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Inan D, Genc D, Şimsek B, Tanık O, Akdeniz E, Korkmaz B, Aydogdu U, Vatanoglu EG, Zeren G, Ceylan B, Yumurtaş Ç, Yüksel G, Pay L, Tanboga H, Karabay CY. Relationship Between CHA₂DS₂-VASc Score on Admission and In-Hospital Major Adverse Cardiovascular Events in Patients Diagnosed With ST-Elevation Myocardial Infarction. Angiology 2024:33197241273382. [PMID: 39133527 DOI: 10.1177/00033197241273382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/13/2024]
Abstract
The CHA₂DS₂-VASc (congestive heart failure, hypertension, age, diabetes mellitus, stroke, vascular disease, sex) scoring system, which includes conventional risk factors of coronary artery disease, was originally created to quantify the risk of thromboembolism in patients with atrial fibrillation. This study evaluated the usefulness of this score to predict adverse outcomes in STEMI (ST-elevation myocardial infarction) patients without atrial fibrillation. Primary end points were identified as MACE (major adverse cardiovascular events) which included in-hospital death or cerebrovascular accident. MACE rate was 10% (193 patients). The CHA₂DS₂-VASc score was an independent predictor of MACE (95% CI, 2.31 [1.37-3.9]; P = .0016). Other independent predictors of MACE included heart rate (95% CI, 1.56 [0.97-2.50]; P = .0242), admission Killip class (95% CI, 24.19 [10.74-54.46]; P < .0001), admission creatinine level (95% CI, 1.54 [1.10-2.16]; P = .0024), peak CK-MB level (95% CI, 1.63 [0.98-2.70]; P = .0001), and no-reflow (95% CI, 2.45 [1.25-4.80]; P = .0085). A nomogram was developed to estimate the risk of in-hospital adverse outcomes for STEMI patients. The CHA₂DS₂-VASc score was an independent predictor of MACE in STEMI patients. Linear analysis of CHA₂DS₂-VASc score without dichotomization was the main difference of this study from others.
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Affiliation(s)
- Duygu Inan
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Duygu Genc
- Department of Cardiology, Basaksehir Cam & Sakura City Hospital, Istanbul, Turkey
| | - Barış Şimsek
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ozan Tanık
- Department of Cardiology, Ankara Etlik City Hospital, Ankara, Turkey
| | - Evliya Akdeniz
- Department of Cardiology, Istanbul Bakırköy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Betül Korkmaz
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ufuk Aydogdu
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Elif G Vatanoglu
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gönül Zeren
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Büşra Ceylan
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Çağdaş Yumurtaş
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gizem Yüksel
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Levent Pay
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Halil Tanboga
- Department of Cardiology, Hisar Intercontinental Hospital, Nişantaşı University, Istanbul, Turkey
| | - Can Y Karabay
- Department of Cardiology, Dr Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
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Wang B, Hao W, Fan J, Yan Y, Gong W, Zheng W, Que B, Ai H, Wang X, Nie S. Clinical significance of obstructive sleep apnea in patients with acute coronary syndrome with or without prior stroke: a prospective cohort study. Eur J Med Res 2023; 28:107. [PMID: 36859391 PMCID: PMC9976418 DOI: 10.1186/s40001-023-01071-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Whether obstructive sleep apnea (OSA) is associated with worse prognosis in patients with acute coronary syndrome (ACS) with or without prior stroke remains unclear. We investigated the association of OSA with cardiovascular events in ACS patients with or without prior stroke. METHODS Between June 2015 and January 2020, we prospectively recruited eligible ACS patients who underwent cardiorespiratory polygraphy during hospitalization. We defined OSA as an apnea hypopnea index (AHI) ≥ 15 events/hour. The primary composite end point was major adverse cardiovascular and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, ischemia-driven revascularization, or hospitalization for unstable angina or heart failure. RESULTS Among 1927 patients enrolled, 207 patients had prior stroke (10.7%) and 1014 had OSA (52.6%). After a mean follow-up of 2.9 years, patients with stroke had significantly higher risk of MACCEs than those without stroke (hazard ratio [HR]:1.49; 95% confidence interval [CI]: 1.12-1.98, P = 0.007). The multivariate analysis showed that patients with OSA had 2.0 times the risk of MACCEs in prior stroke group (41 events [33.9%] vs 18 events [20.9%]; HR:2.04, 95% CI:1.13-3.69, P = 0.018), but not in non-prior stroke group (186 events [20.8%] vs 144 events [17.4]; HR:1.21, 95% CI 0.96-1.52, P = 0.10). No significant interaction was noted between prior stroke and OSA for MACCE (interaction P = 0.17). CONCLUSIONS Among ACS patients, the presence of OSA was associated with an increased risk of cardiovascular events in patients with prior stroke. Further trials exploring the efficacy of OSA treatment in high-risk patients with ACS and prior stroke are warranted. Trial registration Clinicaltrials.gov identifier NCT03362385.
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Affiliation(s)
- Bin Wang
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wen Hao
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Jingyao Fan
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Yan Yan
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wei Gong
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Wen Zheng
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Bin Que
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Hui Ai
- grid.411606.40000 0004 1761 5917Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China ,grid.415105.40000 0004 9430 5605National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029 China
| | - Xiao Wang
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
| | - Shaoping Nie
- Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China. .,National Clinical Research Center for Cardiovascular Diseases, No. 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
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Zhao J, Hou L, Zhu N, Huang R, Su K, Lei Y, Li Y. The Predictive Value of the CHA2DS2-VASc Score for In-Stent Restenosis Among Patients with Drug-Eluting Stents Implantation. Int J Gen Med 2023; 16:69-76. [PMID: 36636712 PMCID: PMC9830419 DOI: 10.2147/ijgm.s391312] [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: 10/03/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The CHA2DS2-VASc score, a system which has been initially recommended for the assessment of thromboembolic risk in patients with atrial fibrillation (AF), arouses attention in the field of adverse coronary events. The purpose of this study was to explore the predictive value of preprocedural CHA2DS2-VASc score on ISR in patients after drug-eluting stent (DES) implantation. Methods To further investigate the relationship between CHA2DS2-VASc scores and ISR after DES, a retrospective study of DES was carried on. Additionally, the preoperative variables for the ISR and control groups were contrasted. Predictive factors were chosen using the optimal subset regression. We validate the model using internal validation. The prediction model was evaluated using the receiver operator characteristic (ROC) analysis. Results We used a 3:7 ratio to create an experimental group and a validation group, and then ran a stepwise regression with the data from each of the two groups. The results showed that CHA2DS2-VASc score was an independent risk factor for ISR in both the experimental (p = 0.0139) and validation groups (p = 0.0014), and both had significant predictive value for ISR. The area of the ROC curve was greater than 0.5 in both groups (AUC = 0.78, 0.719, respectively) indicating that the model fit was good in both groups. Conclusion The CHA2DS2-VASc score is a reliable predictor of in-stent restenosis (ISR) after DES implantation.
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Affiliation(s)
- Jinbo Zhao
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Ling Hou
- Department of Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Shiyan, Hubei Province, 442000, People’s Republic of China
| | - Ni Zhu
- Department of Pathology, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Rui Huang
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Ke Su
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Yuhua Lei
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China
| | - Yuanhong Li
- Cardiovascular Disease Center, Central Hospital of Tujia and Miao Autonomous Prefecture, Hubei University of Medicine, Enshi Prefecture, Hubei Province, 445000, People’s Republic of China,Correspondence: Yuanhong Li, Email
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Lim AKH, Azraai M, Pham JH, Looi WF, Wirth D, Ng ASL, Babu U, Saluja B. Severe Tachycardia Associated with Psychotropic Medications in Psychiatric Inpatients: A Study of Hospital Medical Emergency Team Activation. J Clin Med 2021; 10:jcm10071534. [PMID: 33917515 PMCID: PMC8038822 DOI: 10.3390/jcm10071534] [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: 01/05/2021] [Revised: 03/29/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022] Open
Abstract
The use of antipsychotic medications is associated with side effects, but the occurrence of severe tachycardia (heart rate ≥ 130 per minute) is not well described. The aim of this study was to determine the frequency and strength of the association between antipsychotic use and severe tachycardia in an inpatient population of patients with mental illness, while considering factors which may contribute to tachycardia. We retrospectively analyzed data from 636 Medical Emergency Team (MET) calls occurring in 449 psychiatry inpatients in three metropolitan hospitals co-located with acute medical services, and used mixed-effects logistic regression to model the association between severe tachycardia and antipsychotic use. The median age of patients was 42 years and 39% had a diagnosis of schizophrenia or psychotic disorder. Among patients who experienced MET calls, the use of second-generation (atypical) antipsychotics was commonly encountered (70%), but the use of first-generation (conventional) antipsychotics was less prevalent (10%). Severe tachycardia was noted in 22% of all MET calls, and sinus tachycardia was the commonest cardiac rhythm. After adjusting for age, anticholinergic medication use, temperature >38 °C and hypoglycemia, and excluding patients with infection and venous thromboembolism, the odds ratio for severe tachycardia with antipsychotic medication use was 4.09 (95% CI: 1.64 to 10.2).
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Affiliation(s)
- Andy K. H. Lim
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
- Department of Medicine, School of Clinical Sciences, Monash University, Clayton, VIC 3168, Australia
- Correspondence:
| | - Meor Azraai
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Jeanette H. Pham
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Wenye F. Looi
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Daniel Wirth
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Ashley S. L. Ng
- Department of General Medicine, Monash Health, Clayton, VIC 3168, Australia; (M.A.); (J.H.P.); (W.F.L.); (D.W.); (A.S.L.N.)
| | - Umesh Babu
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
| | - Bharat Saluja
- Department of Psychiatry, Monash Health, Clayton, VIC 3168, Australia; (U.B.); (B.S.)
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Zhang D, Song X, Chen Y, Raposeiras-Roubín S, Abu-Assi E, Henriques JPS, D'Ascenzo F, Saucedo J, González-Juanatey JR, Wilton SB, Kikkert WJ, Nuñez-Gil I, Ariza-Sole A, Alexopoulos D, Liebetrau C, Kawaji T, Moretti C, Huczek Z, Nie S, Fujii T, Correia L, Kawashiri MA, García-Acuña JM, Southern D, Alfonso E, Terol B, Garay A, Xanthopoulou I, Osman N, Möllmann H, Shiomi H, Giordana F, Kowara M, Filipiak K, Wang X, Yan Y, Fan J, Ikari Y, Nakahashi T, Sakata K, Yamagishi M, Kalpak O, Kedev S. Outcome of Patients With Prior Stroke/Transient Ischemic Attack and Acute Coronary Syndromes. Angiology 2019; 71:324-332. [PMID: 31793327 DOI: 10.1177/0003319719889524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The association between prior stroke/transient ischemic attack (TIA) and clinical outcomes in patients with acute coronary syndrome (ACS) has not been well explored. We evaluated the impact of prior stroke/TIA on this specific patient population. We conducted an international multicenter study including 15 401 patients with ACS from the Bleeding Complications in a Multicenter Registry of Patients Discharged With Diagnosis of Acute Coronary Syndrome registry. They were divided into 2 groups: patients with and without prior stroke/TIA. The primary end point was death at 1-year follow-up. Prior stroke/TIA was associated with higher rate of 1-year death (8.7% vs 3.4%; P < .001). It was an independent predictor of 1-year death even after adjustment for confounding variables (odds ratio, 1.705; 95% confidence interval, 1.046-2.778; P = .032). Besides, patients with prior stroke/TIA had significantly increased 1-year reinfarction (5.6% vs 3.8%, P = .015), in-hospital bleeding (8.7% vs 5.8%, P < .001), and 1-year bleeding (5.2% vs 3.0%, P < .001). No difference of antithrombotic therapies or dual antiplatelet therapy (DAPT) types on outcomes was observed in patients with prior stroke/TIA. Prior stroke/TIA was associated with higher 1-year death for patients with ACS who underwent percutaneous coronary intervention. No benefits or harms were observed with different antithrombotic therapies or DAPT types in these patients.
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Affiliation(s)
- Dongfeng Zhang
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiantao Song
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yalei Chen
- Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | | | | | | | - Fabrizio D'Ascenzo
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Stephen B Wilton
- Libin Cardiovascular Institute of Alberta, Calgary, Alberta, Canada
| | | | | | | | | | | | | | - Claudio Moretti
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | - Shaoping Nie
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | | | | | - Masa-Aki Kawashiri
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | | | | | | | | | | | | | - Neriman Osman
- Kerckhoff Heart and Thorax Center, Frankfurt, Germany
| | | | | | - Francesca Giordana
- Dipartimento di Scienze Mediche, Divisione di Cardiologia, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Xiao Wang
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yan Yan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Jingyao Fan
- Institute of Heart, Lung and Blood Vessel Disease, Beijing, China
| | - Yuji Ikari
- Tokai University School of Medicine, Tokyo, Japan
| | - Takuya Nakahashi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kenji Sakata
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masakazu Yamagishi
- Division of Cardiovascular Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Oliver Kalpak
- University Clinic of Cardiology, Skopje, Republic of Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Skopje, Republic of Macedonia
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Magnesium: The Forgotten Electrolyte-A Review on Hypomagnesemia. Med Sci (Basel) 2019; 7:medsci7040056. [PMID: 30987399 PMCID: PMC6524065 DOI: 10.3390/medsci7040056] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 03/25/2019] [Accepted: 04/02/2019] [Indexed: 02/07/2023] Open
Abstract
Magnesium is the fourth most abundant cation in the body and the second most abundant intracellular cation. It plays an important role in different organ systems at the cellular and enzymatic levels. Despite its importance, it still has not received the needed attention either in the medical literature or in clinical practice in comparison to other electrolytes like sodium, potassium, and calcium. Hypomagnesemia can lead to many clinical manifestations with some being life-threatening. The reported incidence is less likely than expected in the general population. We present a comprehensive review of different aspects of magnesium physiology and hypomagnesemia which can help clinicians in understanding, identifying, and treating this disorder.
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Ricci B, Manfrini O, Cenko E, Vasiljevic Z, Dorobantu M, Kedev S, Davidovic G, Zdravkovic M, Gustiene O, Knežević B, Miličić D, Badimon L, Bugiardini R. Primary percutaneous coronary intervention in octogenarians. Int J Cardiol 2016; 222:1129-1135. [PMID: 27506888 DOI: 10.1016/j.ijcard.2016.07.204] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Limited data are available on the outcome of primary percutaneous coronary intervention (PCI) in octogenarian patients, as the elderly are under-represented in randomized trials. This study aims to provide insights on clinical characteristics, management and outcome of the elderly and very elderly presenting with STEMI. METHODS 2225 STEMI patients ≥70years old (mean age 76.8±5.1years and 53.8% men) were admitted into the network of the ISACS-TC registry. Of these patients, 72.8% were ≥70 to 79years old (elderly) and 27.2% were ≥80years old (very-elderly). The primary end-point was 30-day mortality. RESULTS Thirty-day mortality rates were 13.4% in the elderly and 23.9% in the very-elderly. Primary PCI decreased the unadjusted risk of death both in the elderly (OR: 0.32, 95% CI: 0.24-0.43) and very-elderly patients (OR: 0.45, 95% CI 0.30-0.68), without significant difference between groups. In the very-elderly hypertension and Killip class ≥2 were the only independent factors associated with mortality; whereas in the elderly female gender, prior stroke, chronic kidney disease and Killip class ≥2 were all factors independently associated with mortality. Factors associated with the lack of use of reperfusion were female gender and atypical chest pain in the very-elderly and in the elderly; in the elderly, however, there were some more factors, namely: history of diabetes, current smoking, prior stroke, Killip class ≥2 and history chronic kidney disease. CONCLUSIONS Age is relevant in the prognosis of STEMI, but its importance should not be considered secondary to other major clinical factors. Primary PCI appears to have beneficial effects in the octogenarian STEMI patients.
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Affiliation(s)
- Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Maria Dorobantu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Goran Davidovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac Faculty of Medical Sciences, University in Kragujevac, Kragujevac, Serbia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivija Gustiene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Božidarka Knežević
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
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Bozbay M, Uyarel H, Cicek G, Oz A, Keskin M, Murat A, Yildirim E, Karaca G, Ergelen M, Eren M. CHA2DS2-VASc Score Predicts In-Hospital and Long-Term Clinical Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Who Were Undergoing Primary Percutaneous Coronary Intervention. Clin Appl Thromb Hemost 2016; 23:132-138. [DOI: 10.1177/1076029616646874] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
CHA2DS2-VASc score includes similar risk factors for coronary artery disease. We hypothesized that admission CHA2DS2-VASc score might be predictive of adverse clinical outcomes for patients with ST-segment elevation myocardial infarction (STEMI) who were undergoing primary percutaneous coronary intervention. A total of 647 patients with STEMI enrolled in this study. The study population was divided into 2 groups according to their admission CHA2DS2-VASc score. The low group (n = 521) was defined as CHA2DS2-VASc score ≤2, and the high group (n = 126) was defined as CHA2DS2-VASc score >2. Patients in the high group had significantly higher incidence of in-hospital cardiovascular mortality (8.7% vs 1.9%; P < .001). Long-term mortality was significantly frequent in the high group (13.4% vs 3.6%, P < .001). Hypertension, admission CHA2DS2-VASc score, and Killip class >1 were independent predictors of long-term mortality. Admission CHA2DS2-VASc score >2 was identified as an effective cutoff point for long-term mortality (area under curve = 0.821; 95% confidence interval: 0.76-0.89; P < .001). CHA2DS2-VASc score is a simple, very useful, easily remembered bedside score for predicting in-hospital and long-term adverse clinical outcomes in STEMI.
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Affiliation(s)
- Mehmet Bozbay
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Huseyin Uyarel
- Department of Cardiology, School of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Gokhan Cicek
- Department of Cardiology, Ankara Numune Hospital, Ankara, Turkey
| | - Ahmet Oz
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Muhammed Keskin
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ahmet Murat
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
| | - Ersin Yildirim
- Department of Cardiology, Elazıg Research and Training Hospital, Elazıg, Turkey
| | - Gurkan Karaca
- Department of Cardiology, Amasya Sabuncu Serafeddin Research and Training Hospital, Amasya, Turkey
| | - Mehmet Ergelen
- Department of Cardiology, School of Medicine, Bezmi Alem Vakif University, Istanbul, Turkey
| | - Mehmet Eren
- Department of Cardiology, Dr Siyami Ersek Cardiovascular and Thoracic Surgery Research and Training Hospital, Istanbul, Turkey
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Darling CE, Fisher KA, McManus DD, Coles AH, Spencer FA, Gore JM, Goldberg RJ. Survival after hospital discharge for ST-segment elevation and non-ST-segment elevation acute myocardial infarction: a population-based study. Clin Epidemiol 2013; 5:229-36. [PMID: 23901296 PMCID: PMC3724561 DOI: 10.2147/clep.s45646] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Limited recent data are available describing differences in long-term survival, and factors affecting prognosis, after ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI), especially from the more generalizable perspective of a population-based investigation. The objectives of this study were to examine differences in post-discharge prognosis after hospitalization for STEMI and NSTEMI, with a particular focus on factors associated with reduced long-term survival. Methods We reviewed the medical records of residents of the Worcester, MA, USA metropolitan area hospitalized at eleven central Massachusetts medical centers for acute myocardial infarction (AMI) during 2001, 2003, 2005, and 2007. Results A total of 3762 persons were hospitalized with confirmed AMI; of these, 2539 patients (67.5%) were diagnosed with NSTEMI. The average age of study patients was 70.3 years and 42.9% were women. Patients with NSTEMI experienced higher post-discharge death rates with 3-month, 1-year, and 2-year death rates of 12.6%, 23.5%, and 33.2%, respectively, compared to 6.1%, 11.5%, and 16.4% for patients with STEMI. After multivariable adjustment, patients with NSTEMI were significantly more likely to have died after hospital discharge (adjusted hazards ratio 1.28; 95% confidence interval 1.14–1.44). Several demographic (eg, older age) and clinical (eg, history of stroke) factors were associated with reduced long-term survival in patients with NSTEMI and STEMI. Conclusions The results of this study in residents of central Massachusetts suggest that patients with NSTEMI are at higher risk for dying after hospital discharge, and several subgroups are at particularly increased risk.
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Affiliation(s)
- Chad E Darling
- Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA, USA
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Chakrabarti AK, Patel SJ, Salazar RL, Gopalakrishnan L, Kumar V, Rastogi U, Singh P, Zorkun C, Gibson CM. Newer Pharmaceutical Agents for STEMI Interventions. Interv Cardiol Clin 2012; 1:429-440. [PMID: 28581961 DOI: 10.1016/j.iccl.2012.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
ST-elevation myocardial infarction (STEMI) causes 12.6% of deaths worldwide. Treatment strategies involve early revascularization by percutaneous coronary intervention and/or fibrinolytics, with adjunctive pharmacologic therapy. While antiplatelet therapy remains the cornerstone of pharmacologic management, newer antithrombotic therapies are showing benefit in the reduction of long-term thrombotic events following acute vessel occlusion. Future directions in adjunctive STEMI management include the use of hematopoietic stem cell therapy or growth factors to induce proliferation and differentiation of cardiac myocytes.
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Affiliation(s)
- Anjan K Chakrabarti
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Shalin J Patel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Robert L Salazar
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Lakshmi Gopalakrishnan
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA; Cardiovascular Division, Department of Medicine, PERFUSE Angiographic Core Laboratories, Data Coordinating Center, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Varun Kumar
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA; Cardiovascular Division, Department of Medicine, PERFUSE Angiographic Core Laboratories, Data Coordinating Center, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Ujjwal Rastogi
- Cardiovascular Division, Department of Medicine, PERFUSE Angiographic Core Laboratories, Data Coordinating Center, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Priyamvada Singh
- Cardiovascular Division, Department of Medicine, PERFUSE Angiographic Core Laboratories, Data Coordinating Center, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA
| | - Cafer Zorkun
- Cardiovascular Division, Department of Medicine, PERFUSE Angiographic Core Laboratories, Data Coordinating Center, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA; Division of Cardiology, Yedikule Education and Research Hospital, Istanbul, Turkey
| | - C Michael Gibson
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Road, Deaconess 319, Boston, MA 02215, USA; WikiDoc Foundation (a 509 (a)(1) Charitable Organization), San Francisco, California.
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Li YJ, Rha SW, Chen KY, Jin Z, Minami Y, Wang L, Dang Q, Poddar KL, Ramasamy S, Park JY, Oh DJ, Jeong MH. Clinical characteristics and mid-term outcomes of acute myocardial infarction patients with prior cerebrovascular disease in an Asian population: Lessons from the Korea Acute Myocardial Infarction Registry. Clin Exp Pharmacol Physiol 2010; 37:581-6. [DOI: 10.1111/j.1440-1681.2010.05363.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Rich MW. Epidemiology, Clinical Features, and Prognosis of Acute Myocardial Infarction in the Elderly. ACTA ACUST UNITED AC 2006; 15:7-11; quiz 12. [PMID: 16415640 DOI: 10.1111/j.1076-7460.2006.05273.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The incidence and prevalence of acute myocardial infarction (MI) increase progressively with age. In the United States, over 60% of acute MIs occur in patients 65 years of age or older, and approximately one third occur in persons over age 75. In addition, mortality rates following acute MI increase exponentially with age, such that approximately 60% of all MI deaths in the United States occur in the 6% of the population 75 years of age or older. The clinical features of acute MI vary by age. In particular, very elderly patients are less likely than younger patients to report chest pain. Conversely, confusion or altered mental status may be the presenting manifestation of acute MI in up to 20% of patients over 85 years of age. Older patients are also more likely to have "silent" or unrecognized MIs, as well as MIs without ST-segment elevation, compared with younger patients. Elderly patients with acute MI are more likely than younger patients to experience heart failure, atrial fibrillation, cardiac rupture, and shock, all of which are associated with increased mortality. Other factors contributing to the poor prognosis following acute MI in elderly individuals include a marked decline in cardiovascular reserve in the elderly, increased prevalence of comorbid conditions, underutilization of evidence-based therapies, and increased risk of iatrogenic complications.
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Affiliation(s)
- Michael W Rich
- Cardiovascular Division, Washington University School of Medicine, St. Louis, MO 63110, USA.
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