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Hasun M, Dörler J, Alber HF, Bauer A, Berger R, Christ G, Frick M, Hoppe UC, Huber K, Lamm G, Laßnig E, von Lewinski D, Rab A, Roithinger FX, Schuchlenz H, Siostrzonek P, Sipötz J, Stefenelli T, Steinwender C, Edlinger M, Weidinger F. Improved in-hospital outcome for radial access in a large contemporary cohort of primary percutaneous coronary intervention. Cardiovasc Diagn Ther 2021; 11:726-735. [PMID: 34295699 DOI: 10.21037/cdt-20-977] [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: 12/04/2020] [Accepted: 03/28/2021] [Indexed: 11/06/2022]
Abstract
Background Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice. Methods For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access. Results Radial compared to femoral access was associated with lower in-hospital mortality (3.5% vs. 7.7%; P<0.01). Multivariable logistic regression analysis confirmed reduced in-hospital mortality [odds ratio (OR) 0.57, 95% confidence interval (CI): 0.43 to 0.75]. Furthermore, MACE (OR 0.60, 95% CI: 0.47 to 0.78) as well as NACE (OR 0.59, 95% CI: 0.46 to 0.75) occurred less frequently in patients with radial access. Interaction analysis with cardiogenic shock showed an effect modification, resulting in lower mortality in PCI via radial access in patients without, but no difference in those with cardiogenic shock (OR 1.78, 95% CI: 1.07 to 2.96). Conclusions Radial access for patients with acute MI undergoing PPCI is associated with improved survival in a large contemporary cohort of daily practice. However, this beneficial effect is restricted to hemodynamically stable patients.
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Affiliation(s)
- Matthias Hasun
- 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria
| | - Jakob Dörler
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Hannes F Alber
- Department of Internal Medicine and Cardiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
| | - Axel Bauer
- Department of Internal Medicine III, Cardiology and Angiology, Medical University Innsbruck, Innsbruck, Austria
| | - Rudolf Berger
- Department of Internal Medicine I, Cardiology and Nephrology, Krankenhaus der Barmherzigen Brüder Eisenstadt, Eisenstadt, Austria
| | - Günter Christ
- 5th Medical Department with Cardiology, Sozialmedizinisches Zentrum Süd - Kaiser Franz Josef Hospital, Vienna, Austria
| | - Matthias Frick
- 1st Department of Internal Medicine, Landeskrankenhaus Feldkirch, Feldkirch, Austria
| | - Uta C Hoppe
- Department of Internal Medicine II, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Intensive Care Medicine, Wilhelminenspital, and Medical School, Sigmund Freud University, Vienna, Austria
| | - Gudrun Lamm
- Department of Internal Medicine III, Universitätsklinikum St. Pölten, St. Pölten, Austria
| | - Elisabeth Laßnig
- Department of Internal Medicine II, Cardiology and Intensive Care Medicine, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Dirk von Lewinski
- Department of Internal Medicine, Cardiology, Medical University Graz, Graz, Austria
| | - Anna Rab
- Department for Internal Medicine, Landeskrankenhaus Villach, Villach, Austria
| | - Franz X Roithinger
- Department of Internal Medicine, Cardiology and Nephrology, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Herwig Schuchlenz
- Department of Internal Medicine, Cardiology and Intensive Care Medicine, Landeskrankenhaus Graz West, Graz, Austria
| | - Peter Siostrzonek
- Department of Internal Medicine II - Cardiology, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - Johann Sipötz
- 2nd Department of Internal Medicine, Hanusch Hospital, Vienna, Austria
| | - Thomas Stefenelli
- Department of Internal Medicine I, Sozialmedizinisches Zentrum Ost - Donauspital, Vienna, Austria
| | - Clemens Steinwender
- Department of Internal Medicine I, Cardiology and Internal Intensive Medicine, Kepler Universitätsklinikum, Linz, Austria
| | - Michael Edlinger
- Department of Medical Statistics, Informatics, and Health Economics, Medical University Innsbruck, Innsbruck, Austria.,Department of Development and Regeneration, KU Leuven, Belgium
| | - Franz Weidinger
- 2nd Medical Department with Cardiology and Intensive Care Medicine, KA Rudolfstiftung, Vienna, Austria
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In-Hospital Outcome Comparing Bivalirudin to Heparin in Real-World Primary Percutaneous Coronary Intervention. Am J Cardiol 2017; 120:2135-2140. [PMID: 29103603 DOI: 10.1016/j.amjcard.2017.08.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 11/21/2022]
Abstract
Randomized controlled trials have shown conflicting results regarding the outcome of bivalirudin in primary percutaneous coronary intervention (PPCI). The aim of this study was to evaluate the in-hospital outcomes of patients receiving heparin or bivalirudin in a real-world setting of PPCI: 7,023 consecutive patients enrolled in the Austrian Acute PCI Registry were included between January 2010 and December 2014. Patients were classified according to the peri-interventional anticoagulation regimen receiving heparin (n = 6430) or bivalirudin (n = 593) with or without GpIIb/IIIa inhibitors (GPIs). In-hospital mortality (odds ratio [OR] 1.13, 95% confidence interval [CI] 0.57 to 2.25, p = 0.72), major adverse cardiovascular events (OR 1.18, 95% CI 0.65 to 2.14, p = 0.59), net adverse clinical events (OR 1.01, 95% CI 0.57 to 1.77, p = 0.99), and TIMI non-coronary artery bypass graft-related major bleeding (OR 0.41, 95% CI 0.09 to 1.86, p = 0.25) were not significantly different between the groups. However, we detected potential effect modifications of anticoagulants on mortality by GPIs (OR 0.12, 95% CI 0.01 to 1.07, p = 0.06) and access site (OR 0.25, 95% CI 0.06 to 1.03, p = 0.06) favoring bivalirudin in femoral access. In conclusion, this large real-world cohort of PPCI, heparin-based anticoagulation showed similar results of short-term mortality compared with bivalirudin. We observed a potential effect modification by additional GPI use and access favoring bivalirudin over heparin in femoral, but not radial, access.
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Gündüz D, Lesjak A, Wiedemann A, Avanzini M, Winkler WB, Ucar-Altenberger H, Stöllberger C, Weidinger F. Acute coronary syndrome in immigrants and non-immigrants : Results of an Austrian prospective pilot study. Wien Klin Wochenschr 2017; 129:900-905. [PMID: 29058074 DOI: 10.1007/s00508-017-1279-7] [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: 05/13/2017] [Accepted: 09/19/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are indications that immigrant patients with acute coronary syndrome (ACS) differ in demographic characteristics and clinical presentation from non-immigrant patients. The aim of this prospective pilot study was to gather clinical and sociodemographic data from patients with ACS and to compare immigrants with non-immigrants. METHODS Included were consecutive patients who underwent acute coronary angiography in one cardiological department for ACS from September 2011 to September 2013. Information was gathered about age, sex, results of the coronary angiography, classical risk factors, socioeconomic characteristics as well as ethnicity. Patients who had their place of birth outside Austria were specified as immigrants. RESULTS A total of 100 patients (29% female) with a mean age of 60 years (range 34-91 years) were included. Of the patients 35 (35%) were immigrants, 12 came from Serbia, 4 from Bosnia, 3 from South America, 2 from Germany, 2 from Turkey, 2 from the Czech Republic, 2 from Croatia, 2 from Macedonia, and 1 each from Bangladesh, Poland, Romania, Libya, Bulgaria and Pakistan. Immigrants tended to be younger on average (56 vs. 62 years, p = 0.04) and had a two or multivessel disease more often than the non-immigrants but this difference was not significant (51% vs. 38%, p = 0.29). There were no differences between non-immigrants and immigrants concerning the classical risk factors for ACS (hypercholesterinemia 60% vs. 69%, nicotine abuse 51% vs. 60%, hypertension 69% vs. 79%) except diabetes mellitus (15% vs. 37%, p = 0.02). Sociodemographic data showed differences in education and socioeconomic status (SES). Non-immigrants had jobs with high skill level more often than immigrants (30% vs. 4%, p = 0.02), although there was no difference between immigrants and non-immigrants in the level of high education (9% each); however, immigrants more often had low education (31% vs. 11%, p = 0.01) and a monthly income below 1000 € than non-immigrants (41% vs. 14%, p = 0.03). CONCLUSIONS Immigrants with ACS suffered more often from coronary two or multivessel disease and diabetes mellitus and were slightly younger than non-immigrants, although they did not differ regarding classical risk factors. Results suggest that the lower SES of immigrants compared with non-immigrants might contribute to the severity of coronary heart disease.
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Affiliation(s)
- Duygu Gündüz
- Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
| | - Anita Lesjak
- Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
| | - Angela Wiedemann
- Vienna Institute of Demography/Austrian Academy of Sciences, Wittgenstein Centre (IIASA, VID/ÖAW, WU), Welthandelsplatz 2, Level 2, 1020, Vienna, Austria
| | - Marion Avanzini
- Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
| | | | | | - Claudia Stöllberger
- Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria.
- , Steingasse 31/18, 1030, Vienna, Austria.
| | - Franz Weidinger
- Krankenanstalt Rudolfstiftung, Juchgasse 25, 1030, Vienna, Austria
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Goss F, Brachmann J, Hamm CW, Haerer W, Reifart N, Levenson B. High adherence to therapy and low cardiac mortality and morbidity in patients after acute coronary syndrome systematically managed by office-based cardiologists in Germany: 1-year outcomes of the ProAcor Study. Vasc Health Risk Manag 2017; 13:127-137. [PMID: 28435280 PMCID: PMC5388240 DOI: 10.2147/vhrm.s119490] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
We aimed to assess patient acceptance and effectiveness of a 12-month structured management program in patients after an acute coronary syndrome (ACS) event who were treated in a special setting of office-based cardiologists. The program comprised patient documentation with a specific tool (Bundesverband Niedergelassener Kardiologen [German Federation of Office-Based Cardiologists] cardiac pass with visit scheduling) shared by the hospital physician and the office-based cardiologist, the definition of individual treatment targets, and the systematic information of patients in order to optimize adherence to therapy. Participating centers (36 hospitals, 60 office-based cardiologists) included a total of 1,003 patients with ACS (ST-segment elevation myocardial infarction [STEMI] 44.3%, non-ST-segment elevation myocardial infarction [NSTEMI] 39.5%, unstable angina pectoris [UA] 15.2%, and unspecified 1.0%). During follow-up, treatment rates with cardiac medication remained high in all groups, with dual antiplatelet therapy in 91.0% at 3 months, 90.0% at 6 months, and 82.8% at 12 months, respectively. Twelve months after the inclusion, a total of 798 patients (79.6%) still participated in the program. Eighteen patients (1.8%) had died after discharge from hospital (6 in the STEMI, 12 in the NSTEMI group), while for 58 the status was unknown (5.8%). Based on a conservative approach that considered patients with unknown status as dead, 1-year mortality was 7.6%. Recurrent cardiac events were noted in 14.9% at 1 year, with an about equal distribution across STEMI and NSTEMI patients. In conclusion, patients’ acceptance of the ProAcor program as determined by adherence rates over time was high. Treatment rates of recommended medications used for patients with coronary heart disease were excellent. The 1-year mortality rate was comparatively low.
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Affiliation(s)
| | | | | | | | - Nicolaus Reifart
- Kardiologische Praxis Prof. Reifart & Partner, Bad Soden, Germany
| | - Benny Levenson
- Kardiologische Gemeinschaftspraxis und Herzkatheterlabor Berlin-Charlottenburg, Berlin, Germany
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5
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Ribas N, García-García C, Meroño O, Recasens L, Pérez-Fernández S, Bazán V, Salvatella N, Martí-Almor J, Bruguera J, Elosua R. Secondary prevention strategies after an acute ST-segment elevation myocardial infarction in the AMI code era: beyond myocardial mechanical reperfusion. BMC Cardiovasc Disord 2017; 17:54. [PMID: 28173757 PMCID: PMC5297147 DOI: 10.1186/s12872-017-0493-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The AMI code is a regional network enhancing a rapid and widespread access to reperfusion therapy (giving priority to primary angioplasty) in patients with acute ST-segment elevation myocardial infarction (STEMI). We aimed to assess the long-term control of conventional cardiovascular risk factors after a STEMI among patients included in the AMI code registry. DESIGN AND METHODS Four hundred and fifty-four patients were prospectively included between June-2009 and April-2013. Clinical characteristics were collected at baseline. The long-term control of cardiovascular risk factors and cardiovascular morbidity/mortality was assessed among the 6-months survivors. RESULTS A total of 423 patients overcame the first 6 months after the STEMI episode, of whom 370 (87%) underwent reperfusion therapy (363, 98% of them, with primary angioplasty). At 1-year follow-up, only 263 (62%) had adequate blood pressure control, 123 (29%) had LDL-cholesterol within targeted levels, 126/210 (60%) smokers had withdrawn from their habit and 40/112 (36%) diabetic patients had adequate glycosylated hemoglobin levels. During a median follow-up of 20 (11-30) months, cumulative mortality of 6 month-survivors was 6.1%, with 9.9% of hospital cardiovascular readmissions. The lack of assessment of LDL and HDL-cholesterol were significantly associated with higher mortality and cardiovascular readmission rates. CONCLUSIONS Whereas implementation of the AMI code resulted in a widespread access to rapid reperfusion therapy, its long-term therapeutic benefit may be partially counterbalanced by a manifestly suboptimal control of cardiovascular risk factors. Further efforts should be devoted to secondary prevention strategies after STEMI.
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Affiliation(s)
- Núria Ribas
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Medicine Department, Program in Internal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Cosme García-García
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - Oona Meroño
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Lluís Recasens
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Silvia Pérez-Fernández
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
| | - Víctor Bazán
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain
| | - Neus Salvatella
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Julio Martí-Almor
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jordi Bruguera
- Cardiology Department, Hospital del Mar, Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Heart Diseases Biomedical Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Roberto Elosua
- IMIM (Hospital del Mar Medical Research Institute). Cardiovascular Epidemiology and Genetics Group (EGEC), REGICOR Study Group, Barcelona, Spain.,CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Socias L, Frontera G, Rubert C, Carrillo A, Peral V, Rodriguez A, Royo C, Ferreruela M, Torres J, Elosua R, Bethencourt A, Fiol M. Análisis comparativo de 2 registros de infarto agudo de miocardio tras una década de cambios. Estudio IBERICA (1996-1998) y Código Infarto-Illes Balears (2008-2010). Med Intensiva 2016; 40:541-549. [DOI: 10.1016/j.medin.2016.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 10/21/2022]
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Jukema JW, Lettino M, Widimský P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez-Sendón J, Tousek P, Weidinger F, Weston CF, Zaman A, Zeymer U. Contemporary registries on P2Y12 inhibitors in patients with acute coronary syndromes in Europe: overview and methodological considerations: Table 1. EUROPEAN HEART JOURNAL - CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:232-244. [DOI: 10.1093/ehjcvp/pvv024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Dharma S, Andriantoro H, Dakota I, Purnawan I, Pratama V, Isnanijah H, Yamin M, Bagus T, Hartono B, Ratnaningsih E, Suling F, Basalamah MA. Organisation of reperfusion therapy for STEMI in a developing country. Open Heart 2015; 2:e000240. [PMID: 26019883 PMCID: PMC4442233 DOI: 10.1136/openhrt-2015-000240] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Revised: 04/13/2015] [Accepted: 04/16/2015] [Indexed: 12/31/2022] Open
Abstract
Objective Routine evaluation of performance measures for the system of care for patients with ST-elevation myocardial infarction (STEMI) is needed to improve the STEMI network. We sought to evaluate the current status of reperfusion therapy for STEMI in the capital city of a developing country where a STEMI network was introduced in 2010. Methods Data were obtained from a local registry. A total of 28 812 patients admitted to the emergency department of a national cardiovascular hospital in three different periods (2007, 2010 and 2013) were retrospectively analysed; there were 2703 patients with STEMI. Results In 2013 compared with 2007, there was a major increase in the number of primary percutaneous coronary interventions (PCIs) (35% vs 24%, p<0.001), and the proportion of non-reperfused patients fell (62.8% vs 67.7%, p<0.001). An improvement in the overall STEMI mortality rate was also observed (7.5% vs 11.7%, p<0.001). Conclusions Implementation of a regional system of care for STEMI may improve utilisation of primary PCI. Future organisation of reperfusion therapy in a developing country such as Indonesia strongly calls for a strategy that focuses on prehospital care to minimise delay from the first medical contact to reperfusion therapy, and this may reduce the proportion of non-reperfused patients. These strategies are in concordance with guideline recommendations and may reduce or eliminate gaps in healthcare in developing countries, particularly the underutilisation of evidence-based therapies for patients with STEMI. Trial registration number NCT 02319473, Clinicaltrials.gov.
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Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia
| | - Ismi Purnawan
- Chairman, Indonesian Heart Association, Jakarta Branch , Indonesia
| | - Vireza Pratama
- Department of Cardiology, Gatot Soebroto Army Central Hospital, Central Jakarta , Indonesia
| | - Herawati Isnanijah
- Department of Cardiology and Vascular Medicine , Pasar Rebo General Hospital , East Jakarta , Indonesia
| | - Muhammad Yamin
- Integrated Cardiovascular Services, Cardiology Division, Department of Internal Medicine, Faculty of Medicine, University of Indonesia, Cipto Mangunkusumo General Hospital, Central Jakarta , Indonesia
| | - Tjatur Bagus
- Department of Cardiology, Dr Mintohardjo Hospital, Indonesian Naval Hospital, Central Jakarta , Indonesia
| | | | - Endang Ratnaningsih
- Department of Cardiology and Vascular Medicine , Tarakan General Hospital , Central Jakarta , Indonesia
| | - Frits Suling
- Department of Cardiology and Vascular Medicine, Christian University of Indonesia General Hospital, East Jakarta, Indonesia
| | - M Abas Basalamah
- Department of Cardiology and Vascular Medicine, Persahabatan Hospital, East Jakarta, Indonesia
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Chen TE, Lo PH, Li TC, Lin KH, Lin JJ, Hsieh LC, Chang CP, Chen YP, Chang KC, Wang HJ. Prognostic significance of reciprocal ST-segment depression in patients with acute STEMI undergoing immediate invasive intervention. Am J Emerg Med 2012; 30:1865-71. [DOI: 10.1016/j.ajem.2012.03.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 03/19/2012] [Accepted: 03/30/2012] [Indexed: 10/28/2022] Open
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Gómez-Hospital JA, Dallaglio PD, Sánchez-Salado JC, Ariza A, Homs S, Lorente V, Ferreiro JL, Gomez-Lara J, Romaguera R, Salazar-Mendiguchía J, Teruel L, Cequier Á. Impacto en tiempos de actuación y perfil de los pacientes tratados con angioplastia primaria en el área metropolitana sur de Barcelona al implantar el programa Código Infarto. Rev Esp Cardiol 2012; 65:911-8. [DOI: 10.1016/j.recesp.2012.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Accepted: 06/11/2012] [Indexed: 11/29/2022]
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Grieco N, Sesana G, Corrada E, Ieva F, Paganoni A, Marzegalli M. Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2012; 1:192-9. [PMID: 24062907 PMCID: PMC3760542 DOI: 10.1177/2048872612453923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/08/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. METHODS AND RESULTS In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. CONCLUSIONS The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.
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Dörler J, Edlinger M, Alber HF, Altenberger J, Benzer W, Grimm G, Huber K, Pachinger O, Schuchlenz H, Siostrzonek P, Zenker G, Weidinger F. Clopidogrel pre-treatment is associated with reduced in-hospital mortality in primary percutaneous coronary intervention for acute ST-elevation myocardial infarction. Eur Heart J 2011; 32:2954-61. [PMID: 21920970 DOI: 10.1093/eurheartj/ehr360] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
AIMS Pre-treatment with clopidogrel results in a reduction of ischaemic events in non-ST-elevation acute coronary syndromes. Data on upstream clopidogrel in the setting of primary percutaneous coronary intervention (PCI) are limited. The aim of this study was to investigate whether clopidogrel loading before arrival at the PCI centre may result in an improved outcome of primary PCI for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS In a multicentre registry of acute PCI, 5955 patients undergoing primary PCI in Austria between January 2005 and December 2009 were prospectively enrolled. The patients consisted of two groups, a clopidogrel pre-treatment group (n = 1635 patients) receiving clopidogrel before arrival at the PCI centre and a peri-interventional clopidogrel group (n = 4320 patients) receiving clopidogrel at a later stage. Multiple logistic regression analysis including major confounding factors stratified by the participating centres was applied to investigate the effect of pre-treatment with clopidogrel on the in-hospital mortality. Additionally, two subgroups, with or without the use of GP IIb/IIIa antagonist therapy in the catheterization laboratory, were analysed. On univariate analysis, clopidogrel pre-treatment was associated with a reduced in-hospital mortality (3.4 vs. 6.1%, P< 0.01) after primary PCI. On multivariate analysis, clopidogrel pre-treatment remained an independent predictor of in-hospital mortality [odds ratio (OR) = 0.60, 95% confidence interval (CI) 0.35-0.99; P =0.048], especially in patients receiving additional GP IIb/IIIa antagonist therapy in the catheterization laboratory (OR = 0.40, 95% CI 0.19-0.83; P =0.01). CONCLUSION Clopidogrel pre-treatment before arrival at the PCI centre is associated with reduced mortality in a real world setting of primary PCI. These results strongly support the recommendation of clopidogrel treatment 'as soon as possible' in patients with STEMI undergoing pimary PCI.
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Affiliation(s)
- Jakob Dörler
- Department of Internal Medicine, Cardiology, Innsbruck Medical University, Austria
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Jánosi A, Ofner P, Merkely B, Polgár P, Andréka P, Zámolyi K, Kiss RG, Tomcsányi J, László Z, Vértes A, Varjú I, Juhász F, Simon J, Bajkó S. Myocardial Infarction Registry – 2010. Feasibility and first results. Orv Hetil 2011; 152:1278-83. [DOI: 10.1556/oh.2011.29188] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Authors present the methodology and first data of Hungarian Myocardial Infarction Register Pilot Study started 1st of January, 2010. The aim of the study is to collect epidemiological data on myocardial infarction, to examine the natural history of the disease and to investigate the main characteristics on patient care in the pilot area. The program is using standardized diagnostic criteria and predefined electronic data record forms (eCRF). The pilot area consists of 5 districts in the capital, and Szabolcs-Szatmár-Bereg county. The area has 997 324 inhabitants. Eight cardiology departments, 5 with heart catheterization facility (C) in Budapest, four hospitals with one C in Szabolcs-Szatmar-Bereg county have been responsible of the patients’ care. After starting the program 16 other hospitals joined the program from different parts of Hungary. Between 1st of January 2010 and 1st of May 2011 4293 patients were registered, among them 52.1% with ST segment elevation myocardial infarction (STEMI), 42.1% with non-ST segment elevation myocardial infarction (NSTEMI), while 3% of the patients had unstable angina, and 2.8% of the cases had other diagnosis or the hospital diagnosis was missing in the eCRF. Authors compare the patients care with STEMI in five districts of Budapest and Szabolcs-Szatmár-Bereg county. In Budapest 79.7% of the 301 STEMI patients were treated in C and 84.6% of them were treated with primary percutaneous intervention (pPCI). In Szabolcs-Szatmár-Bereg county 402 patients were registered with STEMI, 62.9% of them were treated in C, where 77% of them were treated with pPCI. The drugs (beta blockers, ACE inhibitors, statins) important for secondary prevention were given more often to patients treated in the capital, however no difference was found in the platelet aggregation inhibitors therapy. Hospital mortality of STEMI patients was 8% in the capital, and 10% in Szabolcs- Szatmár-Bereg county. Authors conclude that the web based myocardial infarction register is feasible and important to have reliable data on patient care and a necessary quality control tool. Authors propose to broaden this pilot program and to start a nationwide myocardial infarction register. Orv. Hetil., 2011, 152, 1278–1283.
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Affiliation(s)
- András Jánosi
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Péter Ofner
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Béla Merkely
- Semmelweis Egyetem, Általános Orvostudományi Kar Kardiológiai Központ Budapest
| | - Péter Polgár
- Jósa András Oktatókórház Nonprofit Kft. Nyíregyháza
| | - Péter Andréka
- Gottsegen György Országos Kardiológiai Intézet Budapest Haller u. 29. 1096
| | - Károly Zámolyi
- Fővárosi Önkormányzat Bajcsy-Zsilinszky Kórháza Budapest
| | | | | | - Zoltán László
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Budapest
| | - András Vértes
- Fővárosi Önkormányzat Szent István és Szent László Kórháza Budapest
| | - Imre Varjú
- Fővárosi Önkormányzat Szent János Kórháza és Észak-budai Egyesített Kórházai Budapest
| | | | - János Simon
- Szatmár-Beregi Kórház és Gyógyfürdő Kft. Fehérgyarmat
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Eberli F. Treatment of acute myocardial infarction: beyond process measures to improve outcome. Wien Klin Wochenschr 2010; 122:189-91. [PMID: 20503015 DOI: 10.1007/s00508-010-1366-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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