The objective of the study was to describe the frequency of acute myocardial injury (AMI) assessed by high-sensitivity cardiac troponin I (hs-cTnI) levels and to determine the possible initial risk factors (related to the characteristics of the patient, the disease, and the initial management) in a population of adult patients with early sepsis (within the first 72 h of diagnosis) in a single tertiary hospital center in western Mexico. For the inferential statistics, the proportions of the categorical dichotomous variables were compared using the chi-square test. In all analyses, p values less than 0.05 with a 95% confidence interval were considered significant. We included a total of 64 patients diagnosed with early sepsis, of whom 46 presented elevated hs-cTnI and were classified as having AMI. In our study, the frequency of AMI in patients with early sepsis was 71.87%, and no significant differences were found in all of the characteristics of patients with early sepsis with and without AMI, nor was any significant association found with any of the variables analyzed. In the population of western Mexico, the frequency of AMI in patients with early sepsis, assessed by hs-cTnI levels, is high and similar to that reported in other populations worldwide.

Background Despite investments to improve the quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in non-ST elevation myocardial infarction (NSTEMI) care in the emergency department (ED). We aimed to describe the characteristics, management, and outcomes of NSTEMI. Methods A prospective single-center study enrolled 40 NSTEMI patients in Alshaab Teaching Hospital during the period from May to July 2021. Data regarding demographics, medical history, clinical presentations, laboratory investigation, Killip classifications, electrocardiography (ECG), echocardiogram, diagnostic coronary angiography (CAG), management strategies, medications used, and 30-days outcomes were collected. Results Among 40 patients, NSTEMI was common in the age groups from 56 to 70 years (60%) and males (67.5%; p=0.002). Diabetes (n=24; 60%) and hypertension (n=20; 50%) were the major cardiovascular disease (CVD) risk factors. In most of the cases, 29 (72%) had a late presentation (>6 hours; p=0.0001). In Killip classifications, 36 (90%) patients were Killip class I and four (10%) were Killip class II (p=0.005). No patients underwent risk score assessment during a hospital stay. All patients had sinus rhythm in ECG and 28 (70%) had T-wave inversion. An echocardiogram was performed for 36 (90%) patients, among them six (16.7%) patients had LV systolic dysfunction (p=.003). The median ejection fraction was 52% (ranged from 25-75%). Diagnostic CAG was performed for 38 (95%) patients and a stent was inserted for 23 (58%) of them. The major final management strategy among our study group was PCI in 23 (58%) patients. All patients received aspirin, clopidogrel, parenteral anticoagulant, and ACEi/ARBs, 38 (95%) had statin, 28 (70%) were given PPI, and seven (17.5%) received diuretics. As for 30-day outcomes, all patients survived, but ten (25%) patients were readmitted, and no in-hospital or 30-days mortality occurred. Conclusion NSTEMI predominantly affected male and older patients. Most of them had a delayed presentation to ED. Hypertension and DM were the major risk factors. All patients were in sinus rhythm and the main ECG abnormality was a T-wave inversion. Most of the patients received standard NSTEMI protocol with exception of risk stratification. PCI was the major final management strategy used. Albeit no in-hospital or 30-days mortality occurred, 25% were readmitted.

The potential protective effects of remote ischemic preconditioning (RIPC) on contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI) remain to be defined.
A double blind, randomized, placebo controlled multicenter study was performed. Patients younger than 85years old, with a renal clearance of 30-60ml/min/1.73m2, who were candidates for PCI for all clinical indications except for primary PCI, were allocated 1:1 to RIPC or to standard therapy. The primary endpoint was incidence of CIN. The secondary endpoint was incidence of peri-procedural myocardial infarction (PMI). From February 2013 to April 2014, 3108 patients who were scheduled for coronary angiography were screened for the study. 442 fulfilled the inclusion criteria and 223 received PCI. These patients were randomized to sham RIPC (n=107) or treatment group (n=116). The only pre-specified subgroup of diabetic patients included 85 (38%) cases. RIPC significantly reduced CIN incidence in the overall population (12.1% vs. 26.1%, p=0.01, with a NNT=9) and in non-diabetic patients (9.2% vs. 25.0%, p=0.02), but showed no benefit in diabetics (16.7% vs. 28.2%, p=0.21). A trend for lower PMI was seen in the intervention arm (creatine kinase - muscle brain >5 URL; 8.4% vs. 16.4%, p=0.07; troponin T >5 URL; 27% vs. 38%, p=0.21).
Remote ischemic preconditioning significantly reduces the incidence of acute kidney injury in non-diabetic patients undergoing PCI. Larger sample size is presumably needed to assess the effect of RIPC for patients with diabetes mellitus. Clinical Trial number:NCT02195726https://www.clinicaltrial.gov/.