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Lai P, Gu X, Lin X, He Y, Dai Y, Duan C, Liu Y, He W. Association of random glucose to albumin ratio with post-contrast acute kidney injury and clinical outcomes in patients with ST-elevation myocardial infarction. Front Endocrinol (Lausanne) 2024; 15:1390868. [PMID: 38957440 PMCID: PMC11217170 DOI: 10.3389/fendo.2024.1390868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 06/03/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose Both glucose and albumin are associated with chronic inflammation, which plays a vital role in post-contrast acute kidney injury (PC-AKI). To explore the relationship between random glucose to albumin ratio (RAR) and the incidence of PC-AKI after percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Patients and methods STEMI patients who underwent PCI were consecutively enrolled from January, 01, 2010 to February, 28, 2020. All patients were categorized into T1, T2, and T3 groups, respectively, based on RAR value (RAR < 3.377; 3.377 ≤ RAR ≤ 4.579; RAR > 4.579). The primary outcome was the incidence of PC-AKI, and the incidence of major adverse clinical events (MACE) was the second endpoint. The association between RAR and PC-AKI was assessed by multivariable logistic regression analysis. Results A total of 2,924 patients with STEMI undergoing PCI were finally included. The incidence of PC-AKI increased with the increasing tertile of RAR (3.2% vs 4.8% vs 10.6%, P<0.001). Multivariable regression analysis demonstrated that RAR (as a continuous variable) was associated with the incidence of PC-AKI (adjusted odds ratio (OR) =1.10, 95% confidence interval (CI) =1.04 - 1.16, P<0.001) and in-hospital MACE (OR=1.07, 95% CI=1.02 - 1.14, P=0.012); RAR, as a categorical variable, was significantly associated with PC-AKI (T3 vs. T1, OR=1.70, 95% CI=1.08 - 2.67, P=0.021) and in-hospital MACE (T3 vs. T1, OR=1.63, 95% CI=1.02 - 2.60, P=0.041) in multivariable regression analyses. Receiver operating characteristic curve analysis showed that RAR exhibited a predictive value for PC-AKI (area under the curve (AUC)=0.666, 95% CI=0.625 - 0.708), and in-hospital MACE (AUC= 0.662, 95% CI =0.619 - 0.706). Conclusions The high value of RAR was significantly associated with the increasing risk of PC-AKI and in-hospital MACE after PCI in STEMI patients, and RAR offers a good predictive value for those outcomes.
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Affiliation(s)
- Ping Lai
- Department of Cardiology, First Affiliated Hospital of Gannan Medical University, Key Laboratory of Prevention and Treatment of Cardiovascular and Cerebrovascular Diseases, Ministry of Education, Gannan Medical University, Ganzhou, China
| | - Xiaoyan Gu
- Department of Endocrinology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuhui Lin
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yu He
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yining Dai
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chongyang Duan
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou, China
| | - Yuanhui Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenfei He
- Department of Cardiology, Guangdong Provincial People’s Hospital’s Nanhai Hospital, The Second People’s Hospital of Nanhai District, Foshan, China
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Betesh-Abay B, Shiyovich A, Gilutz H, Plakht Y. An empirical approach for life expectancy estimation based on survival analysis among a post-acute myocardial infarction population. Heliyon 2024; 10:e29968. [PMID: 38699742 PMCID: PMC11063430 DOI: 10.1016/j.heliyon.2024.e29968] [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: 01/02/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/05/2024] Open
Abstract
Background Practical communication of prognosis is pertinent in the clinical setting. Survival analysis techniques are standardly used in cohort studies; however, their results are not straightforward for interpretation as compared to the graspable notion of life expectancy (LE). The present study empirically examines the relationship between Cox regression coefficients (HRs), which reflect the relative risk of the investigated risk factors for mortality, and years of potential life lost (YPLL) values after acute myocardial infarction (AMI). Methods This retrospective population-based study included patients aged 40-80 years, who survived AMI hospitalization from January 1, 2002, to October 25, 2017. A survival analysis approach assessed relationships between variables and the risk for all-cause mortality in an up to 21-year follow-up period. The total score was calculated for each patient as the summation of the Cox regression coefficients (AdjHRs) values. Individual LE and YPLL were calculated. YPLL was assessed as a function of the total score. Results The cohort (n = 6316, age 63.0 ± 10.5 years, 73.4 % males) was randomly split into training (n = 4243) and validation (n = 2073) datasets. Sixteen main clinical risk factors for mortality were explored (total score of 0-14.2 points). After adjustment for age, sex and nationality, a one-point increase in the total score was associated with YPLL of ∼one year. A goodness-of-fit of the prediction model found 0.624 and 0.585 for the training and validation datasets respectively. Conclusions This functional derivation for converting coefficients of survival analysis into the comprehensible form of YPLL/LE allows for practical prognostic calculation and communication.
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Affiliation(s)
- Batya Betesh-Abay
- Student, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Arthur Shiyovich
- Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Harel Gilutz
- Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ygal Plakht
- Student, Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
- Department of Emergency Medicine, Soroka University Medical Center, Beer-Sheva, Israel
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Hoshi T, Sawano M, Kohsaka S, Ishii H, Amano T, Takeuchi T, Takahashi J, Hiraya D, Watabe H, Ishizu T, Kozuma K. Impact of Sex Differences on Clinical Outcomes in Patients Following Primary Revascularization for Acute Myocardial Infarction - Insights From the Japanese Nationwide Registry. Circ J 2024:CJ-23-0966. [PMID: 38684394 DOI: 10.1253/circj.cj-23-0966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND Women with acute myocardial infarction (AMI) often present a worse risk profile and experience a higher rate of in-hospital mortality than men. However, sex differences in post-discharge prognoses remain inadequately investigated. We examined the impact of sex on 1-year post-discharge outcomes in patients with AMI undergoing percutaneous coronary intervention.Methods and Results: We extracted patient-level data for the period January 2017-December 2018 from the J-PCI OUTCOME Registry, endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics. One-year all-cause and cardiovascular mortality and major adverse cardiovascular events were compared between men and women. In all, 29,856 AMI patients were studied, with 6,996 (23.4%) being women. Women were significantly older and had a higher prevalence of comorbidities than men. Crude all-cause mortality was significantly higher among women than men (7.5% vs. 5.4% [P<0.001] for ST-elevation myocardial infarction [STEMI]; 7.0% vs. 5.2% [P=0.006] for non-STEMI). These sex-related differences in post-discharge outcomes were attenuated after stratification by age. Multivariate analysis demonstrated an increase in all-cause mortality in both sexes with increasing age and advanced-stage chronic kidney disease (CKD). CONCLUSIONS Within this nationwide cohort, women had worse clinical outcomes following AMI than men. However, these sex-related differences in outcomes diminished after adjusting for age. In addition, CKD was significantly associated with all-cause mortality in both sexes.
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Affiliation(s)
- Tomoya Hoshi
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Mitsuaki Sawano
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, Yale New Haven Hospital Center of Outcomes Research and Evaluation
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine
| | | | - Toshiharu Takeuchi
- Division of Cardiology, Department of Internal Medicine, Asahikawa Medical University
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Daigo Hiraya
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Hiroaki Watabe
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine, University of Tsukuba
| | - Ken Kozuma
- Department of Cardiology, Teikyo University Hospital
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Padberg JS, Feld J, Padberg L, Köppe J, Makowski L, Gerß J, Dröge P, Ruhnke T, Günster C, Lange SA, Reinecke H. Complications and Outcomes in 39,864 Patients Receiving Standard Care Plus Mechanical Circulatory Support or Standard Care Alone for Infarct-Associated Cardiogenic Shock. J Clin Med 2024; 13:1167. [PMID: 38398478 PMCID: PMC10889198 DOI: 10.3390/jcm13041167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 02/13/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Temporary mechanical circulatory support devices (tMCS) are increasingly being used in patients with infarct-associated cardiogenic shock (AMICS). Evidence on patient selection, complications and long-term outcomes is lacking. We aim to investigate differences in clinical characteristics, complications and outcomes between patients receiving no tMCS or either intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (V-A ECMO) or Impella® for AMICS, with a particular focus on long-term outcomes. METHODS Using health claim data from AOK-Die Gesundheitskasse (local health care funds), we retrospectively analysed complications and outcomes of all insured patients with AMICS between 1 January 2010 and 31 December 2017. RESULTS A total of 39,864 patients were included (IABP 5451; Impella 776; V-A ECMO 833; no tMCS 32,804). In-hospital complications, including renal failure requiring dialysis (50.3% V-A ECMO vs. 30.5% Impella vs. 29.2 IABP vs. 12.1% no tMCS), major bleeding (38.1% vs. 20.9% vs. 18.0% vs. 9.3%) and sepsis (22.5% vs. 15.9% vs. 13.9% vs. 9.3%) were more common in V-A ECMO patients. In a multivariate analysis, the use of both V-A ECMO (HR 1.57, p < 0.001) and Impella (HR 1.25, p < 0.001) were independently associated with long-term mortality, whereas use of IABP was not (HR 0.89, p < 0.001). Kaplan-Meier estimates showed better survival for patients on IABP compared with Impella, V-A ECMO and no-tMCS. Short- and long-term mortality was high across all groups. CONCLUSIONS Our data show noticeably more in-hospital complications in patients on tMCS and higher mortality with V-A ECMO and Impella. The use of both devices is an independent risk factor for mortality, whereas the use of IABP is associated with a survival benefit.
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Affiliation(s)
- Jan-Sören Padberg
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Leonie Padberg
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Lena Makowski
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Münster, D-48149 Münster, Germany
| | - Patrik Dröge
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Thomas Ruhnke
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Christian Günster
- AOK Research Institute (WIdO), AOK-Bundesverband, D-10178 Berlin, Germany
| | - Stefan Andreas Lange
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
| | - Holger Reinecke
- Department for Cardiology I: Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany
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Block A, Köppe J, Feld J, Kühnemund L, Engelbertz C, Makowski L, Malyar N, Gerß J, Reinecke H, Freisinger E. In-patient characteristics of peripheral artery disease in Germany. VASA 2024; 53:28-38. [PMID: 37964740 DOI: 10.1024/0301-1526/a001099] [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] [Indexed: 11/16/2023]
Abstract
Background: Peripheral artery disease (PAD) frequently leads to hospital admission. Sex related differences in in-patient care are a current matter of debate. Patients and methods: Data were provided from the German national in-patient sample provided by the Federal Bureau of Statistics (DESTATIS). Trends on risk profiles, therapeutic procedures, and outcomes were evaluated from 2014 until 2019 stratified by sex and PAD severity. Results: Two-thirds of an annual >191,000 PAD in-patient cases applied to male sex. Chronic limb-threatening ischemia (CLTI) was recorded in 49.6% of male and 55.2% of female cases (2019). CLTI was as a major risk factor of in-hospital amputation (OR 229) and death (OR 10.5), whereas endovascular revascularisation (EVR) with drug-coated devices were associated with decreased risk of in-hospital amputation (OR 0.52; all p<0.001). EVR applied in 47% of CLTI cases compared to 71% in intermittent claudication (IC) irrespective of sex. In-hospital mortality was 4.3% in male vs. 4.8% in female CLTI cases, minor amputations 18.4% vs. 10.9%, and major amputation 7.5% vs. 6.0%, respectively (data 2019; all p<0.001). After adjustment, female sex was associated with lower risk of amputation (OR 0.63) and death (OR 0.96) during in-patient stay. Conclusions: Male PAD patients were twice as likely to be admitted for in-patient treatment despite equal PAD prevalence in the general population. Among in-patient cases, supply with invasive therapy did not relevantly differ by sex, however is strongly reduced in CLTI. CLTI is a major risk factor of adverse short-term outcomes, whereas female sex was associated with lower risk of in-patient amputation and/or death.
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Affiliation(s)
- Alexander Block
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Jeanette Köppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Leonie Kühnemund
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Christiane Engelbertz
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Lena Makowski
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Nasser Malyar
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Germany
| | - Holger Reinecke
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
| | - Eva Freisinger
- Department of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, University Hospital Muenster, Germany
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Rivera FB, Salva F, Gonzales JS, Cha SW, Tang S, Lumbang GNO, Kaur G, Planek I, Lara-Breitinger K, Dela Cruz M, Suboc TMB, Collado FMS, Enriquez JR, Shah N, Volgman AS. Sex differences in trends and outcomes of acute myocardial infarction with mechanical complications in the United States. Expert Rev Cardiovasc Ther 2024; 22:111-120. [PMID: 38284754 DOI: 10.1080/14779072.2024.2311707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Mechanical complications (MC) are rare but significant sequelae of acute myocardial infarction (AMI). Current data on sex differences in AMI with MC is limited. METHODS We queried the National Inpatient Sample database to identify adult patients with the primary diagnosis of AMI and MC. The main outcome of interest was sex difference in-hospital mortality. Secondary outcomes were sex differences in the incidence of acute kidney injury (AKI), major bleeding, use of inotropes, permanent pacemaker implantation (PPMI), performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), surgery (VSD repair and MV surgery), pericardiocentesis, use of mechanical circulatory support (MCS), ischemic stroke, and mechanical ventilation. RESULTS Among AMI-MC cohort, in-hospital mortality was higher among females compared to males (41.24% vs 28.13%: aOR 1.39. 95% CI 1.079-1.798; p = 0.01). Among those who had VSD, females also had higher in-hospital mortality compared to males (56.7% vs 43.1%: aOR 1.74, 95% CI 1.12-2.69; p = 0.01). Females were less likely to receive CABG compared to males (12.03% vs 20%: aOR 0.49 95% CI 0.345-0.690; p < 0.001). CONCLUSION Despite the decreasing trend in AMI admission, females had higher risk of MC and associated mortality. Significant sex disparities still exist in AMI treatment.
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Affiliation(s)
| | - Faye Salva
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | | | - Sung Whoy Cha
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | - Samantha Tang
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Isabel Planek
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Mark Dela Cruz
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Jonathan R Enriquez
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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Mousavi RA, Lamm G, Will M, Schwarz K, Mascherbauer J. Sex differences in the management and outcome of acute coronary syndrome-Still an issue of equal treatment? Wien Klin Wochenschr 2023; 135:663-666. [PMID: 37994938 PMCID: PMC10713742 DOI: 10.1007/s00508-023-02302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 10/16/2023] [Indexed: 11/24/2023]
Abstract
Significant sex-specific differences were described in the presentation, management and outcome of acute coronary syndrom (ACS) patients. Female ACS patients more often presented with noncardiac symptoms, which lead to significant time delays between symptom onset and treatment. Furthermore, multiple studies from various countries described that women with ACS were less likely to receive the medical or reperfusion therapy recommended by the respective guidelines, resulting in higher in-hospital mortality rates.The treating physicians and the patients need to be more aware of the described differences to ensure the best possible medical care for ACS patients, irrespective of sex.
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Affiliation(s)
- Roya Anahita Mousavi
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Gudrun Lamm
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Maximilian Will
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Konstantin Schwarz
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, St. Pölten, Austria
- Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Julia Mascherbauer
- Department of Internal Medicine 3/Cardiology, University Hospital St. Pölten, St. Pölten, Austria.
- Karl Landsteiner University of Health Sciences, Krems, Austria.
- Medical University of Vienna, Vienna, Austria.
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Jian W, Zhou W, Zhang L. The impact of centralized coronary stent procurement program on acute myocardial infarction treatments: evidence from China. Front Public Health 2023; 11:1285558. [PMID: 38098831 PMCID: PMC10720903 DOI: 10.3389/fpubh.2023.1285558] [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: 08/30/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Background The advent of coronary stents has resulted in many more many lives being saved from acute myocardial infarction (AMI). However, the high price associated with this method of treatment also imposes a heavy economic burden on healthcare systems. As a country making significant use of coronary stents, in 2021, China introduced a program around this method of treatment grounded in centralized procurement and it is the focus of this paper to assess the impact of this policy on AMI treatments. Methods The patients with AMI are selected as the study group, and the patients with pre-cerebral vascular stenosis are selected as the control group, and individual-level medical insurance settlement data are collected from the years 2018, 2019, and 2021. Differences-in-differences methodology is used to analyze the impacts of this program on the probability changes in respect of AMI patients receiving stent therapy, as well as changes relating to cost, length of stay and 30-day readmission. Results The results show that the reform has led to a reduction in the probability of AMI patients using stents to 51% of the original rate. Additionally, the average cost is shown to have decreased by 41%, and no significant changes can be found in respect of the length of stay and 30-day readmission. Conclusion In sum, the centralized procurement program is shown to reduce not only the medical expenses incurred by treating patients with AMI, but also the use of coronary stents, resulting in changes to the treatment patterns of patients with AMI.
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Affiliation(s)
- Weiyan Jian
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
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Kim YH, Her AY, Rha SW, Choi CU, Choi BG, Park S, Kang DO, Cho JR, Park JY, Park SH, Jeong MH. The impact of sex differences on 3-year outcomes of patients with non-ST-segment elevation myocardial infarction after successful stent implantation according to symptom-to-balloon time. Hellenic J Cardiol 2023:S1109-9666(23)00189-6. [PMID: 37866718 DOI: 10.1016/j.hjc.2023.09.018] [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: 08/16/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Because no data are available, we compared the 3-year outcomes of patients with non-ST-elevation myocardial infarction (NSTEMI) based on sex and symptom-to-balloon time (SBT). METHODS This study included 4910 patients who were divided into two groups based on SBT: SBT <48 h (n = 3,293, 67.1%) and SBT ≥48 h (n = 1,617, 32.9%). The primary outcome was all-cause death during the 3-year follow-up period. The secondary outcome was major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or repeat coronary revascularization. RESULTS After adjustment, the in-hospital mortality rates for males and females in the SBT <48 h and SBT ≥48 h groups were similar. During a 3-year follow-up period, females in the SBT <48 h group had significantly higher rates of all-cause death (adjusted hazard ratio [aHR], 1.482; P = 0.006), cardiac death (CD, aHR, 1.617; P = 0.009), and MACE (aHR, 1.268; P = 0.024) than those males in the same groups. Females and males in the SBT ≥48 h group did not differ significantly in the primary and secondary outcomes. In males, the rates of all-cause death (P = 0.008) and CD (P = 0.024) were significantly higher in the SBT ≥48 h group than in the SBT <48 h group. CONCLUSIONS This study has identified a higher 3-year mortality rate in female patients with NSTEMI and SBT <48 h compared to their male counterparts. As such, a more preventive approach may be required to reduce mortality in these female patients.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, 24289, Chuncheon, Republic of Korea.
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, 24289, Chuncheon, Republic of Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea.
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Byoung Geol Choi
- Cardiovascular Research Institute, Korea University College of Medicine, 02841, Seoul, Republic of Korea
| | - Soohyung Park
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Dong Oh Kang
- Cardiovascular Center, Korea University Guro Hospital, 08308, Seoul, Republic of Korea
| | - Jung Rae Cho
- Cardiology Division, Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 07441, Seoul, Republic of Korea
| | - Ji Young Park
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, 01830, Seoul, Republic of Korea
| | - Sang-Ho Park
- Cardiology Department, Soonchunhyang University Cheonan Hospital, 31151, Cheonan, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, 61469, Gwangju, Republic of Korea
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Stolpe S, Kowall B, Werdan K, Zeymer U, Bestehorn K, Weber MA, Schneider S, Stang A. OECD indicator 'AMI 30-day mortality' is neither comparable between countries nor suitable as indicator for quality of acute care. Clin Res Cardiol 2023:10.1007/s00392-023-02296-z. [PMID: 37682307 DOI: 10.1007/s00392-023-02296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/24/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Hospital mortality after acute myocardial infarction (AMI, ICD-10: I21-I22) is used as OECD indicator of the quality of acute care. The reported AMI hospital mortality in Germany is more than twice as high as in the Netherlands or Scandinavia. Yet, in Europe, Germany ranks high in health spending and availability of cardiac procedures. We provide insights into this contradictory situation. METHODS Information was collected on possible factors causing the reported differences in AMI mortality such as prevalence of risk factors or comorbidities, guideline conform treatment, patient registration, and health system structures of European countries. International experts were interviewed. Data on OECD indicators 'AMI 30-day mortality using unlinked data' and 'average length of stay after AMI' were used to describe the association between these variables graphically and by linear regression. RESULTS Differences in prevalence of risk factors or comorbidities or in guideline conform acute care account only to a smaller extent for the reported differences in AMI hospital mortality. It is influenced mainly by patient registration rules and organization of health care. Non-reporting of day cases as patients and centralization of AMI care-with more frequent inter-hospital patient transfers-artificially lead to lower calculated hospital mortality. Frequency of patient transfers and national reimbursement policies affect the average length of stay in hospital which is strongly associated with AMI hospital mortality (adj R2 = 0.56). AMI mortality reported from registries is distorted by different underlying populations. CONCLUSION Most of the variation in AMI hospital mortality is explained by differences in patient registration and organization of care instead of differences in quality of care, which hinders cross-country comparisons of AMI mortality. Europe-wide sentinel regions with comparable registries are necessary to compare (acute) care after myocardial infarction.
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Affiliation(s)
- Susanne Stolpe
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany.
| | - Bernd Kowall
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany
| | - Karl Werdan
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Department of Medicine III, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Uwe Zeymer
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Foundation IHF, Institute for Myocardial Infarction Research, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Kurt Bestehorn
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- German Society for Prevention and Rehabilitation of Cardiovascular Diseases e.V., Koblenz, Germany
- Institute for Clinical Pharmacology, Technical University Dresden, Dresden, Germany
| | - Michael A Weber
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Association of Senior Hospital Physicians in Germany e.V., Düsseldorf, Germany
| | - Steffen Schneider
- Center for Health Services Research of the German Cardiac Society, Düsseldorf, Germany
- Foundation IHF, Institute for Myocardial Infarction Research, Hospital Ludwigshafen, Ludwigshafen, Germany
| | - Andreas Stang
- Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), University Hospital Essen, Hufelandstr 55, 45147, Essen, Germany
- Department of Epidemiology, School of Public Health, Boston, MA, USA
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11
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Bijman LAE, Alotaibi R, Jackson CA, Clegg G, Halbesma N. Association between sex and survival after out-of-hospital cardiac arrest: A systematic review and meta-analysis. J Am Coll Emerg Physicians Open 2023; 4:e12943. [PMID: 37128297 PMCID: PMC10148381 DOI: 10.1002/emp2.12943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 03/10/2023] [Accepted: 03/16/2023] [Indexed: 05/03/2023] Open
Abstract
The current literature on sex differences in 30-day survival following out-of-hospital cardiac arrest (OHCA) is conflicting, with 3 recent systematic reviews reporting opposing results. To address these contradictions, this systematic literature review and meta-analysis aimed to synthesize the literature on sex differences in survival after OHCA by including only population-based studies and through separate meta-analyses of crude and adjusted effect estimates. MEDLINE and Embase databases were systematically searched from inception to March 23, 2022 to identify observational studies reporting sex-specific 30-day survival or survival until hospital discharge after OHCA. Two meta-analyses were conducted. The first included unadjusted effect estimates of the association between sex and survival (comparing males vs females), whereas the second included effect estimates adjusted for possible mediating and/or confounding variables. The PROSPERO registration number was CRD42021237887, and the search identified 6712 articles. After the screening, 164 potentially relevant articles were identified, of which 26 were included. The pooled estimate for crude effect estimates (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.22-1.66) indicated that males have a higher chance of survival after OHCA than females. However, the pooled estimate for adjusted effect estimates shows no difference in survival after OHCA between males and females (OR, 0.93; 95% CI, 0.84-1.03). Both meta-analyses involved high statistical heterogeneity between studies: crude pooled estimate I2 = 95.7%, adjusted pooled estimate I2 = 91.3%. There does not appear to be a difference in survival between males and females when effect estimates are adjusted for possible confounding and/or mediating variables in non-selected populations.
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Affiliation(s)
| | | | | | - Gareth Clegg
- Usher InstituteUniversity of EdinburghEdinburghUK
- Resuscitation Research GroupThe University of EdinburghEdinburghUK
| | - Nynke Halbesma
- Usher InstituteUniversity of EdinburghEdinburghUK
- Resuscitation Research GroupThe University of EdinburghEdinburghUK
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12
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Kuehnemund L, Lange SA, Feld J, Padberg JS, Fischer AJ, Makowski L, Engelbertz C, Dröge P, Ruhnke T, Guenster C, Gerß J, Freisinger E, Reinecke H, Koeppe J. Sex disparities in guideline-recommended therapies and outcomes after ST-elevation myocardial infarction in a contemporary nationwide cohort of patients over an eight-year period. Atherosclerosis 2023; 375:30-37. [PMID: 37245424 DOI: 10.1016/j.atherosclerosis.2023.05.007] [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: 02/14/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. METHODS From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. RESULTS Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p <0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00-1.04; p=0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p <0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50-0.55; men HR 0.48, 95% CI 0.47-0.50, pint = 0.014). CONCLUSIONS In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival.
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Affiliation(s)
- Leonie Kuehnemund
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Stefan A Lange
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
| | - Jannik Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Jan-Soeren Padberg
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Alicia J Fischer
- University Hospital Muenster, Cardiol., Dept. of Cardiology III - Adult Congenital and Valvular Heart Disease, Muenster, Germany
| | - Lena Makowski
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Christiane Engelbertz
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | | | | | | | - Joachim Gerß
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Koeppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
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13
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Heidenreich A, Stachon P, Oettinger V, Hilgendorf I, Heidt T, Rilinger J, Zehender M, Westermann D, von Zur Mühlen C, Kaier K. Impact of the COVID-19 pandemic on aortic valve replacement procedures in Germany. BMC Cardiovasc Disord 2023; 23:187. [PMID: 37024779 PMCID: PMC10079149 DOI: 10.1186/s12872-023-03213-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 03/29/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND COVID-19 has caused the deferral of millions of elective procedures, likely resulting in a backlog of cases. We estimate the number of postponed surgical aortic valve replacement (sAVR) and transcatheter aortic valve replacement (TAVR) procedures during the first two waves of the COVID-19 pandemic in Germany. METHODS Using German national records, all isolated TAVR and sAVR procedures between 2007 and 2020 were identified. Using weekly TAVR and sAVR procedures between 2017 and 2019, we created a forecast for 2020 and compared it with the observed number of procedures in 2020. RESULTS In Germany, a total of 225,398 isolated sAVR and 159,638 isolated TAVR procedures were conducted between 2007 and 2020 that were included in our analysis. The reduction in all AVR procedures (sAVR and TAVR) for the entire year 2020 was 19.07% (95%CI: 15.19-22.95%). During the first wave of the pandemic (week 12-21), the mean weekly reduction was 32.06% (23.44-40.68%) and during the second wave of the pandemic (week 41-52), the mean weekly reduction was 25.58% (14.19-36.97%). The number of sAVR procedures decreased more than the number of TAVR procedures (24.63% vs. 16.42% for the entire year 2020). CONCLUSION The first year of the COVID-19 pandemic saw a substantial postponing of AVR procedures in Germany. Postponing was higher for sAVR than for TAVR procedures and less pronounced during the second wave of the COVID-19 pandemic.
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Affiliation(s)
- Adrian Heidenreich
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Stachon
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Vera Oettinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ingo Hilgendorf
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Timo Heidt
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Jonathan Rilinger
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Manfred Zehender
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dirk Westermann
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
| | - Constantin von Zur Mühlen
- Medical Centre, Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, University Heart Centre Freiburg - Bad Krozingen, University of Freiburg, Freiburg, Germany
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Klaus Kaier
- Centre of Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
- Institute of Medical Biometry and Medical Informatics, Faculty of Medicine, University Medical Centre Freiburg, University of Freiburg, Freiburg, Germany.
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14
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Jiang ZH, Aierken A, Wu TT, Zheng YY, Ma YT, Xie X. Rate pressure product as a novel predictor of long-term adverse outcomes in patients after percutaneous coronary intervention: a retrospective cohort study. BMJ Open 2023; 13:e067951. [PMID: 37015792 PMCID: PMC10083747 DOI: 10.1136/bmjopen-2022-067951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES Previous studies have suggested that heart rate and blood pressure play important roles in the development of adverse outcomes in patients with coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI). However, the relationship between the rate pressure product (RPP) and long-term outcomes has rarely been investigated. This study investigated the effects of RPP on the clinical outcomes of patients with CAD who underwent PCI. DESIGN In this study, a total of 6015 patients with CAD were enrolled. All patients were from the CORFCHD-PCI (Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI) Study. They were divided into two groups according to RPP (RPP <10 269, n=4018 and RPP ≥10 269, n=1997). In addition, the median follow-up time was 32 months. PARTICIPANTS Data was obtained from 6050 patients with CAD who underwent PCI at the First Affiliated Hospital of Xinjiang Medical University from January 2008 to December 2016. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was long-term mortality, including all-cause mortality (ACM) and cardiac mortality (CM). The secondary endpoints were major adverse cardiovascular events (MACEs) and major adverse cardiovascular and cerebrovascular events (MACCEs). RESULTS We found that there were significant differences between the two groups in the incidence of ACM, CM, MACCEs and MACEs (all p<0.05). Among the patients with CAD having ACM, CM, MACCEs and MACEs, the mean survival time of the low-value group was significantly higher than that of the high-value group. Multivariate Cox regression analyses showed that RPP was an independent predictor for ACM (HR=1.605, 95% CI: 1.215-2.120, p=0.001), CM (HR=1.733, 95% CI: 1.267-2.369, p=0.001), MACCEs (HR=1.271, 95% CI: 1.063-1.518, p=0.008) and MACEs (HR=1.315, 95% CI: 1.092-1.584, p=0.004) in patients with stable CAD. On the other hand, there was no significant correlation between the RPP and the adverse outcomes in patients with acute coronary syndrome. CONCLUSION In summary, RPP is an independent predictor of long-term prognosis in patients with CAD who underwent PCI. A higher baseline RPP before PCI increased the risk of adverse outcomes. Compared with heart rate and blood pressure alone, RPP has a higher predictive value for adverse clinical outcomes.
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Affiliation(s)
- Zhi-Hui Jiang
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Abudula Aierken
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ting-Ting Wu
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ying-Ying Zheng
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yi-Tong Ma
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xiang Xie
- Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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15
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Pauly V, Vlcek J, Zhang Z, Hesse N, Xia R, Bauer J, Loy S, Schneider S, Renner S, Wolf E, Kääb S, Schüttler D, Tomsits P, Clauss S. Effects of Sex on the Susceptibility for Atrial Fibrillation in Pigs with Ischemic Heart Failure. Cells 2023; 12:cells12070973. [PMID: 37048048 PMCID: PMC10093477 DOI: 10.3390/cells12070973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 03/16/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Atrial fibrillation (AF) is the most prevalent arrhythmia, often caused by myocardial ischemia/infarction (MI). Men have a 1.5× higher prevalence of AF, whereas women show a higher risk for new onset AF after MI. However, the underlying mechanisms of how sex affects AF pathophysiology are largely unknown. In 72 pigs with/without ischemic heart failure (IHF) we investigated the impact of sex on ischemia-induced proarrhythmic atrial remodeling and the susceptibility for AF. Electrocardiogram (ECG) and electrophysiological studies were conducted to assess electrical remodeling; histological analyses were performed to assess atrial fibrosis in male and female pigs. IHF pigs of both sexes showed a significantly increased vulnerability for AF, but in male pigs more and longer episodes were observed. Unchanged conduction properties but enhanced left atrial fibrosis indicated structural rather than electrical remodeling underlying AF susceptibility. Sex differences were only observed in controls with female pigs showing an increased intrinsic heart rate, a prolonged QRS interval and a prolonged sinus node recovery time. In sum, susceptibility for AF is significantly increased both in male and female pigs with ischemic heart failure. Differences between males and females are moderate, including more and longer AF episodes in male pigs and sinus node dysfunction in female pigs.
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Affiliation(s)
- Valerie Pauly
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Vlcek
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Zhihao Zhang
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Nora Hesse
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Ruibing Xia
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Julia Bauer
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Loy
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sarah Schneider
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Simone Renner
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
| | - Eckhard Wolf
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
- Chair for Molecular Animal Breeding and Biotechnology, Gene Center and Department of Veterinary Sciences, LMU Munich, Feodor-Lynen-Strasse 25, D-81377 Munich, Germany
- Center for Innovative Medical Models (CiMM), Department of Veterinary Sciences, LMU Munich, Hackerstrasse 27, D-85764 Oberschleissheim, Germany
- German Center for Diabetes Research (DZD), Ingolstädter Landstrasse 1, D-85764 Neuherberg, Germany
- Laboratory for Functional Genome Analysis (LAFUGA), Gene Center, Grosshadern Campus, LMU Munich, Feodor-Lynen-Stasse 25, D-81377 Munich, Germany
| | - Stefan Kääb
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
| | - Dominik Schüttler
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Philipp Tomsits
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
| | - Sebastian Clauss
- Grosshadern Campus, Department of Medicine I, University Hospital Munich, Ludwig-Maximilians-University (LMU), Marchioninistrasse 15, D-81377 Munich, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Munich, Munich Heart Alliance, D-81377 Munich, Germany
- Institute of Surgical Research at the Walter-Brendel-Centre of Experimental Medicine, University Hospital Munich, LMU Munich, Marchioninistrasse 68, D-81377 Munich, Germany
- Interfaculty Center for Endocrine and Cardiovascular Disease Network Modelling and Clinical Transfer (ICONLMU), LMU Munich, Feodor-Lynen-Strasse 19, D-81377 Munich, Germany
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16
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Ashraf M, Jan MF, Bajwa TK, Carnahan R, Zlochiver V, Allaqaband SQ. Sex Disparities in Diagnostic Evaluation and Revascularization in Patients With Acute Myocardial Infarction-A 15-Year Nationwide Study. J Am Heart Assoc 2023; 12:e027716. [PMID: 36926995 PMCID: PMC10111558 DOI: 10.1161/jaha.122.027716] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/26/2023] [Indexed: 03/18/2023]
Abstract
Background Although sex disparities in the diagnostic evaluation and revascularization of patients with acute myocardial infarction are well documented, no study has evaluated longitudinal trends in these disparities. Methods and Results Using the National Inpatient Sample from 2005 to 2019, 9 259 932 patients with acute myocardial infarction were identified. We divided 15 years into five 3-year periods. The primary objective was to evaluate sex-based trends in the use of diagnostic angiography, percutaneous coronary intervention, and coronary artery bypass graft (CABG) among patients with non-ST-segment-elevation myocardial infarction and ST-segment-elevation myocardial infarction (STEMI) over 15 years. The secondary objective was to evaluate sex disparities in mortality, length of stay, and cost. For non-ST-segment-elevation myocardial infarction, we saw a small reduction in sex disparity in the use of all diagnostic angiography in period 5 versus period 1 (4% versus 5.3%; P<0.01), no change in sex disparity in percutaneous coronary intervention use in period 5 versus period 1 (5.6% versus 5%; P=0.16), and a widening sex disparity in CABG in period 5 versus period 1 (5.4% versus 4.4%; P<0.01). However, we noted decreasing sex disparities in the use of diagnostic angiography, percutaneous coronary intervention, and CABG for ST-segment-elevation myocardial infarction in mostly all periods compared with period 1 (P<0.05, all comparisons), but differences still existed in period 5. Risk-adjusted in-hospital mortality was higher after CABG for non-ST-segment-elevation myocardial infarction and after percutaneous coronary intervention and CABG for ST-segment-elevation myocardial infarction in women than men. Conclusions Despite variable trends in sex disparities in diagnostic and revascularization procedures for acute myocardial infarction, disparities still exist.
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Affiliation(s)
- Muddasir Ashraf
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora HealthUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeWI
| | - M. Fuad Jan
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora HealthUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeWI
| | - Tanvir. K Bajwa
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora HealthUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeWI
| | - Ryan Carnahan
- The University of Iowa College of Public HealthIowa CityIA
| | - Viviana Zlochiver
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora HealthUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeWI
| | - Suhail Q. Allaqaband
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Advocate Aurora HealthUniversity of Wisconsin School of Medicine and Public HealthMilwaukeeWI
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Olmastroni E, Galimberti F, Catapano AL, Tragni E, Casula M. Beta-blockers in post-acute myocardial infarction patients: Drug prescription patterns from 2018 to Italy's first wave of the COVID-19 pandemic. Front Pharmacol 2022; 13:1040710. [PMID: 36569305 PMCID: PMC9768333 DOI: 10.3389/fphar.2022.1040710] [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: 09/09/2022] [Accepted: 11/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Major guidelines recommend the initiation of a beta-blocker therapy after an acute myocardial infarction (AMI). We aimed to map the treatment pathway of beta-blockers for AMI survivors during the first wave of COVID-19 pandemic in Italy and to investigate predictors for treatment non-initiation. Methods: Healthcare utilization databases of Lombardy Region were investigated. Subjects aged ≥18 years who were hospitalised with AMI in the period February-March-April of 2018, 2019, and 2020 were included, and followed for 30 days from the discharge date, to investigate whether they presented a first prescription of beta-blockers. A multivariate logistic model was performed to evaluate the effect of several covariates on the probability of not receiving a post-AMI beta-blocker therapy. Results: The cohorts comprised 2259, 2383, and 1932 individuals who were hospitalised with AMI in the 3-month period in 2018, 2019, and 2020, respectively. Overall in 2020, about 58-60% of individuals with AMI received a prescription of beta-blockers within 1 month after the discharge. A continuous decreasing trend over time was observed. Men were 30% more likely to start the treatment than women, increasing age was associated with significant increasing probability of not receiving a post-infarction beta-blocker therapy, while having received an antihypertensive or lipid-lowering treatment, or having been hospitalized for heart failure prior to the AMI hospitalization reduced the likelihood of not being treated with beta-blockers. Conclusion: The initiation of beta-blocker treatment after AMI remains an under-prescribed practice, that does not seem to have been further affected by the first wave of the COVID-19 pandemic.
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Affiliation(s)
- Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,*Correspondence: Elena Olmastroni,
| | | | - Alberico L. Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,IRCCS MultiMedica, Sesto S. Giovanni, MI, Italy
| | - Elena Tragni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy,IRCCS MultiMedica, Sesto S. Giovanni, MI, Italy
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18
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Kelly DM, Feld J, Rothwell PM, Reinecke H, Koeppe J. Admission Rates, Time Trends, Risk Factors, and Outcomes of Ischemic and Hemorrhagic Stroke From German Nationwide Data. Neurology 2022; 99:e2593-e2604. [PMID: 36332988 PMCID: PMC9754650 DOI: 10.1212/wnl.0000000000201259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/01/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In the past decade, there have been major improvements in the control of risk factors, acute stroke therapies, and rehabilitation after the availability of high-quality evidence and guidelines on best practices in the acute phase. In this changing landscape, we aimed to investigate the stroke admission rates, time trends, risk factors, and outcomes during the period of 2014-2019 using German nationwide data. METHODS We obtained data of all acute stroke hospitalizations by the Federal Statistical Office. All hospitalized cases of adults (age 18 years or older) with acute stroke from the years 2014-2019 were analyzed regarding time trends, risk factors, treatments, morbidity, and in-hospital mortality according to stroke subtype (all-cause/ischemic/hemorrhagic). RESULTS Between 2014 and 2019, overall stroke hospitalizations in adults (median age = 76 years, [IQR: 65-83 years]) initially increased from 306,425 in 2014 to peak at 318,849 in 2017 before falling to again to 312,692 in 2019, whereas percentage stroke hospitalizations that resulted in death remained stable during this period at 8.5% in 2014 and 8.6% in 2019. In a multivariate model of 1,882,930 cases, the strongest predictors of in-hospital stroke mortality were hemorrhagic subtype (adjusted OR [aOR] = 3.06, 95% CI 3.02-3.10; p < 0.001), cancer (aOR = 2.11, 2.06-2.16; p < 0.001), congestive heart failure (aOR = 1.70, 1.67-1.73; p < 0.001), and lower extremity arterial disease (aOR = 1.76, 1.67-1.84; p < 0.001). DISCUSSION Despite recent advances in acute stroke care over the past decade, the percentage of stroke hospitalizations resulting in death remained unchanged. Further research is needed to determine how best to optimize stroke care pathways for multimorbid patients.
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Affiliation(s)
- Dearbhla M Kelly
- From the J Philip Kistler Stroke Research Center (D.M.K.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114 USA; Institute of Biostatistics and Clinical Research (J.F., J.K.), University of Muenster, Germany; Wolfson Centre for the Prevention of Stroke and Dementia (D.M.K., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; and Department of Cardiology I: Coronary and Peripheral Vascular Disease (H.R.), Heart Failure, University Hospital Muenster, Germany.
| | - Jannik Feld
- From the J Philip Kistler Stroke Research Center (D.M.K.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114 USA; Institute of Biostatistics and Clinical Research (J.F., J.K.), University of Muenster, Germany; Wolfson Centre for the Prevention of Stroke and Dementia (D.M.K., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; and Department of Cardiology I: Coronary and Peripheral Vascular Disease (H.R.), Heart Failure, University Hospital Muenster, Germany
| | - Peter M Rothwell
- From the J Philip Kistler Stroke Research Center (D.M.K.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114 USA; Institute of Biostatistics and Clinical Research (J.F., J.K.), University of Muenster, Germany; Wolfson Centre for the Prevention of Stroke and Dementia (D.M.K., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; and Department of Cardiology I: Coronary and Peripheral Vascular Disease (H.R.), Heart Failure, University Hospital Muenster, Germany
| | - Holger Reinecke
- From the J Philip Kistler Stroke Research Center (D.M.K.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114 USA; Institute of Biostatistics and Clinical Research (J.F., J.K.), University of Muenster, Germany; Wolfson Centre for the Prevention of Stroke and Dementia (D.M.K., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; and Department of Cardiology I: Coronary and Peripheral Vascular Disease (H.R.), Heart Failure, University Hospital Muenster, Germany
| | - Jeanette Koeppe
- From the J Philip Kistler Stroke Research Center (D.M.K.), Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114 USA; Institute of Biostatistics and Clinical Research (J.F., J.K.), University of Muenster, Germany; Wolfson Centre for the Prevention of Stroke and Dementia (D.M.K., P.M.R.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, United Kingdom; and Department of Cardiology I: Coronary and Peripheral Vascular Disease (H.R.), Heart Failure, University Hospital Muenster, Germany
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19
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Sex Differences in Ischemic Cerebral Infarction: A Nationwide German Real-Life Analysis from 2014 to 2019. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2022. [DOI: 10.3390/ctn6030023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Female sex has been shown to be associated with an unfavorable outcome after ischemic stroke. In this nationwide analysis, we evaluate a large dataset of patients suffering from acute ischemic stroke to elucidate the factors associated with an increased risk of mortality after stroke in women. We analyzed a nationwide dataset from the German Federal Bureau of Statistics including 1,577,884 (761,537 female sex, 48.3%) in-hospital cases admitted between 1 January 2014 and 31 December 2019 with a primary diagnosis of acute ischemic cerebral infarction. Patients were analyzed regarding morbidity, treatments and in-hospital mortality. A multiple logistic regression analysis was performed, adjusted by patients’ risk profile including age, to evaluate the association of sex and in-hospital mortality. According to the median, women were older than men (79 years vs. 73 years). The multiple logistic regression analysis however revealed female sex remained an independent factor for an increased in-hospital mortality (odds ratio [OR] 1.12; 95% confidence interval [CI] 1.11–1.14; p < 0.001). Women had a higher prevalence of relevant risk factors, namely arterial hypertension (77.0% vs. 74.7%), arterial fibrillation (33.3% vs. 25.6%), chronic heart failure (12.3% vs. 9.7%), chronic kidney disease (15.6% vs. 12.9%) and dementia (6.6% vs. 4.1%), but were less affected with respect to other relevant co-morbidities such as cerebrovascular disease (11.7% vs. 15.1%), coronary heart disease (11.7% vs. 18.8%), diabetes mellitus (26.4% vs. 29.6%), dyslipidemia (38.1% vs. 42.0%), ischemic heart disease (12.3% vs. 19.3%) and previous coronary artery bypass grafting (1.1% vs. 3.2%). Overall, therapeutic interventions were performed less frequently in women such as carotid endarterectomy (1.1% vs. 2.3%), carotid stent (0.7% vs. 1.4%), as well as hematoma drainage (0.1% vs. 0.2%), and renal replacement therapy (0.4% vs. 0.6%). Conclusions: Our nationwide analysis revealed a higher mortality rate after stroke in women. Nevertheless, women had fewer in-hospital complications and were also less likely to experience the severe effects of some important co-morbidities. The dataset, however, showed that women received surgical or interventional carotid treatments after stroke less often. It is important for research on sex disparities in stroke to keep these treatment frequency differences in mind.
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20
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Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry. Cardiol Res Pract 2022; 2022:2835485. [PMID: 36105435 PMCID: PMC9467791 DOI: 10.1155/2022/2835485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences. Method. We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016–2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates. Results. Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%,
) and diabetes (24.5% vs. 15.2%,
). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%,
); the onset to first medical contact (FMC) (255 vs. 190 minutes,
), onset to fibrinolysis (218 vs. 185 minutes,
), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes,
) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%,
), death or treatment withdrawal (14.5% vs. 5.6%,
), and MACCE (18.5% vs. 9.4%,
) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12–2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26–2.24), and MACCE (OR: 1.37, 95% CI: 1.08–1.74) after adjustment for covariates. Among possible explanatory factors, age (−58.46%, −59.04%, −62.20%) and cardiovascular risk factors (−40.77%, −39.36%, −41.73%) accounted for most of the gender-associated risk differences. Conclusions. Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.
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21
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González-Del-Hoyo M, Rodríguez-Leor O, Cid-Álvarez AB, de Prado AP, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras-Roubin S, Moreno R, Rossello X. Short-term mortality differs between men and women according to the presence of previous cardiovascular disease: Insights from a nationwide STEMI cohort. Int J Cardiol 2022; 367:90-98. [PMID: 36030132 DOI: 10.1016/j.ijcard.2022.08.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 08/06/2022] [Accepted: 08/16/2022] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sex and prior cardiovascular disease (CVD) are known independent prognostic factors following an ST-elevation myocardial infarction (STEMI). We aimed to examine whether the association between sex and 30-day mortality differ according to the presence of previous CVD in STEMI patients. METHODS Prospective, observational, multicentre registry of consecutive patients managed in 17 STEMI networks in Spain (83 centres), between April and June 2019. Unadjusted and adjusted logistic regression models assessed the association of 30-day mortality with sex and prior CVD status, as well as their interaction. RESULTS Among 4366 patients (mean age 63.7 ± 13.0 years; 78% male), there were 337 (8.1%) deaths within the first 30 days. There was an association between crude 30-day mortality and sex (women 10.4% vs. men 7.4%, p = 0.003), and prior CVD (CVD 13.7% vs non-CVD 6.8%, p < 0.001). After adjustment for potential confounding, neither sex nor prior CVD were apparently associated with mortality. Nevertheless, we found a significant sex-CVD interaction (p-interaction = 0.006), since women were at lower risk than men in the subset of patients with prior CVD (OR = 0.30, 95%CI = 0.12-0.80) but not in those without CVD (OR = 1.17, 95%CI = 0.79-1.74). CONCLUSIONS Women as well as patients with prior CVD have an increased crude risk of 30-day mortality. However, sex-related differences in short term mortality are modulated by the interaction with CVD in STEMI patients. Compared to men, women had a similar prognosis in the subset of patients without CVD, whereas they were associated with a lower risk of mortality among those with prior CVD after adjusting for other prognostic factors.
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Affiliation(s)
- Maribel González-Del-Hoyo
- Servicio de Cardiología, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain
| | - Oriol Rodríguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Ana Serrador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Ramón Rumoroso
- Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge - IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Borja Ibáñez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge - IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Raposeiras-Roubin
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain
| | - Raúl Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de La Paz, Madrid, Spain
| | - Xavier Rossello
- Servicio de Cardiología, Hospital Universitari Son Espases, Institut d'Investigació Sanitària Illes Balears (IdISBa), Palma de Mallorca, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain.
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22
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Impact of Female Gender on Acute and Mid-Term Mortality in Patients with ST-Segment Elevation Myocardial Infarction during the Pandemic Era. WOMEN 2022. [DOI: 10.3390/women2030019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
There is still much controversy concerning the impact of gender on mortality during ST-segment elevation myocardial infarction (STEMI). The COVID-19 pandemic deeply affected the clinical history of these patients, both in terms of presentation time and management. Our study focuses on STEMI patients hospitalized during the darkest period of the pandemic. From a total of 283 patients, women represented 26.8% of the population, with a mean age of 72 ± 11.2 years vs. 64.7 ± 12.6 years in men. Anterior STEMI was the most represented with a mildly reduced ejection fraction (EF 48.3 ± 11.8%) similar between genders. Coronary angiography showed more extensive disease in man, while women presented with a higher Killip class at admission and a more pronounced anemic status. In-hospital and 1-year mortality of the whole cohort were 11.4% and 7.5%, respectively, with no significant differences between genders (14.5% women vs. 10.6% men, p = ns; 9.2% women vs. 7% man, p = ns). EF resulted in being the only independent predictor of mortality in the short-term and at 1-year follow up in both genders. In the acute phase, the only other independent predictor of mortality was COVID-19 infection, secondary to the higher rate of respiratory complications, without any difference in terms of major adverse cardiac events. The impact of COVID-19 infection on mortality was completely lost at 1-year follow up.
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Coronary Artery Disease and Cancer: Treatment and Prognosis Regarding Gender Differences. Cancers (Basel) 2022; 14:cancers14020434. [PMID: 35053596 PMCID: PMC8774086 DOI: 10.3390/cancers14020434] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 01/04/2022] [Accepted: 01/12/2022] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Cardiovascular disease and cancer are the leading causes of hospitalization and mortality in high-income countries. Studies of myocardial infarction show a disadvantage for the female sex in terms of survival and development of heart failure after myocardial infarction. The extent to which this also applies to the co-occurrence of coronary heart disease and cancer was investigated and analyzed here in large registry studies. Particular attention has been paid to the four most common cancers and hematologic diseases associated with coronary artery disease requiring treatment. Abstract Cardiovascular disease and cancer remain the leading causes of hospitalization and mortality in high-income countries. Survival after myocardial infarction has improved but there is still a difference in clinical outcome, mortality, and developing heart failure to the disadvantage of women with myocardial infarction. Most major cardiology trials and registries have excluded patients with cancer. As a result, there is only very limited information on the effects of coronary artery disease in cancer patients. In particular, the outcomes in women with cancer and coronary artery disease and its management remain empiric. We reviewed studies of over 27 million patients with coronary artery disease and cancer. Our review focused on the most important types of cancer (breast, colon, lung, prostate) and hematological malignancies with particular attention to sex-specific differences in treatment and prognosis.
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OUP accepted manuscript. Eur Heart J 2022; 43:1771-1773. [DOI: 10.1093/eurheartj/ehac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kuehnemund L, Koeppe J, Feld J, Wiederhold A, Illner J, Makowski L, Gerß J, Reinecke H, Freisinger E. Gender differences in acute myocardial infarction-A nationwide German real-life analysis from 2014 to 2017. Clin Cardiol 2021; 44:890-898. [PMID: 34075604 PMCID: PMC8259152 DOI: 10.1002/clc.23662] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Female sex was reported to be associated with an unfavorable outcome in acute myocardial infarction (AMI). In this nationwide analysis we assessed sex differences in acute outcomes of AMI and recent trends in patient healthcare. METHODS We analyzed 875 735 German cases hospitalized with a main diagnosis of ST- (STEMI) and non ST-elevation myocardial infarction (NSTEMI) between January 01 2014 and December 31 2017 regarding morbidity, in-hospital mortality and treatments. A multivariable logistic regression model was designed to evaluate the use of interventions and their impact on in-hospital mortality. RESULTS STEMI cases decreased from 72 894 in 2014 to 68 213 in 2017, with 70% assignable to men. Female sex was associated with older age (74 vs. 62 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.2% vs. 12.5%), hypertension (69.0% vs. 65.0%) and left ventricular heart failure (36.0% vs. 32.1%). In NSTEMI, female sex was also associated with older age (78 vs. 71 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (29.7% vs. 23.9%), hypertension (77.4% vs. 74.5%) and left ventricular heart failure (40.5% vs. 36.4%). Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI, p < 0.001). In NSTEMI, PCI was performed in 40.8% of female and 52.0% of male cases (p < 0.001). In-hospital mortality was notably increased in female patients with STEMI (15.0% vs. 9.6%; p < 0.001; OR 1.07; 95% CI 1.03-1.10) and NSTEMI (8.3% vs. 6.3%; p < 0.001; OR 0.91; 95% CI 0.89-0.93) compared to males. CONCLUSIONS Our nationwide real-world data document that in-patient STEMI cases continue to decrease in women and men. The observed higher in-hospital mortality in women was largely attributed to a more unfavorable risk and age distribution rather than to female-intrinsic factors. Women with AMI continue to be less likely to receive revascularization therapies.
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Affiliation(s)
- Leonie Kuehnemund
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Koeppe
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Jannik Feld
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Achim Wiederhold
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Julia Illner
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Lena Makowski
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
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