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Serrao GW, Lansky AJ, Mehran R, Stone GW. Predictors of Left Ventricular Ejection Fraction Improvement After Primary Stenting in ST-Segment Elevation Myocardial Infarction (from the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction Trial). Am J Cardiol 2018; 121:678-683. [PMID: 29394998 DOI: 10.1016/j.amjcard.2017.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/04/2017] [Accepted: 12/11/2017] [Indexed: 02/06/2023]
Abstract
The predictors of improvement in left ventricular ejection fraction (LVEF) after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) are poorly understood. We sought to determine the prevalence and clinical and angiographic predictors of LVEF improvement after primary PCI in STEMI. In the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction trial, 3,602 patients presenting with STEMI were randomized to heparin + a glycoprotein IIb/IIIa inhibitor versus bivalirudin. Routine 13-month angiographic follow-up was performed in a prespecified substudy of 656 stented patients. The median [25%, 75%] change in LVEF from baseline to 13 months was +2.4% [-5.9%, 11.8%]; LVEF increased or remained unchanged in 379 patients (57.8%; median Δ +9.8% [4.3%, 16.4%]) and fell in 277 patients (42.2%; median Δ -7.0% [-11.8%, -3.6%]). Independent predictors of LVEF improvement were female gender (p = 0.002), lower baseline LVEF (p <0.0001), Thrombolysis in Myocardial Infarction 3 flow after PCI (p = 0.03), shorter lesion length (p = 0.04), and lower post-PCI peak MB isoenzyme of creatine kinase (p <0.0001). In conclusion, in the Harmonizing Outcomes With Revascularization and Stents in Acute Myocardial Infarction trial, although LVEF improved during follow-up after primary PCI in more than half of patients, left ventricular function worsened over time in a substantial proportion, the occurrence of which may be predicted by clinical, angiographic, and laboratory variables.
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Abolahrari-Shirazi S, Kojuri J, Bagheri Z, Rojhani-Shirazi Z. Efficacy of combined endurance-resistance training versus endurance training in patients with heart failure after percutaneous coronary intervention: A randomized controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2018. [PMID: 29531564 PMCID: PMC5842444 DOI: 10.4103/jrms.jrms_743_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Background: This study aimed to compare the effects of combined endurance-resistance training (CT) versus endurance training (ET) on some cardiovascular markers in patients with heart failure after percutaneous coronary intervention (PCI). Materials and Methods: The study applied a randomized, controlled design in which 75 patients with heart failure who had undergone PCI were randomly assigned to one of three groups: ET, CT, and control. The ET group performed ET for 45 min, three times a week for 7 weeks. The CT group performed the same ET for 30 min followed by a resistance exercise protocol. The control group received usual care. Functional capacity, N-terminal pro-brain natriuretic peptide (NT-pro BNP), and high sensitivity C-reactive protein (hs-CRP) levels were measured. Results: After the intervention, functional capacity was improved (P < 0.001) and NT-pro BNP level was significantly reduced (P = 0.004 in the CT group, P = 0.002 in the ET group). Hs-CRP level was significantly reduced only in the ET group (P = 0.030). The control group showed no significant changes in any cardiovascular parameters (P ≥ 0.05). Changes in functional capacity (P < 0.001) in both training groups were significantly different from the control group. No significant differences were found between the ET and CT groups regarding changes in all outcomes after exercise training (P ≥ 0.05). Conclusion: Exercise training is safe and feasible in post-PCI patients, even in those with reduced ejection fraction. CT was as effective as ET in reducing NT-pro BNP level and improving functional capacity in heart failure patients after PCI.
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Affiliation(s)
- Sara Abolahrari-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Javad Kojuri
- Clinical Education Improvement Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Bagheri
- Department of Biostatistics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Rojhani-Shirazi
- Department of Physical Therapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Tomasik A, Młyńczak T, Nowak E, Pigoń K, Iwasieczko A, Opara M, Nowalany-Kozielska E. Quantitative myocardial blush score (QuBE) allows the prediction of heart failure development in long-term follow-up in patients with ST-segment elevation myocardial infarction: Proof of concept study. Cardiol J 2017; 26:322-332. [PMID: 29131283 DOI: 10.5603/cj.a2017.0129] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 09/17/2017] [Accepted: 09/17/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) might lead to left ventricular remodeling. Adequate myocardial perfusion is critical to prevent this adverse remodeling. Quantitative myocardial blush evaluator (QuBE) software, available on-line, is a simple analysis tool which enables the precise quan-tification of myocardial perfusion in the infarct area immediately after interventional treatment. The aim of this study was to assess whether the results of QuBE analysis might predict the development of heart failure (HF) in AMI patients in 3 year-long follow-up. METHODS Ninety five patients with first AMI, single vessel coronary artery disease, Killip class I at presentation were enrolled in the study. Angiograms were reanalyzed using the on-line QuBE software. Data on heart failure development (ICD 10 codes I50) provided by the National Health Fund were considered as primary outcome. RESULTS QuBE values ranged from 0.0 to 25.3 arbitrary units, mean value was 9.9 ± 5.2 arbitrary units. QuBE correlated positively with myocardial blush grade (MBG; Spearman R = 0.342 at p < 0.05). Multivariate Cox proportional hazard modeling, adjusted for initial Thrombolysis in Myocardial In-farction (TIMI flow, and TIMI thrombus grade indicated QuBE score (1 unit increase - HR 0.919, 95% CI 0.846-0.999, p = 0.049) and left ventricular ejection fraction at discharge (1% increase - HR 0.936, 95% CI 0.902-0.971, p = 0.000) as independent predictors of HF development. CONCLUSIONS The QuBE assessment of myocardial perfusion allows the prediction of HF development in the post-infarction period in this highly selective group of patients.
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Affiliation(s)
- Andrzej Tomasik
- 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Tomasz Młyńczak
- Students' Scientific Group at 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Edyta Nowak
- Students' Scientific Group at 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Pigoń
- Students' Scientific Group at 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Artur Iwasieczko
- Students' Scientific Group at 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Opara
- 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Ewa Nowalany-Kozielska
- 2nd Department of Cardiology in Zabrze, Medical Faculty with Dentistry Division in Zabrze, Medical University of Silesia, Katowice, Poland
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Mathur A, Arnold R, Assmus B, Bartunek J, Belmans A, Bönig H, Crea F, Dimmeler S, Dowlut S, Fernández-Avilés F, Galiñanes M, Garcia-Dorado D, Hartikainen J, Hill J, Hogardt-Noll A, Homsy C, Janssens S, Kala P, Kastrup J, Martin J, Menasche P, Miklik R, Mozid A, San Román JA, Sanz-Ruiz R, Tendera M, Wojakowski W, Ylä-Herttuala S, Zeiher A. The effect of intracoronary infusion of bone marrow-derived mononuclear cells on all-cause mortality in acute myocardial infarction: rationale and design of the BAMI trial. Eur J Heart Fail 2017; 19:1545-1550. [PMID: 28948706 PMCID: PMC6607485 DOI: 10.1002/ejhf.829] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 02/22/2017] [Accepted: 03/07/2017] [Indexed: 12/20/2022] Open
Abstract
Over the past 13 years bone marrow‐derived mononuclear cells (BM‐MNCs) have been widely investigated for clinical efficacy in patients following acute myocardial infarction (AMI). These early phase II trials have used various surrogate markers to judge efficacy and, although promising, the results have been inconsistent. The phase III BAMI trial has therefore been designed to demonstrate that intracoronary infusion of BM‐MNCs is safe and will significantly reduce the time to first occurrence of all‐cause death in patients with reduced left ventricular ejection fraction after successful reperfusion for ST‐elevation AMI (powered with the aim of detecting a 25% reduction in all‐cause mortality). This is a multinational, multicentre, randomized, open‐label, controlled, parallel‐group phase III study aiming to enrol approximately 3000 patients in 11 European countries with at least 17 sites. Eligible patients who have impaired left ventricular ejection (≤45%) following successful reperfusion for AMI will be randomized to treatment or control group in a 1:1 ratio. The treatment group will receive intracoronary infusion of BM‐MNCs 2–8 days after successful reperfusion for AMI added on top of optimal standard of care. The control group will receive optimal standard of care. The primary endpoint is time from randomization to all‐cause death. The BAMI trial is pivotal and the largest trial to date of BM‐MNCs in patients with impaired left ventricular function following AMI. The aim of the trial is to provide a definitive answer as to whether BM‐MNCs reduce all‐cause mortality in this group of patients.
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Affiliation(s)
| | - Roman Arnold
- ICICORELAB, Hospital Clínico Universitario, Valladolid, Spain
| | - Birgit Assmus
- Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Jozef Bartunek
- VZW Cardiovascular Research Center Aalst, Aalst, Belgium
| | - Ann Belmans
- KU Leuven-University of Leuven & Universiteit Hasselt, I-BioStat, Leuven, Belgium
| | - Halvard Bönig
- Johann-Wolfgang-Goethe University, Frankfurt and DRK-Blutspendedienst BaWüHe, Germany
| | - Filippo Crea
- Catholic University of the Sacred Heart, Rome, Italy
| | | | | | | | - Manuel Galiñanes
- Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain
| | - David Garcia-Dorado
- Vall d'Hebron University Hospital and Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Juha Hartikainen
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | | | | | | | | | - Petr Kala
- Faculty Hospital and Masaryk University, Brno, Czech Republic
| | - Jens Kastrup
- Rigshospitalet University of Copenhagen, Copenhagen, Denmark
| | | | - Philippe Menasche
- Assistance Publique Hopitaux de Paris, University Paris Descartes, Paris, France
| | - Roman Miklik
- Faculty Hospital and Masaryk University, Brno, Czech Republic
| | | | | | | | | | | | - Seppo Ylä-Herttuala
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
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Rodríguez-Mañero M, Cordero A, Kreidieh O, García-Acuña JM, Seijas J, Agra-Bermejo RM, Abou-Jokh C, Álvarez-Rodríguez L, Álvarez-Iglesias D, López-Palop R, Cid B, Carrillo P, González-Juanatey JR. Proposal of a novel clinical score to predict heart failure incidence in long-term survivors of acute coronary syndromes. Int J Cardiol 2017; 249:301-307. [PMID: 28867245 DOI: 10.1016/j.ijcard.2017.07.084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/18/2017] [Accepted: 07/21/2017] [Indexed: 01/03/2023]
Abstract
INTRODUCTION HF remains a frequent complication following MI and adversely affects prognosis. The objective of this study was to identify predictors of HF following MI and to design a risk score for its prediction. METHODS Retrospective study of all consecutive patients admitted for MI. Primary end point was time to incident HF. Patients with previous history of HF were excluded. Death was modelled as competing risk. RESULTS 5737 patients were included. Mean age was 66.32±12.80. During a median follow-up of 47.0months (23.0-73.0), 686 patients (12%) developed HF. Age, diabetes mellitus, peripheral artery disease, renal insufficiency, chronic obstructive pulmonary disease, persistent atrial fibrillation, haemoglobin, troponin peak, diuretic at admission, ventricular function, and revascularization were independent predictors for HF development. According to this multivariate regression analysis, we developed a novel score that allows for the identification of patients at high (≥16), medium (9-15) and low risk (<9) for HF development, with an AUC of 0.77 (IC 95%, 0.76-0.78; p=0.008). CONCLUSIONS Clinical comorbidities were determinant for the development of HF following MI. A simple score effectively categorize patients into low, intermediate, and high-risk. This could be important in order to intensify medical treatment or consider additional interventions.
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Affiliation(s)
- Moisés Rodríguez-Mañero
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain.
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Universitario de San Juan, Alicante, Spain
| | - Omar Kreidieh
- Cardiology Department, University of Miami/Palm Beach Regional GME Consortium, Atlantis, FL, USA
| | - Jose Mª García-Acuña
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Jose Seijas
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Rosa María Agra-Bermejo
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Charigan Abou-Jokh
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Leyre Álvarez-Rodríguez
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Diego Álvarez-Iglesias
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Universitario de San Juan, Alicante, Spain
| | - Belen Cid
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital Universitario de San Juan, Alicante, Spain
| | - Jose R González-Juanatey
- Servicio de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain, IDIS (Instituto para el Desarrollo e Integración de la Salud), CIBERCV (Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares), Spain
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Taniguchi T, Shiomi H, Morimoto T, Watanabe H, Ono K, Shizuta S, Kato T, Saito N, Kaji S, Ando K, Kadota K, Furukawa Y, Nakagawa Y, Horie M, Kimura T. Incidence and Prognostic Impact of Heart Failure Hospitalization During Follow-Up After Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:1729-1739. [PMID: 28407886 DOI: 10.1016/j.amjcard.2017.03.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/01/2017] [Accepted: 03/01/2017] [Indexed: 10/19/2022]
Abstract
The incidence of heart failure (HF) hospitalization and its impact on long-term outcomes have not been well evaluated in contemporary patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction (AMI) Registry is a multicenter registry enrolling 5,429 consecutive patients with AMI undergoing PCI from 2005 to 2007. The present study population consisted of 3,682 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and discharged alive. The incidence of HF hospitalization was 4.4%/year during the first year after the index STEMI, which attenuated to approximately 1.0%/year beyond 1 year to 5 years with the median follow-up period of 1,956 days. The independent risk factors for HF hospitalization within 1 year included older age, previous myocardial infarction, HF at STEMI, left ventricular dysfunction, anterior AMI, and onset-to-balloon time >3 hours, use of β blocker, and nonuse of statin at discharge. By the landmark analysis at 1 year, the cumulative incidences of all-cause death and HF hospitalization beyond 1 year and up to 5 years were significantly higher in patients with HF hospitalization within 1 year of STEMI than in patients without (36.3% vs 10.1%, p <0.001, and 40.4% vs 4.3%, p <0.001, respectively). Even after adjusting for confounders, HF hospitalization within 1 year remained independently associated with a higher risk for death and HF hospitalization beyond 1 year (hazard ratio 1.64, 95% CI 1.02 to 2.52, p = 0.04 and HR 5.72, 95% CI 3.46 to 9.22, p <0.001, respectively). In conclusion, HF hospitalization within 1 year was independently associated with a higher risk for all-cause death and HF hospitalization beyond 1 year.
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Cahill TJ, Kharbanda RK. Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk. World J Cardiol 2017; 9:407-415. [PMID: 28603587 PMCID: PMC5442408 DOI: 10.4330/wjc.v9.i5.407] [Citation(s) in RCA: 117] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/20/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
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58
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Barauskas M, Unikas R, Tamulenaite E, Unikaite R. The impact of clinical and angiographic factors on percutaneous coronary angioplasty outcomes in patients with acute ST-elevation myocardial infarction. Arch Med Sci Atheroscler Dis 2016; 1:e150-e157. [PMID: 28905038 PMCID: PMC5421528 DOI: 10.5114/amsad.2016.64935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 12/21/2016] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) outcomes are dependent on certain clinical and angiographic factors. The impact of modifiable cardiovascular disease (CVD) risk factors on PCI outcomes is still controversial. The aim of the study was to evaluate the impact of clinical and angiographic factors on PCI outcomes for patients with acute ST-elevation myocardial infarction (STEMI). MATERIAL AND METHODS Age, gender, CVD risk factors, Killip class and culprit coronary artery (CA) localization, total CA occlusion, initial and post-procedural thrombolysis in myocardial infarction (TIMI) flow grade, and thrombus aspiration characteristics were assessed retrospectively in 188 consecutive patients with STEMI who underwent primary PCI. Spearman's rho test was performed to assess hospital stay correlations, and logistic regression was applied to identify predictors of distal embolization (DE), in-hospital worsening of heart failure (WHF), and in-hospital mortality rate. Local ethics committee approval was obtained for the study. RESULTS DE occurred in 12 (6.4%) patients. In-hospital WHF was diagnosed in 16 (8.5%) patients. Twelve (6.4%) patients died in hospital. Age had a positive weak correlation with hospital stay and was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality rate. Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2 were other predictors of death in hospital. CONCLUSIONS Age was an independent predictor of distal embolization, in-hospital worsening of heart failure, and in-hospital mortality. Other independent predictors of in-hospital mortality rate were Killip class, left main CA stenosis (> 50.0%), and post-procedural TIMI flow grade 1-2. The present analysis highlighted the "cholesterol paradox" with respect to in-hospital worsening of heart failure and mortality in hospital.
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Affiliation(s)
- Mindaugas Barauskas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramunas Unikas
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Egle Tamulenaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ruta Unikaite
- Faculty of Medicine, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Ladejobi A, Wayne M, Martin-Gill C, Guyette FX, Althouse AD, Sharbaugh MS, Reis SE, Callaway CW, Kellum JA, Smith AJC, Toma C, Olafiranye O. Association of remote ischemic peri-conditioning with reduced incidence of clinical heart failure after primary percutaneous coronary intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2016; 18:105-109. [PMID: 28038863 DOI: 10.1016/j.carrev.2016.12.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 12/05/2016] [Accepted: 12/08/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Clinical heart failure (HF) occurs frequently after ST-segment elevation myocardial infarction (STEMI), and is associated with increased mortality. We assessed the impact of remote ischemic peri-conditioning (RIPC) during inter-facility air medical transport of STEMI patients on clinical HF following primary percutaneous coronary intervention (pPCI). METHODS Data from Acute Coronary Treatment and Intervention Outcomes Network Registry®-Get With the Guidelines™ (ACTION Registry-GWTG) from two PCI-hospitals that are utilizing RIPC during inter-facility helicopter transport of STEMI patients for pPCI between March, 2013 and September, 2015 were used for this study. The analyses were limited to inter-facility STEMI patients transported by helicopter with LVEF <55% after pPCI. The outcome measures were occurrence of clinical HF and serum level of brain-type natriuretic peptide (BNP). RESULTS Out of the 150 STEMI patients in this analysis, 92 patients received RIPC and 58 did not. The RIPC and non-RIPC groups were generally similar in demographic and clinical characteristics except for lower incidence of cardiac arrest in the RIPC group (3/92 [3.3%] versus 13/58 [22.4%], p=0.002). STEMI patients who received RIPC were less likely to have in-hospital clinical HF compared to patients who did not receive RIPC (3/92 [3.3%] versus 7/58 [12.1%]; adjusted OR=0.22, 95% CI 0.05-0.92, p=0.038) after adjusting for baseline differences. In subgroup analysis, RIPC was associated with lower BNP (123 [interquartile range, 17.0-310] versus 319 [interquartile range, 106-552], p=0.029). CONCLUSION RIPC applied during inter-facility air transport of STEMI patients for pPCI is associated with reduced incidence of clinical HF and serum BNP.
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Affiliation(s)
- Adetola Ladejobi
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Max Wayne
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Andrew D Althouse
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael S Sharbaugh
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Steven E Reis
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - John A Kellum
- Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - A J Conrad Smith
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catalin Toma
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Oladipupo Olafiranye
- Department of Medicine, Division of Cardiology, University of Pittsburgh, Pittsburgh, PA, USA; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Center for Critical Care Nephrology, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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Saunderson CE, Chowdhary A, Brogan RA, Batin PD, Gale CP. In an era of rapid STEMI reperfusion with Primary Percutaneous Coronary Intervention is there a role for adjunct therapeutic hypothermia? A structured literature review. Int J Cardiol 2016; 223:883-890. [DOI: 10.1016/j.ijcard.2016.08.226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
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61
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Canty JM, Weil BR, Suzuki G. Widespread Intracoronary Cardiopoietic Cell Infusion: Treating at the Time of Myocardial Reperfusion to Prevent Rather Than Reverse Established Left Ventricular Dysfunction Moves Us Closer to Practical Clinical Translation. Circ Res 2016; 118:1045-8. [PMID: 27034270 DOI: 10.1161/circresaha.116.308518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- John M Canty
- From the Department of Medicine (J.M.C., B.R.W., G.S.), Department of Physiology and Biophysics (J.M.C.), Department of Biomedical Engineering (J.M.C.), VA WNY Health Care System (J.M.C.), and Division of Cardiovascular Medicine, Clinical and Translational Research Center (J.M.C., B.R.W., G.S.), University at Buffalo, NY.
| | - Brian R Weil
- From the Department of Medicine (J.M.C., B.R.W., G.S.), Department of Physiology and Biophysics (J.M.C.), Department of Biomedical Engineering (J.M.C.), VA WNY Health Care System (J.M.C.), and Division of Cardiovascular Medicine, Clinical and Translational Research Center (J.M.C., B.R.W., G.S.), University at Buffalo, NY
| | - Gen Suzuki
- From the Department of Medicine (J.M.C., B.R.W., G.S.), Department of Physiology and Biophysics (J.M.C.), Department of Biomedical Engineering (J.M.C.), VA WNY Health Care System (J.M.C.), and Division of Cardiovascular Medicine, Clinical and Translational Research Center (J.M.C., B.R.W., G.S.), University at Buffalo, NY
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Sihag S, Haas MS, Kim KM, Guerrero JL, Beaudoin J, Alicot EM, Schuerpf F, Gottschall JD, Puro RJ, Madsen JC, Sachs DH, Newman W, Carroll MC, Allan JS. Natural IgM Blockade Limits Infarct Expansion and Left Ventricular Dysfunction in a Swine Myocardial Infarct Model. Circ Cardiovasc Interv 2016; 9:e002547. [PMID: 26671971 PMCID: PMC4687758 DOI: 10.1161/circinterventions.115.002547] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 11/16/2015] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute coronary syndrome is the leading cause of mortality worldwide. However, treatment of acute coronary occlusion inevitably results in ischemia-reperfusion injury. Circulating natural IgM has been shown to play a significant role in mouse models of ischemia-reperfusion injury. A highly conserved self-antigen, nonmuscle myosin heavy chain II, has been identified as a target of pathogenic IgM. We hypothesized that a monoclonal antibody (m21G6) directed against nonmuscle myosin heavy chain II may inhibit IgM binding and reduce injury in a preclinical model of myocardial infarction. Thus, our objective was to evaluate the efficacy of intravenous m21G6 treatment in limiting infarct expansion, troponin release, and left ventricular dysfunction in a swine myocardial infarction model. METHODS AND RESULTS Massachusetts General Hospital miniature swine underwent occlusion of the midleft anterior descending coronary artery for 60 minutes, followed by 1 hour, 5-day, or 21-day reperfusion. Specificity and localization of m21G6 to injured myocardium were confirmed using fluorescently labeled m21G6. Treatment with m21G6 before reperfusion resulted in a 49% reduction in infarct size (P<0.005) and a 61% reduction in troponin-T levels (P<0.05) in comparison with saline controls at 5-day reperfusion. Furthermore, m21G6-treated animals recovered 85.4% of their baseline left ventricular function as measured by 2-dimensional transthoracic echocardiography in contrast to 67.1% in controls at 21-day reperfusion (P<0.05). CONCLUSIONS Treatment with m21G6 significantly reduced infarct size and troponin-T release, and led to marked preservation of cardiac function in our study. Overall, these findings suggest that pathogenic IgM blockade represents a valid therapeutic strategy in mitigating myocardial ischemia-reperfusion injury.
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Affiliation(s)
- Smita Sihag
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael S Haas
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Karen M Kim
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - J Luis Guerrero
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Jonathan Beaudoin
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Elisabeth M Alicot
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Franziska Schuerpf
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James D Gottschall
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Robyn J Puro
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Joren C Madsen
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - David H Sachs
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Walter Newman
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - Michael C Carroll
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
| | - James S Allan
- From the Transplantation Biology Research Center, Massachusetts General Hospital, Charlestown (S.S., J.D.G., J.C.M., D.H.S., J.S.A.); Cardiac Surgery Research Laboratory, Massachusetts General Hospital, Boston, (J.L.G., J.B., J.S.A.); DecImmune Therapeutics, Cambridge, MA (M.S.H., E.M.A., F.S., R.J.P., W.N.); Program in Cellular and Molecular Medicine, Boston Children's Hospital, MA (M.C.C.); Department of Pediatrics, Harvard Medical School, Boston, MA (M.C.C.); and Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia (K.M.K.)
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Verhoef TI, Morris S, Mathur A, Singer M. Potential economic consequences of a cardioprotective agent for patients with myocardial infarction: modelling study. BMJ Open 2015; 5:e008164. [PMID: 26567251 PMCID: PMC4654357 DOI: 10.1136/bmjopen-2015-008164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To investigate the cost-effectiveness of a hypothetical cardioprotective agent used to reduce infarct size in patients undergoing percutaneous coronary intervention (PCI) after anterior ST-elevation myocardial infarction. DESIGN A cost-utility analysis using a Markov model. SETTING The National Health Service in the UK. PATIENTS Patients undergoing PCI after anterior ST-elevation myocardial infarction. INTERVENTIONS A cardioprotective agent given at the time of reperfusion compared to no cardioprotection. We assumed the cardioprotective agent (given at the time of reperfusion) would reduce the risk and severity of heart failure (HF) after PCI and the risk of mortality after PCI (with a relative risk ranging from 0.6 to 1). The costs of the cardioprotective agent were assumed to be in the range £1000-4000. MAIN OUTCOME MEASURES The incremental costs per quality-adjusted life-year (QALY) gained, using 95% CIs from 1000 simulations. RESULTS Incremental costs ranged from £933 to £3820 and incremental QALYs from 0.04 to 0.38. The incremental cost-effectiveness ratio (ICER) ranged from £3311 to £63 480 per QALY gained. The results were highly dependent on the costs of a cardioprotective agent, patient age, and the relative risk of HF after PCI. The ICER was below the willingness-to-pay threshold of £20 000 per QALY gained in 71% of the simulations. CONCLUSIONS A cardioprotective agent that can reduce the risk of HF and mortality after PCI has a high chance of being cost-effective. This chance depends on the price of the agent, the age of the patient and the relative risk of HF after PCI.
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Affiliation(s)
- Talitha I Verhoef
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Anthony Mathur
- Department of Cardiology, London Chest Hospital, Barts Health NHS Trust, London, UK
- Barts Health NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, Barts Health NHS Trust, London, UK
| | - Mervyn Singer
- Division of Medicine, Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK
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Gémes K, Janszky I, Ahnve S, László KD, Laugsand LE, Vatten LJ, Mukamal KJ. Light-to-moderate drinking and incident heart failure--the Norwegian HUNT study. Int J Cardiol 2015; 203:553-60. [PMID: 26569362 DOI: 10.1016/j.ijcard.2015.10.179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/19/2015] [Accepted: 10/24/2015] [Indexed: 12/29/2022]
Abstract
BACKGROUND We analyzed the association between light-to-moderate alcohol intake and the risk of heart failure (HF). METHODS AND RESULTS We studied 60,665 individuals free of HF who provided information on alcohol consumption in a population-based cohort study conducted in 1995-97 in Norway. Sociodemographic factors, cardiovascular risk factors and common chronic disorders were assessed by questionnaires and/or by a clinical examination. The cohort was followed for a first HF event for an average of 11.2 ± 3.0 years. Mean alcohol consumption was 2.95 ± 4.5 g/day; 1588 HF cases occurred during follow-up. The quantity of alcohol consumption was inversely associated with incident HF in this low-drinking population. The risk was lowest for consumption over three but less than six drinks/week; the multivariate hazard ratio when comparing this category to non-drinkers was 0.67 (95% CI: 0.50-0.92). Among problem drinkers based on CAGE questionnaires, total consumption showed no favorable association with HF, even when overall consumption was otherwise moderate. Excluding former drinkers and controlling for common chronic diseases had minimal effect on these associations. Frequent alcohol consumption, i.e. more than five times/month, was associated with the lowest HF risk; the adjusted hazard ratio comparing this group to alcohol intake less than once/month was 0.83 (95% CI: 0.68-1.03). We found no evidence for a differential effect according to beverage type, nor that the competing risks of death from other causes modified the association. CONCLUSIONS Frequent light-to-moderate alcohol consumption without problem drinking was associated with a lower HF risk in this population characterized by a low average alcohol intake.
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Affiliation(s)
- Katalin Gémes
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
| | - Imre Janszky
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; Center for Health Care Research, St Olav Hospital, Norway.
| | - Staffan Ahnve
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Krisztina D László
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Lars E Laugsand
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars J Vatten
- Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kenneth J Mukamal
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Abdel-Qadir H, Roifman I, Wijeysundera HC. Cost-effectiveness of clopidogrel, prasugrel and ticagrelor for dual antiplatelet therapy after acute coronary syndrome: a decision-analytic model. CMAJ Open 2015; 3:E438-46. [PMID: 26770967 PMCID: PMC4701656 DOI: 10.9778/cmajo.20150056] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The use of prasugrel or ticagrelor as part of dual antiplatelet therapy with acetylsalicylic acid after acute coronary syndrome (ACS) improves clinical outcomes relative to clopidogrel. The relative cost-effectiveness of these agents are unknown. We conducted an economic analysis evaluating 12 months of treatment with clopidogrel, prasugrel or ticagrelor after ACS. METHODS We developed a fully probabilistic Markov cohort decision-analytic model using a lifetime horizon, from the perspective of the Ontario Ministry of Health and Long-Term Care. The model incorporated risks of death, recurrent ACS, heart failure, major bleeding and other adverse effects of treatment. Data on probabilities and utilities were obtained from the published literature where available. The primary outcome was quality-adjusted life-years (QALYs). RESULTS Treatment with clopidogrel was associated with the lowest effectiveness (7.41 QALYs, 95% confidence interval [CI] 1.05-14.79) and the lowest cost ($39 601, 95% CI $8434-$111 186). Ticagrelor treatment had an effectiveness of 7.50 QALYs (95% CI 1.13-14.84) at a cost of $40 649 (95% CI $9327-$111 881). The incremental cost-effectiveness ratio (ICER) for ticagrelor relative to clopidogrel was $12 205 per QALY gained. Prasugrel had an ICER of $57 630 per QALY gained relative to clopidogrel. Ticagrelor was the preferred option in 90% of simulations at a willingness-to-pay threshold of $50 000 per QALY gained. INTERPRETATION Ticagrelor was the most cost-effective agent when used as part of dual antiplatelet therapy after ACS. This conclusion was robust to wide variations in model parameters.
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Affiliation(s)
- Husam Abdel-Qadir
- Institute for Clinical Evaluative Sciences (Abdel-Qadir, Roifman, Wijeysundera); Schulich Heart Program and the Sunnybrook Research Institute (Roifman, Wijeysundera); Institute for Health Policy, Management and Evaluation (Abdel-Qadir, Roifman, Wijeysundera), University of Toronto; Women's College Hospital (Abdel-Qadir), Toronto, Ont
| | - Idan Roifman
- Institute for Clinical Evaluative Sciences (Abdel-Qadir, Roifman, Wijeysundera); Schulich Heart Program and the Sunnybrook Research Institute (Roifman, Wijeysundera); Institute for Health Policy, Management and Evaluation (Abdel-Qadir, Roifman, Wijeysundera), University of Toronto; Women's College Hospital (Abdel-Qadir), Toronto, Ont
| | - Harindra C Wijeysundera
- Institute for Clinical Evaluative Sciences (Abdel-Qadir, Roifman, Wijeysundera); Schulich Heart Program and the Sunnybrook Research Institute (Roifman, Wijeysundera); Institute for Health Policy, Management and Evaluation (Abdel-Qadir, Roifman, Wijeysundera), University of Toronto; Women's College Hospital (Abdel-Qadir), Toronto, Ont
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66
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Krogager ML, Eggers-Kaas L, Aasbjerg K, Mortensen RN, Køber L, Gislason G, Torp-Pedersen C, Søgaard P. Short-term mortality risk of serum potassium levels in acute heart failure following myocardial infarction. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:245-51. [PMID: 27418967 PMCID: PMC4900739 DOI: 10.1093/ehjcvp/pvv026] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 05/20/2015] [Accepted: 05/21/2015] [Indexed: 12/02/2022]
Abstract
AIMS Diuretic treatment is often needed in acute heart failure following myocardial infarction (MI) and carries a risk of abnormal potassium levels. We examined the relation between different levels of potassium and mortality. METHODS AND RESULTS From Danish national registries we identified 2596 patients treated with loop diuretics after their first MI episode where potassium measurement was available within 3 months. All-cause mortality was examined according to seven predefined potassium levels: hypokalaemia <3.5 mmol/L, low normal potassium 3.5-3.8 mmol/L, normal potassium 3.9-4.2 mmol/L, normal potassium 4.3-4.5 mmol/L, high normal potassium 4.6-5.0 mmol/L, mild hyperkalaemia 5.1-5.5 mmol/L, and severe hyperkalaemia: >5.5 mmol/L. Follow-up was 90 days and using normal potassium 3.9-4.2 mmol/L as a reference, we estimated the risk of death with a multivariable-adjusted Cox proportional hazard model. After 90 days, the mortality rates in the seven potassium intervals were 15.7, 13.6, 7.3, 8.1, 10.6, 15.5, and 38.3%, respectively. Multivariable-adjusted risk for death was statistically significant for patients with hypokalaemia [hazard ratio (HR): 1.91, confidence interval (95%CI): 1.14-3.19], and mild and severe hyperkalaemia (HR: 2, CI: 1.25-3.18 and HR: 5.6, CI: 3.38-9.29, respectively). Low and high normal potassium were also associated with increased mortality (HR: 1.84, CI: 1.23-2.76 and HR: 1.55, CI: 1.09-2.22, respectively). CONCLUSION Potassium levels outside the interval 3.9-4.5 mmol/L were associated with a substantial risk of death in patients requiring diuretic treatment after an MI.
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Affiliation(s)
| | | | - Kristian Aasbjerg
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Lars Køber
- Department of Cardiology, The Heart Center, Rigshospitalet, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Peter Søgaard
- Department of Cardiology and Clinical Institute, Aalborg University Hospital, Aalborg, Denmark
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Bivalirudin vs Heparin in Patients Who Undergo Transcatheter Aortic Valve Implantation. Can J Cardiol 2015. [DOI: 10.1016/j.cjca.2015.02.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Massalha S, Luria L, Kerner A, Roguin A, Abergel E, Hammerman H, Boulos M, Dragu R, Kapeliovich MR, Beyar R, Nikolsky E, Aronson D. Heart failure in patients with diabetes undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:455-462. [PMID: 26228449 DOI: 10.1177/2048872615598632] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 07/12/2015] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Diabetes mellitus is associated with increased risk after acute coronary syndromes. Primary percutaneous coronary intervention is the most effective method of reperfusion for acute ST-elevation myocardial infarction and can limit the ischaemic damage to the left ventricle. However, there are few data on the impact of diabetes mellitus on the risk of heart failure following primary percutaneous coronary intervention. METHODS We studied 958 ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention, of whom 263 (27.5%) had diabetes mellitus, with 67 (7.0%) treated with insulin. The primary end points of the study were re-admission for heart failure. Secondary end points were all-cause mortality and recurrent infarctions. The follow-up period was 5 years after hospital discharge. RESULTS The cumulative incidence of re-admission for heart failure was 8.4%, 15.2% and 26.7% in patients without diabetes mellitus, non-insulin-treated and insulin-treated diabetes mellitus, respectively. Compared with patients without diabetes mellitus, the adjusted hazard ratio for heart failure was 1.95 (95% confidence intervals 1.30-2.93) and 3.09 (95% confidence intervals 1.71-5.60) in non-insulin-treated and insulin-treated diabetes mellitus, respectively. The corresponding hazard ratios for mortality were 1.03 (95% confidence intervals 0.68-1.55) and 2.04 (95% confidence intervals 1.22-3.42), respectively. There was a J-shaped association between fasting glucose levels in the acute phase and risk of mortality (P=0.0001) and a direct association with heart failure (P=0.03). CONCLUSION Despite modern treatment of ST-elevation myocardial infarction and high levels of guideline-based medical care, diabetes mellitus had an independent adverse effect on the risk of re-admissions for heart failure, which was particularly high among insulin-treated patients.
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Affiliation(s)
| | - Lior Luria
- Departments of Cardiology, Rambam Medical Center
| | - Arthur Kerner
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Ariel Roguin
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | | | - Haim Hammerman
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Monther Boulos
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Robert Dragu
- Departments of Cardiology, Rambam Medical Center
| | - Michael R Kapeliovich
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Rafael Beyar
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Eugenia Nikolsky
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
| | - Doron Aronson
- Departments of Cardiology, Rambam Medical Center B. Rappaport Faculty of Medicine, Technion Medical School, Israel
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Yabluchanskiy A, Ma Y, DeLeon-Pennell KY, Altara R, Halade GV, Voorhees AP, Nguyen NT, Jin YF, Winniford MD, Hall ME, Han HC, Lindsey ML. Myocardial Infarction Superimposed on Aging: MMP-9 Deletion Promotes M2 Macrophage Polarization. J Gerontol A Biol Sci Med Sci 2015; 71:475-83. [PMID: 25878031 DOI: 10.1093/gerona/glv034] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
In this study, we examined the combined effect of aging and myocardial infarction on left ventricular remodeling, focusing on matrix metalloproteinase (MMP)-9-dependent mechanisms. We enrolled 55 C57BL/6J wild type (WT) and 85 MMP-9 Null (Null) mice of both sexes at 11-36 months of age and evaluated their response at Day 7 post-myocardial infarction. Plasma MMP-9 levels positively linked to age in WT mice (r = .46, p = .001). MMP-9 deletion improved survival (76% for WT vs 88% for Null, p = .021). Post-myocardial infarction, there was a progressive increase in left ventricular dilation with age in WT but not in Null mice. By inflammatory gene array analysis, WT mice showed linear age-dependent increases in three different proinflammatory genes (C3, CCl4, and CX3CL1; all p < .05), whereas Null mice showed increases in three proinflammatory genes (CCL5, CCL9, and CXCL4; all p < .05) and seven anti-inflammatory genes (CCL1, CCL6, CCR1, IL11, IL1r2, IL8rb, and Mif; all p < .05). Compared with WT, macrophages isolated from Null left ventricle infarct demonstrated enhanced expression of anti-inflammatory M2 markers CD163, MRC1, TGF-β1, and YM1 (all p < .05), without affecting proinflammatory M1 markers. In conclusion, MMP-9 deletion stimulated anti-inflammatory polarization of macrophages to attenuate left ventricle dysfunction in the aging post-myocardial infarction.
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Affiliation(s)
- Andriy Yabluchanskiy
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson
| | - Yonggang Ma
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson
| | - Kristine Y DeLeon-Pennell
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson
| | - Raffaele Altara
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson
| | - Ganesh V Halade
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson
| | - Andrew P Voorhees
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Department of Mechanical Engineering and
| | - Nguyen T Nguyen
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Department of Electrical and Computer Engineering, University of Texas at San Antonio
| | - Yu-Fang Jin
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Department of Electrical and Computer Engineering, University of Texas at San Antonio
| | - Michael D Winniford
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Cardiology Division, University of Mississippi Medical Center, Jackson
| | - Michael E Hall
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Cardiology Division, University of Mississippi Medical Center, Jackson
| | - Hai-Chao Han
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Department of Mechanical Engineering and
| | - Merry L Lindsey
- Department of Physiology and Biophysics, San Antonio Cardiovascular Proteomics Center, Mississippi Center for Heart Research, University of Mississippi Medical Center, Jackson. Research Service, G.V. (Sonny) Montgomery Veterans Affairs Medical Center, Jackson, MS.
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70
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Schatz RA. Deciphering stem cell therapy for the interventional cardiologist. Interv Cardiol 2015. [DOI: 10.2217/ica.15.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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71
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Association of age and gender with anterior location of STEMI. Int J Cardiol 2014; 176:1161-2. [DOI: 10.1016/j.ijcard.2014.07.254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 07/27/2014] [Indexed: 11/20/2022]
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Gjesing A, Gislason GH, Køber L, Gustav Smith J, Christensen SB, Gustafsson F, Olsen AMS, Torp-Pedersen C, Andersson C. Nationwide trends in development of heart failure and mortality after first-time myocardial infarction 1997-2010: A Danish cohort study. Eur J Intern Med 2014; 25:731-8. [PMID: 25225051 DOI: 10.1016/j.ejim.2014.08.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 08/22/2014] [Accepted: 08/23/2014] [Indexed: 01/01/2023]
Abstract
AIMS Pharmacological and revascularization strategies following myocardial infarction (MI) have changed substantially during the last two decades. We investigated the temporal trends in heart failure (HF) incidence and mortality during the first 90 days following first-time MI between 1997 and 2010 in Denmark. METHODS AND RESULTS Through administrative nationwide registers we identified 89,389 patients without prior HF hospitalized with first MI. The number of patients treated with percutaneous coronary intervention (PCI) days 0-1 after index MI increased from 2.5% in 1997-98 to 38.2% in 2009-10. Treatment with clopidogrel increased from 0.02% in 1997-98 to 68.1% in 2009-10 and statins from 8.1% in 1997-98 to 78.3% in 2009-10. The incidence of HF (defined as HF diagnosis or incident use of loop diuretics) decreased from 23.6% in 1997-98 to 19.6% in 2009-10 (p<0.001). Adjusted for age, sex, and comorbidity, hazard ratio was 0.77 (95% confidence interval [CI] 0.74-0.79) for developing HF in 2009-10, compared with 1997-98. Adjusted for coronary interventions, and pharmacotherapy HR increased to 0.82 (95% confidence interval (CI) 0.79-0.85) compared with 1997-98. The 90-day mortality decreased from 19.6% in 1997-98 to 11.7% in 2009-10 (p<0.001). Adjusted for age, sex, and comorbidity HR was 0.59 (CI 0.55-0.64) in 2009-10 compared with 1997-98; upon additional adjustment for coronary interventions and pharmacotherapy the estimate was 0.75 (95% CI 0.69-0.81). CONCLUSION We found a temporal decrease in HF incidence and mortality during the first 90 days after MI in 1997-2010. This could partly be explained by changes in interventional and pharmacological treatment strategies.
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Affiliation(s)
- Anne Gjesing
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark.
| | - Gunnar H Gislason
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; National Institute of Public Health, University of Southern, Øster Farimagsgade 5 A, 1353 Copenhagen K, Denmark
| | - Lars Køber
- Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3, 2200 Copenhagen N, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark
| | - J Gustav Smith
- Department of Cardiology, Lund University, Paradisgatan 2, 221 00 Lund, Sweden; Department of Heart Failure and Valvular Disease, Skåne University Hospital, Paradisgatan 2, 221 00 Lund, Sweden; Department of Clinical Sciences, Clinical Research Centre, Skåne University Hospital, Jan Waldenströms Gata 35, Malmö, Sweden
| | | | - Finn Gustafsson
- Department of Cardiology, The Heart Centre, Rigshospitalet, Blegdamsvej 9, Copenhagen University Hospital, 2100 Copenhagen Ø, Denmark
| | | | - Christian Torp-Pedersen
- Institute of Health, Science and Technology, Aalborg University, Fredrik Bajers Vej 7D2, 9220 Aalborg, Denmark
| | - Charlotte Andersson
- Department of Cardiology, Niels Andersens Vej 65, Gentofte University Hospital, 2900 Hellerup, Denmark; Department of Clinical Sciences, Clinical Research Centre, Skåne University Hospital, Jan Waldenströms Gata 35, Malmö, Sweden
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Minimizing Door-to-Balloon Time Is Not the Most Critical Factor in Improving Clinical Outcome of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention*. Crit Care Med 2014; 42:1788-96. [DOI: 10.1097/ccm.0000000000000329] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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74
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Youn JC, Seo SM, Lee HS, Oh J, Kim MS, Choi JO, Lee HY, Cho HJ, Kang SM, Kim JJ, Baek SH, Jeon ES, Park HY, Cho MC, Oh BH. Trends in hospitalized acute myocardial infarction patients with heart failure in Korea at 1998 and 2008. J Korean Med Sci 2014; 29:544-9. [PMID: 24753702 PMCID: PMC3991798 DOI: 10.3346/jkms.2014.29.4.544] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 02/04/2014] [Indexed: 11/20/2022] Open
Abstract
Heart failure (HF) complicating acute myocardial infarction (AMI) is common and is associated with poor clinical outcome. Limited data exist regarding the incidence and in-hospital mortality of AMI with HF (AMI-HF). We retrospectively analyzed 1,427 consecutive patients with AMI in the five major university hospitals in Korea at two time points, 1998 (n = 608) and 2008 (n = 819). Two hundred twenty eight patients (37.5%) in 1998 and 324 patients (39.5%) in 2008 of AMI patients complicated with HF (P = 0.429). AMI-HF patients in 2008 were older, had more hypertension, previous AMI, and lower systolic blood pressure than those in 1998. Regarding treatments, AMI-HF patients in 2008 received more revascularization procedures, more evidence based medical treatment and adjuvant therapy, such as mechanical ventilators, intra-aortic balloon pulsation compared to those in 1998. However, overall in-hospital mortality rates (6.4% vs 11.1%, P = 0.071) of AMI-HF patients were unchanged and still high even after propensity score matching analysis, irrespective of types of AMI and revascularization methods. In conclusion, more evidence-based medical and advanced procedural managements were applied for patients with AMI-HF in 2008 than in 1998. However the incidence and in-hospital mortality of AMI-HF patients were not significantly changed between the two time points.
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Affiliation(s)
- Jong-Chan Youn
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Suk Min Seo
- Cardiovascular Center and Cardiology Division, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, Korea
| | - Hye Sun Lee
- Department of Biostatistics, Yonsei University College of Medicine, Seoul, Korea
| | - Jaewon Oh
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min Seok Kim
- Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Oh Choi
- Cardiovascular Center and Cardiology Division, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Young Lee
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hyun-Jai Cho
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Seok-Min Kang
- Division of Cardiology, Severance Cardiovascular Hospital and Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Joong Kim
- Heart Failure and Cardiac Transplantation Center, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Korea
| | - Sang Hong Baek
- Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun-Seok Jeon
- Cardiovascular Center and Cardiology Division, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun-Young Park
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongwon, Korea
| | - Myeong-Chan Cho
- Division of Cardiovascular and Rare Diseases, Center for Biomedical Sciences, Korea National Institute of Health, Cheongwon, Korea
- Regional Cardiovascular Disease Center, Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Byung-Hee Oh
- Cardiovascular Center and Cardiovascular Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Abstract
The incidence of heart failure (HF) is increasing and it remains the only area in cardiovascular disease wherein hospitalization rates and mortalities have worsened in the past 25 years. This review is provided to assess the role of radionuclide imaging in HF. The focus is on three aspects: the value of nuclear imaging to distinguish ischemic from non-ischemic etiologies; risk stratification of patients with HF with evaluation of candidates for specific treatment strategies; and the role of cardiac neuronal imaging in patients with HF. Distinguishing ischemic from non-ischemic cardiomyopathy is important because patients with ischemic cardiomyopathy can potentially have dramatic improvement with revascularization. Single photon emission computed tomography (SPECT) has excellent reported sensitivity and negative predictive value in the detection of coronary artery disease in HF patients. SPECT imaging is also useful in establishing treatment strategies in patients with HF, including those with new onset CHF. Cardiac neuronal imaging of mIBG is particularly helpful in risk stratification of patients with HF. The modality can be used to monitor the response to therapy as dysfunctional mIBG uptake may show improvement with pharmacological treatment.
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Affiliation(s)
- Vinay Gulati
- University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA,
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Lonborg J, Engstrom T. Correlating infarct size and patient prognosis: are cardiac biomarkers truly insufficient?: reply. Eur Heart J Cardiovasc Imaging 2013; 14:932-3. [DOI: 10.1093/ehjci/jet097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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77
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An optimal cardiothoracic ratio cut-off to predict clinical outcomes in patients with acute myocardial infarction. Int J Cardiovasc Imaging 2013; 29:1889-97. [DOI: 10.1007/s10554-013-0260-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 06/18/2013] [Indexed: 11/30/2022]
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Smith RR, Marbán E, Marbán L. Enhancing retention and efficacy of cardiosphere-derived cells administered after myocardial infarction using a hyaluronan-gelatin hydrogel. BIOMATTER 2013; 3:24490. [PMID: 23538511 PMCID: PMC3732325 DOI: 10.4161/biom.24490] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Cardiosphere-derived cells (CDCs) are under clinical development and are currently being tested in a clinical trial enrolling patients who have undergone a myocardial infarction. CDCs are presently administered via infusion into the infarct-related artery and have been shown in early clinical trials to be effective agents of myocardial regeneration. This review describes the administration of CDCs in a hyaluronan-gelatin hydrogel via myocardial injection and the subsequent improvements in therapeutic benefit seen in animal models. Development of a next generation therapy involving the combination of CDCs and hydrogel is discussed.
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Affiliation(s)
| | | | - Linda Marbán
- Capricor Inc.; 8700 Beverly Boulevard; Los Angeles, CA USA
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