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Gatuz MV, Abu-Fanne R, Abramov D, Mamas MA, Roguin A, Kobo O. Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis. Biomedicines 2024; 12:1900. [PMID: 39200364 PMCID: PMC11351229 DOI: 10.3390/biomedicines12081900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2024] [Revised: 08/13/2024] [Accepted: 08/14/2024] [Indexed: 09/02/2024] Open
Abstract
BACKGROUND Diabetes mellitus (DM) significantly impacts cardiovascular outcomes, particularly in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). The presence of polyvascular disease further complicates the prognosis due to the increased burden of atherosclerosis and comorbidities. This study was designed to investigate the combined impact of DM and polyvascular disease on outcomes in patients with AMI and CS. METHOD Using the National Inpatient Sample database, we analyzed 39,140 patients with AMI complicated by CS and known polyvascular disease. The patients were stratified by diabetes status. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, cerebrovascular accident (CVA) and major bleeding. Multivariable logistic regression models were used to examine the association between in-hospital outcomes and diabetes, adjusting for baseline differences. RESULTS Of the study population, 54% had DM. The patients with DM were younger (69.5 vs. 72.1 years, p < 0.001) and more likely to be female (36.7% vs. 34.2%, p < 0.001). After adjustment, the patients with DM showed a 17% increased mortality risk (aOR 1.17, 95% CI: 1.11-1.23, p < 0.001) and a higher risk of major adverse cardiovascular and cerebrovascular events (aOR 1.05, 95% CI: 1.01-1.10, p = 0.020). CONCLUSIONS DM significantly impacts outcomes in patients with AMI complicated by CS and polyvascular disease, leading to increased mortality risk, longer hospital stays, and higher healthcare costs. These findings underscore the need for targeted interventions and specialized care strategies for this high-risk population.
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Affiliation(s)
- Marlon V. Gatuz
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel; (M.V.G.); (R.A.-F.); (A.R.)
| | - Rami Abu-Fanne
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel; (M.V.G.); (R.A.-F.); (A.R.)
| | - Dmitry Abramov
- Department of Cardiology, Linda Loma University Health, Loma Linda, CA 92354, USA;
| | - Mamas A. Mamas
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, UK;
- National Institute for Health and Care Research (NIHR), Birmingham Biomedical Research Centre, Birmingham B15 2TT, UK
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel; (M.V.G.); (R.A.-F.); (A.R.)
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel; (M.V.G.); (R.A.-F.); (A.R.)
- Keele Cardiovascular Research Group, Keele University, Keele ST5 5BG, UK;
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2
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Razaghizad A, Sharma A, Ni J, Ferreira JP, White WB, Mehta CR, Bakris GL, Zannad F. External validation and extension of the TIMI risk score for heart failure in diabetes for patients with recent acute coronary syndrome: An analysis of the EXAMINE trial. Diabetes Obes Metab 2023; 25:229-237. [PMID: 36082521 DOI: 10.1111/dom.14867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/12/2022] [Accepted: 08/24/2022] [Indexed: 02/01/2023]
Abstract
AIMS The Thrombolysis in Myocardial Infarction Risk Score for Heart Failure (HF) in Diabetes (TRS-HFDM ) prognosticates HF hospitalization in people with type 2 diabetes (T2D). This study aimed to externally validate and extend its use for those with recent acute coronary syndrome (ACS). MATERIALS AND METHODS The TRS-HFDM was externally validated in the Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care (EXAMINE) trial (n = 5380) and extended with natriuretic biomarkers. Missing data were multiply imputed. Initial TRS-HFDM variables were previous HF (2 points), atrial fibrillation (1 point), coronary artery disease (1 point), estimated glomerular filtration rate <60 ml/min/1.73 m2 (1 point), and urine albumin-to-creatinine ratio 30-300 mg/g (1 point) and >300 mg/g (2 points). RESULTS In total, HF hospitalization occurred in 193 (3.6%) patients. Based on the TRS-HFDM , 25% of patients were classified as intermediate risk (1 point), 30% were classified as high risk (2 points), 19% were classified as very-high risk (3 points) and 26% were classified as severe risk (≥4 points). Before model extension, discrimination (C-index 0.76, 95%·CI 0.73-0.80) and calibration (calibration slope 0.82, 95%·CI 0.65-1.0; calibration-in-the-large -0.15, 95%·CI -0.37-0.64) were moderate-to-good in individuals with T2D and recent ACS. The extension of TRS-HFDM with the addition of N-terminal pro-B-type natriuretic peptide (NT-ProBNP) improved discrimination (C-index 0.82, 95%·CI 0.79-0.85) and calibration (calibration slope 0.84, 95%·CI 0.66-1.02; calibration-in-the-large -0.12, 95%·CI -0.33-0.081) for this higher-risk population. CONCLUSION The TRS-HFDM with the extension of NT-ProBNP improves risk stratification and generalizes the use of the risk score for patients with T2D and ACS. Future validation studies in ACS populations may be warranted.
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Affiliation(s)
- Amir Razaghizad
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Abhinav Sharma
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- DREAM-CV Lab, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
- Division of Cardiology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada
| | - Jiayi Ni
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT & Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - William B White
- Cardiology Center, University of Connecticut School of Medicine, Farmington, Connecticut, USA
| | | | - George L Bakris
- Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique Inserm 1433, Université de Lorraine, CHRU de Nancy, Inserm U1116, FCRIN INI-CRCT & Cardiovascular R&D Centre - UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
- Université de Lorraine, CIC Insert-CHRU, Nancy, France
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3
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De Luca G, Verdoia M, Morici N, Ferri LA, Piatti L, Grosseto D, Bossi I, Sganzerla P, Tortorella G, Cacucci M, Ferrario M, Murena E, Tondi S, Toso A, Bongioanni S, Ravera A, Corrada E, Mariani M, Di Ascenzo L, Petronio AS, Cavallini C, Vitrella G, Antonicelli R, Cesana BM, De Luca L, Ottani F, Moffa N, Savonitto S, De Servi S. Impact of hemoglobin levels at admission on outcomes among elderly patients with acute coronary syndrome treated with low-dose Prasugrel or clopidogrel: A sub-study of the ELDERLY ACS 2 trial. Int J Cardiol 2022; 369:5-11. [PMID: 35907504 DOI: 10.1016/j.ijcard.2022.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 07/13/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Hemoglobin (Hb) levels have emerged as a useful tool for risk stratification and the prediction of outcome after myocardial infarction. We aimed at evaluating the prognostic impact of this parameter among patients in advanced age, where the larger prevalence of anemia and the higher rate of comorbidities could directly impact on the cardiovascular risk. METHODS All the patients in the ELDERLY-2 trial, were included in this analysis and stratified according to the values of hemoglobin at admission. The primary endpoint of this study was cardiovascular mortality within one year. The secondary endpoints were all-cause mortality, MI, Bleeding Academic Research Consortium (BARC) type 2-3 or 5 bleeding, any stroke, re-hospitalization for cardiovascular event or stent thrombosis (probable or definite) within 12 months after index admission. RESULTS We included in our analysis 1364 patients, divided in quartiles of Hb values (<12.2; 12.2-13.39; 13.44-14.49; ≥ 4.5 g/dl). At a mean follow- up of 330.4 ± 99.9 days cardiovascular mortality was increased in patients with lower Hb (HR[95%CI] = 0.76 [0.59-0.97], p = 0.03). Results were no more significant after correction for baseline differences (adjusted HR[95%CI] = 1.22 [0.41-3.6], p = 0.16). Similar results were observed for overall mortality. At subgroup analysis, (according to Hb median values) a significant interaction was observed only with the type of antiplatelet therapy, but not with major high-risk subsets of patients. CONCLUSIONS Among elderly patients with acute coronary syndrome managed invasively, lower hemoglobin at admission is associated with higher cardiovascular and all-cause mortality and major ischemic events, mainly explained by the higher risk profile.
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Affiliation(s)
- Giuseppe De Luca
- Clinical and Experimental Cardiology Unit, Azienda Ospedaliera-Universitaria "Sassari", University of Sassari, Sassari, Italy.
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, Biella, Italy
| | - Nuccia Morici
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | - Irene Bossi
- IRCCSS. Maria Nascente Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | | | | | | | | | | | | | | | | | | | - Elena Corrada
- Humanitas Clinical and Research Center, Rozzano, Italy
| | | | | | | | | | | | | | - Bruno M Cesana
- Statistics and Biomathematics Unit, Department of Molecular and Transactional Medicine, University of Brescia, Brescia, Italy
| | - Leonardo De Luca
- Department of Cardiosciences, AO San Camillo-Forlanini, Roma, Italy
| | | | | | | | - Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, Pavia, Italy
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4
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Spione F, Arevalos V, Gabani R, Ortega-Paz L, Gomez-Lara J, Jimenez-Diaz V, Jimenez M, Jiménez-Quevedo P, Diletti R, Pineda J, Campo G, Silvestro A, Maristany J, Flores X, Oyarzabal L, Bastos-Fernandez G, Iñiguez A, Serra A, Escaned J, Ielasi A, Tespili M, Lenzen M, Gonzalo N, Bordes P, Tebaldi M, Biscaglia S, Al-Shaibani S, Romaguera R, Gomez-Hospital JA, Rodes-Cabau J, Serruys PW, Sabaté M, Brugaletta S. Impact of Diabetes on 10-Year Outcomes Following ST-Segment-Elevation Myocardial Infarction: Insights From the EXAMINATION-EXTEND Trial. J Am Heart Assoc 2022; 11:e025885. [PMID: 36444863 PMCID: PMC9851431 DOI: 10.1161/jaha.122.025885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Long-term outcomes of ST-segment-elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from the EXAMINATION-EXTEND (10-Years Follow-Up of the EXAMINATION trial) trial was to compare 10-year outcomes of patients with ST-segment-elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient-oriented composite end point of all-cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient-oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05-1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19-2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow-up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13-2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST-segment-elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.
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Affiliation(s)
- Francesco Spione
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - Victor Arevalos
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Rami Gabani
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Luis Ortega-Paz
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Division of Cardiology University of Florida College of Medicine Jacksonville FL
| | - Josep Gomez-Lara
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Victor Jimenez-Diaz
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | - Gianluca Campo
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | | | | | - Loreto Oyarzabal
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Guillermo Bastos-Fernandez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | - Andrés Iñiguez
- Hospital Alvaro Cunqueiro Vigo Spain.,Cardiovascular Research Group Galicia Sur Health Research Institute SERGAS-UVIGO Vigo Spain
| | | | | | | | | | | | | | | | - Matteo Tebaldi
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | - Simone Biscaglia
- Cardiology Unit Azienda Ospedaliera Universitaria di Ferrara Cona Italy
| | | | - Rafael Romaguera
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Joan Antoni Gomez-Hospital
- Hospital Universitari de Bellvitge Institut d'Investigació Biomedica de Bellvitge Hospitalet de Llobregat Spain
| | - Josep Rodes-Cabau
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
| | - Patrick W Serruys
- International Center of Circulatory Health Imperial College London London United Kingdom.,Department of Cardiology National University of Ireland Galway Ireland
| | - Manel Sabaté
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain.,Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV) Instituto de Salud Carlos III Madrid Spain
| | - Salvatore Brugaletta
- Hospital Clínic, Cardiovascular Clinic Institute Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain
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5
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Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries. Arch Cardiovasc Dis 2022; 115:264-275. [DOI: 10.1016/j.acvd.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 11/19/2022]
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6
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HDL-C/apoA-I Ratio Is Associated with the Severity of Coronary Artery Stenosis in Diabetic Patients with Acute Coronary Syndrome. DISEASE MARKERS 2021; 2021:6689056. [PMID: 34055102 PMCID: PMC8149224 DOI: 10.1155/2021/6689056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 01/01/2023]
Abstract
Background Emerging evidence demonstrates that the lipid metabolism in acute coronary syndrome (ACS) patients with type 2 diabetes mellitus (T2DM) differs from nondiabetic patients. However, the distinct lipid profiles and their relationships with the severity of coronary artery stenosis and prognosis in patients with T2DM remain elusive. Method and Result This single-center, prospective cohort study enrolled 468 patients diagnosed with ACS undergoing coronary angiography, consisting of 314 non-DM and 154 DM patients. The HDL-C/apoA-I ratio was significantly higher in DM patients with a multivessel (≥3 affected vessels) lesion than a single-vessel (1-2 affected vessels) lesion. Regression analyses showed that the HDL-C/apoA-I ratio was positively correlated to the number of stenotic coronary arteries in DM patients but not non-DM patients. However, Kaplan-Meier survival analysis revealed no significant difference in the major adverse cardiovascular event rate regarding different HDL-C/apoA-I levels in DM or non-DM ACS patients at the end of the 2-year follow-up. Conclusion A higher HDL-C/apoA-I ratio is associated with increased severity of coronary artery stenosis in DM patients with ACS but not with the rate of major adverse cardiovascular events at the end of the 2-year follow-up.
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7
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Diabetes mellitus, revascularization and outcomes in elderly patients with myocardial infarction-related cardiogenic shock. J Geriatr Cardiol 2020; 17:604-611. [PMID: 33224179 PMCID: PMC7657943 DOI: 10.11909/j.issn.1671-5411.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background The prognostic role of diabetes mellitus (DM) in elderly patients with myocardial infarction-related cardiogenic shock (MI-CS) remains controversial. Little information exists about the impact of intensive cardiac care unit (ICCU) and revascularization on outcomes of elderly patients with MI-CS. We aimed to assess the prognostic impact of DM according to age in patients with MI-CS, and to analyze the impact ICCU management and revascularization on in-hospital mortality in MI-CS patients at older ages. Methods Discharge episodes with diagnosis of CS associated with MI were selected from the Spanish National Health System's Basic Data Set. Centers were classified according to their availability of ICCU. Main outcome measured was in-hospital mortality. Results A total of 23, 590 episodes of MI-CS were identified, of whom 12, 447 (52.8%) were in patients aged ≥ 75 years. The impact of DM on in-hospital mortality was different among age subgroups. While in younger patients, DM was associated to a higher mortality risk (0.52 vs. 0.47, OR = 1.12, 95% CI: 1.06-1.18, χ2 < 0.001), this association became non-significant in older patients (0.76 vs. 0.81, χ2 = 0.09). Adjusted mortality rate of MI-CS aged ≥ 75 years was lower in patients admitted to hospitals with ICCU (adjusted mortality rate: 74.2% vs. 77.7%, P < 0.001) and in patients undergoing revascularization (74.9% vs. 77.3%, P < 0.001). Conclusions Prognostic impact of DM in patients with MI-CS was different according to age, with a significantly lower impact at older ages. The availability of ICCU and revascularization were associated with better outcomes in these complex patients.
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8
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Xiong R, He L, Du X, Dong J, Ma C. Impact of diabetes mellitus and hemoglobin A1c level on outcomes among Chinese patients with acute coronary syndrome. Clin Cardiol 2020; 43:723-731. [PMID: 32427378 PMCID: PMC7368303 DOI: 10.1002/clc.23373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/24/2020] [Accepted: 04/03/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The impact of different glycemic control conditions on in-hospital and long-term outcomes among patients with acute coronary syndrome (ACS) is less well defined. HYPOTHESIS Diabetes mellitus (DM) with different admission hemoglobin A1c (HbA1c) levels (different glycemic control) could affect outcomes among Chinese patients hospitalized as ACS. METHODS We categorized 8961 Chinese ACS patients into one of the following three groups: "no DM" (group 1, n = 3773; no DM history and admission HbA1c < 6.5%), "DM with optimal control"(group 2, n = 2241; DM with admission HbA1c < 7.0%), "DM with suboptimal control"(group 3, n = 2947; DM with admission HbA1c ≥ 7.0%). The primary outcome was in-hospital major adverse cardiovascular events (MACEs). 6098 patients were followed for a median of 3.85 years. Adjusted associations of these three groups with in-hospital MACEs and long-term mortality were determined. RESULTS DM with suboptimal control (group 3) was associated with greater in-hospital MACEs (OR 1.46, 95% CI 1.17-1.81, P = .001) than "no DM" (group 1). DM patients (group 2 and group 3) also had higher in-hospital MACEs (OR 1.42, 95% CI 1.16-1.73, P = .001) than "no DM" patients (group 1). It showed no significantly different in-hospital MACEs between optimal (group 2) and suboptimal (group 3) control group (OR 1.06, 95% CI 0.84-1.34, P = .63). Both optimal control (group 2) and suboptimal control (group 3) had a higher long-term mortality (HR 1.26, 95% CI 1.02-1.56, P = .03; HR 1.42, 95% CI 1.16-1.73, P = .001). CONCLUSIONS ACS patients with DM were associated with higher in-hospital MACEs and long-term mortality. Moreover, lower HbA1c level seems to have limited impact on cardiovascular events and long-term mortality in this high-risk population.
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Affiliation(s)
- Ran Xiong
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Liu He
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Xin Du
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Jian‐Zeng Dong
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
| | - Chang‐Sheng Ma
- Department of Cardiology, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
- National Clinical Research Center for Cardiovascular Diseases, Beijing Anzhen HospitalCapital Medical UniversityBeijingChina
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9
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Potier L, Roussel R, Zeller M, Schiele F, Puymirat E, Simon T, Danchin N. Chronic Kidney Disease, Diabetes, and Risk of Mortality After Acute Myocardial Infarction: Insight From the FAST-MI Program. Diabetes Care 2020; 43:e43-e44. [PMID: 31974106 DOI: 10.2337/dc19-2209] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 12/21/2019] [Indexed: 02/03/2023]
Affiliation(s)
- Louis Potier
- Department of Diabetology, Endocrinology and Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, and Cordeliers Research Center, INSERM, U-1138, Université de Paris, Paris, France
| | - Ronan Roussel
- Department of Diabetology, Endocrinology and Nutrition, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, and Cordeliers Research Center, INSERM, U-1138, Université de Paris, Paris, France
| | - Marianne Zeller
- Equipe PEC2, EA 7460, UFR Sciences de Santé, Université de Bourgogne Franche Comté, Dijon, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Etienne Puymirat
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and INSERM U-970, Université de Paris, Paris, France
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform (URCEST-CRC-CRB), Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.,French Alliance for Cardiovascular Clinical Trials, Paris, France.,Faculté de Médecine Pierre et Marie Curie, Sorbonne Université, Paris, France
| | - Nicolas Danchin
- Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, and INSERM U-970, Université de Paris, Paris, France
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10
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Roule V, Verdier L, Blanchart K, Ardouin P, Lemaitre A, Bignon M, Sabatier R, Alexandre J, Beygui F. Systematic review and meta-analysis of the prognostic impact of cancer among patients with acute coronary syndrome and/or percutaneous coronary intervention. BMC Cardiovasc Disord 2020; 20:38. [PMID: 32000685 PMCID: PMC6993442 DOI: 10.1186/s12872-020-01352-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background Patients with cancer admitted for an acute coronary syndrome (ACS) and/or percutaneous coronary intervention (PCI) represent a growing and high-risk population. The influence of co-existing cancer on mortality remains unclear in such patients. We aimed to assess the impact of cancer on early and late, all-cause and cardiac mortality in the setting of ACS and/or PCI. Methods We performed a systematic review and meta-analysis of studies comparing outcomes of patients with and without a history of cancer admitted for ACS and/or PCI. Results Six studies including 294,528 ACS patients and three studies including 39,973 PCI patients were selected for our meta-analysis. Patients with cancer had increased rates of in-hospital all-cause death (RR 1.74 [1.22; 2.47]), cardiac death (RR 2.44 [1.73; 3.44]) and bleeding (RR 1.64 [1.35; 1.98]) as well as one-year all-cause death (RR 2.62 [1.2; 5.73]) and cardiac death (RR 1.89 [1.25; 2.86]) in ACS studies. Rates of long term all-cause (RR 1.96 [1.52; 2.53]) but not cardiac death were higher in cancer patients admitted for PCI. Conclusion Cancer patients represent a high-risk population both in the acute phase and at long-term after an ACS or PCI. The magnitude of the risk of mortality should however be tempered by the heterogeneity among studies. Early and long term optimal management of such patients should be promoted in clinical practice.
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Affiliation(s)
- Vincent Roule
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France. .,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.
| | - Laurine Verdier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Katrien Blanchart
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Pierre Ardouin
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Adrien Lemaitre
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Mathieu Bignon
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Rémi Sabatier
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France
| | - Joachim Alexandre
- Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France.,CHU de Caen Normandie, Service de Pharmacologie, 14000, Caen, France
| | - Farzin Beygui
- CHU de Caen Normandie, Service de Cardiologie, Caen University Hospital, Avenue Cote de Nacre, 14033, Caen, France.,Normandie Univ, UNICAEN, EA 4650 Signalisation, électrophysiologie et imagerie des lésions d'ischémie-reperfusion myocardique, 14000, Caen, France
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11
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Diabetes mellitus is not independently associated with mortality in elderly patients with ST-segment elevation myocardial infarction. Insights from the Codi Infart registry. Coron Artery Dis 2020; 31:1-6. [DOI: 10.1097/mca.0000000000000821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Sharma A, Cannon CP, White WB, Liu Y, Bakris GL, Cushman WC, Zannad F. Early and Chronic Dipeptidyl-Peptidase-IV Inhibition and Cardiovascular Events in Patients With Type 2 Diabetes Mellitus After an Acute Coronary Syndrome: A Landmark Analysis of the EXAMINE Trial. J Am Heart Assoc 2018; 7:JAHA.117.007649. [PMID: 29769203 PMCID: PMC6015373 DOI: 10.1161/jaha.117.007649] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Antihyperglycemic therapies may increase the risk of cardiovascular events including hospitalization for heart failure. There is a paucity of data evaluating the cardiovascular safety of antihyperglycemic therapies in the high‐risk period following an acute coronary syndrome (ACS). Methods and Results The EXAMINE (Examination of Cardiovascular Outcomes with Alogliptin versus Standard of Care) trial randomized 5380 patients who were 15 to 90 days post ACS to the dipeptidyl dipeptidase‐IV (DPP‐IV) inhibitor alogliptin versus placebo; mean follow‐up was 18 months. Using a landmark analysis, we assessed the (1) burden of cardiovascular events from randomization to 6 months (early period) and from 6 months to the end of follow‐up (late period) and (2) the risk of cardiovascular events associated with early (up to 6 months) and chronic (6 months to end of follow‐up) DPP‐IV inhibition with alogliptin. Patients with early versus late events had similar baseline demographic profiles. Overall, 42.1% of the composite of cardiovascular death/myocardial infarction/stroke and 47.5% of hospitalization for heart failure occurred in the early period. Early DPP‐IV inhibition did not increase the risk of early cardiovascular death/myocardial infarction/stroke (hazard ratio 0.96, 95% confidence interval, 0.76–1.21) or hospitalization for heart failure (1.23, 95% confidence interval, 0.84–1.82). Similarly, chronic DPP‐IV inhibition did not increase the risk of late cardiovascular death/myocardial infarction/stroke (hazard ratio 1.03, 95% confidence interval, 0.89–1.26) or hospitalization for heart failure (hazard ratio 1.02, 95% confidence interval, 0.85–1.22). Conclusions Early after an ACS, patients with type 2 diabetes mellitus experience a significant burden of HF events and recurrent ACS. DPP‐IV inhibition with alogliptin appears to be safe even in the high‐risk period following an ACS.
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Affiliation(s)
- Abhinav Sharma
- INSERM CIC 1433 Université de Lorraine and CHRU, Nancy, France.,Duke Clinical Research Institute, Duke University, Durham, NC.,Division of Cardiology, Stanford University, Palo Alto, CA
| | - Christopher P Cannon
- Baim Institute for Clinical Research, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - William B White
- University of Connecticut School of Medicine, Farmington, CT
| | - Yuyin Liu
- Baim Institute for Clinical Research, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - George L Bakris
- University of Chicago Pritzker School of Medicine, Chicago, IL
| | - William C Cushman
- Memphis Veterans Affairs Medical Center, University of Tennessee College of Medicine, Memphis, TN
| | - Faiez Zannad
- INSERM CIC 1433 Université de Lorraine and CHRU, Nancy, France
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13
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Joo HJ, Cho SA, Hong SJ, Hur SH, Bae JH, Choi DJ, Ahn YK, Park JS, Choi RK, Choi D, Kim JH, Han KR, Park HS, Choi SY, Yoon JH, Kwon HC, Rha SW, Hwang KK, Jung KT, Oh SK, Lee JH, Shin ES, Kim KS, Kim HS, Lim DS. Impact of low high-density lipoprotein-cholesterol level on 2-year clinical outcomes after acute myocardial infarction in patients with diabetes mellitus. Lipids Health Dis 2016; 15:197. [PMID: 27863493 PMCID: PMC5116186 DOI: 10.1186/s12944-016-0374-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/11/2016] [Indexed: 11/25/2022] Open
Abstract
Background It is still unclear whether low high-density lipoprotein cholesterol (HDL-C) affects cardiovascular outcomes after acute myocardial infarction (AMI), especially in patients with diabetes mellitus. Methods A total of 984 AMI patients with diabetes mellitus from the DIabetic Acute Myocardial InfarctiON Disease (DIAMOND) Korean multicenter registry were divided into two groups based on HDL-C level on admission: normal HDL-C group (HDL-C ≥ 40 mg/dL, n = 519) and low HDL-C group (HDL-C < 40 mg/dL, n = 465). The primary endpoint was 2-year major adverse cardiovascular events (MACE), defined as a composite of cardiac death, non-fatal myocardial infarction (MI), and target vessel revascularization (TVR). Results The median follow-up duration was 730 days. The 2-year MACE rates were significantly higher in the low HDL-C group than in the normal HDL-C group (MACE, 7.44% vs. 3.49%, p = 0.006; cardiac death, 3.72% vs. 0.97%, p = 0.004; non-fatal MI, 1.75% vs. 1.55%, p = 0.806; TVR, 3.50% vs. 0.97%, p = 0.007). Kaplan-Meier analysis revealed that the low HDL-C group had a significantly higher incidence of MACE compared to the normal HDL-C group (log-rank p = 0.013). After adjusting for conventional risk factors, Cox proportional hazards analysis suggested that low HDL-C was an independent risk predictor for MACE (hazard ratio [HR] 3.075, 95% confidence interval [CI] 1.034-9.144, p = 0.043). Conclusions In patients with diabetes mellitus, low HDL-C remained an independent risk predictor for MACE after adjusting for multiple risk factors during 2-year follow-up of AMI. Trial registration This study was the sub-analysis of the prospective multi-center registry of DIAMOND (Diabetic acute myocardial infarction Disease) in Korea. This is the observational study supported by Bayer HealthCare, Korea. Study number is 15614. First patient first visit was 02 April 2010 and last patient last visit was 09 December 2013. Electronic supplementary material The online version of this article (doi:10.1186/s12944-016-0374-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hyung Joon Joo
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Sang-A Cho
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Soon Jun Hong
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea
| | - Seung-Ho Hur
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, South Korea
| | - Jang-Ho Bae
- Division of Cardiology, Konyang University Hospital, Daejeon, South Korea
| | - Dong-Ju Choi
- Division of Cardiology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Keun Ahn
- Division of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Hospital, Daegu, South Korea
| | - Rak-Kyeong Choi
- Division of Cardiology, Sejong General Hospital, Bucheon, South Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei University Severance Hospital, Seoul, South Korea
| | - Joon-Hong Kim
- Division of Cardiology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Kyoo-Rok Han
- Division of Cardiology, Hallym University Kangdong Sacred Heart Hospital, Seoul, South Korea
| | - Hun-Sik Park
- Division of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - So-Yeon Choi
- Division of Cardiology, Ajou University Hospital, Suwon, South Korea
| | - Jung-Han Yoon
- Division of Cardiology, Wonju Severance Christian Hospital, Wonju, South Korea
| | - Hyeon-Cheol Kwon
- Division of Cardiology, Samsung Medical Center, Seoul, South Korea
| | - Seung-Woon Rha
- Division of Cardiology, Korea University Guro Hospital, Seoul, South Korea
| | - Kyung-Kuk Hwang
- Division of Cardiology, Chungbuk National University Hospital, Cheongju, South Korea
| | - Kyung-Tae Jung
- Division of Cardiology, Eulji University Hospital, Daejeon, South Korea
| | - Seok-Kyu Oh
- Division of Cardiology, Wonkwang University Hospital, Iksan, South Korea
| | - Jae-Hwan Lee
- Division of Cardiology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eun-Seok Shin
- Division of Cardiology, Ulsan University Hospital, Ulsan, South Korea
| | - Kee-Sik Kim
- Division of Cardiology, Daegu Catholic University Medical Center, Daegu, South Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Seoul National University Hospital, 101, DaeHak-ro, JongRo-gu, Seoul, 110-744, Republic of Korea.
| | - Do-Sun Lim
- Division of Cardiology, Korea University Anam Hospital, 126-1, 5 ka, Anam-dong, Sungbuk-ku, Seoul, 136-705, Republic of Korea.
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14
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Danzi GB, Piccolo R, Chevalier B, Urban P, Fath-Ordoubadi F, Carrie D, Wiemer M, Serra A, Wijns W, Kala P, Stabile A, Goicolea Ruigomez J, Sagic D, Laanmets P, Strupp G, West N. Five-year clinical performance of a biodegradable polymer-coated biolimus-eluting stent in unselected patients. Heart 2016; 103:111-116. [DOI: 10.1136/heartjnl-2016-309283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 06/27/2016] [Accepted: 07/10/2016] [Indexed: 11/04/2022] Open
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