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Han L, Yan F, Zhang Y, Pan Y, Li S, Yang M, Wang Y, Yanru C, Su W, Ma Y. Prevalence and associated factors of mortality after percutaneous coronary intervention for adult patients with ST-elevation myocardial infarction: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:17. [PMID: 37064794 PMCID: PMC10098139 DOI: 10.4103/jrms.jrms_781_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2022] [Accepted: 11/17/2022] [Indexed: 03/18/2023]
Abstract
Background There is a paucity of systematic reviews on the associated factors of mortality among ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). This meta-analysis was designed to synthesize available evidence on the prevalence and associated factors of mortality after PCI for adult patients with STEMI. Materials and Methods Databases including the Cochrane Library, PubMed, Web of Science, Embase, Ovid, Scopus, ProQuest, MEDLINE, and CINAHL Complete were searched systematically to identify relevant articles published from January 2008 to March 2020 on factors affecting mortality after PCI in STEMI patients. Meta-analysis was conducted using Stata 12.0 software package. Results Our search yielded 91 cohort studies involving a total of 199, 339 participants. The pooled mortality rate for STEMI patients after PCI was 10%. After controlling for grouping criteria or follow-up time, the following 17 risk factors were significantly associated with mortality for STEMI patients after PCI: advanced age (odds ratio [OR] = 3.89), female (OR = 2.01), out-of-hospital cardiac arrest (OR = 5.55), cardiogenic shock (OR = 4.83), renal dysfunction (OR = 3.50), admission anemia (OR = 3.28), hyperuricemia (OR = 2.71), elevated blood glucose level (OR = 2.00), diabetes mellitus (OR = 1.8), chronic total occlusion (OR = 2.56), Q wave (OR = 2.18), without prodromal angina (OR = 2.12), delay in door-to-balloon time (OR = 1.72), delay in symptom onset-to-balloon time (OR = 1.43), anterior infarction (OR = 1.66), ST-segment resolution (OR = 1.40), and delay in symptom onset-to-door time (OR = 1.29). Conclusion The pooled prevalence of mortality after PCI for STEMI patients was 10%, and 17 risk factors were significantly associated with mortality for STEMI patients after PCI.
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Comparison of Outcomes of Patients With ST-Segment Elevation Myocardial Infarction Treated by Primary Percutaneous Coronary Intervention Analyzed by Age Groups (<75, 75 to 85, and >85 Years); (Results from the Bremen STEMI Registry). Am J Cardiol 2015; 116:1802-9. [PMID: 26602071 DOI: 10.1016/j.amjcard.2015.09.022] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/06/2015] [Accepted: 09/06/2015] [Indexed: 02/08/2023]
Abstract
As old patients, who were treated by percutaneous coronary interventions (PCI) for ST-segment elevation myocardial infarction (STEMI), are regularly excluded or underrepresented in randomized trials, data on treatment and outcomes of this patient group at high risk have to be collected by registries. The study population of the German Bremen STEMI Registry was divided into the age groups G1: <75 years (n = 4,108, young), G2: 75 to 85 years (n = 1,032, old), and G3: >85 years (n = 216, very old) and was evaluated for clinical management and course. PCI failure (Thrombolysis In Myocardial Infarction flow 0 or 1 after PCI) was observed more often with increasing age. Patients >85 years without successful PCI had a very high inhospital mortality (40.0% without PCI success vs 18.1% with PCI success, p <0.05). Despite a reduced rate of periinterventional treatment with glycoprotein IIb/IIIa inhibitors in elderly patients of G2 and G3, inhospital bleedings (Thrombolysis In Myocardial Infarction/Bleeding Academic Research Consortium ≥2) occurred more frequently in these patients (G1: 5.4% vs G2: 11.0% vs G3: 19.6%, p <0.0001). Mortality rates during inhospital and long-term course increased with increasing age. In a multivariate analysis successful PCI was associated with improved outcomes in all age groups; even in very old patients successful PCI was associated with a significantly lower inhospital mortality rate (odds ratio 0.26, 95% confidence interval 0.08 to 0.81) and a trend toward a lower 1-year mortality. In conclusion, the present "real-world" data demonstrate an elevated rate of PCI failure, bleeding complications, and mortality in elderly patients treated by primary PCI for STEMI. However, a beneficial effect of successful PCI on mortality was observed in all age groups, even in very old patients, indicating the crucial role of revascularization therapy.
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Kvakkestad KM, Abdelnoor M, Claussen PA, Eritsland J, Fossum E, Halvorsen S. Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: A prospective cohort study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:243-52. [DOI: 10.1177/2048872615574706] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 02/04/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Kristin M Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
| | - Michael Abdelnoor
- Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway
| | - Peter A Claussen
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
| | - Eigil Fossum
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Norway
- University of Oslo, Norway
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Rathod KS, Jones DA, Gallagher S, Rathod VS, Weerackody R, Jain AK, Mathur A, Mohiddin SA, Archbold RA, Wragg A, Knight CJ. Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:23-32. [PMID: 25589633 DOI: 10.1177/2048872614567453] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/17/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Several studies have examined the relationship between age and clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI). The majority of studies have concentrated on describing elderly patients and there has been less focus on the profile and outcome of young patients suffering from STEMI. The aim of this study was to describe the clinical profile and outcomes of young patients compared with an older cohort and to establish what risk factors were associated with young patients having PPCI for STEMI. METHODS This was an observational cohort study of 3618 patients with STEMI treated by PPCI at a regional heart attack centre in London between January 2004 and September 2012. Clinical characteristics and outcomes in (young) patients aged ≤ 45 years were compared with those in (older) patients aged >45 years. The primary and main secondary outcomes were all-cause mortality and major adverse cardiovascular event rates, respectively, at a median follow-up of 3.0 (interquartile range 1.2-4.6) years. RESULTS Of the 3618 patients, 367 (10.1%) were aged ≤ 45 years and 3251 (89.9%) were aged >45 years. The proportion of patients aged ≤ 45 years increased from 8.5% to 11.5% (p=0.04) during the study period. Compared with older patients, those aged ≤ 45 years were more likely to be male, smokers, of South Asian ethnicity and to have a family history of premature coronary artery disease. Young patients were less likely to have a history of hypertension, hypercholesterolaemia, diabetes mellitus, previous myocardial infarction, myocardial revascularisation, or to have left ventricular systolic impairment or renal impairment. Over the follow-up period, mortality (2.7% vs. 7.6%; p<0.0001) and major adverse cardiovascular event rates (7.0% vs. 13.5%; p<0.0001) were significantly lower in patients aged ≤ 45 years compared with older patients. After adjustment for potential confounding factors, young age remained a predictor of reduced all cause mortality when compared with older patients (hazard ratio 0.12 (95% confidence interval 0.04-0.38)), including after incorporation of a propensity score (hazard ratio: 0.14 (95% confidence interval 0.04-0.36)). CONCLUSIONS In this cohort of patients with STEMI treated by PPCI there was an increasing incidence of young patients aged ≤ 45 years throughout the study period. These patients were more often male, smokers and of South Asian ethnicity. Outcomes in younger patients was good. Focusing preventative strategies on smokers and high risk ethnic groups may help reduce the incidence of premature coronary artery disease.
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Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Sean Gallagher
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Vrijraj S Rathod
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK
| | - Roshan Weerackody
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Ajay K Jain
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Saidi A Mohiddin
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - R Andrew Archbold
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Andrew Wragg
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Charles J Knight
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
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Out-of-hospital cardiac arrest and percutaneous coronary intervention for ST-elevation myocardial infarction: Long-term survival and neurological outcome. Int J Cardiol 2013; 166:236-41. [DOI: 10.1016/j.ijcard.2011.11.029] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 10/21/2011] [Accepted: 11/24/2011] [Indexed: 11/18/2022]
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Bertrand OF, Bélisle P, Joyal D, Costerousse O, Rao SV, Jolly SS, Meerkin D, Joseph L. Comparison of transradial and femoral approaches for percutaneous coronary interventions: a systematic review and hierarchical Bayesian meta-analysis. Am Heart J 2012; 163:632-48. [PMID: 22520530 DOI: 10.1016/j.ahj.2012.01.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2011] [Accepted: 01/18/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite lower risks of access site-related complications with transradial approach (TRA), its clinical benefit for percutaneous coronary intervention (PCI) is uncertain. We conducted a systematic review and meta-analysis of clinical studies comparing TRA and transfemoral approach (TFA) for PCI. METHODS Randomized trials and observational studies (1993-2011) comparing TRA with TFA for PCI with reports of ischemic and bleeding outcomes were included. Crude and adjusted (for age and sex) odds ratios (OR) were estimated by a hierarchical Bayesian random-effects model with prespecified stratification for observational and randomized designs. The primary outcomes were rates of death, combined incidence of death or myocardial infarction, bleeding, and transfusions, early (≤ 30 days) and late after PCI. RESULTS We collected data from 76 studies (15 randomized, 61 observational) involving a total of 761,919 patients. Compared with TFA, TRA was associated with a 78% reduction in bleeding (OR 0.22, 95% credible interval [CrI] 0.16-0.29) and 80% in transfusions (OR 0.20, 95% CrI 0.11-0.32). These findings were consistent in both randomized and observational studies. Early after PCI, there was a 44% reduction of mortality with TRA (OR 0.56, 95% CrI 0.45-0.67), although the effect was mainly due to observational studies (OR 0.52, 95% CrI 0.40-0.63, adjusted OR 0.49 [95% CrI 0.37-0.60]), with an OR of 0.80 (95% CrI 0.49-1.23) in randomized trials. CONCLUSION Our results combining observational and randomized studies show that PCI performed by TRA is associated with substantially less risks of bleeding and transfusions compared with TFA. Benefit on the incidence of death or combined death or myocardial infarction is found in observational studies but remains inconclusive in randomized trials.
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Kuch B, Wende R, Barac M, von Scheidt W, Kling B, Greschik C, Meisinger C. Prognosis and outcomes of elderly (75–84 years) patients with acute myocardial infarction 1–2 years after the event — AMI-elderly study of the MONICA/KORA Myocardial Infarction Registry. Int J Cardiol 2011; 149:205-210. [DOI: 10.1016/j.ijcard.2010.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/18/2009] [Accepted: 01/18/2010] [Indexed: 10/19/2022]
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Hafiz AM, Jan MF, Mori N, Gupta A, Bajwa T, Allaqaband S. Contemporary clinical outcomes of primary percutaneous coronary intervention in elderly versus younger patients presenting with acute ST-segment elevation myocardial infarction. J Interv Cardiol 2011; 24:357-65. [PMID: 21414028 DOI: 10.1111/j.1540-8183.2011.00634.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the choice reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). However, data on PPCI in elderly patients are sparse. This study determined clinical outcome post-PPCI in elderly versus younger patients with STEMI. METHODS AND RESULTS A cohort of 790 consecutive STEMI patients was studied for survival and major adverse cardiovascular events (MACE) after PPCI using a precise cardiac catheterization protocol. Patients were divided into two groups: those ≥75 years (elderly) and those <75 years. Median door-to-balloon time (DBT) was 82 minutes in the elderly versus 66 minutes in the younger group (P = 0.002). In-hospital all-cause mortality was higher in the elderly group (15.5% vs. 2.7%, P < 0.001). In elderly patients, MACE were found to be higher (32.3% vs. 16.1%, P < 0.001). Using a multivariate logistic regression analysis, age (odds ratio [OR]= 1.04, 95% confidence interval [CI]= 1.02-1.05, P < 0.001), diabetes (OR = 2.17, 95% CI = 1.33-3.53, P = 0.002), renal failure (OR = 3.75, 95% CI = 1.30-10.79, P = 0.014) and coronary artery disease (OR = 1.61, 95% CI = 1.00-2.59, P = 0.050) were associated with higher in-hospital MACE, while age (OR = 1.05, 95% CI = 1.02-1.08, P = 0.001), diabetes (OR = 2.18, 95% CI = 1.06-4.47, P = 0.034) and renal failure (OR = 6.65, 95% CI = 2.01-22.09, P = 0.002) were associated with higher in-hospital mortality. Kaplan-Meier 1-year survival rate was lower in the elderly. CONCLUSIONS In a contemporary population of STEMI patients treated with PPCI, overall in-hospital MACE and mortality remain higher in elderly compared to younger patients. Although partly due to higher burden of preexisting comorbidities, a higher DBT may also be responsible. (J Interven Cardiol 2011;24:357-365).
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Affiliation(s)
- Abdul Moiz Hafiz
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, USA
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Martínez-Sellés M, Datino T, Díaz-Castro Ó, López-Palop R. Actualización en cardiología geriátrica. Rev Esp Cardiol 2010; 63 Suppl 1:17-28. [DOI: 10.1016/s0300-8932(10)70137-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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