Acute and Critical Care

Review Articles

Neurology
Revolutionizing non-traumatic acute care: a review of the role of artificial intelligence and machine learning in triaging and diagnosis: Omofolarin Debellotte, Rachel Melissa Salins, Pragnya Bandari, Maria Gabriela Cerdas, Aijaz Ul Haq, Shaheen Haidrus, Misha Imtiaz, Anietom Ifechukwu Chelsea, Shaik Mohammed Yezdan Ali, Hameeda Abdul Wahab Baloch, Humza Faisal Siddiqui; Acute Crit Care. 2026;41(1):68-86. Published online November 24, 2025; DOI: https://doi.org/10.4266/acc.002200

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Abstract PDF: Acute care settings, including emergency medicine and intensive care units, comprise a substantial portion of healthcare and are essential in the prompt management of conditions that can prove fatal. Critical care conditions require timely management that can be delayed by high patient volumes and the need for complex clinical decision making. Artificial intelligence (AI) tools have been created to enhance diagnostic accuracy and optimize workflow to improve patient care. This narrative review discusses the current status of AI in acute care, with a focus on its applications in triaging and diagnosis. AI-enhanced electrocardiogram analysis, identification of myocardial infarction and acute coronary syndrome, and heart failure risk stratification led to better patient-specific management and improved results. AI models successfully determined and aided in the timely management of various acute conditions, including pneumonia, pulmonary embolism, and respiratory failure. The AI algorithms used accurately determined sepsis onset and course, superseding traditionally used clinical tools and leading to early diagnosis and reduced sepsis mortality. These models showed high sensitivity and specificity in diagnosing and triaging neurological conditions, including altered levels of consciousness, seizures, and intracranial hemorrhages. AI that involved advanced machine learning imaging software led to faster and more accurate stroke diagnosis. Diagnostic tools assisted by AI improved the detection and classification of acute pancreatitis, appendicitis, and gastrointestinal bleeding. AI has shown promising results in optimizing management in acute care settings. However, critical issues in data standardization, ethical considerations, and clinical workflow integration need to be addressed to enable clinical implementation.

Cardiology
Beta-blocker therapy in patients with acute myocardial infarction: not all patients need it: Seung-Jae Joo; Acute Crit Care. 2023;38(3):251-260. Published online August 31, 2023; DOI: https://doi.org/10.4266/acc.2023.00955

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Most of the evidences for beneficial effects of beta-blockers in patients with acute myocardial infarction (AMI) were from the clinical studies published in the pre-reperfusion era when anti-platelet drugs, statins or inhibitors of renin-angiotensin-aldosterone system which are known to reduce cardiovascular mortality of patients with AMI were not introduced. In the reperfusion era, beta-blockers’ benefit has not been clearly shown except in patients with reduced ejection fraction (EF; ≤40%). In the era of the early reperfusion therapy for AMI, a number of patients with mildly reduced EF (>40%, <50%) or preserved EF (≥50%) become increasing. However, because no randomized clinical trials are available until now, the benefit and the optimal duration of oral treatment with beta-blockers in patients with mildly reduced or preserved EF are questionable. Registry data have not showed the association of oral beta-blocker therapy with decreased mortality in survivors without heart failure or left ventricular systolic dysfunction after AMI. In the Korea Acute Myocardial Infarction Registry-National Institute of Health of in-hospital survivors after AMI, the benefit of beta-blocker therapy at discharge was shown in patients with reduced or mildly reduced EF, but not in those with preserved EF, which provides new information about beta-blocker therapy in patients without reduced EF. However, clinical practice can be changed when the results of appropriate randomized clinical trials are available. Ongoing clinical trials may help to answer the unresolved issues of beta-blocker therapy in patients with AMI.

Citations

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Finn Waagstein and the paradigm shift in the treatment of heart failure with β-adrenergic receptor antagonists (‘β-blockers’)
Kristina Lorenz, Ursula Ravens
Naunyn-Schmiedeberg's Archives of Pharmacology.2026; 399(3): 3133. CrossRef
Chronic β-Blockade and Systemic Homeostasis: Molecular Integration of Cardiorenal and Immune Pathways, a Narrative Review
Jason Park, Amethyst Hamanaka, Issac Park, Hosam Gharib Abdelhady
Biomolecules.2025; 15(12): 1653. CrossRef
Beta-Blockers in Patients With Myocardial Infarction: A Meta-Analysis
Mushood Ahmed, Areeba Ahsan, Aimen Shafiq, Hasan Ahmad, Raheel Ahmed, Jamal S. Rana, Marat Fudim, Gregg C. Fonarow
American Journal of Therapeutics.2025; 32(4): e351. CrossRef
Neuroimmune Interactions and Their Role in Immune Cell Trafficking in Cardiovascular Diseases and Cancer
Yutang Wang, Jack C. Anesi, Indu S. Panicker, Darcy Cook, Prapti Bista, Yan Fang, Ernesto Oqueli
International Journal of Molecular Sciences.2025; 26(6): 2553. CrossRef
Elevated serum amylase concentrations are associated with worse in-hospital outcomes among patients with acute myocardial infarction
Marijana Mikacic, Marko Kumric, Iva Rancic Vidic, Duska Glavas, Tina Ticinovic Kurir, Josko Bozic, Josip Andelo Borovac
BMC Cardiovascular Disorders.2025;[Epub] CrossRef
Cardiac arrhythmia following acute myocardial infarction: a retrospective analysis of 27,648 hospitalized patients in a tertiary heart hospital
Nidal Asaad, Ayman El-Menyar, Rajvir Singh, Betsy Varughese, Shahul Hameed Khan, Hajar AlBinali, Jassim Al Suwaidi
Monaldi Archives for Chest Disease.2025;[Epub] CrossRef
Beta-Adrenergic Blockers for Acute Myocardial Infarction: 50 years of Expert Opinions in Cecil Textbook of Medicine
Peter Manu, Gheorghe-Andrei Dan
American Journal of Therapeutics.2025; 32(3): e274. CrossRef
Prognostic impact of changes in left ventricular ejection fraction and wall motion score index in patients with myocardial infarction
Min-Wook Bae, Seong-guen Moon, Kyung-Tae Jung, Won-Ho Kim, Sang-Hyun Park, Jihun Ahn, Jin-Yong Hwang, Seok Kyu Oh, Seung Ho Hur, Myung Ho Jung, Kyu-Sun Lee
Frontiers in Cardiovascular Medicine.2025;[Epub] CrossRef
Identification and Validation of Calcium-Related Diagnostic Markers for Acute Myocardial Infarction via Bioinformatics Analysis and Machine Learning
Biao Wang, Jianhong Chen, Leili Wang, Yanli Liu, Liu Miao
International Heart Journal.2025; 66(4): 639. CrossRef
A hypoxia-on-a-chip platform for modeling ischemic arrhythmogenesis and evaluating the effects of levosimendan and OR-1896 on ischemic human iPSC-derived cardiomyocytes
Mahmoud Gaballah, Kaisla Walls, Fatma Zakzook, Joose Kreutzer, Jouko Levijoki, Katriina Aalto-Setälä
Frontiers in Bioengineering and Biotechnology.2025;[Epub] CrossRef
In-hospital cardiac arrest after STEMI: prevention strategies and post-arrest care
Walker Boyd, Wesley Young, Mehmet Yildiz, Timothy D. Henry, Kari Gorder
Expert Review of Cardiovascular Therapy.2024; 22(8): 379. CrossRef
Association between Inflammation and New-Onset Atrial Fibrillation in Acute Coronary Syndromes
Ruxandra-Maria Băghină, Simina Crișan, Silvia Luca, Oana Pătru, Mihai-Andrei Lazăr, Cristina Văcărescu, Alina Gabriela Negru, Constantin-Tudor Luca, Dan Gaiță
Journal of Clinical Medicine.2024; 13(17): 5088. CrossRef
Use of Early Intravenous Beta Blockers in Patients with Acute ST-Segment Elevation Myocardial Infarction Without Heart Failure—Revival or Requiem?
Azka Latif, Xiaoming Jia
Cardiovascular Drugs and Therapy.2024; 38(5): 973. CrossRef
Progress in Disease Modeling for Myocardial Infarction and Coronary Artery Disease: Bridging In Vivo and In Vitro Approaches
Riya Kar, Debabrata Mukhopadhyay, Ramcharan Singh Angom
Hearts.2024; 5(4): 429. CrossRef
Optimal duration of medical therapy for patients with acute myocardial infarction
Ki Yung Boo, Seung-Jae Joo, Jae-Geun Lee, Joon-Hyouk Choi, Song-Yi Kim, Geum Ko, Hae Eun Yun, Myung Ho Jeong
Medicine.2024; 103(48): e40697. CrossRef

Original Article

Cardiology
Evaluation of neopterin levels and kynurenine pathway in patients with acute coronary syndrome: Ibrahim Kember, Sonia Sanajou, Bilge Kilicarslan, Gözde Girgin, Terken Baydar; Acute Crit Care. 2023;38(3):325-332. Published online August 30, 2023; DOI: https://doi.org/10.4266/acc.2023.00024

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Abstract PDF

Background
Coronary atherosclerosis is the leading cause of coronary artery disease. Several investigations have indicated that tear-sensitive plaques contain macrophages and T cells. Neopterin is an essential cellular immune response biomarker. The main goal of this study was to see if there were any changes in biomarkers like unconjugated pteridines, neopterin, and biopterin, as well as kynurenine pathway enzymes like indoleamine 2,3-dioxygenase (IDO), which catalyzes the rate-limiting step in tryptophan degradation, in patients with the acute coronary syndrome (ACS) caused by angiographic atherosclerosis.
Methods
High-performance liquid chromatography was used to determine the amounts of neopterin, biopterin, and creatinine in urine samples, as well as tryptophan and kynurenine in serum samples. The enzyme-linked immunosorbent assay was used to assess the amounts of neopterin in serum samples. The measured parameters were evaluated between ACS patients and controls.
Results
The measured levels of neopterin, biopterin and the kynurenine to tryptophan ratio reflecting IDO activity, and the specifically known biomarkers such as cardiac troponin, creatine kinase, myoglobin, and natriuretic peptides are statistically higher in ACS patients compared to control subjects. On the other hand, the measured parameters are inadequate to classify the conventional kinds of ACS, ST-elevation- and non-ST-elevation- myocardial infarction.
Conclusions
The study found that determining and using neopterin and IDO parameters as biomarkers in individuals with the ACS can support traditional biomarkers. However, it can be concluded that evaluating pteridine biomarkers solely have no privilege to clinical findings in ACS diagnosis and classification.

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Assessment of Inflammatory and Oxidative Stress Biomarkers for Predicting of Patients with Asymptomatic Carotid Artery Stenosis
Abdullah Burak Karaduman, Sinem Ilgın, Özlem Aykaç, Mehmetcan Yeşilkaya, Serkan Levent, Atilla Özcan Özdemir, Gozde Girgin
Journal of Clinical Medicine.2025; 14(3): 755. CrossRef
Impact of systemic inflammatory response activation on the risk of coronary conduit dysfunction and the incidence of cardiovascular events after coronary artery bypass grafting
Yu. I. Buziashvili, I. V. Koksheneva, D. Kh. Kamardinov, E. F. Tugeeva, I. P. Shuvaev, A. Sh. Iraskhanov, E. P. Golubev, R. M. Ibragimov, V. Yu. Buziashvili, O. M. Sherstyannikova
Russian Journal of Cardiology.2025; 30(4): 6112. CrossRef
Crimean-Congo hemorrhagic fever: serum neopterin levels and their relationship with clinical course
Mustafa Usanmaz
Revista da Associação Médica Brasileira.2025;[Epub] CrossRef
Kynurenines as a Novel Target for the Treatment of Inflammatory Disorders
Adrian Mor, Anna Tankiewicz-Kwedlo, Marianna Ciwun, Janina Lewkowicz, Dariusz Pawlak
Cells.2024; 13(15): 1259. CrossRef
Biomarkers to monitor the prognosis, disease severity, and treatment efficacy in coronary artery disease
Armand N. Yazdani, Michaela Pletsch, Abraham Chorbajian, David Zitser, Vikrant Rai, Devendra K. Agrawal
Expert Review of Cardiovascular Therapy.2023; 21(10): 675. CrossRef
Evaluation of Neopterin as a Neuroinflammatory Marker for Peripheral Neuropathy in Type 2 Diabetic Patients
Israa Abdelmalik Salem, Sura Ahmed Abdulsattar, Haider Fadhil Alrubaye
Al-Rafidain Journal of Medical Sciences ( ISSN 2789-3219 ).2023; 5(1S): S183. CrossRef

Case Reports

Cardiology
Acute perimyocarditis mimicking acute myocardial infarction in a 12-year-old boy with duchenne muscular dystrophy: Ho Jung Choi, Hye Won Kwon, Kyung Jin Oh, Mi Kyoung Song; Acute Crit Care. 2022;37(2):258-262. Published online November 16, 2021; DOI: https://doi.org/10.4266/acc.2021.00290

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Abstract PDF Supplementary Material

Differential diagnosis of chest pain in the pediatric population is important but can be challenging. A 12-year-old boy with Duchenne muscular dystrophy presented with chest pain, cardiac enzyme elevation, and convex ST elevations in the inferior leads with reciprocal ST depression in the anterior leads on electrocardiogram. Echocardiography on admission revealed normal left ventricular function. Suspecting acute myocardial infarction, we performed invasive coronary angiography, which revealed normal coronary arteries. A follow-up electrocardiogram showed an acute pericarditis pattern with concave ST elevations in most leads and PR depression, and follow-up echocardiography revealed global left ventricular dysfunction, suggestive of acute perimyocarditis. Ibuprofen was administered for acute pericarditis, and a continuous milrinone infusion was commenced for myocardial dysfunction. The chest pain improved by the next day, and the ST segment elevations normalized on day 4. Echocardiography on day 9 revealed improved left ventricular function. The patient was discharged on day 11, and he is doing well without chest pain through 12 months of follow-up. The last electrocardiogram showed normal sinus rhythm without ST change. Differential diagnosis of acute myocardial infarction and acute perimyocarditis is important for proper treatment strategies and the different prognoses of these two conditions.

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Pediatric Chest Pain: A Review of Diagnostic Tools in the Pediatric Emergency Department
Szu-Wei Huang, Ying-Kuo Liu
Diagnostics.2024; 14(5): 526. CrossRef
Case Report: Acute myocarditis in a patient with Duchenne muscular dystrophy
Xinyuan Zhang, Yingkun Guo, Huayan Xu
Frontiers in Cardiovascular Medicine.2024;[Epub] CrossRef
Successful treatment of acute myocardial injury of Duchenne muscular dystrophy with steroids: a case report
Merve Oğuz, Dolunay Gürses, Furkan Ufuk, Münevver Yılmaz, Olcay Güngör
Journal of Cardiothoracic Surgery.2023;[Epub] CrossRef
Comprehensive cardiac magnetic resonance T1, T2, and extracellular volume mapping to define Duchenne cardiomyopathy
Sudeep D. Sunthankar, Kristen George-Durrett, Kimberly Crum, James C. Slaughter, Jennifer Kasten, Frank J. Raucci, Larry W. Markham, Jonathan H. Soslow
Journal of Cardiovascular Magnetic Resonance.2023; 25(1): 44. CrossRef

Cardiology
ST-Segment Elevation Myocardial Infarction as a Result of Coronary Artery Ectasia-Related Intracoronary Thrombus in a Patient with Liver Cirrhosis: Ji Woong Roh, Eun Hyea Park, Joon Cheol Song, Young Seung Oh, Tong Yoon Kim, Hyo Suk Kim, Sungmin Lim; Korean J Crit Care Med. 2015;30(4):358-364. Published online November 30, 2015; DOI: https://doi.org/10.4266/kjccm.2015.30.4.358

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Abstract PDF

Coronary artery ectasia (CAE) is a rare condition defined as the dilatation of coronary artery to at least 1.5 times larger than the normal adjacent coronary artery. Clinical manifestations of CAE vary, ranging from asymptomatic to ST-segment elevation myocardial infarction (STEMI). Because of its rarity and clinical diversity, the best treatment strategy and prognosis for CAE remain unclear. We describe a case of STEMI caused by intracoronary thrombus formation within an ectatic area in a patient with liver cirrhosis (LC). The patient was successfully managed by thrombus aspiration only, without balloon angioplasty or stent implantation, and maintained by dual antiplatelet therapy with aspirin and ticagrelor, a potent new P2Y12 inhibitor.

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Evaluation of body-mass index in patients with coronary artery ectasia
Tolga Memioğlu, Mehmet İnanır, Murat Dıramalı, Salih Vahit Kiriş, İbrahim Güven, Kıvanç Argana, Kenan Toprak, Mehmet Özyaşar
Anatolian Current Medical Journal.2025; 7(4): 404. CrossRef

Cardiology
Cardiac Arrest due to Recurrent Ventricular Fibrillation Triggered by Unifocal Ventricular Premature Complexes in a Silent Myocardial Infarction: Dong Hyun Lee, Seul Lee, Hyo Jin Jung, Soo Jin Kim, Jeong Min Seo, Jae Hyuk Choi, Jong Sung Park; Korean J Crit Care Med. 2014;29(4):331-335. Published online November 30, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.4.331

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Abstract PDF: A 51-year-old male patient was referred for a sudden out-of-hospital cardiac arrest. Upon arrival, he was conscious and had no chest pain complaints. There was no abnormality in initial electrocardiographic and echocardiographic examinations. However, episodes of recurrent ventricular fibrillation (VF) were documented on rhythm monitoring. Each VF episode was triggered by an isolated monomorphic ventricular premature complex (VPC). Suspecting idiopathic VF, emergency radiofrequency catheter ablation was planned for the VPCs. However, when coronary angiography was performed to exclude silent ischemia, the results showed a total occlusion of the right coronary artery posterolateral branch, which is thought to supply the left ventricular inferior and septal wall. After successful reperfusion, VF episodes and the triggering VPCs disappeared. We are documenting this case to emphasize the potential for silent myocardial infarction to cause out-of-hospital sudden cardiac arrest even in a patient without any symptom or sign of acute coronary syndrome.

Cardiology/Pediatric
Acute Myocardial Infarction during the Subacute Phase of Refractory and Incomplete Kawasaki Disease in a Five-year-old Boy: Chul Jin, Yeo Hyang Kim, Hyung Seop Kim; Korean J Crit Care Med. 2014;29(1):23-26. Published online February 28, 2014; DOI: https://doi.org/10.4266/kjccm.2014.29.1.23

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Abstract PDF: Kawasaki disease (KD) is an acute, systemic vasculitis of childhood. The early mortality of KD results from coronary complications, mainly aneurysmal thrombosis with myocardial infarction, and the subacute phase of KD has the highest risk of mortality. Although there have been reports of ischemic heart disease as late cardiologic sequelae of KD in young adults, acute myocardial infarction caused by coronary complications in the subacute phase of KD is rare. We experienced one pediatric patient who developed coronary artery aneurysm and acute myocardiac infarction (AMI) during the subacute phase of incomplete and intravenous immunoglobulin (IVIG)-nonresponsive KD. The patient was given a good prognosis due to close monitoring and early recognition of AMI. Physicians should carefully monitor KD patients who do not respond to initial IVIG therapy and who show progressive coronary artery dilatation. If such a patient complaints of chest pain and the ECG shows hyperacute T waves, the physician should suspect development of AMI.

Original Articles

Gender Differences in Patients with Acute Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Sukwon Hahn; Korean J Crit Care Med. 2012;27(4):230-236.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.230

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Abstract PDF: BACKGROUND
Limited data are available for gender-based differences among patients with acute myocardial infarction (AMI) undergoing coronary revascularization in Korea. The purpose of this study is to identify gender-based differences in clinical characteristics, risk factors and outcomes among Korean patients undergoing percutaneous coronary intervention (PCI).
METHODS
Patients with AMI undergoing PCI between Jan 2009 and Sep 2011 were included (n = 457) in the study. Clinical characteristics and cardiovascular risk factors as well as major adverse cardiac events (MACE), including death after PCI, were compared between women (n = 134) and men (n = 323).
RESULTS
Women were older (69.8 +/- 10.7 vs. 60.0 +/- 11.7 years, p < .001) and had more comorbidities, such as diabetes (44.0% vs. 32.8%, p = .025) and hypertension (64.9% vs. 48.9%, p = .002) compared to men. Women were less likely to have a smoking history (p < .001). There were no significant differences in all causes of death and in MACE between women and men. By the multivariate analysis, age, HDL-cholesterol and left ventricle ejection fraction are associated with mortality and MACE.
CONCLUSIONS
In this study, women did not emerge as an independent predictor for MACE; however, they were older and had a higher incidence of hypertension and diabetes than men.

Metabolic Syndrome as a Risk Factor for Atrial Fibrillation in Patients with Acute Myocardial Infarction: Woo Seung Shin, Mi Youn Park, You Mi Hwang, Hui Kyung Jeon, Man Young Lee, Jong Min Lee, Byoung Joo Shim, Sung Sik Kim, Seung Jae Lee, Yong Seog Oh, Tai Ho Rho, Ki Bae Seung; Korean J Crit Care Med. 2011;26(1):6-12.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.6

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Abstract PDF

BACKGROUND
Atrial fibrillation (AF) has been linked to an increased risk for in-hospital and long-term mortality rates in patients with acute myocardial infarction (AMI). Obesity and metabolic syndrome (MS) are known to play an important role in cardiovascular morbidity and mortality. However, it is uncertain whether obesity and MS increase the risk of AF in patients with AMI. Therefore, we investigated independent risk factors for the occurrence of new-onset AF in patients with AMI who received optimal percutaneous coronary intervention (PCI).
METHODS
We prospectively analyzed the association between MS and the incidence of cardiac arrhythmia in 146 patients with AMI who underwent PCI. Twenty-four-hour Holter monitoring was performed 3 days after AMI. We divided the patients into two different groups based on the development of AF and analysed their obesity based on body mass index (BMI) (kg/m2) and evaluated the existence of MS, as well as visceral obesity with fat computed tomography.
RESULTS
Seventy-five patients (51.4%) were obese (BMI > or = 25) and 64 (44%) had MS. AF occurred in 33 (22.6%) patients. Age, MS, and visceral obesity were significantly associated with AF (p = 0.001, p = 0.003, and p = 0.03, respectively). There was no difference between obese and non-obese patients in the incidence of AF and VT. Multivariate analysis revealed that age and MS were independent risk factors of post-AMI AF.
CONCLUSIONS
MS is an important and modifiable risk factor for new-onset AF especially in patients with AMI who underwent PCI.

Citations

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Impact of Metabolic Syndrome on Procedural Outcomes in Patients With Atrial Fibrillation Undergoing Catheter Ablation
Sanghamitra Mohanty, Prasant Mohanty, Luigi Di Biase, Rong Bai, Agnes Pump, Pasquale Santangeli, David Burkhardt, Joseph G. Gallinghouse, Rodney Horton, Javier E. Sanchez, Shane Bailey, Jason Zagrodzky, Andrea Natale
Journal of the American College of Cardiology.2012; 59(14): 1295. CrossRef

Case Reports

Cardiac Transplantation for a Patient with Intra-aortic Balloon Pump and Extracorporeal Membrane Oxygenator due to Cardiogenic Shock after Acute Myocardial Infarction: A Case Report: Jae Hang Lee, Young Ok Lee, Byoung Ju Min, Byung Su Yoo, Ki Bong Kim; Korean J Crit Care Med. 2010;25(3):194-198.; DOI: https://doi.org/10.4266/kjccm.2010.25.3.194

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Abstract PDF: A 66-year-old male patient who suffered from chest pain and dyspnea was admitted to our hospital. He was diagnosed as having an acute myocardial infarction, and recovered from cardiogenic shock after cardiopulmonary-cerebral resuscitation. Under the support of extracorporeal membrane oxygenator (ECMO) he underwent successful percutaneous coronary intervention. After this, an intra-aortic balloon pump (IABP) was inserted to increase coronary perfusion and reduce the impedance to left ventricular ejection. After 6 days, the patient was weaned from ECMO support; however, IABP therapy and infusion of inotropic agents were required to maintain adequate hemodynamic status. One week later, cardiac transplantation was performed successfully without major complications.

A Case of Accelerated Idioventricular Rhythm Lasted for 5 Days after Reperfusion in a Patient with Spasm-induce Myocardial Infaction: A Case Report: Kyoung Chan Kim, Il Soo Kim, Wook Kang, Jae Kyoon Kim, Chang Hoon Yu, Su Hong Kim; Korean J Crit Care Med. 2009;24(1):33-36.; DOI: https://doi.org/10.4266/kjccm.2009.24.1.33

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Abstract PDF

A 56-year-old man presented with right coronary arterial spasm accompanied by ST segment elevation in the inferior leads. A reperfusion arrhythmia, accelerated idioventricular rhythm (AIVR), developed 1 hour after a nitroglycerin infusion. The AIVR was sustained for 5 days without hemodynamic instability, and resolved spontaneously during hemodynamic monitoring in the coronary intensive care unit.

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Successful Recovery after Cardiac Arrest from Medically Intractable Coronary Spasm Induced by Ergonovine, Using Percutaneous Cardiopulmonary Support - A Case Report -
Jeehoon Kang, In-Chang Hwang, Chang-Hwan Yoon
Korean Journal of Critical Care Medicine.2012; 27(4): 269. CrossRef

Original Article

Predictive Factors for the Mortality of Cardiovascular Patients at Coronary Care Unit: Eun Suk Shin, Myung Ho Jeong, Sang Chun Lim, Myung Ja Choi, Seon Young Jeong, Gill Yup Kim, Eun Jeong Lee, Su Mi Bang, Hyo Ran Lee, Young Joon Hong, Hyung Wook Park, Ju Han Kim, Weon Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang; Korean J Crit Care Med. 2004;19(1):32-37.

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Abstract PDF: BACKGROUND
Recently the incidence of coronary artery disease has been increased rapidly in Korea. After the introduction of coronary care unit, the mortality rate of cardiovascular patients has been decreased. The predictive factors for mortality in patients admitted at Coronary Care Unit (CCU) are important in the management of acutely ill cardiovascular patients. METHODS: One thousand one hundred and thirty patients (64.8+/-14.5 years), who were admitted at CCU from January 2002 to June 2003, were analyzed. The patients were divided into two groups according to mortality: the survived group (Group I: n=1055, 63.3+/-13.3 years) and the moribund group (Group II: n=75, 64.8+/-14.1 years). Clinical characteristics, risk factors, clinical diagnosis, laboratory, echocardiographic and coronary angiographic findings were compared between the two groups.
RESULTS
The overall mortality at CCU was 6.6%, 75 out of 1130 patients. Age and sex were not different between both groups. Coronary artery disease was the most common cause of admission (886 out of 1130 patients) and death (46 out of 75 patients). Coronary angiographic findings were not different between the two groups. Left ventricular ejection fraction (LVEF) by echocardiogram was higher in Group I than in Group II (53.1+/-15.6% vs. 42.3+/-16.3%, p<0.05). Predictive factors for mortality by multiple logistic regression analysis were low LVEF (OR 11.4, 2.9-21.4 95%CI, p<0.001), no performance of percutaneous coronary intervention (PCI, OR 10.8, 2.5-17.8 95%CI, p<0.001) and clinical diagnosis of aortic dissection (OR 3.8, 1.3-9.8 95%CI, p=0.021).
CONCLUSIONS
The predictive factors for mortality at CCU were low LVEF, no PCI and aortic dissection.

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