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Article ; Online: Ötéves sztatinperzisztencia akut myocardialis infarktus után, korábban sztatint nem szedőkben.

Simonyi, Gábor / Ferenci, Tamás / Finta, Ervin / Medvegy, Mihály

2024 Volume 165, Issue 5, Page(s) 171–176

Title translation	Five-year persistence of statins after acute myocardial infarction in statin-naïve patients.
MeSH term(s)	Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use ; Myocardial Infarction/drug therapy ; Medication Adherence
Chemical Substances	Hydroxymethylglutaryl-CoA Reductase Inhibitors
Language	Hungarian
Publishing date	2024-02-04
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2024.32966
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Article: Supplementary Therapeutic Possibilities to Alleviate Myocardial Damage Due to Microvascular Dysfunction in Coronavirus Disease 2019 (COVID-19).

Medvegy, Mihály / Simonyi, Gábor

Cardiology and therapy

2021 Volume 10, Issue 1, Page(s) 1–7

Abstract: Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomenon in severe cases of coronavirus disease 2019 (COVID-19). Its causes are capillary endothelial cell dysfunction, associated carditis, low oxygenization, and ...

Abstract	Myocardial damage with a consequent rise in cardio-specific troponin level is a frequent phenomenon in severe cases of coronavirus disease 2019 (COVID-19). Its causes are capillary endothelial cell dysfunction, associated carditis, low oxygenization, and increased sympathetic tone, which all worsen myocardial stiffness and microvascular dysfunction (MD). They lead to severe myocardial dysfunction, arrhythmia, acute congestive heart failure, and a significant rise in death cases. During COVID-19, no specific cardiological treatment is started. As adjuvant therapy, anxiolytics in COVID-19 are widely used, but not in all anxious patients who had been infected with coronavirus. Anxiolytics can be useful to moderate MD and immunosuppressive effect of anxiety. The favorable effects of trimetazidine (TMZ) and Coenzyme Q
Language	English
Publishing date	2021-04-02
Publishing country	England
Document type	Letter
ZDB-ID	2700626-8
ISSN	2193-6544 ; 2193-8261
ISSN (online)	2193-6544
ISSN	2193-8261
DOI	10.1007/s40119-021-00216-8
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Article ; Online: Versenysportolók hirtelen szívhalálának elemzése, az esetszámok csökkentésének lehetőségei.

Major, Zsuzsanna / Medvegy, Zoltán / Tulit, Tímea Terézia / Simonyi, Gábor / Pavlik, Gábor / Medvegy, Mihály

Orvosi hetilap

2023 Volume 164, Issue 29, Page(s) 1155–1163

Abstract: Introduction: Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock.: Objective: Our research aim was to collect and study as many sudden cardiac death cases as ... ...

Title translation	Analysis of sudden cardiac death in competitive athletes, possibilities for reducing cases.
Abstract	Introduction: Sudden cardiac death in athletes is rare (0.5 to 1 per 100 000 athlete years), but sudden cardiac death in known athletes causes general shock. Objective: Our research aim was to collect and study as many sudden cardiac death cases as possible, judge the role of stress and look for ways to reduce fatal tragedies. Method: From registers and newspaper articles found on the Internet, we collected 360 (including 14 women) athletes' sudden cardiac death cases where the sport, age and place of death (during training/competition/after) could be determined. From these, a single database has been prepared in order of the year of death. The cases were grouped and analyzed by sports. Based on our results and literature data, we made recommendations to reduce fatalities. Results and conclusion: There were more sudden cardiac deaths in competitions than in trainings (239 vs. 99), but tragedies also happened during warm-ups and chess without physical exertion, furthermore, there was no sudden cardiac death in the stakeless training of marathon/half marathon/triathlon athletes; all these prove the role of stress, so we recommend a psychological conversation before a high-stakes race. There were also a lot of sudden cardiac deaths (79/360) during team sports trainings, so we recommend reanimation readiness there as well. After training/competition, sudden cardiac death happened mainly in sports requiring high static effort, where post-competition monitoring is also recommended. Those who died in training were younger than those who died during the race (p<0.01), so young people should be monitored more closely for medical and (under)fitness. Marathon runners and triathletes were older than team athletes (p<0.005) and only died in competition, so for them a basic examination and an ECG within 1 month before competition are recommended. Conclusions drawn from literature data: sports medicine examination should be standardized and documented in an accessible way; since resuscitation started earlier and professionally is more effective, all competitors should receive reanimation training. Orv Hetil. 2023; 164(29): 1155-1163.
MeSH term(s)	Humans ; Female ; Adolescent ; Death, Sudden, Cardiac/epidemiology ; Death, Sudden, Cardiac/etiology ; Death, Sudden, Cardiac/prevention & control ; Sports ; Athletes ; Exercise ; Incidence
Language	Hungarian
Publishing date	2023-07-23
Publishing country	Hungary
Document type	English Abstract ; Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2023.32806
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Article ; Online: Renin-angiotenzin-aldoszteron-rendszer-gátlók fix gyógyszer-kombinációinak egyéves perzisztenciája hypertoniás betegekben.

Simonyi, Gábor / Ferenci, Tamás / Finta, Ervin / Medvegy, Mihály / Wittmann, István

Orvosi hetilap

2023 Volume 164, Issue 34, Page(s) 1337–1341

Abstract: Introduction: Various fixed combinations of antihypertensive agents are highlighted in European and Hungarian hypertension guidelines. A renin-angiotensin-aldosterone system antagonist (RAAS inhibitor) in combination with calcium channel blockers (CCBs) ...

Title translation	One-year persistence of renin-angiotensin-aldosterone system inhibitors fixed drug combinations in hypertensive patients.
Abstract	Introduction: Various fixed combinations of antihypertensive agents are highlighted in European and Hungarian hypertension guidelines. A renin-angiotensin-aldosterone system antagonist (RAAS inhibitor) in combination with calcium channel blockers (CCBs) or diuretics are recommended as the first step in antihypertensive therapy. Objectives: The aim of the authors was to compare the one-year persistence of RAAS inhibitor fixed-dose combinations (FDCs) in hypertension. Method: The authors have analyzed the prescription database of the National Health Insurance Fund and selected patients who first filled prescriptions for any RAAS inhibitor FDC between October 1, 2012, and September 30, 2013, and who did not redeem prescriptions for similar preparations in the year preceding the selection period. Apparatus of survival analysis was used, where "survival" was the time to abandon the medication. Results: A total of 443 149 patients met the selection criteria. The one-year persistence of angiotensin-converting enzyme inhibitor (ACE inhibitor)/CCB FDCs was 44.59%, while that of angiotensin II receptor inhibitor (ARB)/thiazide diuretic (HCT) FDCs was 42.52%. This was followed by ACE inhibitor/indapamide FDCs at 37.27%, ARB/CCB FDCs at 29.04%, and ACE inhibitors/HCT FDCs at 27.47%. Compared to ACE inhibitor/indapamide FDCs (reference), the risk of discontinuing ACE inhibitor/CCBs was 31 percentage points lower (HR = 0.69, 95% CI 0.6855-0.6996, p<0.0001), and the risk of discontinuing ARB/HCT FDCs was 18 percentage points lower (HR = 0.82, 95% CI 0.8096-0.8267, p<0.0001). However, the risk of discontinuing ACE inhibitor/HCT FDCs was 17 percentage points higher (HR = 1.17, 95% CI 1.1562-1.1825, p<0.0001), and the risk of discontinuing ARB/CCB FDCs was 20 percentage points higher (HR = 1.20, 95% CI 1.17316-1.2239, p<0.0001). The average medication adherence time limited to 360 days was 239.9 days for ACE inhibitor/CCB FDCs, 214.8 days for ARB/HCT FDCs, 193.8 days for ACE inhibitor/indapamide FDCs, 178.8 days for ARB/CCB FDCs, and 177.6 days for ACE inhibitor/HCT FDCs. Conclusions: The authors have demonstrated that the one-year persistence of RAAS inhibitor FDCs varies significantly in hypertensive patients. ACE inhibitor/CCB FDCs were found to be the most advantageous. Orv Hetil. 2023; 164(34): 1337-1341.
MeSH term(s)	Renin-Angiotensin System ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Drug Prescriptions ; Calcium Channel Blockers/therapeutic use ; Drug Therapy, Combination ; Humans ; Angiotensin Receptor Antagonists/therapeutic use ; Hypertension/drug therapy
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Calcium Channel Blockers ; Angiotensin Receptor Antagonists
Language	Hungarian
Publishing date	2023-08-27
Publishing country	Hungary
Document type	English Abstract ; Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2023.32840
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Real-world adherence to oral anticoagulants in atrial fibrillation

Simonyi, Gábor / Paksy, András / Várnai, Réka / Medvegy, Mihály

Orvosi hetilap

2020 Volume 161, Issue 20, Page(s) 839–845

Abstract: Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulant (OAC), the patients' adherence to therapy is a very important factor in stroke prevention. Aim: To investigate the one-year persistence of different OAC ... ...

Title translation	[Orális antikoagulánssal kezelt pitvarfibrilláló betegek terápiahűsége a mindennapokban]
Abstract	Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulant (OAC), the patients' adherence to therapy is a very important factor in stroke prevention. Aim: To investigate the one-year persistence of different OAC therapies (vitamin K antagonist [VKA] and new oral anticoagulants [NOAC]) in patients with AF. Method: The authors investigated the persistence of oral anticoagulant (OAC = VKA/NOAC) in atrial fibrillation using the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2016 and December 31, 2016. Results: 122 870 patients met the inclusion criteria. 18 650 patients started OACs therapy newly (therapy-naïve group), while 104 220 were already on one of the OACs. Among new patients, the one-year persistence of NOACs was 65.7% and that of VKA was 39.0% (p<0.001). The one-year persistence rate was 72.6% for NOAC and 53.9% for VKA (p<0.001) in patients already on OACs. In the therapy-naïve group, the one-year persistence to rivaroxaban was 65.7%. To apixaban it was 62.6%, and to dabigatran it was 59.2% (logrank p<0.001 in all comparisons except rivaroxaban vs. apixaban: p = 0.017, and dabigatran vs. apixaban: p<0.01). The one-year persistence rate of patients treated with NOACs was 73.4% to rivaroxaban, 68.0% to apixaban, and 68.4% to dabigatran (logrank p<0.001 in all comparisons except apixaban vs. dabigatran, NS). Conclusions: The one-year persistence of NOACs was significantly higher in AF compared to VKA therapy (in therapy-naïve and in already treated patients, too). Among the NOACs, rivaroxaban has the best one-year persistence in all patient populations. Orv Hetil. 2020; 161(20): 839-845.
MeSH term(s)	Administration, Oral ; Anticoagulants/administration & dosage ; Anticoagulants/therapeutic use ; Atrial Fibrillation/drug therapy ; Atrial Fibrillation/epidemiology ; Drug Prescriptions/statistics & numerical data ; Humans ; Hungary/epidemiology ; Medication Adherence/statistics & numerical data ; Stroke/diagnosis ; Stroke/prevention & control ; Treatment Outcome
Chemical Substances	Anticoagulants
Language	Hungarian
Publishing date	2020-05-01
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2020.31727
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Article ; Online: Orális antikoagulánssal már kezelt pitvarfibrilláló betegek egyéves terápiahűsége.

Simonyi, Gábor / Ferenci, Tamás / Finta, Ervin / Gasparics, Roland / Medvegy, Mihály

Orvosi hetilap

2018 Volume 160, Issue 13, Page(s) 509–515

Abstract: Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulants (OAC), medical adherence is a relevant factor for stroke prevention.: Aim: To evaluate the one-year persistence of vitamin K antagonists (VKA) and direct ...

Title translation	One-year persistence of patients already treated with oral anticoagulants for atrial fibrillation.
Abstract	Introduction: In the treatment of non-valvular atrial fibrillation (AF) with oral anticoagulants (OAC), medical adherence is a relevant factor for stroke prevention. Aim: To evaluate the one-year persistence of vitamin K antagonists (VKA) and direct oral anticoagulants (DOAC) in patients suffering from AF and already treated with OACs. Method: Information from the National Health Insurance Fund of Hungary prescriptions database on pharmacy claims between June 1, 2015 and December 31, 2015 was analysed. Authors identified patients who filled prescriptions for OACs (VKAs or DOACs) prescribed for AF who have already received OACs therapy during one year before. Apparatus of survival analysis was used, where 'survival' was the time to abandon the medication. Results: 196 016 patients met the inclusion criteria. 181 810 patients received VKA and 14 206 patients were treated with DOACs. The one-year persistence rate in patients taking VKA was 52.9% whereas it was 66.8% in those on the DOACs. The persistence rates after 360 days were 67.5% for rivaroxaban, 63.6% for apixaban and 63.4% for dabigatran. The mean duration of persistence was 311 days for rivaroxaban, 308 days for apixaban and 284 days for dabigatran. The actual rate of discontinuation was 14% (HR = 1.14 [95% CI 1.05-1.24]), p = 0.0015) for apixaban, 15% (HR = 1.15 [95% CI 1.08-1.23], p = 0.003) for dabigatran and 62% (HR = 1.62 [95% CI 1.56-1.69], p<0.0001) for VKA compared to rivaroxaban (reference). Conclusions: The authors have confirmed that the one-year persistence of DOAKs was significantly higher compared to KVA therapy in AF. The one-year persistence of rivaroxaban was more favoured than apixaban and dabigatran. Orv Hetil. 2019; 160(13): 509-515.
MeSH term(s)	Administration, Oral ; Anticoagulants/administration & dosage ; Atrial Fibrillation/drug therapy ; Dabigatran/administration & dosage ; Databases, Factual ; Humans ; Hungary ; Pyrazoles/administration & dosage ; Pyridones/administration & dosage ; Rivaroxaban/administration & dosage ; Treatment Outcome ; Vitamin K/antagonists & inhibitors
Chemical Substances	Anticoagulants ; Pyrazoles ; Pyridones ; Vitamin K (12001-79-5) ; apixaban (3Z9Y7UWC1J) ; Rivaroxaban (9NDF7JZ4M3) ; Dabigatran (I0VM4M70GC)
Language	Hungarian
Publishing date	2018-09-08
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2019.31347
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A rivaroxaban a stroke megelőzésében pitvarfibrilláló betegekben.

Simonyi, Gábor / Medvegy, Mihály

Ideggyogyaszati szemle

2012 Volume 65, Issue 11-12, Page(s) 365–368

Abstract: Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective ... ...

Title translation	Rivaroxaban in prevention of stroke in patients with atrial fibrillation.
Abstract	Atrial fibrillation (AF) is well established risk factor for cardioembolic stroke. With thromboprophylatic treatment we can reduce the risk of stroke in patients with AF. Oral vitamin K antagonists (VKA) such as warfarin and acenocoumarol are effective for stroke prevention in patients with atrial fibrillation. VKAs are associated with several limitations including very narrow therapeutic range, several factors (diet, drugs, alcohol consumption) affecting the effect of VKA and excessive bleeding may occur if INR value not controlled successfully. New oral anticoagulant direct Xa factor inhibitor rivaroxaban has a good therapeutic efficacy in prevention (primary and secondary) of stroke in AF patients. Its advantages are including no need for monitoring, fixed oral dose, not affected by meal, age and body weight, all of them can improve patient adherence. In ROCKET AF trial in patients with AF, rivaroxaban was noninferior to warfarin for the prevention of stroke or systemic embolism. There was no significant between-group difference in the risk of major bleeding, although intracranial and fatal bleeding occurred less frequently in the rivaroxaban group.
MeSH term(s)	Anticoagulants/administration & dosage ; Anticoagulants/blood ; Anticoagulants/therapeutic use ; Atrial Fibrillation/blood ; Atrial Fibrillation/complications ; Clinical Trials as Topic ; Drug Administration Schedule ; Humans ; International Normalized Ratio ; Morpholines/administration & dosage ; Morpholines/blood ; Morpholines/therapeutic use ; Risk Factors ; Rivaroxaban ; Stroke/blood ; Stroke/etiology ; Stroke/prevention & control ; Thiophenes/administration & dosage ; Thiophenes/blood ; Thiophenes/therapeutic use ; Treatment Outcome
Chemical Substances	Anticoagulants ; Morpholines ; Thiophenes ; Rivaroxaban (9NDF7JZ4M3)
Language	Hungarian
Publishing date	2012-11-30
Publishing country	Hungary
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2240317-6
ISSN	0019-1442
ISSN	0019-1442
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: A perindopril/amlodipin szabad és fix kombinációk egyéves terápiahűsége.

Simonyi, Gábor / Ferenci, Tamás / Medvegy, Mihály / Gasparics, Roland / Finta, Ervin

Orvosi hetilap

2017 Volume 158, Issue 36, Page(s) 1421–1425

Abstract: Introduction: In management of hypertension patient adherence is one of the most important factors. In hypertension the cardiovascular risk reduction can be reached only by prolonged and effective pharmacotherapy.: Aim: To evaluate the persistence of ...

Title translation	One year persistence of free and fixed dose combinations of perindopril/amlodipine.
Abstract	Introduction: In management of hypertension patient adherence is one of the most important factors. In hypertension the cardiovascular risk reduction can be reached only by prolonged and effective pharmacotherapy. Aim: To evaluate the persistence of one-year treatment of free and fixed-dose combination of perindopril/amlodipine in hypertension. Method: Information from the National Health Insurance of Hungary prescriptions database on pharmacy claims between October 1, 2012 and September 30, 2013 was analysed. Authors identified patients who filled prescriptions for free and fixed-dose combination of perindopril/amlodipine, prescribed for the first time for hypertension. Patients have not received antihypertensive therapy with similar active substances during the one year before. Apparatus of survival analysis was used, where "survival" was the time to abandon the medication. As it was available to month precision, discrete time survival analysis was applied. Results: 109,248 patients met the inclusion criteria. Combination antihypertensive therapy with perindopril/amlodipine was started with a free or a fixed-dose combination of these agents in 19,365 and 89,883 patients, respectively. One year persistence rate in patients taking perindopril/amlodipine as a free combination was 27.15%, whereas it was 46.89% in those on the fixed-dose combination. Mean duration of persistence was 177.6 days in patients on the perindopril/amlodipine free, whereas 245.7 days on fixed-dose combination. Actual rate of discontinuation was approximately twice higher with the treatment of free, compared with the use of the fixed-dose combination (hazard ratio =1.94 [95% CI: 1.91-1.98], p<0.001). Orv Hetil. 2017; 158(36): 1421-1425.
MeSH term(s)	Amlodipine/administration & dosage ; Antihypertensive Agents/administration & dosage ; Drug Administration Schedule ; Drug Combinations ; Drug Prescriptions/statistics & numerical data ; Humans ; Hungary ; Hypertension/drug therapy ; Hypertension/physiopathology ; Medication Adherence/statistics & numerical data ; Perindopril/administration & dosage ; Survival Analysis
Chemical Substances	Antihypertensive Agents ; Drug Combinations ; amlodipine, perindopril drug combination ; Amlodipine (1J444QC288) ; Perindopril (Y5GMK36KGY)
Language	Hungarian
Publishing date	2017-09
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2017.30851
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Az angiotenzinkonvertálóenzim-gátló/kalciumcsatorna-blokkoló fix gyógyszer-kombinációk egyéves perzisztenciája hypertoniában.

Simonyi, Gábor / Ferenci, Tamás / Finta, Ervin / Igaz, Iván / Balogh, Sándor / Gasparics, Roland / Medvegy, Mihály

Orvosi hetilap

2018 Volume 160, Issue 9, Page(s) 343–348

Abstract: Introduction: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as ... ...

Title translation	One-year persistence of fixed-dose combinations of angiotensin-converting enzyme inhibitor and calcium channel blocker in hypertensive patients.
Abstract	Introduction: The most recent European guidelines for the treatment of hypertension suggest the use of renin-angiotensin-aldosterone system antagonists (RAAS inhibitors) and calcium channel blockers (CCBs) or diuretics fixed-dose combinations (FDCs) as the first therapeutic option. In antihypertensive therapy, the patient's adherence is one of the most important factors in reducing unwanted cardiovascular events. Aim: Our aim was to assess the one-year persistence of angiotensin-converting enzyme inhibitor (ACEI) and CCB FDCs in hypertensive patients. Method: Authors have analysed the prescription database of the National Health Insurance Fund in Hungary on pharmacy claims between October 1, 2012 and September 30, 2013. Those patients were identified who filled prescriptions for FDCs of ACEI and CCBs prescribed for the first time for hypertensive patients and who had not received similar drugs during the year before. Apparatus of survival analysis was used, where 'survival' was the time to abandon the medication. Results: 124 388 patients met the inclusion criteria. One-year persistence rate and hazard ratio (HR) of discontinuation in patients with ramipril/amlodipine FDC was 54% (HR = 1.00, reference), perindopril/amlodipine 47% (HR = 1.30, p<0.0001), lisinopril/amlodipine 36% (HR = 1.79, p<0.0001), ramipril/felodipine 26% (HR = 2.28, p<0.0001) and trandolapril/verapamil 12% (HR = 4.13, p<0.0001). The average survival time of drug limited to 360 days was 270.2 days for ramipril/amlodipine FDC, 242.7 days for perindopril/amlodipine FDC, 211.2 days for lisinopril/amlodipine FDC, 186.3 days for ramipril/felodipine FDC and 125.7 days for trandolapril/verapamil FDC. Conclusions: The authors demonstrated that the one-year persistence of ACEI/CCB FDCs was significantly different in hypertensive patients. Ramipril/amlodipine FDC was more advantageous for patient adherence. Orv Hetil. 2019; 160(9): 343-348.
MeSH term(s)	Angiotensin-Converting Enzyme Inhibitors/administration & dosage ; Angiotensin-Converting Enzyme Inhibitors/therapeutic use ; Antihypertensive Agents/administration & dosage ; Antihypertensive Agents/therapeutic use ; Calcium Channel Blockers/administration & dosage ; Calcium Channel Blockers/therapeutic use ; Databases, Factual ; Drug Combinations ; Humans ; Hungary ; Hypertension/drug therapy ; Medication Adherence/statistics & numerical data ; Survival Analysis ; Treatment Outcome
Chemical Substances	Angiotensin-Converting Enzyme Inhibitors ; Antihypertensive Agents ; Calcium Channel Blockers ; Drug Combinations
Language	Hungarian
Publishing date	2018-12-12
Publishing country	Hungary
Document type	Journal Article
ZDB-ID	123879-6
ISSN	1788-6120 ; 0030-6002
ISSN (online)	1788-6120
ISSN	0030-6002
DOI	10.1556/650.2019.31355
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Non-ST elevation myocardial infarction: a new pathophysiological concept could solve the contradiction between accepted cause and clinical observations.

Medvegy, Mihály / Simonyi, G / Medvegy, N / Pécsvárady, Zs

Acta physiologica Hungarica

2011 Volume 98, Issue 3, Page(s) 252–261

Abstract: Unlabelled: Non-ST elevation myocardial infarction (NSTEMI) and ST elevation infarction have many differences in their appearance and prognosis. A comprehensive search made us form a new hypothesis that a further cause also existsin NSTEMI: an acute, ... ...

Abstract	Unlabelled: Non-ST elevation myocardial infarction (NSTEMI) and ST elevation infarction have many differences in their appearance and prognosis. A comprehensive search made us form a new hypothesis that a further cause also existsin NSTEMI: an acute, critical increase in the already existing high microvascular resistance in addition to the subtotal coronary artery occlusion. Various findings and studies can be interpreted only by our hypothesis: hemodynamic findings, ECG changes, autopsy reports and clinical observations (different long-time prognosis and different result of acute revascularization therapy in NSTEMI, similarities of NSTEMI with other clinical symptoms where increased microvascular resistance can be supposed without coronary artery disease). Objective: Despite similarities in the underlying pathologic mechanism non-ST elevation myocardial infarction(NSTEMI) and ST elevation infarction (STEMI) have many differences in their clinical presentation and prognosis. Method: A systematic review of the literature about NSTEMI and the blood supply of the myocardium made us form a hypothesis that a further cause also exists in addition to the accepted cause of NSTEMI (subtotal coronaryartery occlusion): an acute, critical increase in an already existing high intramyocardial microvascular resistance. Evidence: Knowledge about microcirculation disturbances in ischemic heart disease and development of microcirculation damage can be fitted in our hypothesis. Various findings and studies can be interpreted only by our hypothesis: hemodynamic findings, ECG changes, autopsy reports and clinical observations about NSTEMI. The latest ones involve the different long-time prognosis and different result of acute revascularization therapy in STEMI and NSTEMI. Regarding the repolarization changes on the ECG NSTEMI shows similarities with other clinical symptoms where increased intramyocardial microvascular resistance can be supposed without coronary artery disease: false positive exercise stress test, supraventricular tachycardia, left ventricular strain and conduction disturbances. Conclusion: The acute treatment of NSTEMI should aim to improve the blood inflow to the stiff myocardiumand/or impaired microvascular system and decrease the high microvascular resistance.
MeSH term(s)	Animals ; Coronary Artery Disease/complications ; Coronary Artery Disease/diagnosis ; Coronary Artery Disease/physiopathology ; Coronary Circulation ; Evidence-Based Medicine ; Humans ; Microcirculation ; Myocardial Infarction/classification ; Myocardial Infarction/diagnosis ; Myocardial Infarction/etiology ; Myocardial Infarction/physiopathology ; Myocardial Infarction/therapy ; Prognosis ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; Vascular Resistance
Language	English
Publishing date	2011-09
Publishing country	Hungary
Document type	Journal Article ; Review
ZDB-ID	802801-1
ISSN	1588-2683 ; 0231-424X ; 0001-6756
ISSN (online)	1588-2683
ISSN	0231-424X ; 0001-6756
DOI	10.1556/APhysiol.98.2011.3.2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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