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Symptom onset and treatment in acute myocardial infarction

PhD ceremony:Mr K.D.E. (Karim) Mahmoud
When:December 03, 2014
Supervisor:prof. dr. J.L. (Hans) Hillege
Co-supervisors:dr. B.J.G.L. de Smet, M.W.N. Nijsten
Where:Academy building RUG
Faculty:Medical Sciences / UMCG
Symptom onset and treatment in acute myocardial infarction

This thesis describes the role of symptom onset and symptom onset to treatment time in the treatment of a heart attack. The first part focuses on symptom onset. Heart attacks and sudden cardiac death are known to have a predisposition for the morning hours. We show that sudden occlusion of a stent after angioplasty also tends to occur in the morning and that morning heart attacks are often smaller.

Symptom onset to treatment time is investigated in the second part. We found that patient-reported symptom onset time is typically later than can be expected from in-hospital blood measurements, suggesting that the actual heart attack onset is earlier than reported by patients. Patients with a heart attack based on a totally occluded coronary artery benefit from pre-hospital diagnosis to expedite in-hospital angioplasty. We evaluated the ambulance protocol that is being used. When coronary occlusion is subtotal, medical pre-treatment is common. We determined that the optimal timing of any further invasive management by means of angioplasty or bypass surgery is 20-40 hours after pre-treatment.

The last part focuses on in-hospital treatment. We show that thrombus aspiration before angioplasty in patients with an occluded stent improves restoration of blood flow to the heart muscle and that patients with a heart attack and narrowing of multiple coronary arteries benefit most of a staged approach with multiple angioplasty procedures. Finally, we confirm the hypothesis that clinical studies evaluating novel therapies for cardiovascular diseases are often unable to draw firm conclusions from their results.