title: Relationship of echocardiographic and coronary angiographic findings in patients with acute myocardial infarction secondary to penetrating cardiac trauma.
abstract: BACKGROUND
  Patients with cardiac wounds could experience a posttraumatic acute myocardial infarction (PAMI) as a complication. Usually, this complication is explained by occlusion of a coronary artery, but sometimes, it cannot be explained by this pathophysiologic finding. This study aimed to determine the incidence of PAMI, make an approximation of PAMI pathophysiology, and propose management strategies.
  
  
  METHODS
  A prospective observational study was conducted at San Vicente de Paul University Hospital in Medellin, Colombia. During 12 months, we studied 51 patients with a history of a cardiac stab injury. We evaluated variables, such as Revised Trauma Score (RTS), surgical and anesthetic data, and possible risk factors. Diagnosis of PAMI was based on electrocardiogram, echocardiography, and troponin I serum levels. All PAMI patients had an coronary angiography. Risk factors possibly related to the development of PAMI were explored.
  
  
  RESULTS
  Fifty-one patients were evaluated; three died (5.9%). Of the patients, 35 (68.62%) did not develop PAMI, 6 (11.76%) developed PAMI with coronary injury, and 10 (19.6%) experienced PAMI without coronary injury (PAMIWCI). An RTS of 5.3 or lower and a Glasgow Coma Scale score of 9 or lower were risk factors associated with PAMIWCI (relative risk, 11.55; p = 0.03). We did not find a relationship between PAMI and the use of psychoactive substances or other comorbidities.
  
  
  CONCLUSIONS
  Patients with penetrating cardiac trauma may develop PAMIWCI. Active search for PAMI must be done in all patients with cardiac stab wound trauma, even those without artery coronary injury or symptoms suggestive of coronary ischemia. It is likely that Glasgow Coma Scale score of 9 of lower and RTS of 5.3 of lower for patients with cardiac injury are associated with the development of PAMIWCI.
authors: Department of General Surgery, Universidad de Antioquia, Colombia. willfredy78@hotmail.com
authors: Wilfredy
authors: W
authors: Castano
authors: Carlos Hernando
authors: CH
authors: Morales
authors: Juan Manuel
authors: JM
authors: Senior
authors: William Yesid
authors: WY
authors: Benjumea
authors: Jorge
authors: J
authors: Sanchez
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D015600:Glasgow Coma Scale; D006321:Heart / Q000503:physiopathology; D006335:Heart Injuries / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D015601:Injury Severity Score; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D011446:Prospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood; D014950:Wounds, Penetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
chemical_list: D019210:Troponin I