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Hu M, Lang X, Yang J, Wang Y, Li W, Gao X, Yang Y. The prevalence and outcomes in STEMI patients aged ≥75 undergoing primary percutaneous coronary intervention in China. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 21:200251. [PMID: 38464698 PMCID: PMC10921244 DOI: 10.1016/j.ijcrp.2024.200251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/18/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Objective To investigate the prevalence and outcomes of primary percutaneous coronary intervention (PCI) in Chinese patients with ST-segment elevation myocardial infarction (STEMI) aged ≥75 years. Methods We identified STEMI patients aged ≥75 years between 2013 and 2014 from a multicenter registry. The primary outcome was all-cause mortality. The secondary outcome was major adverse cardiac and cerebrovascular event (MACCE) including a composite of all-cause mortality, cardiac death, recurrent MI, stroke, revascularization, and major bleeding. Hazard ratios (HR) and associated 95% confidence interval (CI) were calculated. Results Approximately 32.9% (n = 999) patients received primary PCI. Primary PCI was associated with lower risks of two-year all-cause mortality (18.0% vs. 36.4%; adjusted HR: 0.54, 95% CI: 0.45 to 0.65, P < 0.0001), MACCE (28.7% vs. 43.5%; adjusted HR: 0.68, 95% CI: 0.59 to 0.80, P < 0.0001), and cardiac death (10.0% vs. 23.6%; adjusted HR: 0.49, 95% CI: 0.38 to 0.62, P < 0.0001) relative to no reperfusion (n = 2041) in patients aged ≥75 years. The better outcomes in two-year all-cause mortality, MACCE, and cardiac death were consistently observed in STEMI patients aged ≥85 years. No differences were observed in recurrent MI, stroke, revascularization, and major bleeding between the two groups. Additionally, in patients with relatively high-risk profiles such as cardiogenic shock or delaying hospital admission, primary PCI was also superior to no reperfusion. Conclusion Primary PCI may decrease two-year all-cause mortality, MACCE, and cardiac death in STEMI patients aged ≥75 years, even in these with age ≥85 years, cardiogenic shock, or delaying hospital admission. However, primary PCI was underutilized in Chinese clinical practice.
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Affiliation(s)
- Mengjin Hu
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
| | - Xinyue Lang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Jingang Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yang Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Wei Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Xiaojin Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
| | - for the China Acute Myocardial Infarction Registry Investigators
- Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100037, China
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Wang AZ, Hunter BR. Troponin or not troponin, what is the (clinical) question? Acad Emerg Med 2024. [PMID: 38511483 DOI: 10.1111/acem.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Alfred Z Wang
- West Sound Emergency Physicians, Seattle, Washington, USA
| | - Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Magidson PD. The Aged Heart. Emerg Med Clin North Am 2022; 40:637-649. [DOI: 10.1016/j.emc.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mackay MH, Chruscicki A, Christenson J, Cairns JA, Lee T, Turgeon R, Tallon JM, Helmer J, Singer J, Wong GC, Fordyce CB. Association of pre‐hospital time intervals and clinical outcomes in ST‐elevation myocardial infarction patients. J Am Coll Emerg Physicians Open 2022; 3:e12764. [PMID: 35702143 PMCID: PMC9174874 DOI: 10.1002/emp2.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/07/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022] Open
Abstract
Study Objectives Timely coronary reperfusion is critical for favorable outcomes after ST‐elevation myocardial infarction (STEMI). A substantial proportion of the total ischemic time is patient related, occurring before first medical contact (FMC). We aimed to expand the limited current understanding of the associations between prehospital intervals and clinical outcomes. Methods We conducted a retrospective analysis of consecutive STEMI patients who underwent primary percutaneous coronary intervention (pPCI) (January 2009–March 2016) and assessed the associations between prehospital intervals and the incidence of new heart failure, cardiogenic shock, and hospital length of stay (LOS), adjusting for important clinical variables. Results A total of 773 patients (77% men, median age 65 years) met eligibility criteria. The median pre‐911 activation interval was 29 minutes (interquartile range: 11, 89); the median 911 call to FMC interval was 12 minutes (interquartile range: 9, 15). In multivariable analysis, there was a V‐shaped relationship between the pre‐911 activation interval and outcomes: a lower likelihood of new heart failure (odds ratio [OR] 0.51; 95% confidence interval [CI]: 0.30, 0.87), cardiogenic shock (OR 0.40; 95% CI: 0.21, 0.75) and prolonged LOS (OR 0.24; 95% CI: 0.14, 0.42) for midrange intervals (11–88 minutes) when compared to the early (< 11‐minute) interval. There was no statistically significant relationship between total pre‐FMC time and FMC to device activation time. Conclusions Among ambulance‐transported STEMI patients receiving pPCI, the shortest and longest pre‐911 activation time intervals were associated with poorer outcomes. However, variation in post‐FMC interval alone was not associated with outcomes, suggesting that interventions to reduce pre‐FMC intervals must be prioritized.
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Affiliation(s)
- Martha H. Mackay
- School of Nursing University of British Columbia Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
| | - Adam Chruscicki
- Division of Internal Medicine Vancouver Coastal Health Diamond Health Care Centre Vancouver British Columbia Canada
| | - Jim Christenson
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- Providence Research Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
| | - John A. Cairns
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
| | - Ricky Turgeon
- St. Paul's Hospital Vancouver British Columbia Canada
| | - John M. Tallon
- Department of Emergency Medicine University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Jennifer Helmer
- British Columbia Emergency Health Services Vancouver British Columbia Canada
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- School of Population and Public Health Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Graham C. Wong
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
| | - Christopher B. Fordyce
- Division of Cardiology University of British Columbia Diamond Health Care Centre Vancouver British Columbia Canada
- Centre for Health Evaluation and Outcome Sciences University of British Columbia, St. Paul's Hospital Vancouver British Columbia Canada
- British Columbia Resuscitation Research Collaborative Vancouver British Columbia Canada
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Aubiniere-Robb L, Reid G, Murphy A. Primary percutaneous coronary intervention in patients aged 85 years or older: a retrospective analysis of outcomes. J R Coll Physicians Edinb 2021; 51:13-18. [PMID: 33877128 DOI: 10.4997/jrcpe.2021.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PPCI) is the first-line treatment for acute ST-elevation myocardial infarction (STEMI). Evidence of benefit from PPCI in the elderly is sparse. Our aim was to evaluate survival outcomes in patients aged ≥85 years who undergo PPCI for STEMI. METHODS Clinical data were collected retrospectively on all patients aged ≥85 years who were referred and accepted for PPCI to our centre between 2013 and 2018. RESULTS One hundred and forty-three patients received PPCI. Median hospital stay was seven days. One hundred and thirty-one patients survived admission. One-year mortality was 33.5%. Age and baseline renal function were independent predictors of one-year mortality. Median survival was 2.55 years. CONCLUSION Advanced age alone should not be used as an exclusion criterion for PPCI; rather, a personalised approach that takes into account all clinically relevant patient factors should guide PCI decision-making. Our findings suggest that PPCI as first-line treatment for STEMI in the very old should be considered routinely.
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Affiliation(s)
| | - George Reid
- General Medicine, Inverclyde Royal Hospital, Glasgow, UK
| | - Aengus Murphy
- Department of Cardiology, University Hospital Monklands, Airdrie, UK
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Filgueiras PHC, Cerqueira Junior AM, Bagano GO, Correia VCDA, Lopes FODA, Souza TMBD, Fonseca LL, Kertzman LQ, Lacerda YF, Rabelo MN, Correia LCL. Does Advanced Age Reduce the Typicality of Clinical Presentation in Patients with Acute Chest Pain Related to Coronary Artery Disease? Arq Bras Cardiol 2021; 116:1039-1045. [PMID: 34133584 PMCID: PMC8288541 DOI: 10.36660/abc.20190089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 05/14/2020] [Indexed: 11/18/2022] Open
Abstract
Fundamento De acordo com o pensamento diagnóstico tradicional, indivíduos muito idosos estão mais predispostos a desenvolver sintomas atípicos em síndromes coronarianas agudas. Objetivo Testar a hipótese de que indivíduos muito idosos estão mais predispostos a manifestações de dor torácica atípica devido à doença arterial coronariana obstrutiva (DAC). Métodos O Registro de dor torácica inclui pacientes internados com dor torácica aguda. Primeiramente, foi construído o índice de tipicidade dessa manifestação clínica: a soma de 12 características de sintomas (8 sintomas típicos e 4 sintomas atípicos). No subgrupo de pacientes com etiologia coronariana, o índice de tipicidade foi comparado entre octogenários e não octogenários. A significância estatística foi definida por p<0,05. Resultados 958 pacientes foram incluídos no registro, sendo que 486 (51%) tinham etiologia supostamente coronariana. Nesse grupo, 59 (12%) octogenários (idade 84±3,5; 50% homens) foram comparados a 427 pacientes com idade <80 (60±12 anos; 71% homens). O índice de tipicidade em octogenários foi 3,42±1,92, que é semelhante ao de não octogenários (3,44±1,74; p=0,092 na análise univariada e p=0,80 após ajuste para sexo pela análise de variância — ANOVA). Também não houve diferença estatisticamente significativa quando a amostra foi dividida em idade mediana (62 anos; 3,41±1,77 vs. 3,49 ± 1,77; p=0,61). Não houve associação linear estatisticamente significativa entre idade e índice de tipicidade (r=- 0,05; p=0,24). A análise de regressão logística para predição de DAC na amostra geral de 958 pacientes não mostrou interação do índice de tipicidade com a idade numérica (p=0,94), octogenários (p=0,22) ou idade acima da mediana (p=0,74). Conclusão Em pacientes com dor torácica aguda de etiologia coronariana, a idade avançada não influencia o quadro clínico típico.
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Zhou SH, Huang ST, Xu N, Chen Q, Chen LW, Kuo YR. The application and value of continuous nursing in patients after coronary artery bypass grafting. J Cardiothorac Surg 2020; 15:168. [PMID: 32650829 PMCID: PMC7350717 DOI: 10.1186/s13019-020-01210-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/25/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To investigate the application and value of continuous nursing after coronary artery bypass grafting. METHODS The clinical data of 62 patients after coronary artery bypass grafting from January 2016 to January 2018 were analyzed retrospectively. According to the nursing mode, the patients were divided into two groups: the continuous nursing group (n = 30) and the conventional nursing group (n = 32). All patients completed Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) at admission and 1 year after operation. All patients completed Seattle Angina Pectoris Questionnaire (SAQ) at discharge and 1 year after operation. RESULTS All patients were followed up for more than one year. One year after operation, SAQ score in five items in continuous nursing group was significantly better than that in conventional nursing group.(P < 0.05) The continuous nursing group exhibited significantly decreased SAS and SDS scores 1 year after surgery compared to the preoperative SAS and SDS scores.(P < 0.05) The SAS and SDS scores of the continuous nursing group were significantly better than those of the conventional nursing group 1 year after surgery.(P < 0.05) Then incidence rate of chest tightness or chest pain and coronary restenosis in continuous nursing group were significantly less than that in conventional nursing group.(P < 0.05). CONCLUSION Continuous nursing improved patient compliance with treatment and reduces the occurrence of complications. The patient also receives proper psychological evaluations, which relieve patient anxiety and depression and improve the quality of life.
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Affiliation(s)
- Sheng-Huo Zhou
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Shu-Ting Huang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Ning Xu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China.
| | - Liang-Wang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, 350001, People's Republic of China
| | - Yur-Ren Kuo
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, 100 TzYou 1st Rd, Kaohsiung City, 80756, Taiwan
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Etaher A, Nguyen TL, Saad YM, Frost S, Ferguson I, Juergens CP, Chew D, French JK. Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes. Heart Lung Circ 2020; 29:1696-1703. [PMID: 32439246 DOI: 10.1016/j.hlc.2020.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/07/2020] [Accepted: 02/29/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Patients aged ≥80 years old often present to Emergency Departments (ED) with symptoms potentially due to an acute coronary syndrome (ACS). This study aimed to evaluate associations between baseline level(s) of high sensitivity troponin T (HsTnT), adjudicated diagnoses and outcomes. METHODS Consecutive patients aged ≥80 years were studied, who presented to the ED at Liverpool Hospital, NSW, Australia during the 4 months period March to June 2014 (inclusive) with symptoms suggestive of an ACS, and who had at least one HsTnT assay performed. Diagnoses were based on the fourth universal definition of MI (myocardial infarction) including type-1 MI, type-2 MI, acute myocardial injury, chronic myocardial injury; the rest were termed "other diagnoses". Patients were categorised by baseline HsTnT levels 1) ≤14 ng/L, 2) 15-29 ng/L, 3) 30-49 ng/L and 4) ≥50 ng/L. RESULTS Of 2,773 patients screened, 545 were aged ≥80 years (median age 85 [IQR 82-88]); median follow-up was 32 months (IQR 5-56). The respective rates of adjudicated diagnoses were type-I MI 3.1%, type-2 MI 13%, acute myocardial injury 9.5%, chronic myocardial injury 56% and 18.6% had other diagnoses. Mortality rates increased, irrespective of adjudicated diagnoses with increasing HsTnT levels (ng/L): 17% (16/96) for ≤14; 35% (67/194) for 15-29; 51% (65/127) for 30-49; and 64% (82/128) for ≥50 ng/L; log rank p≤0.001. On multi-variable analyses, after adjusting for potential confounding factors including age, hypertension, chronic kidney disease (CKD) and chronic obstructive pulmonary disease (COPD), MI type was not associated with late mortality. CONCLUSIONS Among patients aged ≥80 years higher HsTnT levels, irrespective of adjudicated diagnoses, were associated with increased mortality. Most very elderly patients presenting with symptoms suggestive of an ACS undergoing HsTnT testing in EDs had elevated levels most commonly due to chronic myocardial injury. Whether any interventions can modify outcomes require prospective evaluation.
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Affiliation(s)
- Aisha Etaher
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Tuan L Nguyen
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Department of Emergency, Liverpool Hospital, Sydney, NSW, Australia
| | - Yousef M Saad
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Steven Frost
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia; Western Sydney University, Sydney, NSW, Australia
| | - Ian Ferguson
- The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Department of Emergency, Liverpool Hospital, Sydney, NSW, Australia
| | - Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Derek Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, Sydney, NSW, Australia; The University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia; Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
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Ulrich R, Pischon T, Robra BP, Freier C, Heintze C, Herrmann WJ. Health care utilisation and medication one year after myocardial infarction in Germany - a claims data analysis. Int J Cardiol 2020; 300:20-26. [PMID: 31371116 DOI: 10.1016/j.ijcard.2019.07.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND After myocardial infarction, guidelines recommend pharmaceutical treatment with a combination of five different types of drugs for prevention in patients. However, studies from different countries have shown that this goal is not achieved in many patients. The aim of this study was to assess both healthcare and prescribed pharmaceutical treatment in the fourth quarter after index myocardial infarction. METHODS We conducted a claims data analysis with the data of patients who had had a myocardial infarction in the years 2013 or 2014, using information from the largest German health insurance fund ('AOK'). We analysed contact with physicians, hospital care and actual prescriptions for medication recommended in international guidelines, referring to beta-blockers, ACE inhibitors or angiotensin II receptor blockers, P2Y12-antiplatelet agents, acetylsalicylic acid and statins, one year after myocardial infarction. Analysis was stratified by age and sex, compared between patient groups and over time. RESULTS We identified 2352 patients who had survived myocardial infarction. Some 96.9% of these participants had at least one contact with their general practitioner (GP) one year after myocardial infarction, 22.8% contacted a cardiologist and 19.7% were hospitalised. Prescription rates range from 37.8% for acetylsalicylic acid to 70.4% for ACE inhibitors. However, only 24.1% received statins, beta-blockers, ACE inhibitors and an antiplatelet drug simultaneously. Prescription of recommended drugs after myocardial infarction decreased steadily over time. DISCUSSION Long-term medical prevention after myocardial infarction is improvable. GPs should take care of the pharmaceutical prevention after myocardial infarction as they are the physicians seen most intensively in this period.
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Affiliation(s)
| | | | | | | | | | - Wolfram J Herrmann
- Charité-Universitätsmedizin Berlin, Germany; Hochschule Furtwangen University, Furtwangen, Germany.
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Chien DK, Lee SY, Hung CL, Sun FJ, Lin MR, Chang WH. Do patients with non-ST-elevation myocardial infarction without chest pain suffer a poor prognosis? Taiwan J Obstet Gynecol 2019; 58:788-792. [PMID: 31759528 DOI: 10.1016/j.tjog.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Previous studies have discussed acute myocardial infarction (AMI) patients without chest pain, but have not focused on non-ST-elevation myocardial infarction (NSTEMI). MATERIALS AND METHODS This 1-year study investigated whether chest pain presence relates to demographics, risk factors, and outcomes in NSTEMI patients. We retrospectively reviewed 194 patients, 73 without chest pain vs. 121 with chest pain, and compared the differences between clinical presentations, risk factors, medical management, and outcomes of these two groups. RESULTS Compared to patients with chest pain, patients without chest pain were significantly older, had lower SBP, higher HR, more cerebrovascular disease, less ischemic heart disease, higher delay to ED (emergency department) visit, lower ED medication prescriptions, lower percutaneous cardiac intervention, and higher in-hospital and one-year mortality rate. In a multivariate logistic regression, the adjusted odds ratios (OR) of patients without chest pain were 4.38 for the elderly, 0.99 for every 1 mmHg increase in SBP, 1.02 for every beat/min HR increase, 0.37 for those with ischemic heart disease, and 5.09 for those with cerebrovascular disease. The adjusted OR of in-hospital mortality were 3.09 for patients without chest pain, 0.32 for those with hypertension, 0.32 for smokers, 3.98 for those with shock, and 0.16 for those with percutaneous cardiac intervention. Finally, the only significantly adjusted OR of one-year mortality was 5.37 for patients without chest pain. CONCLUSION NSTEMI patients without chest pain were significantly older, had lower SBP, more tachycardia, more cerebrovascular disease, but less ischemic heart disease. They also experienced higher in-hospital and one-year mortality rates.
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Affiliation(s)
- Ding-Kuo Chien
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Department of Medicine, Mackay Memorial College, Taipei, Taiwan
| | - Shih-Yi Lee
- Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Fang-Ju Sun
- Assistant Research, Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Mau-Roung Lin
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
| | - Wen-Han Chang
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan; Mackay Medicine, Nursing and Management College, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan; Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan; Department of Medicine, Mackay Memorial College, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan.
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Al-khadra Y, Kajy M, Idris A, Darmoch F, Pacha HM, Kabach A, Garcia S, Bagur R, Kwok CS, Kaki A, Glazier JJ, Kapadia S, Mamas M, Alraies MC. Comparison of Outcomes After Percutaneous Coronary Interventions in Patients of Eighty Years and Above Compared With Those Less Than 80 Years. Am J Cardiol 2019; 124:1372-1379. [PMID: 31500819 DOI: 10.1016/j.amjcard.2019.07.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/15/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022]
Abstract
Life expectancy in the United States has increased due to advances in health care. Despite increased utilization of percutaneous coronary intervention (PCI), octogenarian patients are less likely to be referred to the catheterization laboratory for coronary interventions. This is in part due to multiple patient co-morbidities and lack of established guidelines. We examined in-hospital clinical outcomes of octogenarian and nonoctogenarian patients who underwent PCI in the United States. Using the National Inpatient Sampling database, we identified all adult patients who are older than 18 years and underwent PCI. Patient were stratified by age into 2 groups, ≥80 years old and <80 years old and in-hospital adverse outcome rates were determined. A total of 11,056,559 patients underwent PCI between the years of 2002 and 2014 and 1,544,563 patients were ≥80 years old (14%). After multivariable adjustment, patients who are ≥80 years old had higher in-hospital mortality (3.3% vs 1.3%, adjusted Odds Ratio, 1.624; 95% confidence interval, 1.602 to 1.647, p <0.0001) and longer length of stay (median length of stay days 3, range 2 to 8 days vs median 2 days, range 1 to 4 days) (p <0.0001). Patients ≥80 years old had a higher rate of cardiopulmonary complications, postprocedural stroke, acute kidney injury, postprocedural thromboembolic complications, and hemorrhage requiring transfusion. There was no difference in vascular complications between the 2 groups. In conclusion, octogenarians who underwent PCI were at increased risk for in-hospital mortality and morbidity compared with nonoctogenarians. The decision to proceed with PCI in this patient population should be individualized, taking into consideration known risk factors and patient's wishes.
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Claessen BE, Henriques JPS. Patient delay in women with STEMI: Time to raise awareness. Int J Cardiol 2018; 262:30-31. [PMID: 29706392 DOI: 10.1016/j.ijcard.2018.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 03/14/2018] [Accepted: 03/16/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Bimmer E Claessen
- Academic Medical Center - University of Amsterdam, department of cardiology, Amsterdam, The Netherlands
| | - José P S Henriques
- Academic Medical Center - University of Amsterdam, department of cardiology, Amsterdam, The Netherlands.
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Liu G, Niu X, Meng X, Zhang Z. Sensitive miRNA markers for the detection and management of NSTEMI acute myocardial infarction patients. J Thorac Dis 2018; 10:3206-3215. [PMID: 30069316 DOI: 10.21037/jtd.2018.05.141] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background NSTEMI patients will benefit greatly with better biomarker screening to detect and prognose the disease. Using miRNAs, we evaluated the clinical utility in acute myocardial infarction (AMI) patients during disease onset and therapy. Methods A total of 145 NSTEMI patients and 30 healthy volunteers with no history of cardiovascular disease (CVD) were recruited. miRNA levels in plasma were measured during disease manifestation and serially during treatment phase. Levels of multiple candidates (miR-1, miR-133, miR-208, miR-499) were analysed. The miRNA levels were directly compared between NSTEMI and healthy volunteers. Results Cardiac related miRNAs levels demonstrated significant increase compared with healthy controls. miR-499 exhibited the highest elevation with more than 6.03-fold change compared with healthy participants. Conventional cTnT measurements were in good agreement to miRNA relative expressions. In serial measurements, miR-499 demonstrated large fluctuations and could be linked to the secondary complications. In contrast, miR-133 showed insignificant variations in mean levels during serial sampling. Conclusions miRNA is a potentially sensitive biomarker for NSTEMI AMI patients for disease detection and treatment monitoring. The sensitivities were comparable to cTnT for diagnostic accuracy and patients with sustained or higher levels were correlated to secondary complications.
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Affiliation(s)
- Guoyong Liu
- Heart Center, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China.,The Cardiovascular Department, Qinghai Provincial People's Hospital, Xining 810007, China
| | - Xiaowei Niu
- Heart Center, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China
| | - Xiaoxue Meng
- Heart Center, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China
| | - Zheng Zhang
- Heart Center, The First Affiliated Hospital of Lanzhou University, Lanzhou 730000, China
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Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry. Aging Clin Exp Res 2017; 29:885-893. [PMID: 27832467 PMCID: PMC5590486 DOI: 10.1007/s40520-016-0649-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 10/12/2016] [Indexed: 11/21/2022]
Abstract
Background Katowice–Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES). Methods The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up. Results Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49–4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19–0.82); p = 0.012] in the elderly. Conclusion This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.
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Gnanenthiran SR, Kritharides L, D’Souza M, Lowe HC, Brieger DB. Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis. Heart 2017. [DOI: 10.1136/heartjnl-2017-311233] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Do elderly females have a higher risk of acute myocardial infarction? A retrospective analysis of 329 cases at an emergency department. Taiwan J Obstet Gynecol 2017; 55:563-7. [PMID: 27590383 DOI: 10.1016/j.tjog.2016.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE Acute myocardial infarction (AMI) is a medical emergency; a missed or delayed diagnosis of this disease may contribute to a poor outcome and even death. Several studies have found elderly patients with AMI have atypical presentations for diagnosis, therefore we undertook this study to determine the risks among the elderly population, especially in female patients. MATERIALS AND METHODS In this one-year retrospective study, we reviewed the cases of AMI patients who had visited the emergency department at Mackay Memorial Hospital, Taiwan, and who had either been discharged or had died following a diagnosis of AMI (ICD code 410). We compared the differences between the clinical presentations of these two groups as well as the risk factors, medical management, and outcomes. RESULTS In our study, only 329 patients (164 elderly; 165 adults) met the defined criteria. The most common symptom of AMI was chest pain, and this was more common in adult patients than in elderly patients (81.8% vs. 60.4%, p < 0.001). In comparison with patients in the adult group, the patients in the elderly group had a significantly higher proportion of females (46.3% vs. 12.7%), non-ST-elevation myocardial infarction (NSTEMI) (71.3% vs. 46.7%), presenting with no chest pain (39.6% vs. 18.2%), shortness of breath (17.7% vs. 8.8%), nausea/vomiting/dizziness (7.9% vs. 2.4%), abdominal pain (4.3% vs. 0.6%), diabetes mellitus (45.1% vs. 26.1%), cerebrovascular disease (22.6% vs. 6.1%), longer hospital stays (18.2 ± 31.0 days vs. 9.8 ± 8.2 days), and increased in-hospital mortality rates (15.9% vs. 6.7%). CONCLUSION Compared with the adult AMI group, the elderly AMI group had a higher proportion of females, electrocardiography with NSTEMI and no chest-pain complaints, and a larger proportion of elderly patients with diabetes, ischemic heart disease, heart attacks at home and cardiac shock, which had longer hospital stays, and higher mortality rates.
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Peiyuan H, Jingang Y, Haiyan X, Xiaojin G, Ying X, Yuan W, Wei L, Yang W, Xinran T, Ruohua Y, Chen J, Lei S, Xuan Z, Rui F, Yunqing Y, Qiuting D, Hui S, Xinxin Y, Runlin G, Yuejin Y. The Comparison of the Outcomes between Primary PCI, Fibrinolysis, and No Reperfusion in Patients ≥ 75 Years Old with ST-Segment Elevation Myocardial Infarction: Results from the Chinese Acute Myocardial Infarction (CAMI) Registry. PLoS One 2016; 11:e0165672. [PMID: 27812152 PMCID: PMC5094717 DOI: 10.1371/journal.pone.0165672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 10/14/2016] [Indexed: 12/22/2022] Open
Abstract
Background Only a few randomized trials have analyzed the clinical outcomes of elderly ST-segment elevation myocardial infarction (STEMI) patients (≥ 75 years old). Therefore, the best reperfusion strategy has not been well established. An observational study focused on clinical outcomes was performed in this population. Methods Based on the national registry on STEMI patients, the in-hospital outcomes of elderly patients with different reperfusion strategies were compared. The primary endpoint was defined as death. Secondary endpoints included recurrent myocardial infarction, ischemia driven revascularization, myocardial infarction related complications, and major bleeding. Multivariable regression analysis was performed to adjust for the baseline disparities between the groups. Results Patients who had primary percutaneous coronary intervention (PCI) or fibrinolysis were relatively younger. They came to hospital earlier, and had lower risk of death compared with patients who had no reperfusion. The guideline recommended medications were more frequently used in patients with primary PCI during the hospitalization and at discharge. The rates of death were 7.7%, 15.0%, and 19.9% respectively, with primary PCI, fibrinolysis, and no reperfusion (P < 0.001). Patients having primary PCI also had lower rates of heart failure, mechanical complications, and cardiac arrest compared with fibrinolysis and no reperfusion (P < 0.05). The rates of hemorrhage stroke (0.3%, 0.6%, and 0.1%) and other major bleeding (3.0%, 5.0%, and 3.1%) were similar in the primary PCI, fibrinolysis, and no reperfusion group (P > 0.05). In the multivariable regression analysis, primary PCI outweighs no reperfusion in predicting the in-hospital death in patients ≥ 75 years old. However, fibrinolysis does not. Conclusions Early reperfusion, especially primary PCI was safe and effective with absolute reduction of mortality compared with no reperfusion. However, certain randomized trials were encouraged to support the conclusion.
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Affiliation(s)
- He Peiyuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Jingang
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xu Haiyan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Xiaojin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xian Ying
- Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, United States of America
| | - Wu Yuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Li Wei
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Wang Yang
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Tang Xinran
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Ruohua
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jin Chen
- Medical Research & Biometrics Center, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Song Lei
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhang Xuan
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Fu Rui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Ye Yunqing
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dong Qiuting
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Sun Hui
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yan Xinxin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Gao Runlin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yang Yuejin
- Department of Cardiology, Cardiovascular Institute and Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- * E-mail:
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ST-elevation myocardial infarction risk in the very elderly. BBA CLINICAL 2016; 6:108-12. [PMID: 27635386 PMCID: PMC5024138 DOI: 10.1016/j.bbacli.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 08/24/2016] [Accepted: 09/01/2016] [Indexed: 12/31/2022]
Abstract
Background Despite the high incidence and mortality of ST-segment elevation myocardial infarction (STEMI) among the very elderly, risk markers for this condition remain poorly defined. This study was designed to identify independent markers of STEMI among individuals carefully selected for being healthy or manifesting STEMI in < 24 h. Methods We enrolled participants aged 80 years or older of whom 50 were STEMI patients and 207 had never manifested cardiovascular diseases. Blood tests, medical and psychological evaluations were obtained at study admission. Odds Ratio (OR) and attributed risk (AR) were obtained by multivariate regression models using STEMI as dependent variable. Results Low glomerular filtration rate (GFR) [OR:4.41 (1.78–10.95); p = 0.001], reduced levels of HDL-C [OR:10.70 (3.88–29.46); p = 0.001], male gender [OR:12.08 (5.82–25.08); p = 0.001], moderate to severe depressive symptoms [OR:10.00 (2.82–35.50); p = 0.001], prior smoking [OR:2.00 (1.05–3.80); p = 0.034] and current smoking [OR:6.58 (1.99–21.70); p = 0.002] were significantly associated with STEMI. No association was found between STEMI and age, diabetes, hypertension, mild depressive symptoms, triglyceride or LDL-C. Conclusions This is the first case–control study carried out with very elderlies to assess STEMI risk. Our findings indicate that reduced HDL-C, GFR, male gender, smoking habits and moderate to severe depressive symptoms are markers of STEMI in this age group. General Significance In Individuals aged 80 or more years, a greater attention must be paid to low HDL-C and GFR at the expense of conventional STEMI risk factors for younger adults such as diabetes mellitus, hypertension and high LDL-C or triglyceride. Population aging are rapidly increasing worldwide, especially in developing countries. Incidence and mortality due to cardiovascular diseases is extremely high in the very elderly population. There is no specific algorithm for cardiovascular disease risk estimation for very elderly individuals. Among the very elderly, markers of cardiovascular risk are distinct from younger adults.
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Key Words
- ANCOVA, analysis of covariance
- AR, attributable risk
- Aged
- Aged, 80 and over
- BDI-II, Beck Depression Inventory version II
- BHS, Brasília Heart Study
- BSHA, Brasília Study on Healthy Aging
- CK-MB, MB fraction of creatine kinase
- CRP, C-reactive protein
- CVD, cardiovascular disease
- DBP, diastolic blood pressure
- EDTA, ethylenediamine tetraacetic acid
- GDS, Geriatric Depression Scale
- GFR, glomerular filtration rate
- HDL-C, high-density lipoprotein cholesterol
- HDL-cholesterol
- HbA1c, glycated hemoglobin
- IQR, interquartile range
- LDL-C, low-density lipoprotein cholesterol
- MI, myocardial infarction
- Myocardial infarction
- OR, odds ratio
- SBP, systolic blood pressure
- SD, standard deviation
- STEMI, ST-segment elevation myocardial infarction
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Bromage DI, Jones DA, Rathod KS, Grout C, Iqbal MB, Lim P, Jain A, Kalra SS, Crake T, Astroulakis Z, Ozkor M, Rakhit RD, Knight CJ, Dalby MC, Malik IS, Mathur A, Redwood S, MacCarthy PA, Wragg A. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc 2016; 5:e003027. [PMID: 27353606 PMCID: PMC4937253 DOI: 10.1161/jaha.115.003027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. METHODS AND RESULTS We analyzed 10 249 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all-cause mortality at a median follow-up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In-hospital mortality (7.7% vs 2.4%, P<0.0001) and long-term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07-1.09, P<0.0001). Time-stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long-term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. CONCLUSIONS In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in-hospital outcomes were reasonable, and long-term mortality rates were static.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Daniel A Jones
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Claire Grout
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - M Bilal Iqbal
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ajay Jain
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sundeep S Kalra
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Crake
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mick Ozkor
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | | | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Simon Redwood
- BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wragg
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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Doizon T, Orion L, Dimet J, Boiffard E. [ST elevation myocardial infarction (STEMI) in patients aged 85 and over. Invasive management versus exclusive medical treatment: Departmental study]. Ann Cardiol Angeiol (Paris) 2015; 64:345-51. [PMID: 26482627 DOI: 10.1016/j.ancard.2015.09.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Percutaneous coronary intervention (PCI) and/or fibrinolysis for management of an ST elevation myocardial infarction (STEMI) are at high risk in the elderly. Is there any place for an invasive management in this particular population? METHODS It is a single-center retrospective study (CHD Vendée, La Roche-sur-Yon) including patients aged 85 and over who had STEMI between January 2008 and December 2013, divided into two groups: coronary angiogram/fibrinolysis ("invasive") versus exclusive medical treatment ("non-invasive"), comparing mortality, morbidity, complications and loss of independence. RESULTS Among the 1373 patients hospitalized for STEMI, 118 (8.6%) were included: 71 (60.2%) underwent an invasive procedure for reperfusion whereas 47 had "non-invasive" management. All cause mortality rate was higher in the "non-invasive" group (28% versus 45%; P=0.077 NS). The identified pejorative criteria are age, female gender, past history of severe valvular disease, and delay for primary care. No difference was found in intrahospital complication rate (23 vs 21; P=0.21) nor in loss of independence. CONCLUSION The invasive management of STEMI in the elderly may reduce the one-year mortality rate without increasing morbidity.
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Affiliation(s)
- T Doizon
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France.
| | - L Orion
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
| | - J Dimet
- Service de recherche clinique, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
| | - E Boiffard
- Service de cardiologie, CHD de Vendée, Les Oudairies, 85000 La Roche-sur-Yon, France
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Li X, Yang Y, Wang L, Qiao S, Lu X, Wu Y, Xu B, Li H, Gu D. Plasma miR-122 and miR-3149 Potentially Novel Biomarkers for Acute Coronary Syndrome. PLoS One 2015; 10:e0125430. [PMID: 25933289 PMCID: PMC4416808 DOI: 10.1371/journal.pone.0125430] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Accepted: 03/23/2015] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We evaluated the potentiality of plasma microRNAs (miRNAs, or miRs) that were considered as novel biomarkers for acute coronary syndrome (ACS), including acute myocardial infarction (AMI) and unstable angina (UA). METHODS AND RESULTS We initially identified plasma miR-122, -140-3p, -144, -720, -1225-3p, -2861, and -3149 as candidate miRNAs associated with AMI (≥2 fold and P < 0.05) by comparing expression differences of miRNAs among AMI, non-coronary heart disease (non-CHD) and stable angina (SA) groups, using miRNA microarrays (n = 8 independent arrays in each group). Those seven plasma miRNAs were further examined with qRT-PCR analyses in two replications including 111 and 428 patients separately, and the results demonstrated that plasma miR-122, -140-3p, -720, -2861, and -3149 were elevated in the ACS group vs. the non-ACS (non-CHD + SA) group (P < 0.01). The area under the receiver operating characteristic curve (AUC) of the five miRNAs for ACS classification was 0.838, 0.818, 0.865, 0.852, and 0.670, respectively (all P < 0.001), while the values reached 0.843 and 0.925 when simultaneously with miR-122 and -3149 or with miR-122, -2861, and -3149 together (all P < 0.001). In plasma of pigs after coronary ligation, miR-122 was increased from 180 min to 240 min and miR-3149 was augmented from 30 min to 240 min compared with the sham pigs (all P < 0.05). CONCLUSION Plasma miR-122, -140-3p, -720, -2861, and -3149 were associated with and potentially novel biomarkers for ACS.
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Affiliation(s)
- Xiangdong Li
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yuejin Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Laiyuan Wang
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xiangfeng Lu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Bo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Hongfan Li
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- * E-mail:
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Biener M, Mueller M, Vafaie M, Katus HA, Giannitsis E. Impact of Leading Presenting Symptoms on the Diagnostic Performance of High-Sensitivity Cardiac Troponin T and on Outcomes in Patients with Suspected Acute Coronary Syndrome. Clin Chem 2015; 61:744-51. [DOI: 10.1373/clinchem.2014.235317] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 02/03/2015] [Indexed: 12/23/2022]
Abstract
Abstract
BACKGROUND
Diagnostic performance of high-sensitivity cardiac troponin T (hs-cTnT) varies depending on presenting symptoms in patients with suspected acute coronary syndrome (ACS).
METHODS
We compared performance measures of hs-cTnT among patients admitted to the emergency department with typical chest pain (angina), dyspnea, and atypical symptoms and assessed outcomes by leading presenting symptoms.
RESULTS
A total of 658 patients suspected of ACS and presenting with typical chest pain (n = 241, 36.6%), dyspnea (n = 142, 21.6%), or atypical symptoms (n = 275, 41.8%) were included. Diagnostic accuracy of hs-cTnT on admission was higher among patients with typical chest pain compared to those with atypical symptoms [area under the curve (AUC) 0.823 vs AUC 0.776 vs AUC 0.705, P > 0.05 and P = 0.04]. Absolute concentration changes within 6 h improved accuracy among all subgroups, with the smallest added benefit in typical chest pain and dyspnea (ΔAUC, 0.078; P = 0.02 and 0.05, P > 0.05). During 1-year follow-up, dyspnea was associated with a higher risk of death (hazard ratio, 2.36; 95% CI, 1.26–4.43, P = 0.008) and death/AMI (hazard ratio, 2.23; 95% CI, 1.21–4.11, P = 0.01) compared to typical chest pain. Optimal discriminating values for hs-cTnT were higher among patients presenting with dyspnea compared to those with typical chest pain (91.2 vs 14.1 ng/L, P < 0.001).
CONCLUSION
The diagnostic performance of hs-cTnT in patients with suspected ACS depends on the leading presenting symptom. Patients admitted with dyspnea represent a high-risk cohort in which the diagnosis of ACS is less frequent and with inferior performance of serial hs-cTnT measurements. Higher hs-cTnT cutoffs at baseline and absolute changes after 6 h help to identify non-STEMI (ST segment elevation myocardial infarction) in this population.
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Affiliation(s)
- Moritz Biener
- Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany
| | - Matthias Mueller
- Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany
| | - Mehrshad Vafaie
- Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany
| | - Hugo A Katus
- Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany
| | - Evangelos Giannitsis
- Medizinische Klinik, Abteilung für Innere Medizin III, Universitätsklinikum Heidelberg, Germany
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The German CPU Registry: Dyspnea independently predicts negative short-term outcome in patients admitted to German Chest Pain Units. Int J Cardiol 2015; 181:88-95. [DOI: 10.1016/j.ijcard.2014.11.199] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 10/28/2014] [Accepted: 11/24/2014] [Indexed: 01/21/2023]
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[Situation of acute inpatient geriatric patients. A retrospective analysis of health care processes of geriatric and non-geriatric patients with acute myocardial infarction]. Z Gerontol Geriatr 2014; 47:27-34. [PMID: 23760521 DOI: 10.1007/s00391-013-0490-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although cardiovascular diseases belong to the most frequent causes of inpatient treatment of older people the specific characteristics of geriatric patients in the acute care unit still receive marginal attention. The aim of this study was the descriptive representation of clinical health care processes of geriatric and non-geriatric patients with acute myocardial infarction. PATIENTS AND METHODS Using a retrospective document analysis 83 medical patient records were examined with regard to nursing, therapeutic as well as medical measures and social counseling. The classification in geriatric and non-geriatric patients was based on a predefined list of criteria. RESULTS In the study a total of 48 geriatric and 35 non-geriatric patients could be identified. There was a comprehensive need for support of nursing and therapeutic care, a high frequency of complications and a long length of stay as well as specifics concerning the place of discharge in geriatric patients. CONCLUSIONS Complex problems and special care needs of geriatric patients with acute myocardial infarction were shown. This vulnerable group of patients should be given more attention in acute care. Further investigations with a prospective character are necessary in order to detect the specific needs of geriatric patients in acute care.
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Li PWC, Lee DTF, Yu DSF. Psychometric evaluation of the Symptoms of Acute Coronary Syndromes Inventory in Chinese patients with acute coronary syndromes. Eur J Cardiovasc Nurs 2013; 13:295-303. [DOI: 10.1177/1474515113509558] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 09/30/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Polly WC Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Diana TF Lee
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
| | - Doris SF Yu
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
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26
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Recchioni R, Marcheselli F, Olivieri F, Ricci S, Procopio AD, Antonicelli R. Conventional and novel diagnostic biomarkers of acute myocardial infarction: a promising role for circulating microRNAs. Biomarkers 2013; 18:547-58. [PMID: 24025051 DOI: 10.3109/1354750x.2013.833294] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Biomarkers play a critical role in the diagnosis of acute myocardial infarction (AMI), especially in patients with atypical clinical and/or electrocardiographic presentation or co-morbidities, like the elderly. High-sensitivity assays based on specific biomarkers (e.g. cardiac troponins) enabling earlier AMI diagnosis have recently become available in clinical practice. Although no single biomarker of myocardial necrosis is ever likely to afford AMI diagnosis, a combination including different biomarkers for necrosis and ischemia, like new circulating molecules (microRNAs), could enhance diagnostic specificity. We review the recent literature on conventional and novel AMI biomarkers, with special emphasis on circulating microRNAs.
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Affiliation(s)
- Rina Recchioni
- Center of Clinical Pathology and Innovative Therapy, Italian National Research Center on Aging (I.N.R.C.A-IRCCS) , Ancona , Italy
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27
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Pleister A, Selemon H, Elton SM, Elton TS. Circulating miRNAs: novel biomarkers of acute coronary syndrome? Biomark Med 2013; 7:287-305. [PMID: 23547823 DOI: 10.2217/bmm.13.8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Acute coronary syndrome refers to any group of clinical symptoms compatible with acute myocardial infarction (AMI). AMI is a major cause of death and disability worldwide with the greatest risk of death within the first hours of AMI onset. Therefore, delays in ‘ruling in’ AMI may increase morbidity and mortality due to the time lag in initiating therapy. Likewise, since the majority of patients presenting with acute chest pain do not have AMI, the rapid ‘ruling out’ of AMI in those patients would increase emergency department triage efficiency, decrease medical costs, and reduce morbidity and mortality. Thus, the identification of novel biomarkers that improve current strategies and/or accurately identify subjects who are at risk of developing acute and chronic manifestations of cardiovascular disease are desperately needed. This article discusses the potential of peripheral blood microRNAs as clinical biomarkers for the diagnosis and prognosis of cardiovascular diseases such as AMI.
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Affiliation(s)
- Adam Pleister
- Department of Internal Medicine, Division of Cardiovascular Medicine, The Ohio State University, 473 West 12th Avenue, OH 43210, USA
| | - Helina Selemon
- Davis Heart & Lung Research Institute, The Ohio State University, 473 West 12th Avenue, OH 43210, USA
| | | | - Terry S Elton
- College of Pharmacy, Division of Pharmacology, The Ohio State University, 473 West 12th Avenue, OH 43210, USA
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Antonsen L, Jensen LO, Terkelsen CJ, Tilsted HH, Junker A, Maeng M, Hansen KN, Lassen JF, Thuesen L, Thayssen P. Outcomes after primary percutaneous coronary intervention in octogenarians and nonagenarians with ST-segment elevation myocardial infarction: From the Western Denmark heart registry. Catheter Cardiovasc Interv 2013; 81:912-9. [DOI: 10.1002/ccd.24591] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Lisbeth Antonsen
- Department of Cardiology; Odense University Hospital; Odense; Denmark
| | | | | | | | - Anders Junker
- Department of Cardiology; Odense University Hospital; Odense; Denmark
| | - Michael Maeng
- Department of Cardiology; Aarhus University Hospital; Skejby; Aarhus; Denmark
| | | | | | - Leif Thuesen
- Department of Cardiology; Aarhus University Hospital; Skejby; Aarhus; Denmark
| | - Per Thayssen
- Department of Cardiology; Odense University Hospital; Odense; Denmark
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29
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Olivieri F, Galeazzi R, Giavarina D, Testa R, Abbatecola AM, Çeka A, Tamburrini P, Busco F, Lazzarini R, Monti D, Franceschi C, Procopio AD, Antonicelli R. Aged-related increase of high sensitive Troponin T and its implication in acute myocardial infarction diagnosis of elderly patients. Mech Ageing Dev 2012; 133:300-5. [PMID: 22446505 DOI: 10.1016/j.mad.2012.03.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/12/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
High sensitive cardiac Troponin T (hs-cTnT) represents an important tool in acute myocardial infarction (AMI) diagnosis. Even though the hs-cTnT evaluation is relevant for AMI diagnosis in elderly patients characterized by clinical and instrumental atypical presentation, the overall reliability in elderly patients is unknown. We aimed at: (1) defining the hs-cTnT 99th percentile value in an aged healthy reference population and (2) testing hs-cTnT diagnostic accuracy in elderly patients with a suspected AMI. 294 healthy subjects (50-105 years old) and 299 elderly patients (75-96 years old) with suspected AMI at presentation, were enrolled. Conventional cTnT, hs-cTnT, NT-proBNP and creatinine levels were determined in all participants. Our main results are: (1) a significant hs-cTnT age-related increase was observed in an healthy reference population ranging 50-105 years old; (2) hs-cTnT levels showed an age-related multimodal distribution in the healthy reference population: 16 ng/L corresponds to the 99th percentile in subjects ranging 50-75 years old, whereas 70.6 ng/L corresponds to the 99th percentile in subjects ≥75 years old; (3) 86.8 ng/L resulted the hs-cTnT cut-off value with the highest efficiency in AMI diagnosis of geriatric patients. Our data suggest that the hs-cTnT cut-off value must be age-tailored to improve the AMI diagnostic accuracy.
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Affiliation(s)
- Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
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Wu YF, Wang PC, Hsiao CT, Hsiao KY, Chen IC. Risk Factors of Acute ST Segment Elevation Myocardial Infarction Patients without Chest Pain. HONG KONG J EMERG ME 2012. [DOI: 10.1177/102490791201900204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction To identify factors associated with ST-segment myocardial infarction (STEMI) patients who had no chest pain, and to improve recognition of STEMI patients without presentation of chest pain in the emergency department (ED). Method Clinical characteristics and presentations were recorded in patients diagnosed with STEMI in the ED in a retrospective study of patients treated from 2006 to 2009. Patients with and without chest pain were compared according to clinical features. Results Among 260 STEMI patients, 12.7% of patients had no chest pain presentation in the ED. Syncope, epigastric pain, and dyspnea accounted for more than 60% of symptoms in STEMI patients without chest pain. Diabetes mellitus (DM), cerebrovascular accident (CVA), and old age were risk factors for STEMI patients without chest pain. Conclusions DM, CVA, and elderly patients are more likely to be without chest pain when STEMI occurred.
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Affiliation(s)
| | - PC Wang
- Chang Gung Memorial Hospital, Department of Cardiology, Puzih City, Chiayi, Taiwan, ROC
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31
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Stepien M, Rosniak-Bak K, Paradowski M, Misztal M, Kujawski K, Banach M, Rysz J. Waist circumference, ghrelin and selected adipose tissue-derived adipokines as predictors of insulin resistance in obese patients: preliminary results. Med Sci Monit 2012; 17:PR13-18. [PMID: 22037753 PMCID: PMC3539504 DOI: 10.12659/msm.882030] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The aim of the study was to estimate the association between anthropometric obesity parameters, serum concentrations of ghrelin, resistin, leptin, adiponectin and homeostasis model assessment (HOMA-IR) in obese non-diabetic insulin-sensitive and insulin-resistant patients. Material/Methods Study subjects included 37 obese (body mass index [BMI] ≥30 kg/m2) out-clinic patients aged 25 to 66 years. Insulin resistance was evaluated by HOMA-IR. Serum fasting concentrations of glucose, insulin, ghrelin, adiponectin, resistin and leptin were measured by using the ELISA method. Body weight, waist and hip circumferences were measured to calculate BMI and waist-to-hip ratio (WHR) values for all the patients. According to HOMA-IR, patients were divided into two groups: A, insulin sensitive (n=19); and B, insulin resistant (n=18). Results Patients with insulin resistance have greater mean waist circumference (WC) higher mean serum insulin level and leptin concentration, but lower concentrations of adiponectin and ghrelin. In the insulin-sensitive patient group we observed positive correlations between BMI and HOMA-IR, WC and HOMA-IR, and adiponectin and leptin, and negative correlations between ghrelin and HOMA-IR, WC and adiponectin, and WHR and adiponectin. In the insulin-resistant group, there was a positive correlation between resistin and ghrelin and a negative correlation between WHR and leptin. Conclusions Waist circumference, adiponectin, leptin and ghrelin are associated with insulin resistance and may be predictors of this pathology.
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Affiliation(s)
- Mariusz Stepien
- Department of Nephrology, Hypertension and Family Medicine, WAM University Hospital in Lodz, Lodz, Poland.
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32
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Olivieri F, Antonicelli R, Lorenzi M, D'Alessandra Y, Lazzarini R, Santini G, Spazzafumo L, Lisa R, La Sala L, Galeazzi R, Recchioni R, Testa R, Pompilio G, Capogrossi MC, Procopio AD. Diagnostic potential of circulating miR-499-5p in elderly patients with acute non ST-elevation myocardial infarction. Int J Cardiol 2012; 167:531-6. [PMID: 22330002 DOI: 10.1016/j.ijcard.2012.01.075] [Citation(s) in RCA: 181] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 12/13/2011] [Accepted: 01/22/2012] [Indexed: 12/20/2022]
Abstract
BACKGROUND Geriatric patients with acute non-ST elevation myocardial infarction (NSTEMI) can frequently present atypical symptoms and non-diagnostic electrocardiogram. The detection of modest cardiac troponin T (cTnT) elevation is challenging for physicians needing to routinely triage these patients. Unfortunately, non-coronary diseases, such as acute heart failure (CHF), may cause cTnT elevation. Circulating microRNAs (miRs) have emerged as biomarkers of MI. However, their diagnostic potential needs to be determined in elderly NSTEMI patients. METHODS 92 NSTEMI patients (82.6 ± 6.9 years old; complicated by CHF in 74% of cases) and 81 patients with acute CHF without AMI (81.3 ± 6.8 years old) were enrolled at presentation. A third group comprised 99 age-matched healthy control subjects (CTR). Plasma levels of miR-1, -21, -133a, -208a, -423-5p and -499-5p were analyzed. RESULTS MiR-1, -21 -133a and -423-5p showed a 3- to 10-fold increase and miR-499-5p exhibited >80-fold increase in acute NSTEMI patient vs. CTR. MiR-499-5p and -21 showed a significantly increased expression in NSTEMI vs. CHF. Interestingly, mir-499-5p was comparable to cTnT in discriminating NSTEMI vs. CTR and CHF patients. Its diagnostic accuracy was higher than conventional and hs-cTnT in differentiating NSTEMI (n=31) vs. acute CHF (n=32) patients with modest cTnT elevation at presentation (miR-499-5p AUC=0.86 vs. cTnT AUC=0.68 and vs. hs-cTnT AUC=0.70). CONCLUSIONS Circulating miR-499-5p is a sensitive biomarker of acute NSTEMI in the elderly, exhibiting a diagnostic accuracy superior to that of cTnT in patients with modest elevation at presentation.
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Affiliation(s)
- Fabiola Olivieri
- Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy.
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Barylski M, Małyszko J, Rysz J, Myśliwiec M, Banach M. Lipids, blood pressure, kidney - what was new in 2011? Arch Med Sci 2011; 7:1055-66. [PMID: 22328891 PMCID: PMC3265000 DOI: 10.5114/aoms.2011.26620] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Revised: 11/10/2011] [Accepted: 12/10/2011] [Indexed: 01/12/2023] Open
Abstract
The year 2011 was very interesting regarding new studies, trials and guidelines in the field of lipidology, hypertensiology and nephrology. Suffice it to mention the new European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on the management of dyslipidaemias, American College of Cardiology Foundation (ACCF)/American Heart Association (AHA) guidelines on hypertension in the elderly, and many important trials presented among others during the American Society of Nephrology (ASN) Annual Congress in Philadelphia and the AHA Annual Congress in Orlando. The paper is an attempt to summarize the most important events and reports in the mentioned areas in the passing year.
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Affiliation(s)
- Marcin Barylski
- Department of Internal Diseases and Cardiological Rehabilitation, Medical University of Lodz, Poland
| | - Jolanta Małyszko
- Department of Nephrology and Transplantology, Medical University of Bialystok, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Poland
| | - Michał Myśliwiec
- Department of Nephrology and Transplantology, Medical University of Bialystok, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
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Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med 2011; 124:40-7. [PMID: 21187184 PMCID: PMC3011975 DOI: 10.1016/j.amjmed.2010.07.023] [Citation(s) in RCA: 446] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 07/12/2010] [Accepted: 07/20/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND despite the widespread use of electrocardiographic changes to characterize patients presenting with acute myocardial infarction, little is known about recent trends in the incidence rates, treatment, and outcomes of patients admitted for acute myocardial infarction further classified according to the presence of ST-segment elevation. The objectives of this population-based study were to examine recent trends in the incidence and death rates associated with the 2 major types of acute myocardial infarction in residents of a large central Massachusetts metropolitan area. METHODS We reviewed the medical records of 5383 residents of the Worcester (MA) metropolitan area hospitalized for either ST-segment elevation acute myocardial infarction (STEMI) or non-ST-segment acute myocardial infarction (NSTEMI) between 1997 and 2005 at 11 greater Worcester medical centers. RESULTS the incidence rates (per 100,000) of STEMI decreased appreciably (121 to 77), whereas the incidence rates of NSTEMI increased slightly (126 to 132) between 1997 and 2005. Although in-hospital and 30-day case-fatality rates remained stable in both groups, 1-year postdischarge death rates decreased between 1997 and 2005 for patients with STEMI and NSTEMI. CONCLUSIONS the results of this study demonstrate recent decreases in the magnitude of STEMI, slight increases in the incidence rates of NSTEMI, and decreases in long-term mortality in patients with STEMI and NSTEMI. Our findings suggest that acute myocardial infarction prevention and treatment efforts have resulted in favorable decreases in the frequency of STEMI and death rates from the major types of acute myocardial infarction.
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Piotrowski G, Szymański P, Banach M, Piotrowska A, Gawor R, Rysz J, Gawor Z. Left atrial and left atrial appendage systolic function in patients with post-myocardial distal blocks. Arch Med Sci 2010; 6:892-9. [PMID: 22427763 PMCID: PMC3302701 DOI: 10.5114/aoms.2010.19298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2010] [Revised: 05/15/2010] [Accepted: 12/24/2010] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The study aimed to evaluate function of the left atrium (LA) and of the left atrial appendage (LAA) after myocardial infarction (MI) complicated by intracardiac conduction disturbances. MATERIAL AND METHODS The study comprised 59 patients with persistent post-myocardial distal blocks, who were allocated to one of the three following subgroups: study group I - 20 patients with left bundle branch block (LBBB); study group II - 20 patients with right bundle branch block (RBBB), and study group III -19 pts with left anterior hemiblock (LAHB). The control groups included patients with MI in their history and no BBBs (19 pts - group IV) and clinically healthy people (16 patients - group V). The parameters of LA and LAA systolic function were determined by means of transthoracic (TTE) and transoesophageal echocardiography (TOE). RESULTS We showed that patients who experienced myocardial infarction not complicated with conduction disturbances expressed compensatory LA systolic function enhancement. In patients with post-myocardial RBBB and LAHB significant enhancement of LA systolic function was observed as well but it was expressed to a lesser degree. There was also a tendency towards deterioration of LA systolic function in patients with post-myocardial LBBB. LBBB did not affect LAA systolic function negatively. CONCLUSIONS Parameters of LAA systolic function showed its enhancement in all patients after myocardial infarction irrespective of whether it was complicated by conduction disturbances.
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Affiliation(s)
- Grzegorz Piotrowski
- Department of Cardiology, M. Kopernik Specialist District Hospital, Lodz, Poland
| | - Piotr Szymański
- Department of Cardiology, M. Kopernik Specialist District Hospital, Lodz, Poland
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Poland
| | - Aneta Piotrowska
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Poland
| | - Rafał Gawor
- Department of Cardiology, M. Kopernik Specialist District Hospital, Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, Poland
| | - Zenon Gawor
- Department of Cardiology, M. Kopernik Specialist District Hospital, Lodz, Poland
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Bielecka-Dabrowa A, Mikhailidis DP, Hannam S, Rysz J, Michalska M, Akashi YJ, Banach M. Takotsubo cardiomyopathy--the current state of knowledge. Int J Cardiol 2010; 142:120-5. [PMID: 20051293 DOI: 10.1016/j.ijcard.2009.11.040] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 11/09/2009] [Accepted: 11/29/2009] [Indexed: 12/16/2022]
Abstract
Takotsubo cardiomyopathy is defined as acute chest pain during stressful incidents which is associated with ST-segment abnormalities and/or increased serum troponin levels. There is also regressive systolic dysfunction which is usually localized in the apical and medial left ventricles but there are no significant coronary artery lesions. The ventricular asynergy is also described in the right ventricle but is less common. Almost all the patients are women. The onset of this disease is typically triggered by an acute emotional or stress event or by an accumulation of trivial and repetitive stresses. The etiology of this syndrome remains unclear. Myocardial ischemia and reperfusion due to microvascular spasm, aborted myocardial infarction and related no-reflow phenomenon have been proposed as inducers of Takotsubo cardiomyopathy. The temporal relationship between the stressful event and the triggering of the clinical syndrome as well as the report of elevated catecholamine plasma levels during the acute phase suggest a possible involvement of the sympathetic nervous system. A smaller left ventricular size and hormonal disturbances in women may also play a role.
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