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Gholap NN, Achana FA, Davies MJ, Ray KK, Gray L, Khunti K. Long-term mortality after acute myocardial infarction among individuals with and without diabetes: A systematic review and meta-analysis of studies in the post-reperfusion era. Diabetes Obes Metab 2017; 19:364-374. [PMID: 27862801 DOI: 10.1111/dom.12827] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 12/13/2022]
Abstract
AIMS To conduct a systematic review and meta-analysis with the aim of providing robust estimates of the association between diabetes and long-term (≥1 year) mortality after acute myocardial infarction (AMI). MATERIAL AND METHODS Medline, Embase and Web of Science databases were searched (January 1985 to July 2016) for terms related to long-term mortality, diabetes and AMI. Two authors independently abstracted the data. Hazard ratios (HRs) comparing mortality in people with and without diabetes were pooled across studies using Bayesian random-effects meta-analysis. RESULTS A total of 10 randomized controlled trials and 56 cohort studies, including 714 780 patients, reported an estimated total of 202 411 deaths over the median (range) follow-up of 2.0 (1-20) years. The risk of death over time was significantly higher among those with diabetes compared with those without (unadjusted HR 1.82, 95% credible interval [CrI] 1.73-1.91). Mortality remained higher in the analysis restricted to 23/64 cohorts reporting data adjusted for confounders (adjusted HR 1.48, 95% CrI 1.43-1.53). The excess long-term mortality in diabetes was evident irrespective of the phenotype and modern treatment of AMI, and persisted in early survivors (unadjusted HR 1.82, 95% CrI 1.70-1.95). CONCLUSIONS Despite medical advances, individuals with diabetes have a 50% greater long-term mortality compared with those without. Further research to understand the determinants of this excess risk are important for public health, given the predicted rise in global diabetes prevalence.
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Affiliation(s)
- Nitin N Gholap
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Department of Health Sciences, University of Leicester, Leicester, UK
- Department of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, NHS Trust, Coventry, UK
| | - Felix A Achana
- Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Clinical Trials Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
- Lifestyle and Physical Activity Biomedical Research Unit, Leicester-Loughborough NIHR Diet, Leicester, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK
| | - Kausik K Ray
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Laura Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
- Leicester Clinical Trials Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK
- Lifestyle and Physical Activity Biomedical Research Unit, Leicester-Loughborough NIHR Diet, Leicester, UK
- NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK
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2
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Mortensen MB, Kulenovic I, Falk E. Statin use and cardiovascular risk factors in diabetic patients developing a first myocardial infarction. Cardiovasc Diabetol 2016; 15:81. [PMID: 27229923 PMCID: PMC4882784 DOI: 10.1186/s12933-016-0400-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 05/18/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The risk for a first myocardial infarction (MI) in people with diabetes has been shown to be as high as the risk for a new MI in non-diabetic patients with a prior MI. Consequently, risk-reducing statin therapy is recommended for nearly all patients with diabetes 40 years of age or older, regardless of cholesterol level. The purpose of this study was to assess the recommended and real-life use of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in diabetic patients who develop ASCVD. METHODS In a cross-sectional multicenter study of consecutive patients without previous ASCVD hospitalized with a first MI in 2010-2012, we obtained information on diabetic status, statin use, and cardiovascular risk factors prior to MI. RESULTS The study population consisted of 1622 patients with first MI (63 % men), 228 of whom had known diabetes before MI. All but three of the diabetic patients were ≥40 years of age. Diabetic patients were older (70 vs 68, p = 0.006), were more often women (43 vs 36 %, p = 0.05) and had a higher prevalence of statin use (47 vs 11 %, p < 0.001) compared with non-diabetic patients. Despite a high risk factor burden, the majority (53 %) of patients with known diabetes was not treated with statins before MI, and there was no relationship between the number of high-risk markers and statin use. Nearly all diabetic patients not treated with statins before first MI had at least one marker of very high cardiovascular risk, including hypertension (71 %), current smoking (37 %), and nephropathy (33 %). CONCLUSIONS Primary prevention with statins had been initiated in less than half of diabetic patients destined for a first MI, despite the presence of one or more markers of very high cardiovascular risk in nearly all. These results highlight an urgent need for optimizing statin therapy and global risk factor control in diabetic patients.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark.
| | - Imra Kulenovic
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard, 8200, Aarhus, Denmark
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3
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Schmidt M, Ulrichsen SP, Pedersen L, Bøtker HE, Sørensen HT. Thirty-year trends in heart failure hospitalization and mortality rates and the prognostic impact of co-morbidity: a Danish nationwide cohort study. Eur J Heart Fail 2016; 18:490-9. [DOI: 10.1002/ejhf.486] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/23/2015] [Accepted: 12/12/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | | | - Lars Pedersen
- Department of Clinical Epidemiology; Aarhus University Hospital; Aarhus Denmark
| | - Hans Erik Bøtker
- Department of Cardiology; Aarhus University Hospital; Skejby Aarhus Denmark
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Nikolaou N, Arntz H, Bellou A, Beygui F, Bossaert L, Cariou A. Das initiale Management des akuten Koronarsyndroms. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0084-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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5
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Nikolaou NI, Arntz HR, Bellou A, Beygui F, Bossaert LL, Cariou A, Danchin N. European Resuscitation Council Guidelines for Resuscitation 2015 Section 8. Initial management of acute coronary syndromes. Resuscitation 2015; 95:264-77. [DOI: 10.1016/j.resuscitation.2015.07.030] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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6
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Diabetes and Heart Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_6] [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: 11/29/2022]
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7
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Potential cost-effectiveness of therapeutic drug monitoring in patients with resistant hypertension. J Hypertens 2014; 32:2411-21; discussion 2421. [DOI: 10.1097/hjh.0000000000000346] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Luo G, Liu H, Luo S, Li F, Su M, Lu H. Fasting hyperglycemia increases in-hospital mortality risk in nondiabetic female patients with acute myocardial infarction: a retrospective study. Int J Endocrinol 2014; 2014:745093. [PMID: 25132854 PMCID: PMC4123565 DOI: 10.1155/2014/745093] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/14/2014] [Accepted: 06/19/2014] [Indexed: 02/06/2023] Open
Abstract
Previous studies had shown that elevated admission plasma glucose (APG) could increase mortality rate and serious complications of acute myocardial infarction (AMI), but whether fasting plasma glucose (FPG) had the same role remains controversial. In this retrospective study, 253 cases of AMI patients were divided into diabetic (n = 87) and nondiabetic group (n = 166). Our results showed that: compared with the nondiabetic patients, diabetic patients had higher APG, FPG, higher plasma triglyceride, higher rates of painless AMI (P < 0.01), non-ST-segment elevation myocardial infarction (NSTEMI), and reinfraction (P < 0.05). They also had lower high density lipoprotein cholesterol and rate of malignant arrhythmia, but in-hospital mortality rate did not differ significantly (P > 0.05). While nondiabetic patients were subgrouped in terms of APG and FPG (cut points were 11.1 mmol/L and 7.0 mmol/L, resp.), the mortality rate had significant difference (P < 0.01), whereas glucose level lost significance in diabetic group. Multivariate logistic regression analysis showed that FPG (OR: 2.014; 95% confidence interval: 1.296-3.131; p < 0.01) but not APG was independent predictor of in-hospital mortality for nondiabetic patients. These results indicate that FPG can be an independent predictor for mortality in nondiabetic female patients with AMI.
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Affiliation(s)
- Guojing Luo
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hong Liu
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Shunkui Luo
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Fang Li
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Minhong Su
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
| | - Hongyun Lu
- Department of Endocrinology and Metabolism, the Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong 519000, China
- *Hongyun Lu:
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Perkan A, Vitrella G, Barbati G, De Monte A, D’Agata B, Merlo M, Giannini F, Grazia ED, Rakar S, Salvi A, Igidbashian D, Morgera T, Zalukar W, Sinagra G. Impact of abciximab on prognosis in diabetic patients undergoing primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2013; 14:127-35. [DOI: 10.2459/jcm.0b013e32834eec7a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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10
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Dorenkamp M, Bonaventura K, Leber AW, Boldt J, Sohns C, Boldt LH, Haverkamp W, Frei U, Roser M. Potential lifetime cost-effectiveness of catheter-based renal sympathetic denervation in patients with resistant hypertension. Eur Heart J 2012; 34:451-61. [PMID: 23091202 DOI: 10.1093/eurheartj/ehs355] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
AIMS Recent studies have demonstrated the safety and efficacy of catheter-based renal sympathetic denervation (RDN) for the treatment of resistant hypertension. We aimed to determine the cost-effectiveness of this approach separately for men and women of different ages. METHODS AND RESULTS A Markov state-transition model accounting for costs, life-years, quality-adjusted life-years (QALYs), and incremental cost-effectiveness was developed to compare RDN with best medical therapy (BMT) in patients with resistant hypertension. The model ran from age 30 to 100 years or death, with a cycle length of 1 year. The efficacy of RDN was modelled as a reduction in the risk of hypertension-related disease events and death. Analyses were conducted from a payer's perspective. Costs and QALYs were discounted at 3% annually. Both deterministic and probabilistic sensitivity analyses were performed. When compared with BMT, RDN gained 0.98 QALYs in men and 0.88 QALYs in women 60 years of age at an additional cost of €2589 and €2044, respectively. As the incremental cost-effectiveness ratios increased with patient age, RDN consistently yielded more QALYs at lower costs in lower age groups. Considering a willingness-to-pay threshold of €35 000/QALY, there was a 95% probability that RDN would remain cost-effective up to an age of 78 and 76 years in men and women, respectively. Cost-effectiveness was influenced mostly by the magnitude of effect of RDN on systolic blood pressure, the rate of RDN non-responders, and the procedure costs of RDN. CONCLUSION Renal sympathetic denervation is a cost-effective intervention for patients with resistant hypertension. Earlier treatment produces better cost-effectiveness ratios.
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Affiliation(s)
- Marc Dorenkamp
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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11
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Arnold M, Mattle S, Galimanis A, Kappeler L, Fischer U, Jung S, De Marchis GM, Gralla J, Mono ML, Brekenfeld C, Nedeltchev K, Schroth G, Mattle HP. Impact of Admission Glucose and Diabetes on Recanalization and Outcome after Intra-Arterial Thrombolysis for Ischaemic Stroke. Int J Stroke 2012; 9:985-91. [DOI: 10.1111/j.1747-4949.2012.00879.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Stroke patients with diabetes and admission hyperglycaemia have worse outcomes than non-diabetics, with or without intravenous thrombolysis. Poor vessel recanalization was reported in diabetics treated with intravenous thrombolysis. Aims This study aimed to determine the impact of admission glucose and diabetes on recanalization and outcome after intra-arterial thrombolysis. Methods We analysed 389 patients (213 men, 176 women) treated with intra-arterial thrombolysis. The association of diabetes and admission glucose value with recanalization, outcome, mortality, and symptomatic intracranial haemorrhage was determined. Recanalization was classified according to thrombolysis in myocardial infarction grades. Outcome was measured using the modified Rankin Scale at three-months and categorized as favourable (modified Rankin Scale 0–2) or poor (modified Rankin Scale 3–6). Results The rate of partial or complete recanalization (thrombolysis in myocardial infarction 2–3) did not differ between patients with and without diabetes (67% vs. 66%; P = 1·000). Mean admission glucose values were similar in patients with poor recanalization (thrombolysis in myocardial infarction 0–1) and patients with partial or complete recanalization (thrombolysis in myocardial infarction 2–3; 7·3 vs. 7·3 mmol/l; P = 0·746). Follow-up at three-months was obtained in 388 of 389 patients. Clinical outcome was favourable (modified Rankin Scale 0–2) in 189 patients (49%) and poor (modified Rankin Scale 3–6) in 199 patients (51%). Mortality at three-months was 20%. Diabetics were more likely to have poor outcome (72% vs. 48%; P = 0·001) and to be dead (30% vs. 19%; P = 0·044) at three-months. After multivariable analysis, there remained an independent relationship between diabetes and outcome ( P = 0·003; odds ratio 3·033, 95% confidence interval 1·452–6·336), but not with mortality ( P = 0·310; odds ratio 1·436; 95% confidence interval 0·714–2·888). Moreover, higher age ( P = 0·001; odds ratio 1·039; 95% confidence interval 1·017–1·061), higher baseline National Institutes of Health Stroke Scale score ( P < 0·0001; odds ratio 1·130; 95% confidence interval 1·079–1·182), location of vessel occlusion as categorical variable ( P < 0·0001), poor collaterals ( P = 0·02; odds ratio 1·587; 95% confidence interval 1·076–2·341), poor vessel recanalization ( P < 0·0001; odds ratio 4·713; 95% confidence interval 2·627–8·454), and higher leucocyte count ( P = 0·032; odds ratio 1·094; 95% confidence interval 1·008–1·188) were independent baseline predictors of poor outcome. Higher admission glucose was associated with poor outcome ( P = 0·006) and mortality ( P < 0·0001). After multivariate analyses, glucose remained independently associated with poor outcome ( P = 0·019; odds ratio 1·150; 95% confidence interval 1·023-1-292) and mortality ( P = 0·005; odds ratio 1·183; 95% confidence interval 1052–1·331). The rate of symptomatic intracranial haemorrhage was similar in diabetics and non-diabetics (6·7% vs. 4·6%; P = 0·512). Mean admission glucose was higher in patients with symptomatic intracranial haemorrhage than without (8·58 vs. 7·26 mmol/l; P = 0·010). Multivariable analysis confirmed an independent association between admission glucose and symptomatic intracranial haemorrhage ( P = 0·027; odds ratio 1·187; 95% confidence interval 1·020–1·381). Conclusions Diabetes and glucose value on admission did not influence recanalization after intra-arterial thrombolysis; nevertheless, they were independent predictors of poor outcome after intra-arterial thrombolysis and a higher admission glucose value was an independent predictor of symptomatic intracranial haemorrhage. This indicates that factors on the capillary, cellular, or metabolic level may account for the worse outcome in patients with elevated glucose value and diabetes.
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Affiliation(s)
- Marcel Arnold
- Department of Neurology, University Bern, Bern, Switzerland
| | - Selina Mattle
- Department of Neurology, University Bern, Bern, Switzerland
| | | | | | - Urs Fischer
- Department of Neurology, University Bern, Bern, Switzerland
| | - Simon Jung
- Department of Neurology, University Bern, Bern, Switzerland
| | | | - Jan Gralla
- Institute of Diagnostic and Interventional Neuroradiology University Hospital, Bern, Switzerland
| | | | - Caspar Brekenfeld
- Institute of Diagnostic and Interventional Neuroradiology University Hospital, Bern, Switzerland
| | | | - Gerhard Schroth
- Institute of Diagnostic and Interventional Neuroradiology University Hospital, Bern, Switzerland
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Wisløff T, Selmer RM, Halvorsen S, Fretheim A, Norheim OF, Kristiansen IS. Choice of generic antihypertensive drugs for the primary prevention of cardiovascular disease--a cost-effectiveness analysis. BMC Cardiovasc Disord 2012; 12:26. [PMID: 22475076 PMCID: PMC3353849 DOI: 10.1186/1471-2261-12-26] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 04/04/2012] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Hypertension is one of the leading causes of cardiovascular disease (CVD). A range of antihypertensive drugs exists, and their prices vary widely mainly due to patent rights. The objective of this study was to explore the cost-effectiveness of different generic antihypertensive drugs as first, second and third choice for primary prevention of cardiovascular disease. METHODS We used the Norwegian Cardiovascular Disease model (NorCaD) to simulate the cardiovascular life of patients from hypertension without symptoms until they were all dead or 100 years old. The risk of CVD events and costs were based on recent Norwegian sources. RESULTS In single-drug treatment, all antihypertensives are cost-effective compared to no drug treatment. In the base-case analysis, the first, second and third choice of antihypertensive were calcium channel blocker, thiazide and angiotensin-converting enzyme inhibitor. However the sensitivity and scenario analyses indicated considerable uncertainty in that angiotensin receptor blockers as well as, angiotensin-converting enzyme inhibitors, beta blockers and thiazides could be the most cost-effective antihypertensive drugs. CONCLUSIONS Generic antihypertensives are cost-effective in a wide range of risk groups. There is considerable uncertainty, however, regarding which drug is the most cost-effective.
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Affiliation(s)
- Torbjørn Wisløff
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Atle Fretheim
- Institute of Health and Society, University of Oslo, Oslo, Norway
- Norwegian Knowledge Centre for the Health Services, Oslo, Norway
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13
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Schmidt M, Jacobsen JB, Lash TL, Bøtker HE, Sørensen HT. 25 year trends in first time hospitalisation for acute myocardial infarction, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity: a Danish nationwide cohort study. BMJ 2012; 344:e356. [PMID: 22279115 PMCID: PMC3266429 DOI: 10.1136/bmj.e356] [Citation(s) in RCA: 345] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To examine 25 year trends in first time hospitalisation for acute myocardial infarction in Denmark, subsequent short and long term mortality, and the prognostic impact of sex and comorbidity. DESIGN Nationwide population based cohort study using medical registries. SETTING All hospitals in Denmark. SUBJECTS 234,331 patients with a first time hospitalisation for myocardial infarction from 1984 through 2008. MAIN OUTCOME MEASURES Standardised incidence rate of myocardial infarction and 30 day and 31-365 day mortality by sex. Comorbidity categories were defined as normal, moderate, severe, and very severe according to the Charlson comorbidity index, and were compared by means of mortality rate ratios based on Cox regression. RESULTS The standardised incidence rate per 100,000 people decreased in the 25 year period by 37% for women (from 209 to 131) and by 48% for men (from 410 to 213). The 30 day, 31-365 day, and one year mortality declined from 31.4%, 15.6%, and 42.1% in 1984-8 to 14.8%, 11.1%, and 24.2% in 2004-8, respectively. After adjustment for age at time of myocardial infarction, men and women had the same one year risk of dying. The mortality reduction was independent of comorbidity category. Comparing patients with very severe versus normal comorbidity during 2004-8, the mortality rate ratio, adjusted for age and sex, was 1.96 (95% CI 1.83 to 2.11) within 30 days and 3.89 (3.58 to 4.24) within 31-365 days. CONCLUSIONS The rate of first time hospitalisation for myocardial infarction and subsequent short term mortality both declined by nearly half between 1984 and 2008. The reduction in mortality occurred for all patients, independent of sex and comorbidity. However, comorbidity burden was a strong prognostic factor for short and long term mortality, while sex was not.
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Affiliation(s)
- Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark.
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14
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Arntz HR, Bossaert L, Danchin N, Nicolau N. Initiales Management des akuten Koronarsyndroms. Notf Rett Med 2010. [DOI: 10.1007/s10049-010-1371-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Morgan K, Leahy M, Butts J, Beatt K. The cost effectiveness of primary angioplasty compared to thrombolysis in the real world: one year results from West London. EUROINTERVENTION 2010; 6:596-603. [DOI: 10.4244/eijv6i5a100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Gruppetta M, Calleja N, Fava S. Long-term survival after acute myocardial infarction and relation to type 2 diabetes and other risk factors. Clin Cardiol 2010; 33:424-9. [PMID: 20641120 DOI: 10.1002/clc.20776] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetes mellitus (DM) is well established as a short-term prognostic indicator after myocardial infarction (MI), but little long-term data are available. HYPOTHESIS The objective of the study was to assess the impact of DM and other patient characteristics at baseline on long-term mortality after acute MI. METHODS Patients who were hospitalized with MI from December 1990 to November 1992 were recruited. Baseline data were recorded and patients were followed up through January 31, 2008, to assess their survival rates. Survival curves were generated by the Kaplan-Meier method. The main outcome measure was long-term survival (median 16.6 y). RESULTS The study followed 337 patients (mean age 66.4 y, 61.1% men) for a median of 16.6 years. Using Cox regression analysis, survival was associated with history of MI (hazard ratio [HR]: 1.47, P = 0.016), DM at baseline (HR: 1.31, P = 0.038), and age (HR: 1.061 for each additional year, P < 0.001). By multivariable regression, cardiovascular mortality was also associated with previous MI (HR: 1.58, P = 0.017), DM at baseline (HR: 1.69, P = 0.001), and age (HR: 1.075 for each additional year, P < 0.001). There was no statistically significant difference between the HRs for history of MI and history of DM. CONCLUSIONS Diabetic patients with MI have a higher long-term all-cause and cardiovascular mortality. Our data also show that in patients with MI, DM confers the same level of risk as a previous MI. This extends to patients with documented MI, our concept of diabetes being a coronary heart disease equivalent. Based on this and on data from the literature, we propose that it would be more accurate to consider DM as an MI equivalent rather than a coronary heart disease equivalent.
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Affiliation(s)
- Mark Gruppetta
- Diabetes and Endocrine Centre, Mater Dei Hospital, Msida, Malta
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Arntz HR, Bossaert LL, Danchin N, Nikolaou NI. European Resuscitation Council Guidelines for Resuscitation 2010 Section 5. Initial management of acute coronary syndromes. Resuscitation 2010; 81:1353-63. [DOI: 10.1016/j.resuscitation.2010.08.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Cresci S, Huss JM, Beitelshees AL, Jones PG, Minton MR, Dorn GW, Kelly DP, Spertus JA, McLeod HL. A PPARα promoter variant impairs ERR-dependent transactivation and decreases mortality after acute coronary ischemia in patients with diabetes. PLoS One 2010; 5:e12584. [PMID: 20838448 PMCID: PMC2933242 DOI: 10.1371/journal.pone.0012584] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Accepted: 07/19/2010] [Indexed: 11/19/2022] Open
Abstract
Activation of peroxisome proliferator-activated receptor alpha (PPARα) occurs in animal models of diabetes (DM) and is implicated in pathological responses to myocardial ischemia. Using bioinformatics, we identified a single nucleotide polymorphism (SNP) in the PPARα gene promoter (PPARA -54,642 G>A; rs135561) that altered the consensus sequence for a nuclear receptor binding site. Electrophoretic mobility shift assays showed that the domain bound two known PPARA transcriptional activators, estrogen-related receptor (ERR)-α and -γ and that PPARA G bound with greater affinity than PPARA A (>2-fold; P<0.05). Likewise, promoter-reporter analyses showed enhanced transcriptional activity for PPARA G vs. PPARA A for both ERR-α and -γ (3.1 vs.1.9-fold; P<0.05). Since PPARα activation impairs post-ischemic cardiac function in experimental models of DM, we tested whether decreased PPARA transcription in PPARA A carriers favorably impacted outcome after acute coronary ischemia in 705 patients hospitalized with acute coronary syndromes (ACS; 552 Caucasian, 106 African American). PPARA A allele frequencies were similar to non-diseased subjects. However, PPARA genotype correlated with 5-year mortality in diabetic (22.2% AA vs. 18.8% AG vs. 39.5% GG; P = 0.008), but not non-diabetic (P = 0.96) subjects (genotype by diabetes interaction P = 0.008). In the diabetic ACS subjects, PPARA A carriers had strikingly reduced all-cause mortality compared to PPARA G homozygotes, (unadjusted HR 0.44, 95% CI 0.26-0.75; P = 0.003; adjusted HR 0.48, 95% CI 0.27-0.83; P = 0.009). Consistent with previous descriptions of PPARα in experimental models and human disease, we describe a novel PPARA promoter SNP that decreases transcriptional activation of PPARA and protects against mortality in diabetic patients after ACS.
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Affiliation(s)
- Sharon Cresci
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Janice M. Huss
- City of Hope National Medical Center, Duarte, California, United States of America
| | | | - Philip G. Jones
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Matt R. Minton
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Gerald W. Dorn
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, United States of America
| | - Daniel P. Kelly
- Burnham Institute for Medical Research, Orlando, Florida, United States of America
| | - John A. Spertus
- Saint Luke's Mid America Heart Institute and the University of Missouri-Kansas City, Kansas City, Missouri, United States of America
| | - Howard L. McLeod
- University of North Carolina Institute for Pharmacogenomics and Individualized Therapy, Chapel Hill, North Carolina, United States of America
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Maeng M, Nielsen PH, Busk M, Mortensen LS, Kristensen SD, Nielsen TT, Andersen HR. Time to treatment and three-year mortality after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction-a DANish Trial in Acute Myocardial Infarction-2 (DANAMI-2) substudy. Am J Cardiol 2010; 105:1528-34. [PMID: 20494656 DOI: 10.1016/j.amjcard.2010.01.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 01/13/2010] [Accepted: 01/13/2010] [Indexed: 11/29/2022]
Abstract
In patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention (pPCI), early reperfusion is believed to improve left ventricular systolic function and reduce mortality; however, long-term (>1 year) data are sparse. In the DANish Trial in Acute Myocardial Infarction-2 (DANAMI-2) study, 686 patients with ST-segment elevation myocardial infarction were treated with pPCI. Long-term mortality was obtained during 3 years of follow-up. We classified the patients according to the symptom-to-balloon time (<3, 3 to 5, and > or =5 hours). The groups were compared using a Cox proportional hazards regression model adjusted for confounding factors. The left ventricular systolic ejection fraction was estimated by echocardiography before discharge. Coronary flow was evaluated using the Thrombolysis In Myocardial Infarction score. Mortality did not differ between the 2 earliest symptom-to-balloon groups, and they were therefore combined into 1 group in the analysis of survival. Mortality was significantly increased for patients with a symptom-to-balloon time > or =5 hours (hazard ratio 2.36, 95% confidence interval 1.51 to 3.67, p <0.001), a difference that remained significant after controlling for confounding factors (adjusted hazard ratio 2.44, 95% confidence interval 1.31 to 4.54, p = 0.007). The symptom-to-balloon time was inversely associated with a left ventricular systolic ejection fraction of < or =40% (19.7% vs 22.8% vs 33.1%, p = 0.036), with the latter a major predictor of 3-year mortality in this cohort (hazard ratio 6.02, 95% confidence interval 3.68 to 9.85, p <0.001). A shorter symptom-to-balloon time was associated with greater rates of Thrombolysis In Myocardial Infarction 3 flow after pPCI (86.5% vs 80.9% vs 75.7%, p = 0.002). In conclusion, a shorter symptom-to-balloon time was associated with improved coronary flow, an increased likelihood of subsequent left ventricular systolic ejection fraction >40%, and greater 3-year survival in patients with ST-segment elevation myocardial infarction treated with pPCI.
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Affiliation(s)
- Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
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Bonnefoy E, Steg PG, Boutitie F, Dubien PY, Lapostolle F, Roncalli J, Dissait F, Vanzetto G, Leizorowicz A, Kirkorian G, Mercier C, McFadden EP, Touboul P. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 2009; 30:1598-606. [PMID: 19429632 DOI: 10.1093/eurheartj/ehp156] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AIMS The CAPTIM (Comparison of primary Angioplasty and Pre-hospital fibrinolysis In acute Myocardial infarction) study found no evidence that a strategy of primary angioplasty was superior in terms of 30-day outcomes to a strategy of pre-hospital fibrinolysis with transfer to an interventional facility in patients managed early at the acute phase of an acute myocardial infarction. The present analysis was designed to compare both strategies at 5 years. METHODS AND RESULTS The CAPTIM study included 840 patients managed in a pre-hospital setting within 6 h of an acute ST-segment elevation myocardial infarction. Patients were randomized to either a primary angioplasty (n = 421) or a pre-hospital fibrinolysis (rt-PA) with immediate transfer to a centre with interventional facilities (n = 419). Long-term follow-up was obtained in blinded fashion from 795 patients (94.6%). Using an intent-to-treat analysis, all-cause mortality at 5 years was 9.7% in the pre-hospital fibrinolysis group when compared with 12.6% in the primary angioplasty group [HR 0.75 (95% CI, 0.50-1.14); P = 0.18]. For patients included within 2 h, 5 year mortality was 5.8% in the pre-hospital fibrinolysis group when compared with 11.1% in the primary angioplasty group [HR 0.50 (95% CI, 0.25-0.97); P = 0.04], whereas it was, respectively, 14.5 and 14.4% in patients included after 2 h [HR 1.02, (95% CI 0.59-1.75), P = 0.92]. CONCLUSION The 5-year follow-up is consistent with the 30-day outcomes of the trial, showing similar mortality for primary percutaneous coronary intervention and a policy of pre-hospital lysis followed by transfer to an interventional center. In addition, for patients treated within 2 h of symptom onset, 5-year mortality was lower with pre-hospital lysis.
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Affiliation(s)
- Eric Bonnefoy
- UMR 5558, Univeristé Lyon 1 et Centre d'Investigation Clinique, Hôpital Cardio-Vasculaire et Pneumologique, Hospices Civils de Lyon, 69394 Lyon Cedex 03, France.
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Romano M, Buffoli F, Tomasi L, Aroldi M, Lettieri C, Ferrari MR, Zanini R. The no-reflow phenomenon in acute myocardial infarction after primary angioplasty: incidence, predictive factors, and long-term outcomes. J Cardiovasc Med (Hagerstown) 2008; 9:59-63. [DOI: 10.2459/jcm.0b013e328028fe4e] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Ishihara M, Kagawa E, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nakama Y, Maruhashi T, Ookawa K, Dai K, Aokage Y. Impact of admission hyperglycemia and diabetes mellitus on short- and long-term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol 2007; 99:1674-9. [PMID: 17560874 DOI: 10.1016/j.amjcard.2007.01.044] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2006] [Revised: 01/29/2007] [Accepted: 01/29/2007] [Indexed: 01/08/2023]
Abstract
The influence of admission hyperglycemia and diabetes on short- and long-term mortality of patients with acute myocardial infarction (AMI) in the percutaneous coronary intervention (PCI) era was investigated. From 1996 to 2003, a total of 802 consecutive patients with AMI underwent coronary angiography. Primary PCI was performed in 724 patients (90%). Three-year mortality curves were constructed using the Kaplan-Meier method. Cox proportional hazard regression was used to identify independent predictors of 30-day mortality and mortality from 30 days to 3 years. There were 261 patients with admission hyperglycemia (admission glucose>or=11.1 mmol/L) and 212 patients with diabetes. Admission hyperglycemia was associated with a significantly higher 30-day mortality rate (8.4% vs 2.4%, p<0.001). However, there was no significant difference in 30-day mortality rates between diabetic and nondiabetic patients (5.7% vs 3.9%, p=0.29). Conversely, diabetes significantly increased mortality from 30 days to 3 years (10.0% vs 5.5%, p=0.03), but admission hyperglycemia did not (8.4% vs 5.9%, p=0.19). Multivariate analysis showed that hyperglycemia was an independent predictor of 30-day mortality (odds ratio [OR] 1.71, 95% confidence interval [CI] 1.13 to 2.61, p=0.01), but diabetes was not (OR 0.84, 95% CI 0.55 to 1.27, p=0.42). Diabetes was independently associated with mortality from 30 days to 3 years (OR 1.43, 95% CI 1.02 to 1.97, p=0.04), but hyperglycemia had a neutral effect (OR 0.98, 95% CI 0.70 to 1.36, p=0.92). In conclusion, in the PCI era, admission hyperglycemia was associated with short-term mortality, whereas diabetes increased long-term mortality after convalescence in patients with AMI. Admission hyperglycemia and diabetes should be treated as 2 distinct disease states.
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Affiliation(s)
- Masaharu Ishihara
- Department of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
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