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Oristrell G, Ribera A. [Evolution of the prognosis of acute myocardial infarction]. Med Clin (Barc) 2023; 160:118-120. [PMID: 36049971 DOI: 10.1016/j.medcli.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Gerard Oristrell
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, España; Centro de Investigación Biomédica en Red - Enfermedades Cardiovasculares (CIBER CV), Madrid, España.
| | - Aida Ribera
- Grupo de Investigación en Envejecimiento, Fragilidad y Transiciones (REFiT), Parc Sanitari Pere Virgili e Instituto de Investigación Vall d'Hebron (VHIR), Barcelona, España; Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), España
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Huckaby LV, Sultan I, Mulukutla S, Kliner D, Gleason TG, Wang Y, Thoma F, Kilic A. Revascularization following non-ST elevation myocardial infarction in multivessel coronary disease. J Card Surg 2020; 35:1195-1201. [PMID: 32362025 DOI: 10.1111/jocs.14539] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND The optimal revascularization approach for patients with multivessel coronary artery disease (MVCAD) is controversial. We sought to investigate outcomes in patients undergoing coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) for non-ST elevation myocardial infarction (NSTEMI). METHODS Adult patients with MVCAD and NSTEMI undergoing either CABG or PCI at a single institution between 2011 and 2018 were included. Multivariable analysis was utilized to determine independent predictors of death, major adverse cardiac and cerebrovascular events (MACCE), and readmissions. A subanalysis examined patients undergoing complete revascularization. RESULTS A total of 2001 patients were included, of whom 1480 (74.0%) underwent CABG. CABG was associated with a lower risk-adjusted hazard for death (hazard ratio, 0.59, P < .001) and with improved survival at 1 year (92.0 vs 81.8%, P < .001) and 5 years (80.7 vs 63.3%, P < .001). Additionally, freedom from MACCE (P < .001) was greater in the CABG group and cumulative readmission, rates of MI, and rates of repeat revascularization were lower with CABG (each P < .001). Among patients undergoing complete revascularization, overall survival (1 year: 92.7 vs 83.9%, P = .010; 5 years: 81.1 vs 69.4%, P < .001) and freedom from MACCE (1 year: 92.3 vs 75.2%, P < .001; 5 years: 81.7 vs 61.4%, P < .001) remained higher for the CABG group; cumulative incidence of readmission was also decreased in those undergoing CABG (P < .001). CONCLUSIONS In this real-world analysis of patients with MVCAD presenting with NSTEMI, revascularization with CABG resulted in improved survival with lower rates of MACCE and readmission as compared to PCI, which persisted when accounting for complete revascularization.
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Affiliation(s)
- Lauren V Huckaby
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Ibrahim Sultan
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Suresh Mulukutla
- Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Dustin Kliner
- Department of Medicine, Division of Cardiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Thomas G Gleason
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Yisi Wang
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Floyd Thoma
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Arman Kilic
- Department of Cardiothoracic Surgery, Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Piuhola J, Holmström LTA, Niemelä M, Kervinen K, Tulppo M, Asikainen R, Hypèn L, Junttila MJ. Three-year outcomes related to coronary stenting; a registry-based real-life population study. SCAND CARDIOVASC J 2019; 54:162-168. [PMID: 31752551 DOI: 10.1080/14017431.2019.1693057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. Developments in medication and coronary interventions have improved coronary artery disease (CAD) treatment. We studied long-term outcomes in an observational, real-life population of CAD patients undergoing percutaneous coronary intervention (PCI) depending on the presentation and the stent type used. Design and results. Register included 789 consecutive patients undergoing PCI. Follow up period was three years with primary composite outcome (MACE) of all cause -mortality, myocardial infarction and target lesion revascularization. Mean age was 65 ± 11 and 69% were male. New-generation drug-eluting stents (DES-2) were associated with lower adjusted rates of MACE (HR 0.47; 95% CI 0.29-0.77) but not mortality (HR 0.50; 95% CI 0.22-1.14) in comparison to bare-metal stents. Patients with STEMI (14.4%) or NSTEMI (13.7%) had higher crude mortality rates than those with unstable (4.5%) or stable CAD (3.1%; p < .001). The association diminished after adjustments in NSTEMI (HR 2.01; 95% CI 0.88-4.58). Among smokers 45% quitted and 36% achieved recommended cholesterol levels. Conclusions. The overall prognosis was good. Irrespective of comorbidities, NSTEMI was not associated with worse outcome than stable CAD. DES-2 was associated with lower rates of MACE than BMS without affecting mortality rate. Patients succeeded better in smoking cessation than reaching recommended cholesterol levels.
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Affiliation(s)
- J Piuhola
- Division of Cardiology, Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - L T A Holmström
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Niemelä
- Division of Cardiology, Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - K Kervinen
- Division of Cardiology, Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - M Tulppo
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - R Asikainen
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - L Hypèn
- Division of Cardiology, Department of Medicine, Oulu University Hospital, Oulu, Finland
| | - M J Junttila
- Research Unit of Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Rising Events and Improved Outcomes of Gastrointestinal Bleed With Shock in USA: A 12-year National Analysis. J Clin Gastroenterol 2019; 53:e194-e201. [PMID: 29369239 DOI: 10.1097/mcg.0000000000000995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE Limited information is available based on single-center studies on trends of incidence and outcomes in gastrointestinal (GI) bleed with shock. METHODS We analyzed data from 2002 to 2013 National Inpatient Sample. Using ICD-9 codes we identified 6.4 million hospital discharges of GI bleed from National Inpatient Sample database. Events were analyzed based on type of GI bleed, in-hospital mortality, hemodynamic status, and use of blood products. RESULTS GI bleed with shock results in higher hospital mortality (20.77% with shock vs. 2.6% without shock). Between 2002 and 2013, there has been an increase in the percentage of upper and lower GI bleed with shock (1.35% to 4.92% and 1.49% to 3.06%) along with a reduction in mortality in both upper GI bleed with shock (26.9% to 13.8%) and lower GI bleed with shock (54.7% to 19.7%). Consistent with the rise in GI bleed with shock was an increase in blood product utilization. Packed red blood cell (pRBC) transfusion was associated with reduction in mortality in both nonvariceal upper GI bleed with shock (18.3% without pRBC vs. 13.9% receiving pRBC) and lower GI bleed with shock (36.05% without pRBC vs. 22.13% receiving pRBC), but did not affect mortality in variceal upper GI bleed with shock (31.79% vs. 32.22%). CONCLUSIONS GI bleed with shock carries a higher mortality and have been steadily increasing from 2002 to 2013. pRBC transfusion was associated in improved mortality in GI bleed with shock except variceal bleed.
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Reduced Left Ventricular Ejection Fraction Is a Risk Factor for In-Hospital Mortality in Patients after Percutaneous Coronary Intervention: A Hospital-Based Survey. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8753176. [PMID: 30627579 PMCID: PMC6304602 DOI: 10.1155/2018/8753176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/24/2018] [Accepted: 11/21/2018] [Indexed: 01/23/2023]
Abstract
Background To evaluate whether a reduced left ventricular ejection fraction (LVEF) is a risk factor in patients after percutaneous coronary intervention (PCI). Methods A retrospective cohort study from February 2013 to January 2017 was performed, and 1600 patients were included (136 patients with EF <50% and 1464 patients with EF ≥50%); all patients underwent PCI. Revascularization, in-hospital mortality, and in-hospital myocardial infarction (MI) during hospitalization were evaluated. Results The mean age of patients with EF <50% was 62.18 ± 10.31 years, while the mean age of patients with EF ≥50% was 60.06 ± 10.89 years (P=0.029). In-hospital mortality of patients with EF ≥50% was significantly lower than that of patients with EF <50% (0.12% vs. 3.68%, P<0.001), while no difference was observed in revascularization and in-hospital MI between the two groups (2.39% vs. 2.20%, P=0.892; 0.415% vs. 1.47%, P=0.093, respectively). In the univariate analysis, no significant difference was found in revascularization and in-hospital MI between the two groups (OR: 1.50, 95% CI: 0.95 to 2.38; OR: 0.28, 95% CI: 0.06 to 1.38, respectively) except for in-hospital mortality (OR: 1.12, 95% CI: 1.05 to 1.27). In multivariate analyses, in-hospital mortality of patients with EF ≥50% was still significantly lower than of patients with EF <50% (OR: 1.15, 95% CI: 1.08 to 1.33). There were no differences in revascularization and in-hospital MI between the two groups (OR: 0.85, 95% CI: 0.44 to 1.63; OR: 0.04, 95% CI: 0.00 to 1.84, respectively). Conclusions Reduced LVEF is a risk factor for in-hospital mortality in patients after PCI.
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Radovanovic D, Seifert B, Roffi M, Urban P, Rickli H, Pedrazzini G, Erne P. Gender differences in the decrease of in-hospital mortality in patients with acute myocardial infarction during the last 20 years in Switzerland. Open Heart 2017; 4:e000689. [PMID: 29177059 PMCID: PMC5687526 DOI: 10.1136/openhrt-2017-000689] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 08/23/2017] [Accepted: 10/04/2017] [Indexed: 01/07/2023] Open
Abstract
Objective To assess temporal trends of in-hospital mortality in patients with acute myocardial infarction (AMI) enrolled in the Swiss nationwide registry (AMIS Plus) over the last 20 years with regard to gender, age and in-hospital treatment. Methods All patients with AMI from 1997 to 2016 were stratified according to ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI), and gender using logistic regression analyses. Results Among 51 725 patients, 30 398 (59%) had STEMI and 21 327 (41%) had NSTEMI; 73% were men (63.9±12.8 years) and 27% were women (71.7±12.5 years). Over 20 years, crude in-hospital STEMI mortality decreased from 9.8% to 5.5% in men and from 18.3% to 6.9% in women. In patients with NSTEMI, it decreased from 7.1% to 2.1% in men and from 11.0% to 3.6% in women. After adjustment for age, mortality decreased per additional admission year by 3% in men with STEMI (OR 0.97, 95% CI 0.96 to 0.98, P<0.001), by 5% in women with STEMI (OR 0.95, 95% CI 0.93 to 0.96, P<0.001), by 6% in men with NSTEMI (OR 0.94, 95% CI 0.93 to 0.96, P<0.001) and by 5% in women with NSTEMI (OR 0.95, 95% CI 0.93 to 0.97, P<0.001). In patients <60 years, a decrease in mortality was seen in women with STEMI (OR 0.94, 95% CI 0.90 to 0.99, P=0.025) and NSTEMI (OR 0.87, 95% CI 0.80 to 0.94, P<0.001) but not in men with STEMI (OR 1.01, 95% CI 0.98 to 1.04, P=0.46) and NSTEMI (OR 0.98, 95% CI 0.94 to 1.03, P=0.41). The mortality decrease in patients with AMI was closely associated with the increase in reperfusion therapy. Conclusion From 1997 to 2016, in-hospital mortality of patients with AMI in Switzerland has halved and was more pronounced in women, particularly in the age category <60 years. Trial registration number NCT01305785; Results.
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Affiliation(s)
- Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Burkhardt Seifert
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Marco Roffi
- Division of Cardiology, University Hospital Geneva, Geneva, Switzerland
| | - Philip Urban
- Cardiology Department, La Tour Hospital, Geneva, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Paul Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
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Sugiyama T, Hasegawa K, Kobayashi Y, Takahashi O, Fukui T, Tsugawa Y. Differential time trends of outcomes and costs of care for acute myocardial infarction hospitalizations by ST elevation and type of intervention in the United States, 2001-2011. J Am Heart Assoc 2015; 4:e001445. [PMID: 25801759 PMCID: PMC4392430 DOI: 10.1161/jaha.114.001445] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Little is known whether time trends of in-hospital mortality and costs of care for acute myocardial infarction (AMI) differ by type of AMI (ST-elevation myocardial infarction [STEMI] vs. non-ST-elevation [NSTEMI]) and by the intervention received (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], or no intervention) in the United States. METHODS AND RESULTS We conducted a serial cross-sectional study of all hospitalizations for AMI aged 30 years or older using the Nationwide Inpatient Sample, 2001-2011 (1,456,154 discharges; a weighted estimate of 7,135,592 discharges). Hospitalizations were stratified by type of AMI and intervention, and the time trends of in-hospital mortality and hospital costs were examined for each combination of the AMI type and intervention, after adjusting for both patient- and hospital-level characteristics. Compared with 2001, adjusted in-hospital mortality improved significantly for NSTEMI patients in 2011, regardless of the intervention received (PCI odds ratio [OR] 0.68, 95% CI 0.56 to 0.83; CABG OR 0.57, 0.45 to 0.72; without intervention OR 0.61, 0.57 to 0.65). As for STEMI, a decline in adjusted in-hospital mortality was significant for those who underwent PCI (OR 0.83; 0.73 to 0.94); however, no significant improvement was observed for those who received CABG or without intervention. Hospital costs per hospitalization increased significantly for patients who underwent intervention, but not for those without intervention. CONCLUSIONS In the United States, the decrease in in-hospital mortality and the increase in costs differed by the AMI type and the intervention received. These non-uniform trends may be informative for designing effective health policies to reduce the health and economic burdens of AMI.
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Affiliation(s)
- Takehiro Sugiyama
- Department of Clinical Study and Informatics, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan (T.S.) Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.)
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA (K.H.)
| | - Yasuki Kobayashi
- Department of Public Health/Health Policy, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan (T.S., Y.K.)
| | - Osamu Takahashi
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.)
| | - Tsuguya Fukui
- Center for Clinical Epidemiology, St. Luke's International University, Tokyo, Japan (O.T., T.F.)
| | - Yusuke Tsugawa
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA (Y.T.) Harvard Interfaculty Initiative in Health Policy, Cambridge, MA (Y.T.)
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Dégano IR, Elosua R, Marrugat J. Epidemiología del síndrome coronario agudo en España: estimación del número de casos y la tendencia de 2005 a 2049. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2013.01.019] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Dégano IR, Elosua R, Marrugat J. Epidemiology of acute coronary syndromes in Spain: estimation of the number of cases and trends from 2005 to 2049. ACTA ACUST UNITED AC 2013; 66:472-81. [PMID: 24776050 DOI: 10.1016/j.rec.2013.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Abstract
Acute coronary syndromes are a leading cause of mortality, morbidity, and health care cost in Spain. The aims of this report are to estimate the number of acute coronary syndromes cases in the Spanish population in 2013 and 2021, and the trend from 2005 to 2049. We estimated the number of acute coronary syndromes cases by sex and Spanish autonomous community using data from the most updated population and hospital registries. We present the estimated number of cases with an exact 95% confidence interval, assuming that the number of cases followed a Poisson distribution. There will be 115,752 acute coronary syndromes cases in Spain in 2013 (95% confidence interval, 114,822-116,687). Within 28 days, 39,086 of these patients will die and 85,326 will be hospitalized. Non-ST segment elevation acute coronary syndromes (56%) and acute myocardial infarction (81%) will be the most common admission and discharge diagnoses, respectively. We estimate approximately 109,772 acute coronary syndromes cases in 2021 (95% confidence interval, 108,868-110,635). The trend of acute coronary syndromes cases from 2005 to 2049 will stabilize in the population aged 25 to 74 years, but increase in those older than 74 years. Due to population aging, the number of acute coronary syndrome cases will increase overall until 2049, it may stabilize in the population aged <75 years. The acute coronary syndromes case-fatality has decreased in hospitalized patients but the proportion of sudden deaths remains unchanged.
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Affiliation(s)
- Irene R Dégano
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain
| | - Roberto Elosua
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain.
| | - Jaume Marrugat
- Grupo de Investigación de Epidemiología y Genética Cardiovascular, Programa de Investigación en Trastornos Inflamatorios y Cardiovasculares, IMIM, Barcelona, Spain
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