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Mas-Llado C, Rossello X, González-Del-Hoyo M, Pocock S, de Werf FV, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines. Am J Med 2024; 137:137-146.e10. [PMID: 37838236 DOI: 10.1016/j.amjmed.2023.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE We aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries. METHODS Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients. RESULTS There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers). CONCLUSION Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
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Affiliation(s)
- Caterina Mas-Llado
- Cardiology Department, Hospital de Manacor, Spain; Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain; Cardiology Department, Health Research Institute of the Balearic Islands, Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | | | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
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González-Del-Hoyo M, Rossello X, Peral V, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Impact of standard modifiable cardiovascular risk factors on 2-year all-cause mortality: Insights from an international cohort of 23,489 patients with acute coronary syndrome. Am Heart J 2023; 264:20-30. [PMID: 37279841 DOI: 10.1016/j.ahj.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/20/2023] [Accepted: 05/28/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Controversial findings have been reported in the literature regarding the impact of the absence of standard modifiable cardiovascular risk factors (SMuRFs) on long-term mortality risk in patients with acute coronary syndrome (ACS). While the prognostic additive value of SMuRFs has been well described, the prognostic role of prior cardiovascular disease (CVD) by sex is less well-known in patients with and without SMuRFs. METHODS EPICOR and EPICOR Asia are prospective, observational registries conducted between 2010 and 2014, which enrolled ACS patients in 28 countries across Europe, Latin America, and Asia. Association between SMuRFs (diabetes, dyslipidaemia, hypertension, and smoking) and 2-year postdischarge mortality was evaluated using adjusted Cox models stratified by geographical region. RESULTS Among 23,489 patients, the mean age was 60.9 ± 11.9 years, 24.3% were women, 4,582 (20.1%) presented without SMuRFs, and 16,055 (69.5%) without prior CVD. Patients with SMuRFs had a higher crude 2-year postdischarge mortality (HR 1.86; 95% CI, 1.56-2.22; P < .001), compared to those without SMuRFs. After adjustment for potential confounding, the association between SMuRFs and 2-year mortality risk was substantially attenuated (HR 1.17, 95% CI 0.98-1.41; P = .087), regardless of the type of ACS. The risk conferred by prior CVD was added to the underlying risk of SMuRFs to provide risk-specific phenotypes (eg, women with SMuRFs and with prior CVD were at higher risk of dying than women without SMuRFs and without CVD; HR 1.67, 95% CI 1.34-2.06). CONCLUSIONS In this large-scale international ACS cohort the absence of SMuRFs was not associated with a lower adjusted 2-year postdischarge mortality risk. Patients with both SMuRFs and prior CVD had a higher mortality irrespective of their sex.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain.
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Stuart Pocock
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain; London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | | | - Jesús Medina
- BioPharmaceuticals Medical, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Wang J, Gao W, Chen G, Chen M, Wan Z, Zheng W, Ma J, Pang J, Wang G, Wu S, Wang S, Xu F, Chew DP, Chen Y. Biomarker-based risk model to predict cardiovascular events in patients with acute coronary syndromes - Results from BIPass registry. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 25:100479. [PMID: 35664511 PMCID: PMC9160492 DOI: 10.1016/j.lanwpc.2022.100479] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Risk models integrating new biomarkers to predict cardiovascular events in acute coronary syndromes (ACS) are lacking. Therefore, we evaluated the prognostic value of biomarkers in addition to clinical predictors and developed a biomarker-based risk model for major adverse cardiovascular events (MACE) within 12 months after hospital admission with ACS. METHODS Patients (n = 4407) consecutively enrolled from November, 2017 to October, 2019 in three hospitals of a prospective Chinese registry (BIomarker-based Prognostic Assessment for Patients with Stable Angina and Acute Coronary Syndromes, BIPass) were designated as the risk model development cohort. Validation was performed in 1409 patients enrolled in two independent hospitals. Cox proportional hazards regression analysis was used to generate a risk prediction model and evaluate the incremental prognostic value of each biomarker. FINDINGS Over 12 months, 196 patients experienced MACE (5.1%/year). Among twelve candidate biomarkers, N-terminal pro-B-type natriuretic peptide (NT-proBNP) measured at baseline showed the most prognostic capability independent of clinical predictors. The developed BIPass risk model included age, hypertension, previous myocardial infarction, stroke, Killip class, heart rate, and NT-proBNP. It displayed improved discrimination (C-statistic 0.79, 95% CI 0.73-0.85), calibration (GOF = 9.82, p = 0.28) and clinical decision curve in the validation cohort, outperforming the GRACE and TIMI risk scores. Cumulative rates for MACE demonstrated good separation in the BIPass predicted low, intermediate, and high-risk groups. INTERPRETATION The BIPass risk model, integrating clinical variables and NT-proBNP, is useful for predicting 12-month MACE in ACS. It effectively identifies a gradient risk of cardiovascular events to aid personalized care. FUNDING National Key R&D Program of China (2017YFC0908700, 2020YFC0846600), National S&T Fundamental Resources Investigation Project (2018FY100600, 2018FY100602), Taishan Pandeng Scholar Program of Shandong Province (tspd20181220), Taishan Young Scholar Program of Shandong Province (tsqn20161065, tsqn201812129), Youth Top-Talent Project of National Ten Thousand Talents Plan and Qilu Young Scholar Program.
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Affiliation(s)
- Jiali Wang
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Wei Gao
- Department of Cardiology, Peking University Third Hospital, Beijing 100191, China
| | - Guanghui Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing 100034, China
| | - Zhi Wan
- Department of Emergency, Huaxi Hospital, Chengdu 610041, China
| | - Wen Zheng
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jingjing Ma
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jiaojiao Pang
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Guangmei Wang
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Shuo Wu
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Shuo Wang
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Feng Xu
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Derek P. Chew
- Department of Cardiovascular Medicine, Flinders University, Adelaide, Australia
| | - Yuguo Chen
- Department of Emergency and Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China
- Shandong Provincal Clinical Research Center for Emergency and Critical Care Medicine, Jinan 250012, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Jinan, 250012, China
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
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Rossello X, Mas-Lladó C, Pocock S, Vicent L, van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Sex differences in mortality after an acute coronary syndrome increase with lower country wealth and higher income inequality. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:392-400. [PMID: 34175245 DOI: 10.1016/j.rec.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/05/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION AND OBJECTIVES Although several factors associated with sex differences in the management and outcomes after acute coronary syndrome (ACS) have been reported, little is known about the influence of socioeconomic factors on sex disparities. Our aim was to evaluate the influence of country wealth and income inequality on national sex differences in mortality after ACS. METHODS Sex differences in 2-year postdischarge mortality were evaluated in 23 489 ACS patients from the EPICOR and EPICOR Asia registries. Adjusted Cox regression models by country-based terciles of gross national income per capita and income inequality were used. RESULTS Women (24.3%) were older than men (65.5 vs 59.4 years, P <.001), had more comorbidities, were less often revascularized (63.6% vs 75.6%, P <.001) and received fewer guideline recommended therapies at discharge. Compared with men, a higher percentage of women died during follow-up (6.4% vs 4.9%, P <.001). The association between sex and mortality changed direction from hazard ratio (HR) 1.32 (95%CI, 1.17-1.49) in the univariate assessment to HR 0.76 (95%CI, 0.67-0.87) after adjustment for confounders. These differences were more evident with increasing country wealth (HRlow-incomecountries = 0.85; 95%CI, 0.72-1.00; HRmid-incomecountries = 0.66; 95%CI, 0.50-0.87; HRhigh-incomecountries = 0.60; 95%CI, 0.40-0.90; trend test P = .115) and with decreasing income inequality (HRlow-inequalityindex = 0.54; 95%CI, 0.36-0.81; HRintermediate-inequalityindex = 0.66; 95%CI, 0.50-0.88; HRhigh-inequalityindex = 0.87; 95%CI, 0.74-1.03; trend test P = .031). CONCLUSIONS Women with ACS living in high socioeconomic countries showed a lower postdischarge mortality risk compared with men. This risk was attenuated in countries with poorer socioeconomic background, where adjusted mortality rates were similar between women and men.
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Affiliation(s)
- Xavier Rossello
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain; Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom; Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Balearic Islands, Spain
| | - Caterina Mas-Lladó
- Servicio de Cardiología, Hospital Universitari Son Espases (HUSE), Palma, Balearic Islands, Spain; Grupo de Fisiopatología y Terapéutica Cardiovascular, Institut d'Investigació Sanitària Illes Balears (IdISBa), University Hospital Son Espases, Palma, Balearic Islands, Spain
| | - Stuart Pocock
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Lourdes Vicent
- Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Frans van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Chee Tang Chin
- Cardiology Department, National Heart Centre Singapore, Singapore, Republic of Singapore
| | - Nicolas Danchin
- Service de Cardiologie, Hôpital Européen Georges Pompidou & René Descartes University, Paris, France
| | - Stephen W L Lee
- Cardiology Department, Queen Mary Hospital, Pok Fu Lam, China
| | | | - Yong Huo
- Cardiology Department, Beijing University First Hospital, Beijing, China
| | - Héctor Bueno
- Laboratorio Traslacional para la Imagen y Terapia Cardiovascular, Centro Nacional de Investigaciones Cardiovasculares Carlos (CNIC), Madrid, Spain; Instituto de Investigación i+12 y Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Rossello X, Mas-Lladó C, Pocock S, Vicent L, Van de Werf F, Chin CT, Danchin N, Lee SW, Medina J, Huo Y, Bueno H. Las diferencias por sexo en la mortalidad tras un síndrome coronario agudo se incrementan en los países de menor riqueza y mayor desigualdad de ingresos. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Gawinski L, Engelseth P, Kozlowski R. Application of Modern Clinical Risk Scores in the Global Assessment of Risks Related to the Diagnosis and Treatment of Acute Coronary Syndromes in Everyday Medical Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179103. [PMID: 34501692 PMCID: PMC8431105 DOI: 10.3390/ijerph18179103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 08/23/2021] [Accepted: 08/25/2021] [Indexed: 11/16/2022]
Abstract
This article presents an overview of contemporary risk assessment systems used in patients with myocardial infarction. The full range of risk scales, both recommended by the European Society of Cardiology and others published in recent years, is presented. Scales for assessing the risk of ischemia/death as well as for assessing the risk of bleeding are presented. A separate section is devoted to systems assessing the integrated risk associated with both ischemia and bleeding. In the first part of the work, each of the risk scales is described in detail, including the clinical trials/registers on the basis of which they were created, the statistical methods used to develop them, as well as the specification of their individual parameters. The next chapter presents the practical application of a given scale in the patient risk assessment process, the timing of its application on the timeline of myocardial infarction, as well as a critical assessment of its potential advantages and limitations. The last part of the work is devoted to the presentation of potential directions for the development of risk assessment systems in the future.
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Affiliation(s)
- Lukasz Gawinski
- Department of Management and Logistics in Health Care, Medical University of Lodz, 90-237 Lodz, Poland
- Correspondence:
| | - Per Engelseth
- Narvik Campus, Tromsø School of Business and Economics, University of Tromsø, 8505 Narvik, Norway;
| | - Remigiusz Kozlowski
- Center of Security Technologies in Logistics, Faculty of Management, University of Lodz, 90-237 Lodz, Poland;
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Huo Y, Van de Werf F, Han Y, Rossello X, Pocock SJ, Chin CT, Lee SWL, Li Y, Jiang J, Vega AM, Medina J, Bueno H. Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia. Am J Cardiovasc Drugs 2021; 21:471-482. [PMID: 33537947 PMCID: PMC8263456 DOI: 10.1007/s40256-020-00447-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Information is lacking on long-term management of patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). OBJECTIVES Our objectives were to describe antithrombotic management patterns and outcomes in patients with ACS with varying renal function from the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients; NCT01171404) and EPICOR Asia (NCT01361386) studies. METHODS EPICOR and EPICOR Asia were prospective observational studies of patients who survived hospitalization for ACS and were enrolled at discharge in 28 countries across Europe, Latin America, and Asia. The studies were conducted from 2010 to 2013 and from 2011 to 2014, respectively. This analysis evaluated patient characteristics and oral antithrombotic management patterns and outcomes up to 2 years post-discharge according to admission eGFR: ≥ 90, 60-89, 30-59, or < 30 mL/min/1.73 m2. RESULTS Among 22,380 patients with available data, eGFR < 60 mL/min/1.73 m2 was observed in 16.7%. Patients with poorer renal function were older, were at greater cardiovascular risk, and had more prior cardiovascular disease and bleeding. Patients with CKD underwent fewer cardiovascular interventions and had more in-hospital cardiovascular and bleeding events. Dual antiplatelet therapy was less likely at discharge in patients with eGFR < 30 (82.3%) than in those with ≥ 90 (91.3%) mL/min/1.73 m2 and declined more sharply during follow-up in patients with low eGFR (p < 0.0001). An adjusted proportional hazards model showed that patients with lower eGFR levels had a higher risk of cardiovascular events and bleeding. CONCLUSIONS The presence of CKD in patients with ACS was associated with less aggressive cardiovascular management and an increased risk of cardiovascular events.
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China.
| | | | - Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, China
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Yi Li
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China
| | | | | | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
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Rossello X, Medina J, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Huo Y, Bueno H. Assessment of quality indicators for acute myocardial infarction management in 28 countries and use of composite quality indicators for benchmarking. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2020; 9:911-922. [DOI: 10.1177/2048872620911853] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background:
The European Society of Cardiology established a set of quality indicators for the management of acute myocardial infarction. Our aim was to evaluate their degree of attainment, prognostic value and potential use for centre benchmarking in a large international cohort.
Methods:
Quality indicators were extracted from the long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients (EPICOR) (555 hospitals, 20 countries in Europe and Latin America, 2010–2011) and EPICOR Asia (218 hospitals, eight countries, 2011–2012) registries, including non-ST-segment elevation acute myocardial infarction (n=6558) and ST-segment elevation acute myocardial infarction (n=11,559) hospital survivors. The association between implementation rates for each quality indicator and two-year adjusted mortality was evaluated using adjusted Cox models. Composite quality indicators were categorized for benchmarking assessment at different levels.
Results:
The degree of attainment of the 17 evaluated quality indicators ranged from 13% to 100%. Attainment of most individual quality indicators was associated with two-year survival. A higher compliance with composite quality indicators was associated with lower mortality at centre-, country- and region-level. Moreover, the higher the risk for two-year mortality, the lower the compliance with composite quality indicators.
Conclusions:
When EPICOR and EPICOR Asia were conducted, the European Society of Cardiology quality indicators would have been attained to a limited extent, suggesting wide room for improvement in the management of acute myocardial infarction patients. After adjustment for confounding, most quality indicators were associated with reduced two-year mortality and their prognostic value should receive further attention. The two composite quality indicators can be used as a tool for benchmarking either at centre-, country- or world region-level.
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Affiliation(s)
- Xavier Rossello
- Department of Cardiology, Hospital Universitari Son Espases (HUSE), Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Health Research Institute of the Balearic Islands (IdISBa), University Hospital Son Espases, Palma, Spain
| | | | - Stuart Pocock
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- London School of Hygiene and Tropical Medicine, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
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Zhou J, Chin CT, Huang X, Guo N, Wu Y, Yu B, Qiao S, Chen J, Han Y, Ge J, Pocock SJ, Huo Y, Wang Z, Yuan Z. Long-term antiplatelet therapy in medically managed non-ST-segment elevation acute coronary syndromes: The EPICOR Asia study. Int J Cardiol 2020; 327:19-24. [PMID: 33186669 DOI: 10.1016/j.ijcard.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/27/2020] [Accepted: 11/04/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To describe long-term antithrombotic management patterns (AMPs) in medically managed Asian patients with non-ST-segment myocardial infarction (NSTEMI) or unstable angina (UA). BACKGROUND Current guidelines support an early invasive strategy in NSTEMI and UA patients, but many are medically managed, and data are limited on long-term AMPs in Asia. METHODS Data were analyzed from medically managed NSTEMI and UA patients included in the prospective, observational EPICOR Asia study (NCT01361386). Survivors to hospital discharge were enrolled (June 2011 to May 2012) from 8 countries/regions across Asia. Baseline characteristics and AMP use up to 2 years post-discharge were collected. Outcomes were major adverse cardiovascular events (MACE: myocardial infarction, ischemic stroke, and death) and bleeding. RESULTS Among 2289 medically managed patients, dual antiplatelet therapy (DAPT) use at discharge was greater in NSTEMI than in UA patients (81.8% vs 65.3%), and was significantly associated with male sex, positive cardiac markers, and prior cardiovascular medications (p < 0.0001). By 2 years, 57.9% and 42.6% of NSTEMI and UA patients, respectively, were on DAPT. On multivariable Cox regression analysis, risk of MACE at 2 years was most significantly associated with older age (HR [95% CI] 1.85 [1.36, 2.50]), diagnosis of NSTEMI vs UA (1.96 [1.47, 2.61]), and chronic renal failure (2.14 [1.34, 3.41]), all p ≤ 0.001. Risk of bleeding was most significantly associated with region (East Asia vs Southeast/South Asia) and diabetes. CONCLUSIONS Approximately half of all patients were on DAPT at 2 years. MACE were more frequent in NSTEMI than UA patients during follow-up.
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Affiliation(s)
- Juan Zhou
- First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, PR China
| | | | - Xin Huang
- First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Ning Guo
- First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Yue Wu
- First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China
| | - Bo Yu
- Second Affiliated Hospital of Harbin Medical University, Harbin, PR China
| | - Shubin Qiao
- Fuwai Hospital, Xicheng District, Beijing, PR China
| | - Jiyan Chen
- Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yaling Han
- General Hospital of Shenyang Military Region, Liaoning, PR China
| | - Junbo Ge
- Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Yong Huo
- Peking University People's Hospital, Beijing, PR China
| | | | - Zuyi Yuan
- First Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, PR China; Key Laboratory of Environment and Genes Related to Diseases (Xi'an Jiaotong University), Ministry of Education, Xi'an, PR China.
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Guan S, Xu X, Li Y, Li J, Guan M, Wang X, Jing Q, Huo Y, Han Y. Impact of Diabetes Mellitus on Antithrombotic Management Patterns and Long-Term Clinical Outcomes in Patients With Acute Coronary Syndrome: Insights From the EPICOR Asia Study. J Am Heart Assoc 2020; 9:e013476. [PMID: 33164633 PMCID: PMC7763726 DOI: 10.1161/jaha.119.013476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Long‐term use of antiplatelet agents after acute coronary syndrome in diabetic patients is not well known. Here, we describe antiplatelet use and outcomes in such patients enrolled in the EPICOR Asia (Long‐Term Follow‐up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia) registry. Methods and Results EPICOR Asia is a prospective, observational study of 12 922 patients with acute coronary syndrome surviving to discharge, from 8 countries/regions in Asia. The present analysis included 3162 patients with diabetes mellitus (DM) and 9602 patients without DM. The impact of DM on use of antiplatelet agents and events (composite of death, myocardial infarction, and stroke, with or without any revascularization; individual components, and bleeding) was evaluated. Significant baseline differences were seen between patients with DM and patients without DM for age, sex, body mass index, cardiovascular history, angiographic findings, and use of percutaneous coronary intervention. At discharge, ≈90% of patients in each group received dual antiplatelet therapy. At 2‐year follow‐up, more patients with DM tended to still receive dual antiplatelet therapy (60% versus 56%). DM was associated with increased risk from ischemic but not major bleeding events. Independent predictors of the composite end point of death, myocardial infarction, and stroke in patients with DM were age ≥65 years and use of diuretics at discharge. Conclusions Antiplatelet agent use is broadly comparable in patients with DM and patients without DM, although patients with DM are more likely to be on dual antiplatelet therapy at 2 years. Patients with DM are at increased risk of ischemic events, suggesting an unmet need for improved antithrombotic treatment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01361386.
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Affiliation(s)
- Shaoyi Guan
- General Hospital of Northern Theater Command Shenyang China
| | - Xiaoming Xu
- General Hospital of Northern Theater Command Shenyang China
| | - Yi Li
- General Hospital of Northern Theater Command Shenyang China
| | - Jing Li
- General Hospital of Northern Theater Command Shenyang China
| | - Mingzi Guan
- General Hospital of Northern Theater Command Shenyang China
| | - Xiaozeng Wang
- General Hospital of Northern Theater Command Shenyang China
| | - Quanmin Jing
- General Hospital of Northern Theater Command Shenyang China
| | - Yong Huo
- Peking University First Hospital Beijing China
| | - Yaling Han
- General Hospital of Northern Theater Command Shenyang China
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Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. Int J Cardiol 2020; 315:1-8. [DOI: 10.1016/j.ijcard.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/28/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
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12
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Zheng B, Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Pocock SJ, Nhan VT, Alonso Garcia A, Chin CT, Jiang J, Jan S, Vega AM, Hayashi N, Ong TK. Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study. Clin Cardiol 2020; 43:999-1008. [PMID: 32618009 PMCID: PMC7462192 DOI: 10.1002/clc.23400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real‐world AMPs up to 2 years post discharge for ACS. Hypothesis There is wide variability in AMP use for ACS management in Asia. Methods EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months. Results Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow‐up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non‐randomized study. Conclusions Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.
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Affiliation(s)
- Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong, SAR, China
| | | | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
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13
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Zhang S, Wang W, Sawhney JPS, Krittayaphong R, Kim HS, Nhan VT, Lee SWL, Ong TK, Chin CT, Pocock SJ, Huo Y, Qian J, Ge J. Antithrombotic management and long-term outcomes following percutaneous coronary intervention for acute coronary syndrome in Asia. Int J Cardiol 2020; 310:16-22. [PMID: 32192746 DOI: 10.1016/j.ijcard.2020.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular diseases account for approximately half of all deaths in Asia. The present analysis aimed to evaluate characteristics, antithrombotic management patterns (AMPs), and outcomes in patients with acute coronary syndrome (ACS) who underwent in-hospital percutaneous coronary intervention (PCI) and survived to hospital discharge, using data from the EPICOR Asia registry (NCT01361386). METHODS Two-year post-discharge follow-up data were analyzed from 8757 ACS PCI patients from EPICOR Asia (218 centers, eight countries). Major adverse cardiovascular events (MACE; death, non-fatal myocardial infarction [MI], non-fatal ischemic stroke), PCI characteristics, and AMPs were recorded. For MACE, time - to - event was analyzed using Cox regression. RESULTS Primary PCI was performed in 62.0% of ST-segment elevation MI (STEMI), 38.7% of non-STEMI (NSTEMI), and 24.2% of unstable angina (UA) patients. At 12 months, 88.1% of patients were on dual antiplatelet therapy (DAPT), with no differences by index event. Most (61.5%) still received DAPT at 2 years. Two-year incidences of mortality, composite MACE, and bleeding were 3.6%, 6.2%, and 6.6%, respectively. Risk of death and MACE was increased with STEMI and NSTEMI vs. UA. Patients from East Asia showed lower mortality and more bleeding vs. Southeast Asia/India. CONCLUSIONS Many patients in EPICOR Asia underwent PCI and received DAPT up to 2 years post-discharge. These real-world findings improve our understanding of AMP impact on outcomes in Asian patients with ACS undergoing PCI.
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Affiliation(s)
- Shuning Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | | | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
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Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in China. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2020; 17:246-255. [PMID: 32547607 PMCID: PMC7276310 DOI: 10.11909/j.issn.1671-5411.2020.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objective To describe the long-term antithrombotic management patterns (AMPs) and clinical outcomes of Chinese patients with acute coronary syndrome (ACS). Methods This was an observational, multicenter, longitudinal cohort extension study of Chinese patients who had completed the EPICOR Asia 2-year follow-up study post-hospitalization for an ACS event. Changes in AMP and clinical outcomes for up to 5 years post-ACS event were evaluated. Results Overall, 2334 patients with ACS were enrolled at 49 sites. The mean age was 61.6 years and 76.3% were men. By study end, 2093 patients completed the 3-year follow-up. At baseline (2 years post-ACS event), 72.4% of patents received one antiplatelet (AP) medication, with aspirin being the preferred one. A small proportion of patients (21.5%) was treated with two or more APs (2+ AP), and even fewer patients (6.1%) did not receive any AP medication at baseline. Upon study completion, the proportion of patients without AP therapy increased to 13.6%, while the percentage of patients on one AP and 2+ AP decreased to 69.3% and 17.1%, respectively. Numerically, a higher incidence of clinical events (composite of all-cause mortality, myocardial infarction, stroke) was observed for the 2+ AP (13.2%) subgroup than for the no AP (10.5%) and one AP (8.6%) subgroups. Furthermore, the 2+ AP subgroup exhibited the greatest number of bleeding events, outpatient visits, and hospitalization rates. Unlike myocardial infarction or stroke, bleeding events prompted an adjustment in AMP. Conclusion Most patients in China received at least one AP medication up to 5 years after an ACS event.
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Zou Y, Yang S, Wang S, Lv B, Xiu L, Li L, Lee SWL, Chin CT, Pocock SJ, Huo Y, Yu B. Prolonged dual antiplatelet therapy in patients with non-ST-segment elevation myocardial infarction: 2-year findings from EPICOR Asia. Clin Cardiol 2020; 43:346-354. [PMID: 31967663 PMCID: PMC7144485 DOI: 10.1002/clc.23322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/29/2019] [Accepted: 12/01/2019] [Indexed: 11/15/2022] Open
Abstract
Background Patients with non‐ST‐segment elevation myocardial infarction (NSTEMI) have a generally poor prognosis and antithrombotic management patterns (AMPs) used post‐acute coronary syndrome (ACS) remain unclear. Duration of dual antiplatelet therapy (DAPT) and patient characteristics was evaluated in NSTEMI patients enrolled in EPICOR Asia. Hypothesis Patients stopping DAPT early may benefit from more intensive monitoring. Methods EPICOR Asia was a prospective, real‐world, primary data collection, cohort study in adults with an ACS, conducted in eight countries/regions in Asia, with 2 year follow‐up. Eligible patients were hospitalized within 48 hours of symptom onset and survived to discharge. We describe AMPs and baseline characteristics in NSTEMI patients surviving ≥12 months with DAPT duration ≤12 and > 12 months post‐discharge. Clinical outcomes (composite of death, myocardial infarction, and stroke; and bleeding) were also explored. Results At discharge, 90.8% of patients were on DAPT (including clopidogrel, 99%). At 1‐ and 2‐year follow‐up, this was 79.2% and 60.0%. Patients who stopped DAPT ≤12 months post‐discharge tended to be older, female, less obese, have prior cardiovascular disease, and have renal dysfunction. While causality cannot be inferred, the incidence of the composite endpoint over the subsequent 12 months was 10.6% and 3.1% with shorter vs longer use of DAPT, and mortality risk over the same period was 8.4% and 1.6%. Conclusions Over 90% of NSTEMI patients were discharged on DAPT, with 60% on DAPT at 2 years. Patients stopping DAPT early were more likely to have higher baseline risk and may therefore benefit from more intensive monitoring during long‐term follow‐up.
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Affiliation(s)
- Yanan Zou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shuang Yang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Shipeng Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Bo Lv
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lili Xiu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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Zheng Q, Jiang J, Huo Y, Chen D. Genetic predisposition to type 2 diabetes is associated with severity of coronary artery disease in patients with acute coronary syndromes. Cardiovasc Diabetol 2019; 18:131. [PMID: 31594547 PMCID: PMC6784340 DOI: 10.1186/s12933-019-0930-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 09/17/2019] [Indexed: 12/24/2022] Open
Abstract
Background Accumulating evidence has shown that type 2 diabetes (T2D) and coronary artery disease (CAD) may stem from a ‘common soil’. The aim of our study was to examine the association between genetic predisposition to T2D and the risk of severe CAD among patients with acute coronary syndromes (ACS) undergoing angiography. Methods The current case–control study included 1414 ACS patients with at least one major epicardial vessel stenosis > 50% enrolled in the ACS Genetic Study. The severity of CAD was quantified by the number of coronary arteries involved. Genetic risk score (GRS) was calculated using 41 common variants that robustly associated with increased risk of T2D in East Asians. Logistic regression models were used to estimate the association between GRS and the severity of CAD. Results In the age-, sex- and BMI-adjusted model, each additional risk allele was associated with a 6% increased risk of multi-vessel disease (OR = 1.06, 95% CI 1.02–1.09). The OR was 1.43 (95% CI 1.08–1.89) for the risk of severe CAD when comparing the extreme tertiles of T2D-GRS. The association was not reduced after further adjustment for conventional cardiovascular risk factors. Additional adjustment for T2D status in our regression model attenuated the association by approximately one quarter. In subgroup analysis, the strengths of the associations between GRS and the severity of CAD were broadly similar in terms of baseline demographic information and disease characteristics. Conclusions Our data indicated that genetic predisposition to T2D is associated with elevated risk of severe CAD. This association revealed a possible causal relationship and is partially mediated through diabetic status.
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Affiliation(s)
- Qiwen Zheng
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China.
| | - Dafang Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
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In-Hospital Coronary Revascularization Rates and Post-Discharge Mortality Risk in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2019; 74:1454-1461. [DOI: 10.1016/j.jacc.2019.06.068] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 06/21/2019] [Accepted: 06/27/2019] [Indexed: 01/12/2023]
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Sawhney JPS, Mullasari A, Kahali D, Mehta V, Nair T, Kaul U, Hirematth MS. Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. Indian Heart J 2019; 71:25-31. [PMID: 31000179 PMCID: PMC6477169 DOI: 10.1016/j.ihj.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/14/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023] Open
Abstract
Background Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study. Methods EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns. Results EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients. Conclusion This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.
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Jan S, Lee SWL, Sawhney JPS, Ong TK, Chin CT, Kim HS, Krittayaphong R, Nhan VT, Pocock SJ, Vega AM, Hayashi N, Huo Y. Predictors of high-cost hospitalization in the treatment of acute coronary syndrome in Asia: findings from EPICOR Asia. BMC Cardiovasc Disord 2018; 18:139. [PMID: 29973147 PMCID: PMC6033225 DOI: 10.1186/s12872-018-0859-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 06/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background The EPICOR Asia (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) study (NCT01361386) was an observational study of patients hospitalized for acute coronary syndromes (ACS) enrolled in 218 hospitals in eight countries/regions in Asia. This study examined costs, length of stay and the predictors of high costs during an ACS hospitalization. Methods and results Data for patients hospitalized for an ACS (n = 12,922) were collected on demographics, medical history, event characteristics, socioeconomic and insurance status at discharge. Patients were followed up at 6 weeks’ post-hospitalization for an ACS event to assess associated treatment costs from a health sector perspective. Primary outcome was the incurring of costs in the highest quintile by country and index event diagnosis, and identification of associated predictors. Cost data were available for 10,819 patients. Mean length of stay was 10.1 days. The highest-cost countries were China, Singapore, and South Korea. Significant predictors of high-cost care were age, male sex, income, country, prior disease history, hospitalization in 3 months before index event, no dependency before index event, having an invasive procedure, hospital type and length of stay. Conclusions Substantial variability exists in healthcare costs for hospitalized ACS patients across Asia. Of concern is the observation that the highest costs were reported in China, given the rapidly increasing numbers of procedures in recent years. Trial registration NCT01361386. Electronic supplementary material The online version of this article (10.1186/s12872-018-0859-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stephen Jan
- The George Institute for Global Health, Sydney Medical School, University of Sydney, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | | | | | | | | | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | - Vo T Nhan
- Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Ana M Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | | | - Yong Huo
- Peking University First Hospital, Beijing, China
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Bueno H, Rossello X, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Vega A, Huo Y. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 2018; 107:836-844. [PMID: 29663124 DOI: 10.1007/s00392-018-1254-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS 11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010-March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011-May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9-7.3%) in KS to 10.5% (8.3-12.7%) in LA. CONCLUSION Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.
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Affiliation(s)
- Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain. .,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. .,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.,London School of Hygiene and Tropical Medicine, London, UK.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou and René Descartes University, Paris, France
| | | | - Jesús Medina
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Ana Vega
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
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Chin CT, Ong TK, Krittayaphong R, Lee SWL, Sawhney JP, Kim HS, Garcia AA, Bueno H, Pocock SJ, Nhan VT, Vega A, Hayashi N, Huo Y. Characteristics and outcomes of medically managed patients with non-ST-segment elevation acute coronary syndromes: Insights from the multinational EPICOR Asia study. Int J Cardiol 2017; 243:15-20. [DOI: 10.1016/j.ijcard.2017.04.059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 12/31/2022]
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Pocock SJ, Huo Y, Van de Werf F, Newsome S, Chin CT, Vega AM, Medina J, Bueno H. Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:727-737. [PMID: 28777005 DOI: 10.1177/2048872617719638] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term risk of post-discharge mortality associated with acute coronary syndrome remains a concern. The development of a model to reliably estimate two-year mortality risk from hospital discharge post-acute coronary syndrome will help guide treatment strategies. METHODS EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (EPICOR Asia, NCT01361386) are prospective observational studies of 23,489 patients hospitalized for an acute coronary syndrome event, who survived to discharge and were then followed up for two years. Patients were enrolled from 28 countries across Europe, Latin America and Asia. Risk scoring for two-year all-cause mortality risk was developed using identified predictive variables and forward stepwise Cox regression. Goodness-of-fit and discriminatory power was estimated. RESULTS Within two years of discharge 5.5% of patients died. We identified 17 independent mortality predictors: age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class. Geographic variation in mortality risk was seen following adjustment for other predictive variables. The developed risk-scoring system provided excellent discrimination (c-statistic=0.80, 95% confidence interval=0.79-0.82) with a steep gradient in two-year mortality risk: >25% (top decile) vs. ~1% (bottom quintile). A simplified risk model with 11 predictors gave only slightly weaker discrimination (c-statistic=0.79, 95% confidence interval =0.78-0.81). CONCLUSIONS This risk score for two-year post-discharge mortality in acute coronary syndrome patients ( www.acsrisk.org ) can facilitate identification of high-risk patients and help guide tailored secondary prevention measures.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Simon Newsome
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ana Maria Vega
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Jesús Medina
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
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Global geographical variations in ST-segment elevation myocardial infarction management and post-discharge mortality. Int J Cardiol 2017; 245:27-34. [PMID: 28750924 DOI: 10.1016/j.ijcard.2017.07.039] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 06/15/2017] [Accepted: 07/12/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a shortage of information on regional variations in ST-segment elevation myocardial infarction (STEMI) management and prognosis at a global level. We aimed to compare patient profiles, in-hospital management and post-discharge mortality across several world regions. METHODS In total, 11,559 patients with STEMI were enrolled in two prospective studies of acute coronary syndrome survivors: EPICOR (4943 patients from 555 hospitals in 20 countries in Europe and Latin America recruited between September 2010 and March 2011) and EPICOR Asia (6616 patients from 218 hospitals in eight Asian countries recruited between June 2011 and May 2012). Comparisons were performed by eight pre-defined regions: Northern Europe (NE), Southern Europe (SE), Eastern Europe (EE), Latin America (LA), China (CN), India (IN), Southeast Asia (SA), and South Korea/Hong Kong/Singapore (KS). RESULTS Reperfusion therapy rates ranged between 53.9% (IN) and 81.2% (SE), primary percutaneous coronary intervention (PCI) between 24.8% (IN) and 65.6% (NE) and fibrinolysis between 8.1% (CN) and 34.2% (SA). Median time to primary PCI (h) ranged from 3.9 (NE) to 20.9 (IN) and to fibrinolysis from 2.4 (SE) to 6.3 (IN). Two-year mortality ranged between 2.5% in NE and 7.4% in LA. Regional variations in mortality persisted after adjustment for reperfusion therapy and known prognostic factors. CONCLUSIONS Among patients with STEMI, there is a wide regional variation in clinical profiles, hospital care and mortality. Substantial room for improvement remains at a global level for increasing reperfusion rates, reducing delays and post-discharge mortality in patients with STEMI.
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Ruda MY, Averkov OV, Khomitskaya YV. Long-term follow-up of antithrombotic management patterns in patients with acute coronary syndrome in Russia: an observational study (EPICOR-RUS study). Curr Med Res Opin 2017; 33:1269-1276. [PMID: 28420281 DOI: 10.1080/03007995.2017.1313214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study sought to describe the short- and long-term (up to 2 years) antithrombotic management patterns in a real-life setting for patients hospitalized for an acute coronary syndrome (ACS) event, and to document clinical outcomes. RESEARCH DESIGN AND METHODS EPICOR-RUS was a multicenter (34 centers), prospective, observational, longitudinal cohort study conducted across Russia on antithrombotic management in hospitalized (within 24 hours of symptom onset) ACS patients with 2 year follow-up. CLINICAL TRIAL REGISTRATION NCT01373957. RESULTS A total of 600 ACS patients (71.1% male, mean age 60 years) were enrolled; 599 were included for analysis. Diagnosis comprised STEMI (n = 375, 62.6%), NSTEMI (n = 147, 24.5%), and unstable angina (UA) (n = 77, 12.9%). Percutaneous coronary intervention (PCI) was conducted in 64.3% of patients with STEMI (with or without thrombolysis), 36.7% with NSTEMI, and 58.4% with UA. There was undertreatment with dual antiplatelet therapy (DAPT) for STEMI, NSTEMI, and UA: 14.7%, 25.9% and 16.9% of patients, respectively, were not receiving DAPT during hospitalization, and 10.1%, 21.8% and 16.9% at discharge. Post-discharge, of the STEMI group, only 72.4% of patients who were managed by PCI and 39.8% of conservatively treated patients received DAPT at 12 months. The respective figures in the NSTEMI group were 77.3% and 26.4%. In the STEMI cohort the cumulative incidence of all-cause mortality was 3.2% at 1 year and 5.1% at 2 years of follow-up; in the NSTEMI cohort this was 2.7% and 4.8%, respectively. There were no deaths by 12 months and one death by 24 months (1.3%) in the UA population. CONCLUSION Despite evidence-based guidelines for the management of ACS, the real-world setting in Russia shows discrepancies in clinical practice, highlighting the need for improvements for the optimal management of high-risk patients with ACS.
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Affiliation(s)
- Mikhail Ya Ruda
- a The Russian Cardiology Research and Production Complex , Moscow , Russian Federation
| | - Oleg V Averkov
- b City Clinical Hospital #15 , Moscow , Russian Federation
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Jan S, Lee SWL, Sawhney JPS, Ong TK, Chin CT, Kim HS, Krittayaphong R, Nhan VT, Itoh Y, Huo Y. Catastrophic health expenditure on acute coronary events in Asia: a prospective study. Bull World Health Organ 2016; 94:193-200. [PMID: 26966330 PMCID: PMC4773930 DOI: 10.2471/blt.15.158303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/24/2015] [Accepted: 12/04/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate out-of-pocket costs and the incidence of catastrophic health expenditure in people admitted to hospital with acute coronary syndromes in Asia. METHODS Participants were enrolled between June 2011 and May 2012 into this observational study in China, India, Malaysia, Republic of Korea, Singapore, Thailand and Viet Nam. Sites were required to enrol a minimum of 10 consecutive participants who had been hospitalized for an acute coronary syndrome. Catastrophic health expenditure was defined as out-of-pocket costs of initial hospitalization > 30% of annual baseline household income, and it was assessed six weeks after discharge. We assessed associations between health expenditure and age, sex, diagnosis of the index coronary event and health insurance status of the participant, using logistic regression models. FINDINGS Of 12,922 participants, 9370 (73%) had complete data on expenditure. The mean out-of-pocket cost was 3237 United States dollars. Catastrophic health expenditure was reported by 66% (1984/3007) of those without insurance versus 52% (3296/6366) of those with health insurance (P < 0.05). The occurrence of catastrophic expenditure ranged from 80% (1055/1327) in uninsured and 56% (3212/5692) of insured participants in China, to 0% (0/41) in Malaysia. CONCLUSION Large variation exists across Asia in catastrophic health expenditure resulting from hospitalization for acute coronary syndromes. While insurance offers some protection, substantial numbers of people with health insurance still incur financial catastrophe.
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Affiliation(s)
- Stephen Jan
- George Institute for Global Health, King George V Building, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
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Gridnev VI, Kiselev AR, Posnenkova OM, Popova YV, Dmitriev VA, Prokhorov MD, Dovgalevsky PY, Oschepkova EV. Objectives and Design of the Russian Acute Coronary Syndrome Registry (RusACSR). Clin Cardiol 2015; 39:1-8. [PMID: 26695366 DOI: 10.1002/clc.22495] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 11/01/2015] [Indexed: 12/21/2022] Open
Abstract
The Russian Acute Coronary Syndrome Registry (RusACSR) is a retrospective, continuous, nationwide, Web-based registry of patients with acute coronary syndromes (ACS). The RusACSR is a database that uses a secure Web-based interface for data entry by individual users. Participation in the RusACSR is voluntary. Any clinical center that provides health care to ACS patients can take part in the RusACSR. The RusACSR enrolls ACS patients who have undergone care in Russian hospitals from February 2008 to the present. Key data elements and methods of data analysis in the RusACSR are presented in this article. Up to 2015, 213 clinical centers from 36 regions of Russia had participated in the RusACSR. Currently, the database contains data on more than 250 000 ACS patients who underwent care from 2008 to 2015. Some current problems are highlighted in this article. The RusACSR is a perspective project for different epidemiologic studies in Russian ACS patients.
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Affiliation(s)
- Vladimir I Gridnev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Anton R Kiselev
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Olga M Posnenkova
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Yulia V Popova
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Viktor A Dmitriev
- Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia
| | - Mikhail D Prokhorov
- Laboratory of Nonlinear Dynamics Modelling, Saratov Branch of the Institute of Radio Engineering and Electronics of the Russian Academy of Sciences, Saratov, Russia
| | - Pavel Ya Dovgalevsky
- Department of New Cardiological Informational Technologies, Research Institute of Cardiology, Saratov State Medical University n.a. V.I. Razumovsky, Saratov, Russia
| | - Elena V Oschepkova
- Department of Registries of Cardiovascular Diseases, Russian Cardiology Research and Production Complex, Moscow, Russia
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