surgery has been already reported as a non-infectious risk factor of Guillain-Barré syndrome (GBS) in previous literatures, and cardiac catheterization such as percutaneous coronary intervention and transcatheter aortic valve implantation, which were relatively less invasive procedure, may be a potential risk factor for GBS occurrence as well. • If a patient complains of progressive, symmetrical neurological symptoms after cardiac catheterization, GBS should be considered as the possible cause, and nerve conduction study and cerebrospinal fluid examination may be helpful for the diagnosis. [ABSTRACT FROM AUTHOR]

Background: No study has investigated the prognostic importance of the combined use of QRS distortion and fragmented QRS (fQRS) for risk stratification in acute ST segment elevation myocardial infarction (STEMI).Objective: To determine the prognostic value of the combined use of QRS distortion and fQRS in patients with acute STEMI undergoing primary percutaneous coronary intervention (pPCI).Methods: A total of 454 patients with first STEMI who underwent pPCI were included in this study. Patients were categorized into three groups according to the presence of QRS distortion and fQRS on admission electrocardiography. Group I was defined as fQRS (-) and QRS distortion (-), group 2 was defined as fQRS (+) and QRS distortion (-), or fQRS (-) and QRS distortion (+), and group 3 was defined as both fQRS (+) and QRS distortion (+).Results: Patients in group III had a significantly higher in-hospital mortality rate compared with patients in groups I and II. These patients also had lower left ventricular ejection fraction and ST resolution ratios, higher maximum troponin, and higher frequency of three-vessel disease. Multivariate analysis indicated that group III (OR: 8.84, 95% CI: 2.73-28.62, p<0.001) was an independent predictors of in-hospital mortality.Conclusion: The combined use of QRS distortion and fQRS provides additional prognostic value compared with the presence of QRS distortion or fQRS alone for early risk stratification in patients with STEMI treated with pPCI. [ABSTRACT FROM AUTHOR]

Background: The objective of this study was to assess the methodological quality and clarity of reporting of the systematic reviews (SRs) supporting clinical practice guideline (CPG) recommendations in the management of ST-elevation myocardial infarction (STEMI) across international CPGs.Methods: We searched 13 guideline clearinghouses including the National Guideline Clearinghouse and Guidelines International Network (GIN). To meet inclusion criteria CPGs must be pertinent to the management of STEMI, endorsed by a governing body or national organization, and written in English. We retrieved SRs from the reference sections using a combination of keywords and hand searching. Two investigators scored eligible SRs using AMSTAR and PRISMA.Results: We included four CPGs. We extracted 71 unique SRs. These SRs received AMSTAR scores ranging from 1 (low) to 9 (high) on an 11-point scale. All CPGs consistently underperformed in areas including disclosure of funding sources, risk of bias, and publication bias according to AMSTAR. PRISMA checklist completeness ranged from 44% to 96%. The PRISMA scores indicated that SRs did not provide a full search strategy, study protocol and registration, assessment of publication bias or report funding sources. Only one SR was referenced in all four CPGs. All CPGs omitted a large subset of available SRs cited by other guidelines.Conclusions: Our study demonstrates the variable quality of SRs used to establish recommendations within guidelines included in our sample. Although guideline developers have acknowledged this variability, it remains a significant finding that needs to be addressed further.Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. [ABSTRACT FROM AUTHOR]

Left ventricular free wall rupture is not a rare complication of ST-elevated myocardial infarction, and causes fatal results. This complication is often diagnosed on the basis of hemodynamic collapse and transthoracic echocardiography. We describe a case of posterolateral free wall rupture that could not be diagnosed using transthoracic echocardiography but was diagnosed using left ventriculography, mainly in the left anterior oblique view. We were unsuccessful in preventing patient fatality because of late diagnosis. Therefore, we must keep in mind the limitation of each diagnostic modality. < Learning objective: A posterior wall rupture sometimes shows no pericardial effusion on transthoracic echocardiography. Left ventriculography may be a useful modality as a last resort to detect posterior wall rupture. In this situation, the right anterior oblique view may not demonstrate the contrast extravasation of a posterior wall rupture, and the left anterior oblique view may be useful in detecting it.> [ABSTRACT FROM AUTHOR]

Abstract: With the advent of thrombolytics, guidelines for ST-elevated myocardial infarction (STEMI) recognition were presented in terms of an ST segment exceeding a particular level (1 or 2 mm) in 2 contiguous leads. However, more than half of prehospital electrocardiograms that exceed these ST criteria are from patients not having an acute myocardial infarction. In contrast, expert physicians (EXMD) maintain a high specificity (>95%) for the recognition of STEMI. Likewise, in terms of increasing sensitivity, it has been found that the EXMD will classify STEMI at lower levels than specified in the guideline. Thus, the EXMD uses additional electrocardiogram features to identify patients for appropriate intervention. Given that STEMI can be defined in terms of a pattern that is recognized by the EXMD as well as a clinical classification that can be evaluated in terms of clinical outcomes, the development and validation of a computer algorithm for STEMI need to include both the art of understanding how the human is detecting STEMI as well as the science required to develop quantified criteria based on clinical outcomes. Evidence is presented that demonstrates that reciprocal depression is a strong indicator of STEMI versus other causes of ST elevation. [Copyright &y& Elsevier]

Abstract: Background: High-dose statin treatment improves clinical outcome of ST-elevated myocardial infarction (STEMI). However, the effect of low-dose atorvastatin treatment on inflammatory and pro-thrombotic molecules during the post-STEMI period is unclear. We investigated the effect of low-dose atorvastatin treatment on the kinetics of cytokine IL-6, vascular cell adhesion molecule (sVCAM-1) and endothelium-derived markers of thrombosis/fibrinolysis such as von Willebrand factor (vWF), plasminogen activator inhibitor-1 (PAI-1) and tissue plasminogen activator (tPA), post STEMI. Methods: Twenty-four normocholesterolemic patients with STEMI were randomised to receive atorvastatin 10mg/day or no statin treatment for 6 weeks after the event. Blood samples were obtained by their admission to the hospital as well as at weeks 1 and 6. Circulating levels of IL-6, sVCAM-1, vWF, PAI-1 and tPA were determined by ELISA. Results: Atorvastatin induced a decrease of IL-6 at 1 week, an effect which reached significance compared to baseline at 6 weeks post STEMI (p <0.05 vs baseline). Serum sVCAM-1 was increased in controls both at 1 and 6 weeks post-STEMI (p <0.05 vs baseline), an effect prevented by atorvastatin. Plasma vWF was increased 1 week post-STEMI in controls (p <0.05 vs baseline) and returned to baseline at 6 weeks, an effect prevented by atorvastatin. Plasma PAI-1, tPA and the PAI-1/tPA ratio remained unchanged in both groups. Conclusion: Early initiation of low-dose atorvastatin treatment decreases the expression of IL-6 and sVCAM-1 and the release of vWF in patients with STEMI. Therefore, low-dose atorvastatin, modulates inflammatory response and decreases endothelial injury and activation in patients with recent STEMI. [Copyright &y& Elsevier]