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Hall M, Smith L, Wu J, Hayward C, Batty JA, Lambert PC, Hemingway H, Gale CP. Health outcomes after myocardial infarction: A population study of 56 million people in England. PLoS Med 2024; 21:e1004343. [PMID: 38358949 PMCID: PMC10868847 DOI: 10.1371/journal.pmed.1004343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 01/05/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND The occurrence of a range of health outcomes following myocardial infarction (MI) is unknown. Therefore, this study aimed to determine the long-term risk of major health outcomes following MI and generate sociodemographic stratified risk charts in order to inform care recommendations in the post-MI period and underpin shared decision making. METHODS AND FINDINGS This nationwide cohort study includes all individuals aged ≥18 years admitted to one of 229 National Health Service (NHS) Trusts in England between 1 January 2008 and 31 January 2017 (final follow-up 27 March 2017). We analysed 11 non-fatal health outcomes (subsequent MI and first hospitalisation for heart failure, atrial fibrillation, cerebrovascular disease, peripheral arterial disease, severe bleeding, renal failure, diabetes mellitus, dementia, depression, and cancer) and all-cause mortality. Of the 55,619,430 population of England, 34,116,257 individuals contributing to 145,912,852 hospitalisations were included (mean age 41.7 years (standard deviation [SD 26.1]); n = 14,747,198 (44.2%) male). There were 433,361 individuals with MI (mean age 67.4 years [SD 14.4)]; n = 283,742 (65.5%) male). Following MI, all-cause mortality was the most frequent event (adjusted cumulative incidence at 9 years 37.8% (95% confidence interval [CI] [37.6,37.9]), followed by heart failure (29.6%; 95% CI [29.4,29.7]), renal failure (27.2%; 95% CI [27.0,27.4]), atrial fibrillation (22.3%; 95% CI [22.2,22.5]), severe bleeding (19.0%; 95% CI [18.8,19.1]), diabetes (17.0%; 95% CI [16.9,17.1]), cancer (13.5%; 95% CI [13.3,13.6]), cerebrovascular disease (12.5%; 95% CI [12.4,12.7]), depression (8.9%; 95% CI [8.7,9.0]), dementia (7.8%; 95% CI [7.7,7.9]), subsequent MI (7.1%; 95% CI [7.0,7.2]), and peripheral arterial disease (6.5%; 95% CI [6.4,6.6]). Compared with a risk-set matched population of 2,001,310 individuals, first hospitalisation of all non-fatal health outcomes were increased after MI, except for dementia (adjusted hazard ratio [aHR] 1.01; 95% CI [0.99,1.02];p = 0.468) and cancer (aHR 0.56; 95% CI [0.56,0.57];p < 0.001). The study includes data from secondary care only-as such diagnoses made outside of secondary care may have been missed leading to the potential underestimation of the total burden of disease following MI. CONCLUSIONS In this study, up to a third of patients with MI developed heart failure or renal failure, 7% had another MI, and 38% died within 9 years (compared with 35% deaths among matched individuals). The incidence of all health outcomes, except dementia and cancer, was higher than expected during the normal life course without MI following adjustment for age, sex, year, and socioeconomic deprivation. Efforts targeted to prevent or limit the accrual of chronic, multisystem disease states following MI are needed and should be guided by the demographic-specific risk charts derived in this study.
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Affiliation(s)
- Marlous Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Lesley Smith
- Leeds Institute for Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Jianhua Wu
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Chris Hayward
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Jonathan A. Batty
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
| | - Paul C. Lambert
- Biostatistics Research Group, Department of Population Health Sciences, University of Leicester, Leicester, United Kingdom
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Harry Hemingway
- Institute of Health Informatics, University College London, London, United Kingdom
- Health Data Research UK, University College London, London, United Kingdom
- NIHR Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, University College London, London, United Kingdom
- Charité Universitätsmedizin, Berlin, Germany
| | - Chris P. Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
- Leeds Institute for Data Analytics, University of Leeds, Leeds, United Kingdom
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Krishnamurthy SN, Pocock S, Kaul P, Owen R, Goodman SG, Granger CB, Nicolau JC, Simon T, Westermann D, Yasuda S, Andersson K, Brandrup-Wognsen G, Hunt PR, Brieger DB, Cohen MG. Comparing the long-term outcomes in chronic coronary syndrome patients with prior ST-segment and non-ST-segment elevation myocardial infarction: findings from the TIGRIS registry. BMJ Open 2023; 13:e070237. [PMID: 38110389 DOI: 10.1136/bmjopen-2022-070237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
OBJECTIVES Compared with ST-segment elevation myocardial infarction (STEMI) patients, non-STEMI (NSTEMI) patients have more comorbidities and extensive coronary artery disease. Contemporary comparative data on the long-term prognosis of stable post-myocardial infarction subtypes are needed. DESIGN Long-Term rIsk, clinical manaGement and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS) was a multinational, observational and longitudinal cohort study. SETTING Patients were enrolled from 350 centres, with >95% coming from cardiology practices across 24 countries, from 19 June 2013 to 31 March 2017. PARTICIPANTS This study enrolled 8277 stable patients 1-3 years after myocardial infarction with ≥1 additional risk factor. OUTCOME MEASURES Over a 2 year follow-up, cardiovascular events and deaths and self-reported health using the EuroQol 5-dimension questionnaire score were recorded. Relative risk of clinical events and health resource utilisation in STEMI and NSTEMI patients were compared using multivariable Poisson regression models, adjusting for prognostically relevant patient factors. RESULTS Of 7752 patients with known myocardial infarction type, 46% had NSTEMI; NSTEMI patients were older with more comorbidities than STEMI patients. NSTEMI patients had significantly poorer self-reported health and lower prevalence of dual antiplatelet therapy at hospital discharge and at enrolment 1-3 years later. NSTEMI patients had a higher incidence of combined myocardial infarction, stroke and cardiovascular death (5.6% vs 3.9%, p<0.001) and higher all-cause mortality (4.2% vs 2.6%, p<0.001) compared with STEMI patients. Risks were attenuated after adjusting for other patient characteristics. Health resource utilisation was higher in NSTEMI patients, although STEMI patients had more cardiologist visits. CONCLUSIONS Post-NSTEMI chronic coronary syndrome patients had a less favourable risk factor profile, poorer self-reported health and more adverse cardiovascular events during long-term follow-up than individuals post STEMI. Efforts are needed to recognise the risks of stable patients after NSTEMI and optimise secondary prevention and care. TRIAL REGISTRATION NUMBER NCT01866904.
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Affiliation(s)
- Sibi N Krishnamurthy
- Cardiovascular Division Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Prashant Kaul
- Interventional Cardiology, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Ruth Owen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Shaun G Goodman
- Division of Cardiology, Department of Medicine, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Granger
- Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Tabassome Simon
- Department of Clinical Pharmacology, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France
| | - Dirk Westermann
- Department of Cardiology and Angiology, University Heart Center Freiburg-Bad Krozingen, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | | | | | | | - David B Brieger
- Concord Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Mauricio G Cohen
- Heart, Vascular & Thoracic Institute, Cleveland Clinic Florida, Weston, Florida, USA
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Soloveva A, Gale CP, Han NT, Hurdus B, Aktaa S, Palin V, Mebrahtu TF, Van Spall H, Batra G, Dondo TB, Bäck M, Munyombwe T. Associations of health-related quality of life with major adverse cardiovascular and cerebrovascular events for individuals with ischaemic heart disease: systematic review, meta-analysis and evidence mapping. Open Heart 2023; 10:e002452. [PMID: 37890894 PMCID: PMC10619110 DOI: 10.1136/openhrt-2023-002452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE To investigate the association between health-related quality of life (HRQoL) and major adverse cardiovascular and cerebrovascular events (MACCE) in individuals with ischaemic heart disease (IHD). METHODS Medline(R), Embase, APA PsycINFO and CINAHL (EBSCO) from inception to 3 April 2023 were searched. Studies reporting association of HRQoL, using a generic or cardiac-specific tool, with MACCE or components of MACCE for individuals with IHD were eligible for inclusion. Risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale to assess the quality of the studies. Descriptive synthesis, evidence mapping and random-effects meta-analysis were performed stratified by HRQoL measures and effect estimates. Between-study heterogeneity was assessed using the Higgins I2 statistic. RESULTS Fifty-one articles were included with a total of 134 740 participants from 53 countries. Meta-analysis of 23 studies found that the risk of MACCE increased with lower baseline HeartQoL score (HR 1.49, 95% CI 1.16 to 1.93) and Short Form Survey (SF-12) physical component score (PCS) (HR 1.39, 95% CI 1.28 to 1.51). Risk of all-cause mortality increased with a lower HeartQoL (HR 1.64, 95% CI 1.34 to 2.01), EuroQol 5-dimension (HR 1.17, 95% CI 1.12 to 1.22), SF-36 PCS (HR 1.29, 95% CI 1.19 to 1.41), SF-36 mental component score (HR 1.18, 95% CI 1.08 to 1.30). CONCLUSIONS This study found an inverse association between baseline values or change in HRQoL and MACCE or components of MACCE in individuals with IHD, albeit with between-study heterogeneity. Standardisation and routine assessment of HRQoL in clinical practice may help risk stratify individuals with IHD for tailored interventions. PROSPERO REGISTRATION NUMBER CRD42021234638.
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Affiliation(s)
- Anzhela Soloveva
- Department of Cardiology, Almazov National Medical Research Centre, Sankt-Peterburg, Russian Federation
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Naung Tun Han
- Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Ben Hurdus
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Suleman Aktaa
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Victoria Palin
- Department of Cardiology, Leeds General Infirmary, Leeds, UK
| | - Teumzghi F Mebrahtu
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Harriette Van Spall
- Population Health Research Institute, Hamilton, Ontario, Canada
- Division of Cardiology, McMaster University, Hamilton, Ontario, Canada
| | - Gorav Batra
- Cardiology and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Tatendashe Bernadette Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
| | - Maria Bäck
- Department of Medical and Health Sciences, Linköping University, Linkoping, Sweden
| | - Theresa Munyombwe
- Leeds Institute of Cardiovascular and Metabolic Medicine/Leeds Institute of Data analytics, University of Leeds, Leeds, UK
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Liegey JS, Fawaz S, Ducos C, Pucheu Y, Boulestreau R, Sibon I, Couffinhal T. Predictive utility of stress tests in the detection of asymptomatic coronary artery disease in atherosclerotic stroke patients. J Stroke Cerebrovasc Dis 2023; 32:107290. [PMID: 37567133 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/26/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION Whether and how atherosclerotic ischemic stroke patients should be investigated for asymptomatic coronary artery disease (CAD) is controversial. Our aim was to carry out a prospective observational study to determine the frequency and predictors of functionally significant coronary stenosis in these patients as well as the predictors of major adverse cardiovascular events (MACE) during post-stroke follow-up. MATERIAL AND METHODS From January 2014 to June 2018, patients with atherosclerotic ischemic stroke were referred from the stroke unit to our cardiovascular department 3+/- 1 months after the acute event where they benefited from evaluation of cardiovascular risk factors, vascular and myocardial disease. Main outcome was defined as the prevalence of myocardial ischemia defined by perfusion stress echography 3 months after stroke. Secondary outcome (MACE) was defined as the incidence of stroke, transient ischemic attack (TIA), acute coronary syndrome, cardiovascular (CV) death or coronary or peripheral revascularization during a 3 year follow-up. RESULTS Three hundred and twenty five patients (92% of strokes and 8% TIA) were included and median follow-up was 1075 days. At 3 months post-stroke, myocardial ischemia was found in 17 patients (5.2%). During the 3 year follow-up, 11 MACE occurred (3.4%, all in the non-ischemic group) of which 6 were recurrent strokes. In multivariate analysis, myocardial ischemia was significantly associated with the number of atheromatous vascular beds (OR 4.3; 95% CI, 1.7 to 10.6) and ECG signs of necrosis (OR 6.5; 95% CI, 1.9 to 21.9). MACE were also associated with ECG signs of necrosis (OR 3.5; 95% CI, 1.3 to 9.1), and unrelated to myocardial ischemia. CONCLUSION Myocardial ischemia and CV events were infrequent and both strongly associated with ECG signs of necrosis, suggesting a low yield of stress tests and the potential for a more straightforward algorithm in the choice of patients eligible to coronary angiogram or other coronary imaging in post-stroke setting.
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Affiliation(s)
- Jean-Sébastien Liegey
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France.
| | - Sami Fawaz
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France.
| | - Claire Ducos
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France.
| | - Yann Pucheu
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France.
| | - Romain Boulestreau
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France.
| | - Igor Sibon
- CHU de Bordeaux, Service de Neurologie, Hopital Pellegrin, Rue de la Pelouse de Douet, Bordeaux, 33076, France.
| | - Thierry Couffinhal
- CHU de Bordeaux, Service de Maladies Coronaires et Vasculaires, F-33600 Pessac, France; Univ. Bordeaux, INSERM, Biologie des maladies cardiovasculaires, U1034, F-33600 Pessac, France.
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Nicolau JC, Owen R, Furtado RHM, Goodman SG, Granger CB, Cohen MG, Westermann D, Yasuda S, Simon T, Hedman K, Hunt PR, Brieger DB, Pocock SJ. Long-term outcomes among stable post-acute myocardial infarction patients living in rural versus urban areas: insights from the prospective, observational TIGRIS registry. Open Heart 2023; 10:e002326. [PMID: 37604649 PMCID: PMC10445369 DOI: 10.1136/openhrt-2023-002326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/11/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited. METHODS The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stable coronary artery dISease (TIGRIS), a prospective, observational registry, enrolled 8452 patients aged ≥50 years 1-3 years post-AMI from June 2013 to November 2014 from 24 countries in Asia Pacific/Australia, Europe, North America and South America. Differences in QoL (measured using the EuroQol Research Foundation instrument) and HRU between patients in rural and urban settings were evaluated in this post hoc analysis. The incidence of clinical endpoints (cardiovascular (CV) death, AMI, unstable angina with urgent revascularisation and stroke; bleeding; and all-cause mortality) was analysed. Data were collected at baseline and every 6 months for 24 months. RESULTS There were fewer hospitalisations and visits to general practitioners (GPs) and cardiologists in the rural versus urban populations (adjusted event rate ratio (ERR)=0.90 (95% CI, 0.82 to 1.00, p=0.04); ERR=0.84 (95% CI, 0.78 to 0.92, p<0.001); ERR=0.86 (95% CI, 0.81 to 0.92, p<0.001), respectively). No statistically significant differences were observed between rural and urban populations in all-cause death, AMI, unstable angina with urgent revascularisation, CV death, stroke, major bleeding events and health-related QoL. The adjusted incidence rate ratio was 0.92 (95% CI, 0.74 to 1.15) for the composite of CV death, AMI and stroke. CONCLUSIONS Living in rural areas was associated with fewer GP/cardiologist visits and hospitalisations; no significant differences in clinical outcomes and QoL were observed. TRIAL REGISTRATION NUMBER NCT01866904.
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Affiliation(s)
- Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, UK
| | - Remo H M Furtado
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Christopher B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Mauricio G Cohen
- Cleveland Clinic Florida, Heart & Vascular Center, Cleveland, Ohio, USA
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Tabassome Simon
- Department of Clinical Pharmacology and Research Platform of East of Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Université, Paris, France
| | - Katarina Hedman
- BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden
| | | | - David B Brieger
- Cardiology Department, Concord Hospital, Sydney, New South Wales, Australia
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Rachwalik M, Matusiewicz M, Jasiński M, Hurkacz M. Evaluation of the usefulness of determining the level of selected inflammatory biomarkers and resistin concentration in perivascular adipose tissue and plasma for predicting postoperative atrial fibrillation in patients who underwent myocardial revascularisation. Lipids Health Dis 2023; 22:2. [PMID: 36624488 PMCID: PMC9827643 DOI: 10.1186/s12944-022-01769-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/28/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The development of coronary artery disease (CAD) is related to the impaired quantity and composition of inflammatory proteins found in plasma and tissue, such as interleukin 6 (IL-6), adipokines, and resistin. Therefore, the level of plasma resistin in patients with advanced CAD could be indicative of the condition of epicardial adipose tissue and thus have an impact on the frequency and severity of postoperative complications in the form of paroxysmal atrial fibrillation. METHODS The study included 108 patients who qualified for elective coronary artery bypass grafting (CABG) surgery from 2017 to 2020 and were categorized into two groups. The first group consisted of patients who developed atrial fibrillation in the postoperative period - the AF group, and the second group included patients who did not have arrhythmia - the non-AF group. The analysis incorporates the history, course of treatment, anthropometric characteristics of the test subjects, biochemical laboratory tests, and echocardiography. Perivascular adipose tissue (PVAT) sections were surgically harvested from the area of the left coronary trunk. RESULTS The resistin levels in the PVAT were significantly higher in the AF group than in the non-AF group (P = 0.000015). Similarly, plasma resistin levels increased significantly in the AF group compared to the non-AF group (P = 0.044). The values of other analyzed variables were not significantly different (analysis performed using the Mann-Whitney U test). Spearman's rank-order correlation technique found a correlation between resistin in PVAT and plasma (r = 0.5933; P < 0.0001) in the whole study group, as well as in the AF group (r = 0.4782; P = 0.021) and the non-AF group (r = 0.4938; P < 0.0001). A correlation arose between the level of resistin in PVAT and the level of hsCRP (r = 0.3463; P = 0.005) in the whole study group and the non-AF group (r = 0.4448; P = 0.0011); however, no such correlation appeared in the AF group (r = 0.3076; P = 0.306). CONCLUSIONS Elevated levels of plasma resistin, which reflect PVAT resistin levels in patients qualified for myocardial revascularisation, may be associated with postoperative atrial fibrillation complications.
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Affiliation(s)
- M. Rachwalik
- grid.4495.c0000 0001 1090 049XClinical Department of Cardiac Surgery, Department of Cardiac Surgery and Heart Transplantation, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - M. Matusiewicz
- grid.4495.c0000 0001 1090 049XDepartment of Biochemistry and Immunochemistry, Wroclaw Medical University, Wrocław, Poland
| | - M. Jasiński
- grid.4495.c0000 0001 1090 049XClinical Department of Cardiac Surgery, Department of Cardiac Surgery and Heart Transplantation, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland ,grid.413923.e0000 0001 2232 2498Childrens Memorial Health Institute in Warsaw, Warsaw, Poland
| | - M. Hurkacz
- grid.4495.c0000 0001 1090 049XDepartment of Clinical Pharmacology, Wroclaw Medical University, Borowska 211 Str 50-556, Wrocław, Poland
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Bagai A, Ali FM, Gregson J, Alexander KP, Cohen MG, Sundell KA, Simon T, Westermann D, Yasuda S, Brieger D, Goodman SG, Nicolau JC, Granger CB, Pocock S. Multimorbidity, functional impairment, and mortality in older patients stable after prior acute myocardial infarction: Insights from the TIGRIS registry. Clin Cardiol 2022; 45:1277-1286. [PMID: 36317424 DOI: 10.1002/clc.23915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/16/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Data on the association of multimorbidity and functional impairment with cardiovascular (CV) and non-CV outcomes among older myocardial infarction (MI) patients are limited. HYPOTHESIS Multimorbidity and functional impairment among older MI patients are associated with CV and non-CV mortality. METHODS Patients aged ≥65 years, 1-3 years post-MI, and enrolled between June 2013 and Novemeber 2014 from 349 sites in 25 countries in the global TIGRIS registry were categorized by age, number of comorbidities, and presence and degree of functional impairment. Functional impairment was calculated using five-dimension EuroQol based on three domains-mobility, self-care, and usual activities. The association between age, number of comorbid conditions, and degree of functional impairment with 2-year incidence of CV and non-CV death was evaluated using Poisson regression analysis. RESULTS Older age was associated with higher number of comorbidities and functional impairment; after adjustment, increasing age was significantly associated with non-CV mortality (p = .03) but not CV mortality (p = .38). Greater functional impairment was associated with a higher rate and relatively equal magnitude risk of CV (rate ratios [RR] 1.52, 95% confidence intervals [CI]: 1.29-1.79, per one-step increase) and non-CV mortality (RR 1.42, 95% CI: 1.17-1.73). Multimorbidity was more strongly associated with CV mortality (RR 1.52, 95% CI: 1.38-1.67, per additional comorbidity) versus non-CV mortality (RR 1.29, 95% CI: 1.14-1.47, per additional comorbidity). CONCLUSIONS Multimorbidity and functional impairment are prevalent among older post-MI patients and are associated with increased CV and non-CV mortality. These findings highlight the importance of considering comorbid conditions and functional impairment as predictors of risk for adverse outcomes and aspects of medical decision making. Clinical Trial Registration: NCT01866904.
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Affiliation(s)
- Akshay Bagai
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Faeez M Ali
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Karen P Alexander
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Mauricio G Cohen
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique-Hopitaux de Paris, Paris, France
- Clinical Pharmacology-Research Platform (UPMC-Paris 06), Sorbonne Université, Paris, France
| | - Dirk Westermann
- Department of Cardiology and Angiology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - David Brieger
- Cardiology Department, Concord Hospital, Sydney, Australia
| | - Shaun G Goodman
- Terrence Donnelly Heart Center, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
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Hwang SY, Kim SH, Uhm IA, Shin JH, Lim YH. Prognostic implications for patients after myocardial infarction: an integrative literature review and in-depth interviews with patients and experts. BMC Cardiovasc Disord 2022; 22:348. [PMID: 35918641 PMCID: PMC9344648 DOI: 10.1186/s12872-022-02753-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background As patients with myocardial infarction (MI) survive for a long time after acute treatment, it is necessary to pay attention to the prevention of poor prognosis such as heart failure (HF). To identify the influencing factors of adverse clinical outcomes through a review of prospective cohort studies of post-MI patients, and to draw prognostic implications through in-depth interviews with post-MI patients who progressed to HF and clinical experts. Methods A mixed-method design was used that combined a scoping review of 21 prospective cohort studies, in-depth interviews with Korean post-MI patients with HF, and focus group interviews with cardiologists and nurses. Results A literature review showed that old age, diabetes, high Killip class, low left ventricular ejection fraction, recurrent MI, comorbidity of chronic disease and current smoking, and low socioeconomic status were identified as influencing factors of poor prognosis. Through interviews with post-MI patients, these influencing factors identified in the literature as well as a lack of disease awareness and lack of self-care were confirmed. Experts emphasized the importance of maintaining a healthy lifestyle after acute treatment with the recognition that it is a chronic disease that must go together for a lifetime. Conclusion This study confirmed the factors influencing poor prognosis after MI and the educational needs of post-MI patients with transition to HF. Healthcare providers should continue to monitor the risk group, which is expected to have a poor prognosis, along with education emphasizing the importance of self-care such as medication and lifestyle modification.
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Affiliation(s)
| | - Sun Hwa Kim
- Department of Nursing, Hanyang University Medical Center, 222-1 Wangsimniro, Seondong-gu, Seoul, 04763, South Korea.
| | - In Ae Uhm
- School of Nursing, Hanyang University, Seoul, South Korea
| | - Jeong-Hun Shin
- Division of Cardiology, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri-si, Gyeonggi-do, South Korea
| | - Young-Hyo Lim
- Division of Cardiology Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, South Korea.
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9
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Brieger D, Chew D, Goodman S, Hammett C, Lefkovits J, Farouque O, Atherton J, Hyun K, D'Souza M. Balancing the Risks of Recurrent Ischaemic and Bleeding Events in a Stable Post ACS Population. Heart Lung Circ 2022; 31:1349-1359. [PMID: 35863981 DOI: 10.1016/j.hlc.2022.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 05/20/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To better guide decisions regarding antithrombotic treatment in individual patients surviving 6 months following an acute coronary syndrome (ACS) by balancing between subsequent recurrent ischaemic and bleeding risk. METHODS Patients surviving 6 months following an ACS were followed in an Australian registry. Ischaemic (composite of cardiovascular death, myocardial infarction or stroke) and bleeding (≥BARC 2) events were collected. A dual binary outcome modelling strategy was used arriving at a common set of variables from which bleeding and ischaemic risk could be independently determined in individual patients. Patients in whom bleeding rates exceeded composite ischaemic event rates during the follow-up period were identified. RESULTS The cohort comprised 5,905 patients in whom 215 experienced an ischaemic event and 49 a bleeding event. The single set of variables included in both ischaemic and bleeding models (C-statistics 0.71 and 0.72 respectively) included modified TIGRIS1 ischaemic score, mode of revascularisation, history of heart failure, anaemia, multivessel disease, readmission within 6 months of index ACS and age >75. In the majority, ischaemic events were more frequent than bleeding events. In higher risk patients post coronary artery bypass grafting (CABG), bleeding events were more frequent than recurrent ischaemic events. CONCLUSION The risk of recurrent ischaemic events exceeds bleeding in most patients followed 6 to 24 months following an ACS. Post CABG patients with comorbidities have a higher risk of bleeding over this period during which time attention should be directed towards modifiable bleeding risk factors including requirement for dual antiplatelet therapy.
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Affiliation(s)
- David Brieger
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia.
| | - Derek Chew
- Flinders Medical Centre, Adelaide, SA, Australia
| | | | | | | | | | - John Atherton
- Princess Alexandra Hospital, Brisbane, Qld, Australia
| | - Karice Hyun
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia; School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Mario D'Souza
- Concord Hospital, and ANZAC Institute University of Sydney, Sydney, NSW, Australia
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10
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Carnicelli AP, Owen R, Pocock SJ, Brieger DB, Yasuda S, Nicolau JC, Goodman SG, Cohen MG, Simon T, Westermann D, Hedman K, Andersson Sundell K, Granger CB. Atrial fibrillation and clinical outcomes 1 to 3 years after myocardial infarction. Open Heart 2021; 8:openhrt-2021-001726. [PMID: 34911791 PMCID: PMC8679122 DOI: 10.1136/openhrt-2021-001726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 12/12/2022] Open
Abstract
Objective Atrial fibrillation (AF) and myocardial infarction (MI) are commonly comorbid and associated with adverse outcomes. Little is known about the impact of AF on quality of life and outcomes post-MI. We compared characteristics, quality of life and clinical outcomes in stable patients post-MI with/without AF. Methods/results The prospective, international, observational TIGRIS (long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease) registry included 8406 patients aged ≥50 years with ≥1 atherothrombotic risk factor who were 1–3 years post-MI. Patient characteristics were summarised by history of AF. Quality of life was assessed at baseline using EQ-5D. Clinical outcomes over 2 years of follow-up were compared. History of AF was present in 702/8277 (8.5%) registry patients and incident AF was diagnosed in 244/7575 (3.2%) over 2 years. Those with AF were older and had more comorbidities than those without AF. After multivariable adjustment, patients with AF had lower self-reported quality-of-life scores (EQ-5D UK-weighted index, visual analogue scale, usual activities and pain/discomfort) than those without AF. CHA2DS2-VASc score ≥2 was present in 686/702 (97.7%) patients with AF, although only 348/702 (49.6%) were on oral anticoagulants at enrolment. Patients with AF had higher rates of all-cause hospitalisation (adjusted rate ratio 1.25 [1.06–1.46], p=0.008) over 2 years than those without AF, but similar rates of mortality. Conclusions In stable patients post-MI, those with AF were commonly undertreated with oral anticoagulants, had poorer quality of life and had increased risk of clinical outcomes than those without AF. Trial registration number ClinicalTrials: NCT01866904.
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Affiliation(s)
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Stuart J Pocock
- Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David B Brieger
- Cardiology, Concord Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo Instituto do Coracao, Sao Paulo, Brazil
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Mauricio G Cohen
- Cardiovascular Division Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of East of Paris, Assistance Publique - Hopitaux de Paris, Paris, France.,Clinical Pharmacology-Research Platform (UPMC-Paris 06), Sorbonne Université, Paris, France
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Partner Site Hamburg/Lübeck/Kiel, German Center for Cardiovascular Research (DZHK), Hamburg, Germany
| | | | | | - Christopher B Granger
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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11
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Wahrenberg A, Kuja-Halkola R, Magnusson PKE, Häbel H, Warnqvist A, Hambraeus K, Jernberg T, Svensson P. Cardiovascular Family History Increases the Risk of Disease Recurrence After a First Myocardial Infarction. J Am Heart Assoc 2021; 10:e022264. [PMID: 34845931 PMCID: PMC9075368 DOI: 10.1161/jaha.121.022264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background Family history of atherosclerotic cardiovascular disease (ASCVD) is easily accessible and captures genetic cardiovascular risk, but its prognostic value in secondary prevention is unknown. Methods and Results We followed 25 615 patients registered in SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) from their 1‐year revisit after a first‐time myocardial infarction during 2005 to 2013, until December 31, 2018. Data on relatives, diagnoses and socioeconomics were extracted from national registers. The association between family history and recurrent ASCVD was studied with Cox proportional‐hazard regression, adjusting for risk factors and socioeconomics. A family history of ASCVD was defined as hospitalization due to myocardial infarction, angina with coronary revascularization, stroke, or cardiovascular death in ≥1 parent or full sibling, with early‐onset defined as disease‐onset before 55 years in men and 65 in women. The additional discriminatory value of family history to Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention was assessed with Harrell’s C‐index difference and reclassification was studied with continuous net reclassification improvement. Family history of early‐onset ASCVD in ≥1 first‐degree relative was present in 2.3% and was associated with recurrent ASCVD (hazard ratio [HR] 1.31; 95% CI, 1.17–1.47), fully adjusted for risk factors (HR, 1.22; 95% CI, 1.05–1.42). Early‐onset family history improved the discriminatory ability of the Thrombolysis in Myocardial Infarction Risk Score for Secondary Prevention, with Harrell’s C improving 0.003 points (95% CI, 0.001–0.005) from initial 0.587 (95% CI, 0.576–0.595) and improved reclassification (continuous net reclassification improvement 2.1%, P<0.001). Conclusions Family history of early‐onset ASCVD is associated with recurrent ASCVD after myocardial infarction, independently of traditional risk factors and improves secondary risk prediction. This may identify patients to target for intensified secondary prevention.
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Affiliation(s)
- Agnes Wahrenberg
- Division of Cardiology Department of Clinical Science and Education Karolinska InstitutetSödersjukhuset Stockholm Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Patrik K E Magnusson
- Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden
| | - Henrike Häbel
- Karolinska InstitutetInstitute of Environmental Medicine Stockholm Sweden
| | - Anna Warnqvist
- Karolinska InstitutetInstitute of Environmental Medicine Stockholm Sweden
| | | | - Tomas Jernberg
- Department of Clinical Sciences Karolinska InstitutetDanderyd University Hospital Stockholm Sweden
| | - Per Svensson
- Division of Cardiology Department of Clinical Science and Education Karolinska InstitutetSödersjukhuset Stockholm Sweden
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12
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Russo JJ, Yan AT, Pocock SJ, Brieger D, Owen R, Sundell KA, Bagai A, Granger CB, Cohen MG, Yasuda S, Nicolau JC, Brandrup-Wognsen G, Westermann D, Simon T, Goodman SG. Determinants of long-term dual antiplatelet therapy use in post myocardial infarction patients: Insights from the TIGRIS registry. J Cardiol 2021; 79:522-529. [PMID: 34857432 DOI: 10.1016/j.jjcc.2021.10.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/15/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Patterns of dual antiplatelet therapy (DAPT) use beyond 1 year post-myocardial infarction (MI) have not been well studied. METHODS TIGRIS (NCT01866904) was a prospective, multi-center (369 centers in 24 countries), observational study of patients 1 to 3 years post-MI. We sought to identify the prevalence and determinants of DAPT use ≥1 year post-MI in patients enrolled in TIGRIS. We used multivariable logistic regression to identify determinants of DAPT use at 396 days post-MI (365 days plus a 31day overrun period to account for intended DAPT discontinuation at 1 year). Patients treated with an oral anticoagulant were excluded. RESULTS Of 7708 patients (median age 67 years, women 25%, ST-elevation MI 50%), 39% and 16% were on DAPT at 396 days and 5 years post-MI, respectively. DAPT use at 396 days post-MI was more prevalent in patients <65 years of age, treated with percutaneous coronary intervention (versus coronary artery bypass grafting or medical therapy), and with multivessel disease or a history of angina. Additional clinical determinants of ischemic and/or bleeding events following MI (diabetes, second prior MI, hypertension, peripheral artery disease, heart failure, smoking, and renal insufficiency) were not independently associated with DAPT use at 396 days. There were geographic variations in the use of DAPT at 396 days (p<0.001), with the lowest use in Europe and the highest in Asia and Australia. CONCLUSION In a contemporary patient cohort, DAPT use beyond 1 year post MI was prevalent and associated with patient and index event characteristics. There were marked geographical variations in DAPT use beyond 1 year post MI.
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Affiliation(s)
- Juan J Russo
- University of Ottawa Heart Institute, Ottawa, Canada
| | - Andrew T Yan
- St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Brieger
- Concord Hospital, University of Sydney, Sydney, Australia
| | - Ruth Owen
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Akshay Bagai
- St Michael's Hospital, University of Toronto, Toronto, Canada
| | | | | | - Satoshi Yasuda
- National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Jose C Nicolau
- Instituto do Coracao (InCor), Hospital das Clínicas sHCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Tabassome Simon
- Assistance Publique-Hôpitaux de Paris (APHP), UPMC-Paris 06 University, Paris, France
| | - Shaun G Goodman
- St Michael's Hospital, University of Toronto, Toronto, Canada.
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13
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Coyle M, Flaherty G, Jennings C. A critical review of chronic kidney disease as a risk factor for coronary artery disease. IJC HEART & VASCULATURE 2021; 35:100822. [PMID: 34179334 PMCID: PMC8213912 DOI: 10.1016/j.ijcha.2021.100822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/14/2021] [Accepted: 06/04/2021] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease (CKD) is a significant risk factor for cardiovascular disease (CVD). In addition to common CVD risk factors, the presence of CKD is independently associated with an elevated cardiovascular (CV) risk. We examined the association between CKD and CVD, focusing on coronary artery disease (CAD) in both primary and secondary CVD. A total of 94 articles were included for this review using search strategies on Pubmed and Google scholar. The main findings of our review included that besides sharing common risk factors, CKD induces several physiological microscopic changes leading to increased CV risk. These microscopic changes manifest macroscopically with evidence of the development of primary CAD in CKD patients, in addition to accelerating CAD in those with pre-established CV pathology, with CKD consequently being a risk factor for both primary and secondary CAD progression. Current CV guideline recommendations do not discriminate between those patients with and without CKD. Future research is needed in this area, examining if there may be a role for tighter modifiable risk factor targets in this high-risk population.
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Affiliation(s)
- Mark Coyle
- Corresponding author at: National Institute for Prevention and Cardiovascular Health, Galway, Ireland.
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14
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Ho CLB, Chih HJ, Garimella PS, Matsushita K, Jansen S, Reid CM. Prevalence and risk factors of peripheral artery disease in a population with chronic kidney disease in Australia: A systematic review and meta-analysis. Nephrology (Carlton) 2021; 26:798-808. [PMID: 34156137 DOI: 10.1111/nep.13914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 05/27/2021] [Accepted: 06/08/2021] [Indexed: 12/24/2022]
Abstract
There is a lack of clarity and guidance for screening peripheral artery disease (PAD) in persons with chronic kidney disease (CKD) and end stage kidney disease (ESKD) despite this group being at excess risk of cardiovascular disease (CVD). In this current study, we performed a systematic review and meta-analysis to examine the prevalence and risk factors for PAD in persons with CKD in Australian cohorts. We used the inverse variance heterogeneity meta-analysis with double arcsine transformation to summarize the prevalence of PAD (with 95% CIs). Nine studies and 18 reports from the Australia and New Zealand dialysis and transplant registry with 36 cohorts were included in the review. We found a substantially higher PAD prevalence in cohorts based on an ankle-brachial index (ABI) or toe systolic pressure (TBI) than cohorts based on self-reported history. Higher PAD prevalence was observed in ESKD persons than CKD persons without dialysis (PAD diagnosis based on ABI or TBI: 31% in ESKD persons and 23% in CKD persons, PAD diagnosis based on self-reported history: 17% in ESKD persons and 10% in CKD persons). Older age, Caucasian race, cerebrovascular disease and haemodialysis were associated with the presence of PAD in ESKD persons. Our findings indicated a considerable proportion of PAD in CKD and ESKD persons particularly in those with ESKD. To develop and provide an adequate plan to clinically manage CKD patients with PAD, evidence of cost-effectiveness and clinical benefit of early detection of PAD in persons with CKD in Australia is recommended for future studies.
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Affiliation(s)
- Chau L B Ho
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Hui J Chih
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Pranav S Garimella
- Department of Medicine, University of California San Diego, California, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Division of Cardiology, Johns Hopkins School of Medicine, Maryland, USA.,Welch Center for Prevention, Epidemiology, and Clinical Research, Maryland, USA
| | - Shirley Jansen
- Curtin Medical School, Curtin University, Perth, WA, Australia.,Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia.,Heart and Vascular Research Institute, Harry Perkins Institute for Medical Research, Perth, WA, Australia.,Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia.,CCRE Therapeutics, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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15
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Pocock S, Brieger DB, Owen R, Chen J, Cohen MG, Goodman S, Granger CB, Nicolau JC, Simon T, Westermann D, Yasuda S, Hedman K, Mellström C, Andersson Sundell K, Grieve R. Health-related quality of life 1-3 years post-myocardial infarction: its impact on prognosis. Open Heart 2021; 8:openhrt-2020-001499. [PMID: 33563776 PMCID: PMC7962722 DOI: 10.1136/openhrt-2020-001499] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 11/08/2022] Open
Abstract
Objective To assess associations of health-related quality of life (HRQoL) with patient profile,
resource use, cardiovascular (CV) events and mortality in stable patients
post-myocardial infarction (MI). Methods The global, prospective, observational TIGRIS Study enrolled 9126 patients 1–3
years post-MI. HRQoL was assessed at enrolment and 6-month intervals using the
patient-reported EuroQol-5 dimension (EQ-5D) questionnaire, with scores anchored at 0
(worst possible) and 1 (perfect health). Resource use, CV events and mortality were
recorded during 2-years’ follow-up. Regression models estimated the associations
of index score at enrolment with patient characteristics, resource use, CV events and
mortality over 2-years’ follow-up. Results Among 8978 patients who completed the EQ-5D questionnaire, 52% reported
‘some’ or ‘severe’ problems on one or more health
dimensions. Factors associated with a lower index score were: female sex, older age,
obesity, smoking, higher heart rate, less formal education, presence of comorbidity (eg,
angina, stroke), emergency room visit in the previous 6 months and non-ST-elevation MI
as the index event. Compared with an index score of 1 at enrolment, a lower index score
was associated with higher risk of all-cause death, with an adjusted rate ratio of 3.09
(95% CI 2.20 to 4.31), and of a CV event, with a rate ratio of 2.31 (95%
CI 1.76 to 3.03). Patients with lower index score at enrolment had almost two times as
many hospitalisations over 2-years’ follow-up. Conclusions Clinicians managing patients post-acute coronary syndrome should recognise that a
poorer HRQoL is clearly linked to risk of hospitalisations, major CV events and
death. Trial registration number ClinicalTrials.gov Registry (NCT01866904) (https://clinicaltrials.gov).
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Affiliation(s)
- Stuart Pocock
- Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - David B Brieger
- Cardiology, Concord Hospital, Concord, New South Wales, Australia
| | - Ruth Owen
- London School of Hygiene & Tropical Medicine, London, UK
| | - Jiyan Chen
- Cardiology, Guangdong General Hospital, Guangzhou, Guangdong, China
| | - Mauricio G Cohen
- Cardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Shaun Goodman
- Consultant, Canadian Heart Research Centre, North York, Ontario, Canada.,Cardiology, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - José C Nicolau
- Instituto do Coração, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Tabassome Simon
- Department of Clinical Pharmacology, Assistance Publique-Hôpitaux de Paris, Saint Antoine Hospital, Paris, France.,Clinical Research Platform of East of Paris, Sorbonne-Université (UPMC- Paris 06), Paris, France
| | - Dirk Westermann
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany
| | - Satoshi Yasuda
- Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Katarina Hedman
- BioPharmaceuticals R&D, CVRM Biometrics, AstraZeneca, Gothenburg, Sweden
| | - Carl Mellström
- BioPharmaceuticals CVRM, AstraZeneca, Gothenburg, Sweden
| | | | - Richard Grieve
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
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16
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Koziolova NA, Karavaev PG, Veklich AS. [Choosing Antithrombotic Therapy in Patients with Coronary Heart Disease and Type 2 Diabetes Mellitus: How to Reduce the Risk of Death]. KARDIOLOGIIA 2020; 60:109-119. [PMID: 32394865 DOI: 10.18087/cardio.2020.4.n1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
This review presents prevalence of type 2 diabetes mellitus (DM) in patients with ischemic heart disease (IHD), risk factors in common, and a considerable worsening of prognosis in their combination. The authors addressed pathophysiological mechanisms of platelet dysfunction and negative changes in the coagulation system in IHD patients with type 2 DM, which predetermine activation of the prothrombotic pathway of hemostasis formation. Difficulties in optimal selection of antithrombotic therapy were demonstrated for both patients with type 2 DM without a history of cardiovascular diseases and IHD patients with type 2 DM. The authors paid attention to the fact that results of randomized clinical studies (RCS) that included patients with type 2 DM and acute coronary syndrome or after coronary revascularization cannot be extrapolated to the entire population of patients with stable IHD. At present, the preferable choice of antithrombotic therapy for patients with type 2 DM and stable IHD is a combination of rivaroxaban 2.5 mg twice a day and acetylsalicylic acid 100 mg/day. This combination provides a maximal clinical benefit compared to other strategies presented in RCS.
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Affiliation(s)
- N A Koziolova
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
| | - P G Karavaev
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
| | - A S Veklich
- State funded educational institution of the highest education "E.A. Wagner Perm State Medical University" Public Health Ministry of Russian Federation, Perm, Russia
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17
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Pocock SJ, Brieger D, Gregson J, Chen JY, Cohen MG, Goodman SG, Granger CB, Grieve R, Nicolau JC, Simon T, Westermann D, Yasuda S, Hedman K, Rennie KL, Sundell KA. Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry. Clin Cardiol 2020; 43:24-32. [PMID: 31713893 PMCID: PMC6954378 DOI: 10.1002/clc.23283] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/30/2019] [Accepted: 10/10/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Risk prediction tools are lacking for patients with stable disease some years after myocardial infarction (MI). HYPOTHESIS A practical long-term cardiovascular risk index can be developed. METHODS The long-Term rIsk, Clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients prospective global registry enrolled patients 1 to 3 years post-MI (369 centers; 25 countries), all with ≥1 risk factor (age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, or chronic non-end-stage kidney disease [CKD]). Self-reported health was assessed with EuroQoL-5 dimensions. Multivariable Poisson regression models were used to determine key predictors of the primary composite outcome (MI, unstable angina with urgent revascularization [UA], stroke, or all-cause death) over 2 years. RESULTS The primary outcome occurred in 621 (6.9%) of 9027 eligible patients: death 295 (3.3%), MI 195 (2.2%), UA 103 (1.1%), and stroke 58 (0.6%). All events accrued linearly. In a multivariable model, 11 significant predictors of primary outcome (age ≥65 years, diabetes, second prior MI, CKD, history of major bleed, peripheral arterial disease, heart failure, cardiovascular hospitalization (prior 6 months), medical management (index MI), on diuretic, and poor self-reported health) were identified and combined into a user-friendly risk index. Compared with lowest-risk patients, those in the top 16% had a rate ratio of 6.9 for the primary composite, and 18.7 for all-cause death (overall c-statistic; 0.686, and 0.768, respectively). External validation was performed using the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events registry (c-statistic; 0.748, and 0.849, respectively). CONCLUSIONS In patients >1-year post-MI, recurrent cardiovascular events and deaths accrue linearly. A simple risk index can stratify patients, potentially helping to guide management.
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Affiliation(s)
- Stuart J. Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - David Brieger
- Division of Cardiology, Concord Hospital and University of SydneySydneyAustralia
| | - John Gregson
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - Ji Y. Chen
- Department of Cardiology, Guangdong General Hospital, Provincial Key Laboratory of Coronary DiseaseGuangzhouChina
| | - Mauricio G. Cohen
- Cardiovascular Division, University of Miami Miller School of MedicineMiamiFlorida
| | - Shaun G. Goodman
- Already given, Terrence Donnelly Heart Centre, St Michael's Hospital, University of TorontoTorontoCanada
| | - Christopher B. Granger
- Cardiac Intensive Care Unit, Duke Clinical Research Institute, Duke University Medical CenterDurhamNorth Carolina
| | - Richard Grieve
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
| | - Jose C. Nicolau
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São PauloSão PauloSPBrazil
| | - Tabassome Simon
- Assistance Publique‐Hopitaux de Paris (APHP) Department of Clinical Pharmacology and Clinical Research Platform of East of ParisParisFrance
- Department of Pharmacology, Sorbonne‐Université (UPMC‐Paris 06)ParisFrance
| | - Dirk Westermann
- Department of General and Interventional CardiologyUniversity Heart Center EppendorfHamburgGermany
- German Center for Cardiovascular Research (DZHK)Partner site Hamburg/Lübeck/KielHamburgGermany
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular CenterOsakaJapan
| | - Katarina Hedman
- Global Medical Affairs Cardiovascular, Renal and Metabolic, AstraZenecaGothenburgSweden
| | - Kirsten L. Rennie
- Department of Medical Statistics, London School of Hygiene and Tropical MedicineLondonUK
- Oxon Epidemiology (UK)LondonUK
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