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Kemp BJ, Thompson DR, Coates V, Bond S, Ski CF, Monaghan M, McGuigan K. International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review. Health Policy 2024; 146:105116. [PMID: 38943831 DOI: 10.1016/j.healthpol.2024.105116] [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: 07/31/2023] [Revised: 05/07/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.
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Affiliation(s)
- Bridie J Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Vivien Coates
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Sarah Bond
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | | | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK.
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2
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Gao W, Wang XY, Wang XJ, Huang L. An integrated signature of clinical metrics and immune-related genes as a prognostic indicator for ST-segment elevation myocardial infarction patient survival. Heliyon 2024; 10:e31247. [PMID: 38813183 PMCID: PMC11133808 DOI: 10.1016/j.heliyon.2024.e31247] [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: 01/14/2024] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/31/2024] Open
Abstract
Background The immune-inflammatory pathway plays a critical role in myocardial infarction development. However, few studies have systematically explored immune-related genes in relation to myocardial infarction prognosis using bioinformatic analysis. Our study aims to identify differentially expressed immune-related genes(DEIRGs) in ST-segment elevation myocardial infarction (STEMI) patients and investigate their association with clinical outcomes. Materials and methods We conducted a systematic review of Gene Expression Omnibus datasets, selecting GSE49925, GSE60993, and GSE61144 for analysis. DEIRGs were identified using GEO2R and overlapped across the chosen datasets. Functional enrichment analysis elucidated the DEIRGs' biological functions and pathways. We established an optimal prognostic prediction model using LASSO penalized Cox proportional hazards regression. The signature's clinical utility was evaluated through survival analysis, ROC curve assessment, and decision curve analysis. Additionally, we constructed a prognostic nomogram for survival rate prediction. External validation was performed using our own plasma samples. Results The resulting prognostic signature integrated two dysregulated DEIRGs (S100A12 and IL2RB) and two clinical variables (serum creatinine level and Gensini score). This signature effectively stratified patients into low- and high-risk groups. Survival analysis, ROC curve analysis, and decision curve analysis demonstrated its robust predictive performance and clinical utility within the first two years post-disease onset. External validation confirmed significant outcome differences between risk groups. Conclusions Our study establishes a prognostic signature that combines DEIRGs and clinical variables for STEMI patients. The signature exhibits promising predictive capabilities for patient stratification and survival risk assessment.
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Affiliation(s)
- Wei Gao
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, 300170, PR China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Third Central Hospital, Tianjin, 300170, PR China
- Artificial Cell Engineering Technology Research Center, Tianjin, 300170, PR China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170, PR China
| | - Xiao-yan Wang
- Institute of Biomedical Science, Fudan University, Shanghai, 200030, PR China
| | - Xing-jie Wang
- Clinical Laboratory of Tianjin Chest Hospital, Tianjin, 300222, PR China
| | - Lei Huang
- Department of Heart Center, Tianjin Third Central Hospital, Tianjin, 300170, PR China
- Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin Third Central Hospital, Tianjin, 300170, PR China
- Artificial Cell Engineering Technology Research Center, Tianjin, 300170, PR China
- Tianjin Institute of Hepatobiliary Disease, Tianjin, 300170, PR China
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3
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Schwalm JD, Ivers NM, Bouck Z, Taljaard M, Natarajan MK, Nguyen F, Hijazi W, Thavorn K, Dolovich L, McCready T, O'Brien E, Grimshaw JM. Length of initial prescription at hospital discharge and long-term medication adherence for elderly, post-myocardial infarction patients: a population-based interrupted time series study. BMC Med 2022; 20:213. [PMID: 35725542 PMCID: PMC9210591 DOI: 10.1186/s12916-022-02401-5] [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] [Received: 10/05/2021] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preliminary evidence suggests that providing longer duration prescriptions at discharge may improve long-term adherence to secondary preventative cardiac medications among post-myocardial infarction (MI) patients. We implemented and assessed the effects of two hospital-based interventions-(1) standardized prolonged discharge prescription forms (90-day supply with 3 repeats for recommended cardiac medications) plus education and (2) education only-on long-term cardiac medication adherence among elderly patients post-MI. METHODS We conducted an interrupted time series study of all post-MI patients aged 65-104 years in Ontario, Canada, discharged from hospital between September 2015 and August 2018 with ≥ 1 dispensation(s) for a statin, beta blocker, angiotensin system inhibitor, and/or secondary antiplatelet within 7 days post-discharge. The standardized prolonged discharge prescription forms plus education and education-only interventions were implemented at 2 (1,414 patients) and 4 (926 patients) non-randomly selected hospitals in September 2017 for 12 months, with all other Ontario hospitals (n = 143; 18,556 patients) comprising an external control group. The primary outcome, long-term cardiac medication adherence, was defined at the patient-level as an average proportion of days covered (over 1-year post-discharge) ≥ 80% across cardiac medication classes dispensed at their index fill. Primary outcome data were aggregated within hospital groups (intervention 1, 2, or control) to monthly proportions and independently analyzed using segmented regression to evaluate intervention effects. A process evaluation was conducted to assess intervention fidelity. RESULTS At 12 months post-implementation, there was no statistically significant effect on long-term cardiac medication adherence for either intervention-standardized prolonged discharge prescription forms plus education (5.4%; 95% CI - 6.4%, 17.2%) or education only (1.0%; 95% CI - 28.6%, 30.6%)-over and above the counterfactual trend; similarly, no change was observed in the control group (- 0.3%; 95% CI - 3.6%, 3.1%). During the intervention period, only 10.8% of patients in the intervention groups received ≥ 90 days, on average, for cardiac medications at their index fill. CONCLUSIONS Recognizing intervention fidelity was low at the pharmacy level, and no statistically significant post-implementation differences in adherence were found, the trends in this study-coupled with other published retrospective analyses of administrative data-support further evaluation of this simple intervention to improve long-term adherence to cardiac medications. TRIAL REGISTRATION ClinicalTrials.gov : NCT03257579 , registered June 16, 2017 Protocol available at: https://pubmed.ncbi.nlm.nih.gov/33146624/ .
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Affiliation(s)
- J D Schwalm
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, DBCVSRI, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada. .,Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada.
| | - Noah M Ivers
- Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,ICES, Toronto, ON, Canada
| | - Zachary Bouck
- Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Toronto, ON, Canada
| | - Madhu K Natarajan
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, DBCVSRI, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada.,Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | | | - Waseem Hijazi
- Division of Cardiology, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kednapa Thavorn
- ICES, Toronto, ON, Canada.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lisa Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Tara McCready
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, DBCVSRI, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Erin O'Brien
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, DBCVSRI, 237 Barton Street East, Hamilton, ON, L8L 2X2, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Neville HL, Mann K, Killen J, Callaghan M. Pharmacist Intervention to Improve Medication Adherence in Patients with Acute Coronary Syndrome: The PRIMA-ACS Study. Can J Hosp Pharm 2021; 74:350-360. [PMID: 34602623 DOI: 10.4212/cjhp.v74i4.3198] [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: 11/10/2022]
Abstract
Background Despite ample evidence of benefit, adherence to secondary prevention medication therapy after acute coronary syndrome (ACS) is often suboptimal. Hospital pharmacists are uniquely positioned to improve adherence by providing medication education at discharge. Objective To determine whether a standardized counselling intervention at hospital discharge significantly improved patients' adherence to cardiovascular medications following ACS. Methods This single-centre, prospective, nonrandomized comparative study enrolled patients with a primary diagnosis of ACS (January 2014 to July 2015). Patients who received standardized discharge counselling from a clinical pharmacist were compared with patients who did not receive counselling. At 30 days and 1 year after discharge, follow-up patient surveys were conducted and community pharmacy refill data were obtained. Adherence was assessed using pharmacy refill data and patient self-reporting for 5 targeted medications: acetylsalicylic acid, P2Y purinoceptor 12 (P2Y12) inhibitors, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, β-blockers, and statins. Thirty-day and 1-year medication utilization, cardiovascular readmission rates, and all-cause mortality were also assessed. Results Of the 259 patients enrolled, 88 (34.0%) received discharge counselling. Medication data were obtained for 253 patients (97.7%) at 30 days and 242 patients (93.4%) at 1 year. At 1 year after discharge, there were no statistically significant differences between patients who did and did not receive counselling in terms of rates of nonadherence (11.9% versus 18.4%, p = 0.19), cardiovascular readmission (17.6% versus 22.3%, p = 0.42), and all-cause mortality (3.4% versus 4.2%, p > 0.99). Overall medication nonadherence was 2.8% (7/253) at 30 days and 16.1% (39/242) at 1 year. Conclusions Discharge medication counselling provided by hospital pharmacists after ACS was not associated with significantly better medication adherence at 1 year. Higher-quality evidence is needed to determine the most effective and practical interventions to ensure that patients adhere to their medication regimens and achieve positive outcomes after ACS.
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Affiliation(s)
- Heather L Neville
- , BScPharm, MSc, FCSHP, is with Nova Scotia Health, Halifax, Nova Scotia
| | - Kelsey Mann
- , BScPharm, was, at the time of this study, with Nova Scotia Health, Halifax, Nova Scotia
| | - Jessica Killen
- , BScPharm, ACPR, is with Nova Scotia Health, Halifax, Nova Scotia
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Rayner-Hartley E, Wong GC, Fayowski C, Cairns JA, Singer J, Lee T, Sedlak T, Humphries KH, Perry-Arnesen M, Mackay M, Fordyce CB. Impact of regionalizing ST-elevation myocardial infarction care on sex differences in reperfusion times and clinical outcomes. Clin Cardiol 2021; 44:1113-1119. [PMID: 34101211 PMCID: PMC8364721 DOI: 10.1002/clc.23658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/04/2021] [Accepted: 05/18/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Women with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention historically experience worse in-hospital outcomes compared to men. HYPOTHESIS Implementation of a regional STEMI system will reduce care gaps in reperfusion times and in-hospital outcomes between women and men. METHODS 1928 patients (413 women, 21.4%) presented with an acute STEMI between June 2007 and March 2016. The population was divided into an early cohort (n = 728 patients, 2007-May 2011), and a late cohort (n = 1200 patients, June 2011-2016). The primary endpoints evaluated were reperfusion times and in-hospital outcomes. RESULTS Compared to men, women experienced significant delays in first medical contact (FMC) to arrival at the emergency room (26.0 vs. 22.0 min, p < 0.001) and FMC-to-device (109 vs. 101 min p = 0.001). Women had higher incidences of post-PCI heart failure and death compared to men (p < 0.05). Following multivariable adjustment, no mortality difference was observed for women versus men (adjusted OR; 0.82; 95% confidence interval [CI], 0.51-1.34; p = 0.433) or for early versus late cohorts (adjusted OR; 1.04; 95% CI, 0.68-1.60; p = 0.856). CONCLUSION Following STEMI regionalization, women continued to experience significantly longer reperfusion times, although there was no difference in adjusted mortality. These results highlight the ongoing disparity of STEMI care between women and men, and suggest that regionalization alone is insufficient to close sex-based care gaps.
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Affiliation(s)
- Erin Rayner-Hartley
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Graham C Wong
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Cassandra Fayowski
- Division of General Internal Medicine, Western University, London, Ontario, Canada
| | - John A Cairns
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Terry Lee
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tara Sedlak
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karin H Humphries
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michele Perry-Arnesen
- Royal Columbian Hospital, Division of Cardiology, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Martha Mackay
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.,School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Christopher B Fordyce
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.,Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences (CHEOS), Providence Health Care Research Institute, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Ivers NM, Schwalm JD, Bouck Z, McCready T, Taljaard M, Grace SL, Cunningham J, Bosiak B, Presseau J, Witteman HO, Suskin N, Wijeysundera HC, Atzema C, Bhatia RS, Natarajan M, Grimshaw JM. Interventions supporting long term adherence and decreasing cardiovascular events after myocardial infarction (ISLAND): pragmatic randomised controlled trial. BMJ 2020; 369:m1731. [PMID: 32522811 PMCID: PMC7284284 DOI: 10.1136/bmj.m1731] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To test a scalable health system intervention to improve long term adherence to secondary prevention treatments among patients who have had a recent myocardial infarction. DESIGN Three arm, pragmatic randomised controlled trial with blinded outcome assessment. SETTING Nine cardiac centres in Ontario, Canada. PARTICIPANTS 2632 patients with obstructive coronary artery disease after a myocardial infarction, identified from a centralised cardiac registry. INTERVENTIONS Participants were randomised 1:1:1 to receive usual care, five mail-outs developed through a user centred design process, or mail-outs plus phone calls. The phone calls were delivered first by an interactive automated system to screen for non-adherence to treatment. Trained lay health workers followed up as necessary. Interventions were coordinated centrally but delivered from each patient's hospital site. MAIN OUTCOME MEASURES Co-primary outcomes were completion of cardiac rehabilitation and adherence to recommended medication. Data were collected by blinded assessors through patient report and from administrative health databases at 12 months. RESULTS 2632 patients (mean age 66, 71% male) were randomised: 878 to the full intervention (mail plus phone calls), 878 to mail only, and 876 to usual care. Of the respondents, 174 (27%) of 643 in the usual care group, 200 (32%) of 628 in the mail only group, and 196 (37%) of 531 allocated to the full intervention completed cardiac rehabilitation (adjusted odds ratio 1.55, 95% confidence interval 1.18 to 2.03). In the mail plus phone group, 11.7%, 6.0%, 14.4%, 32.9%, and 35.0% reported adherence to 0, 1, 2, 3, and 4 drug classes after one year, respectively, in comparison with 12.5%, 6.8%, 13.6%, 30.2%, and 36.8% in the mail only group, and 12.2%, 8.4%, 13.1%, 30.3%, and 36.1% in the usual care group, respectively (mail only v usual care, odds ratio 0.98, 95% confidence interval 0.81 to 1.19; full intervention v usual care, 0.99, 0.82 to 1.20). CONCLUSIONS Scalable interventions delivered by mail plus phone can increase completion of cardiac rehabilitation after myocardial infarction but not adherence to medication. More intensive interventions should be tested to improve adherence to medication and to evaluate the association between attendance at cardiac rehabilitation and adherence to medication. TRIAL REGISTRATION ClinicalTrials.gov NCT02382731, registered 9 March 2015 before any patient enrolment.
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Affiliation(s)
- Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S1B2, Canada
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
| | - Jon-David Schwalm
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Tara McCready
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Sherry L Grace
- Faculty of Health, York University, Toronto, ON, Canada
- KITE Research Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer Cunningham
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Beth Bosiak
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Justin Presseau
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Holly O Witteman
- Department of Family and Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Neville Suskin
- Cardiac Rehabilitation and Secondary Prevention Programme of St Joseph's Health Care London, ON, Canada
- Lawson Health Research Institute, Departments of Medicine, Epidemiology and Biostatistics, Western University, London, ON, Canada
| | - Harindra C Wijeysundera
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Clare Atzema
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - R Sacha Bhatia
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Madhu Natarajan
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada
- Department of Medicine, Division of Cardiology, Hamilton Health Sciences, and McMaster University, Hamilton, ON, Canada
| | - Jeremy M Grimshaw
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Population and Public Health, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Burlacu A, Artene B, Covic A. A Narrative Review on Thrombolytics in Advanced CKD: Is it an Evidence-Based Therapy? Cardiovasc Drugs Ther 2019; 32:463-475. [PMID: 30187347 DOI: 10.1007/s10557-018-6824-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE A timely pharmacoinvasive strategy consisting of thrombolytic therapy (TT) plays a pivotal role in three major scenarios: acute ischemic stroke (AIS), acute myocardial infarction (STEMI), and massive pulmonary embolism (PE). Presence of advanced chronic kidney disease (CKD) (estimated glomerular filtration rate < 30 mL/min/1.73 m2), known to disturb thrombotic/thrombolytic equilibrium, causes difficulties for clinicians in evaluating risk-benefit balance, as current guidelines do not address the relationship between TT and the advanced CKD. This narrative review aims to evaluate the most important scientific resources regarding the evidences, benefits, and risks of using thrombolytics in advanced CKD. METHODS We searched the electronic database of PubMed for studies evaluating the relationship between renal dysfunction and TT in patients with STEMI, AIS, and massive PE. Randomized controlled trials (RCTs), observational studies including prospective or retrospective cohort studies, reviews, meta-analyses, and guidelines were included if referring to TT for one of the three scenarios in advanced CKD. RESULTS Prothrombotic conditions in CKD, associated with an increased risk of hemorrhages, can affect the safety and efficacy of TT. Concerns regarding in-hospital bleeding events and poor clinical outcomes subsequent to TT in advanced CKD continue to cause underutilization or delaying routine reperfusion therapy. CONCLUSIONS The impact of TT on the outcomes of advanced CKD patients is poorly understood to date, with scarce data available in current guidelines and conflicting results from observational studies. Until evidence-based data from RCTs will be obtained, the clinical challenge of maximizing benefits for this high-risk subgroup lays in the hands of practicing clinicians.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania.,University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania
| | - Bogdan Artene
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania. .,University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.
| | - Adrian Covic
- University of Medicine and Pharmacy Gr. T. Popa, Iasi, Romania.,Nephrology Department, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
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8
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Andersson H, Ullgren A, Holmberg M, Karlsson T, Herlitz J, Wireklint Sundström B. Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care. Int Emerg Nurs 2017; 33:43-47. [PMID: 28438478 DOI: 10.1016/j.ienj.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/25/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome. METHODS This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010. RESULTS In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI). CONCLUSION This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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Affiliation(s)
- Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Andreas Ullgren
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Emergency Medical Service System, Skaraborg Hospital, Skövde, Sweden
| | - Mats Holmberg
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Thomas Karlsson
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Birgitta Wireklint Sundström
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
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9
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Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction. JACC Cardiovasc Interv 2016; 9:2014-2020. [DOI: 10.1016/j.jcin.2016.07.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/20/2016] [Accepted: 06/30/2016] [Indexed: 11/18/2022]
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10
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Lerner M, Pal RS, Borici-Mazi R. Kounis syndrome and systemic mastocytosis in a 52-year-old man having surgery. CMAJ 2016; 189:E208-E211. [PMID: 27486207 DOI: 10.1503/cmaj.151314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Marina Lerner
- Division of Respirology (Lerner), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Medicine (Pal, Borici-Mazi), Queens University, Kingston, Ont
| | - Raveen S Pal
- Division of Respirology (Lerner), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Medicine (Pal, Borici-Mazi), Queens University, Kingston, Ont
| | - Rozita Borici-Mazi
- Division of Respirology (Lerner), Department of Medicine, McMaster University, Hamilton, Ont.; Department of Medicine (Pal, Borici-Mazi), Queens University, Kingston, Ont.
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11
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Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study. Anatol J Cardiol 2016; 16:900-915. [PMID: 27443472 PMCID: PMC5324909 DOI: 10.14744/anatoljcardiol.2016.6755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To evaluate the acute phase (pre- and in-hospital) antithrombotic management patterns (AMPs) and in-hospital outcomes for patients hospitalized with an acute coronary syndrome (ACS). Methods: In total, 1034 patients [514 patients with ST-segment elevation myocardial infarction (STEMI) and 520 with unstable angina/non-STEMI (UA/NSTEMI)] hospitalized for ACS within 24 h of symptom onset were included in this multicenter prospective registry study conducted at 34 hospitals across Turkey. Patient characteristics, index event description, pre- and in-hospital AMPs, and clinical outcomes were evaluated. Results: Majority (89.1%) of patients did not receive pre-hospital treatment. Overall 87.9% patients with STEMI and 55.6% patients with NSTEMI underwent percutaneous coronary intervention and dual antiplatelet therapy (DAPT) was based mainly on acetylsalicylic acid (ASA) and clopidogrel during hospitalization (99.8% and 98.2%, respectively). DAPT use at discharge was 98.4% and 86.8%, respectively. The percentage of patients with STEMI who received pre-hospital care, in-hospital cardiac catheterization, and pre and/or in-hospital triple antiplatelet therapy was higher than that of patients with UA/NSTEMI. In addition, higher rate of in-hospital hemorrhagic (2.3% vs. 0.8%) and cardiac ischemic (1.2% vs. 0.4% for MI and 1.6% vs. 0.8% for recurrent ischemia) complications and earlier induction of pre and/or in-hospital antiplatelet therapy and cardiac catheterization were also noted in patients with STEMI than in those with UA/NSTEMI. Conclusion: Our findings revealed in-hospital and at-discharge management to be mainly based on DAPT in patients with ACS. Interventional strategies were used in the majority of patients with STEMI, while the usage and timing of immediate pre-hospital ECG from symptom onset should be improved in these patients.
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12
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DeFronzo RA, Chilton R, Norton L, Clarke G, Ryder REJ, Abdul-Ghani M. Revitalization of pioglitazone: the optimum agent to be combined with a sodium-glucose co-transporter-2 inhibitor. Diabetes Obes Metab 2016; 18:454-62. [PMID: 26919068 DOI: 10.1111/dom.12652] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 02/06/2016] [Accepted: 02/21/2016] [Indexed: 12/15/2022]
Abstract
The recently completed EMPA-REG study showed that empagliflozin significantly decreased the major adverse cardiac events (MACE) endpoint, which comprised cardiovascular death, non-fatal myocardial infarction (MI) and stroke, in patients with high-risk type 2 diabetes (T2DM), primarily through a reduction in cardiovascular death, without a significant decrease in either MI or stroke. In the PROactive study, pioglitazone decreased the MACE endpoint by a similar degree to that observed in the EMPA-REG study, through a marked reduction in both recurrent MI and stroke and a modest reduction in cardiovascular death. These observations suggest that pioglitazone might be an ideal agent to combine with empagliflozin to further reduce cardiovascular events in patients with high-risk diabetes as empagliflozin also promotes salt/water loss and would be expected to offset any fluid retention associated with pioglitazone therapy. In the present paper, we provide an overview of the potential benefits of combined pioglitazone/empagliflozin therapy to prevent cardiovascular events in patients with T2DM.
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Affiliation(s)
- R A DeFronzo
- Diabetes Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX, USA
| | - R Chilton
- Cardiology Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX, USA
| | - L Norton
- Diabetes Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX, USA
| | - G Clarke
- Diabetes Division and Department of Radiology, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX, USA
| | - R E J Ryder
- Diabetes and Endocrine Unit, City Hospital, Birmingham, UK
| | - M Abdul-Ghani
- Diabetes Division, University of Texas Health Science Center and Texas Diabetes Institute, San Antonio, TX, USA
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13
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Schwalm JD, Ivers NM, Natarajan MK, Taljaard M, Rao-Melacini P, Witteman HO, Zwarenstein M, Grimshaw JM. Cluster randomized controlled trial of Delayed Educational Reminders for Long-term Medication Adherence in ST-Elevation Myocardial Infarction (DERLA-STEMI). Am Heart J 2015; 170:903-13. [PMID: 26542498 DOI: 10.1016/j.ahj.2015.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Discontinuation of guideline-recommended cardiac medications post-ST-elevation myocardial infarction (STEMI) is common and associated with increased mortality. DERLA-STEMI tested an intervention to improve long-term adherence to cardiac medications post-STEMI. METHODS AND RESULTS Between September 2011 and December 2012, STEMI patients from one health region in Ontario, who underwent an angiogram during their admission and survived to discharge, were cluster randomized (by primary care provider) to intervention or control. The intervention was an automated system of personalized, educational-reminders sent to the patient and their family physician, urging long-term use of secondary-prevention medications. Interventions were mailed at 1, 2, 5, 8, and 11 months after discharge. A total of 852 eligible participants were randomized to intervention (n = 424, 287 clusters) and control (n = 428, 295 clusters); 87% completed a 12-month follow-up. The primary outcome, defined as the proportion of participants taking (persistence) all 4-cardiovascular medication classes (acetylsalicylic acid, angiotensin blockers, statin, and β-blocker) at 12 months, was 58.4% (intervention) and 58.9% (control; adjusted odds ratio 1.03, 95% CI 0.77-1.36). Medication adherence, as assessed by the Morisky Medication Adherence Score, was statistically significantly better in the intervention group as compared with control (65.3% vs 58.0%, adjusted odds ratio 1.35, 95% CI 1.01-1.81). CONCLUSION The results suggest suboptimal use of 4 of 4 cardiac medication classes at 12 months. There was no significant difference compared with usual care in the persistence to guideline-recommended medications post-STEMI when participants (and their family physicians) receive repeated postal reminders.
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14
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Eikelboom JW, Connolly SJ. Unmet Needs in Anticoagulant Therapy: Potential Role of Rivaroxaban. Cardiol Res 2015; 6:267-277. [PMID: 28197239 PMCID: PMC5295520 DOI: 10.14740/cr413w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2015] [Indexed: 01/22/2023] Open
Abstract
The new generation of non-vitamin K antagonist oral anticoagulants (NOACs) have been welcomed as a convenient alternative to warfarin. Three new oral anticoagulants, dabigatran etexilate, rivaroxaban and apixaban have been approved for the prevention of stroke and systemic embolism (SSE) in patients with atrial fibrillation (AF) and the prevention of venous thromboembolic events (VTEs) in patients who have undergone elective hip or knee replacement surgery. Dabigatran etexilate and rivaroxaban are also indicated for the treatment of VTE and the long-term prevention of recurrent deep vein thrombosis (DVT) and pulmonary embolism (PE). A fourth agent, edoxaban, has been successfully tested for several indications but is not yet approved for use in North America or Europe. Building on these successes, new trials are planned to address remaining unmet needs and knowledge gaps. This paper examines the unresolved issues in anticoagulant therapy with a focus on planned and ongoing trials.
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Affiliation(s)
- John W Eikelboom
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
| | - Stuart J Connolly
- Population Health Research Institute, McMaster University and Hamilton Health Sciences, 237 Barton St. E., Hamilton, ON L8L 2X2, Canada
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15
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Wu CH, Liu PY, Tsai TN, Lin CS, Lin WY, Cheng CC, Lin WS, Hsu CH, Liou JT, Cheng SM, Lin GM. Clinical and prognostic correlates of ST-elevation myocardial infarction patients with normal coronary angiography. JOURNAL OF MEDICAL SCIENCES 2015. [DOI: 10.4103/1011-4564.163820] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology/Canadian Society of Cardiac Surgery Position Statement on Revascularization—Multivessel Coronary Artery Disease. Can J Cardiol 2014; 30:1482-91. [DOI: 10.1016/j.cjca.2014.09.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 09/28/2014] [Accepted: 09/28/2014] [Indexed: 12/17/2022] Open
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17
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Veress LA, Anderson DR, Hendry-Hofer TB, Houin PR, Rioux JS, Garlick RB, Loader JE, Paradiso DC, Smith RW, Rancourt RC, Holmes WW, White CW. Airway tissue plasminogen activator prevents acute mortality due to lethal sulfur mustard inhalation. Toxicol Sci 2014; 143:178-84. [PMID: 25331496 DOI: 10.1093/toxsci/kfu225] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Sulfur mustard (SM) is a chemical weapon stockpiled today in volatile regions of the world. SM inhalation causes a life-threatening airway injury characterized by airway obstruction from fibrin casts, which can lead to respiratory failure and death. Mortality in those requiring intubation is more than 80%. No therapy exists to prevent mortality after SM exposure. Our previous work using the less toxic analog of SM, 2-chloroethyl ethyl sulfide, identified tissue plasminogen activator (tPA) an effective rescue therapy for airway cast obstruction (Veress, L. A., Hendry-Hofer, T. B., Loader, J. E., Rioux, J. S., Garlick, R. B., and White, C. W. (2013). Tissue plasminogen activator prevents mortality from sulfur mustard analog-induced airway obstruction. Am. J. Respir. Cell Mol. Biol. 48, 439-447). It is not known if exposure to neat SM vapor, the primary agent used in chemical warfare, will also cause death due to airway casts, and if tPA could be used to improve outcome. METHODS Adult rats were exposed to SM, and when oxygen saturation reached less than 85% (median: 6.5 h), intratracheal tPA or placebo was given under isoflurane anesthesia every 4 h for 48 h. Oxygen saturation, clinical distress, and arterial blood gases were assessed. Microdissection was done to assess airway obstruction by casts. RESULTS Intratracheal tPA treatment eliminated mortality (0% at 48 h) and greatly improved morbidity after lethal SM inhalation (100% death in controls). tPA normalized SM-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress. Moreover, tPA treatment resulted in greatly diminished airway casts, preventing respiratory failure from airway obstruction. CONCLUSIONS tPA given via airway more than 6 h after exposure prevented death from lethal SM inhalation, and normalized oxygenation and ventilation defects, thereby rescuing from respiratory distress and failure. Intra-airway tPA should be considered as a life-saving rescue therapy after a significant SM inhalation exposure incident.
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Affiliation(s)
- Livia A Veress
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Dana R Anderson
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Tara B Hendry-Hofer
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Paul R Houin
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Jacqueline S Rioux
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Rhonda B Garlick
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Joan E Loader
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Danielle C Paradiso
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Russell W Smith
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Raymond C Rancourt
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Wesley W Holmes
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
| | - Carl W White
- *Department of Pediatrics, University of Colorado Denver, Aurora, Colorado 80045 and Medical Toxicology Branch/Analytical Toxicology Division U.S. Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland 21010-5400, Maryland
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18
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Mayyas FA, Al-Jarrah MI, Ibrahim KS, Alzoubi KH. Level and significance of plasma myeloperoxidase and the neutrophil to lymphocyte ratio in patients with coronary artery disease. Exp Ther Med 2014; 8:1951-1957. [PMID: 25371762 PMCID: PMC4218701 DOI: 10.3892/etm.2014.2034] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 10/06/2014] [Indexed: 12/14/2022] Open
Abstract
Inflammation plays a pivotal role in the etiology of coronary artery disease (CAD). Myeloperoxidase (MPO) is a potent inflammatory factor and a critical modulator of coronary inflammation and oxidative stress. The goal of this study was to determine the impact of the plasma MPO (pMPO) level and neutrophil/lymphocyte ratio on the clinical characteristics and outcomes of patients with CAD. Blood samples were collected from 210 patients with underlying chest pain or recent myocardial infarction (MI) prior to coronary angiography in order to measure pMPO levels. The pMPO levels and neutrophil/lymphocyte ratio were correlated with clinical characteristics and outcomes following catheterization. The pMPO level and neutrophil/lymphocyte ratio were higher in patients with recent MI than in patients with CAD (coronary occlusion ≥50%) or without CAD (coronary occlusion <50%). Patients with ST segment elevated MI (STEMI) had a higher neutrophil/lymphocyte ratio relative to patients with non-STEMI. The pMPO level was identified to correlate with the neutrophil/lymphocyte ratio and the need for coronary artery reperfusion by coronary artery bypass surgery or percutaneous coronary intervention. Patients who were taking aspirin had lower pMPO levels and neutrophil/lymphocyte ratio compared with those who were not taking aspirin. The plasma neutrophil/lymphocyte ratio was negatively associated with the left ventricular ejection fraction at baseline and the 30-day follow-up, whereas pMPO showed no correlation. Multivariate analysis indicated that the pMPO level was positively associated with MI, the neutrophil/lymphocyte ratio and coronary intervention. The preoperative use of aspirin was associated with a lower pMPO level and neutrophil/lymphocyte ratio. In conclusion, pMPO is positively associated with MI, the neutrophil/lymphocyte ratio and coronary intervention. The preoperative use of aspirin is associated with a lower pMPO level and neutrophil/lymphocyte ratio. pMPO may serve as a predictor of coronary intervention and as a potential therapeutic target for the reduction of inflammation in patients with CAD.
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Affiliation(s)
- Fadia A Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Mohammad I Al-Jarrah
- Department of General Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan ; Princess Muna Heart Institute, King Abdullah University Hospital, Irbid 22110, Jordan
| | - Khalid S Ibrahim
- Princess Muna Heart Institute, King Abdullah University Hospital, Irbid 22110, Jordan ; Department of General Surgery, Division of Cardiovascular Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
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Laribi S, Aouba A, Resche-Rigon M, Johansen H, Eb M, Peacock FW, Masip J, Ezekowitz JA, Cohen-Solal A, Jougla E, Plaisance P, Mebazaa A. Trends in death attributed to myocardial infarction, heart failure and pulmonary embolism in Europe and Canada over the last decade. QJM 2014; 107:813-20. [PMID: 24729266 DOI: 10.1093/qjmed/hcu083] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Worldwide, cardiovascular diseases and cancer account for ∼40% of deaths. Certain reports have shown a progressive decrease in mortality. Our main objective was to assess mortality trends related to myocardial infarction (MI), heart failure (HF) and pulmonary embolism (PE). METHODS MI, HF and PE were studied as cause of death based on the analysis of death certificates in Canada (C), England and Wales (E), France (F) and Sweden (S). We also used a multiple cause approach. Age-standardized death rates (SDR) were calculated. RESULTS The SDR for MI, HF or PE as the underlying cause of death, all decreased during the last decade. The decrease in SDR secondary to MI exceeded that for HF or PE. Concerning multiple cause of death, a greater decrease was also found for MI, compared with HF or PE. CONCLUSIONS We confirm the beneficial trends in SDR with MI, HF or PE both as underlying or multiple causes in the studied countries. For HF and PE, multiple cause approach seems more accurate to describe the burden of these two pathologies. Our study also suggests that more efforts should be dedicated to HF and PE in order to achieve similar trends than in MI.
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Affiliation(s)
- S Laribi
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - A Aouba
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - M Resche-Rigon
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - H Johansen
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - M Eb
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - F W Peacock
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - J Masip
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - J A Ezekowitz
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - A Cohen-Solal
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - E Jougla
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France
| | - P Plaisance
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
| | - A Mebazaa
- From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Lariboisière, 75010 Paris, France, GREAT network (http://www.greatnetwork.org), Center of Epidemiology for Medical Causes of Death (Inserm, CépiDc, Kremlin-Bicêtre), France, Univ Paris Diderot, Sorbonne Paris Cité, 75010 Paris, France, Department of Biostatistics and Clinical Epidemiology, APHP, Saint-Louis University Hospital, INSERM U717, Paris, France, Department of Epidemiology and Community Medicine, University of Ottawa, Canada, Baylor College of Medicine, Houston, TX, USA, Intensive Care Department, Consorci Sanitari Integral, University of Barcelona, Spain, Mazankowski Alberta Heart Institute, Edmonton, Alberta, Canada, Department of Cardiology, AP-HP, Hôpital Lariboisière, 75010 Paris, France and Department of Anesthesiology and Critical Care, APHP, Hôpital Lariboisière, 75010 Paris, France From the INSERM, UMRS 942, Biomarkers and cardiac diseases, 75010 Paris, France, Emergency Department, APHP, Hôpital Laribois
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Mayyas F, Al-Jarrah M, Ibrahim K, Mfady D, Van Wagoner DR. The significance of circulating endothelin-1 as a predictor of coronary artery disease status and clinical outcomes following coronary artery catheterization. Cardiovasc Pathol 2014; 24:19-25. [PMID: 25213716 DOI: 10.1016/j.carpath.2014.08.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/16/2014] [Accepted: 08/08/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/OBJECTIVES Coronary artery disease (CAD) is responsible for significant morbidity and mortality. Inflammatory, pro-thrombotic and structural factors contribute to the etiology of CAD. This study sought to determine the relationship of plasma endothelin-1 (pET-1), a potent vasoconstrictor, mitogen and modulator of cardiac inflammation, to clinical characteristics and outcomes of CAD patients. METHODS Blood samples were collected from 336 patients with underlying chest pain or recent myocardial infarction (MI), prior to coronary catheterization. pET-1 was correlated with clinical characteristics and outcomes following catheterization and at 30-day follow-up. RESULTS pET-1 was higher in recent MI patients than in patients with CAD (coronary occlusion≥50%) or without CAD (<50%) (Mean±sem (pg/ml): 2.12±0.13, 1.51±0.10, 1.21±0.06; 95% confidence interval (1.85-2.38, 1.31-1.72, 1.07-1.32; respectively, P<.0001). Patients with ST elevation MI (STEMI) had higher pET-1 than non-STEMI (P=.008). pET-1 was associated with heart failure (HF) and low left ventricular ejection fraction (LVEF) and was highest in MI patients presented with acute HF. At 30-day follow up, pET-1 was not associated with the change in LVEF. In multivariate analysis, pET-1 was positively associated with age, smoking, HF, CAD status, and need for revascularization by coronary artery bypass surgery (CABG). pET-1 was negatively correlated with LVEF and preoperative statin use. CONCLUSIONS pET-1 is associated with recent MI, HF, age, smoking, CABG, and low LVEF. Preoperative statin use was associated with lower pET-1. pET-1 may serve as a risk marker and a potential therapeutic target in CAD patients.
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Affiliation(s)
- Fadia Mayyas
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Mohammad Al-Jarrah
- Department of General Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; Department of Internal Medicine, Division of Cardiology, Faculty of Medicine, King Abdullah University Hospital, Irbid, Jordan
| | - Khalid Ibrahim
- Department of General Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan; Department of General Surgery, Division of Cardiovascular Surgery, Faculty of Medicine, King Abdullah University Hospital, Irbid, Jordan
| | - Doaa Mfady
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - David R Van Wagoner
- Department of Molecular Cardiology, Cleveland Clinic Foundation, Cleveland, OH, USA
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21
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Mancini GJ, Gosselin G, Chow B, Kostuk W, Stone J, Yvorchuk KJ, Abramson BL, Cartier R, Huckell V, Tardif JC, Connelly K, Ducas J, Farkouh ME, Gupta M, Juneau M, O’Neill B, Raggi P, Teo K, Verma S, Zimmermann R. Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. Can J Cardiol 2014; 30:837-49. [DOI: 10.1016/j.cjca.2014.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
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22
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Jabor B, Choi H, Ruel I, Hafiane A, Mourad W, Genest J. Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in Acute Coronary Syndrome: Relationship With Low-Density Lipoprotein Cholesterol. Can J Cardiol 2013; 29:1679-86. [DOI: 10.1016/j.cjca.2013.09.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Revised: 09/25/2013] [Accepted: 09/25/2013] [Indexed: 11/29/2022] Open
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23
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Abramsohn EM, Decker C, Garavalia B, Garavalia L, Gosch K, Krumholz HM, Spertus JA, Lindau ST. "I'm not just a heart, I'm a whole person here": a qualitative study to improve sexual outcomes in women with myocardial infarction. J Am Heart Assoc 2013; 2:e000199. [PMID: 23885024 PMCID: PMC3828784 DOI: 10.1161/jaha.113.000199] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Little is known about recovery of female sexual function following an acute myocardial infarction (MI). Interventions to improve sexual outcomes in women are limited. Methods and Results Semistructured, qualitative telephone interviews were conducted with 17 partnered women (aged 43 to 75 years) purposively selected from the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients’ Health Status Registry to deepen knowledge of recovery of female sexual function following an acute myocardial infarction (MI) and to improve sexual outcomes in women. Sixteen women had a monogamous relationship with a male spouse; 1 had a long‐term female partner. Most women resumed sexual activity within 4 weeks of their MI. Sexual problems and concerns were prevalent, including patient and/or partner fear of “causing another heart attack.” Few women received counseling about sexual concerns or the safety of returning to sex. Most women who discussed sex with a physician initiated the discussion themselves. Inquiry about strategies to improve sexual outcomes elicited key themes: need for privacy, patient‐centeredness, and information about the timing and safe resumption of sexual activity. In addition, respondents felt that counseling should be initiated by the treating cardiologist, who “knows whether your heart is safe,” and then reinforced by the care team throughout the rehabilitation period. Conclusions Partnered women commonly resume sexual activity soon after an MI with fear but without directed counseling from their physicians. Proactive attention to women's concerns related to sexual function and the safety of sexual activity following an MI could improve post‐MI outcomes for women and their partners.
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Affiliation(s)
- Emily M Abramsohn
- Program in Integrative Sexual Medicine for Women and Girls, Department of Obstetrics and Gynecology, Section of Gynecology Oncology, the University of Chicago, Chicago, IL
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24
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Veress LA, Hendry-Hofer TB, Loader JE, Rioux JS, Garlick RB, White CW. Tissue plasminogen activator prevents mortality from sulfur mustard analog-induced airway obstruction. Am J Respir Cell Mol Biol 2013; 48:439-47. [PMID: 23258228 DOI: 10.1165/rcmb.2012-0177oc] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Sulfur mustard (SM) inhalation causes the rare but life-threatening disorder of plastic bronchitis, characterized by bronchial cast formation, resulting in severe airway obstruction that can lead to respiratory failure and death. Mortality in those requiring intubation is greater than 80%. To date, no antidote exists for SM toxicity. In addition, therapies for plastic bronchitis are solely anecdotal, due to lack of systematic research available to assess drug efficacy in improving mortality and/or morbidity. Adult rats exposed to SM analog were treated with intratracheal tissue plasminogen activator (tPA) (0.15-0.7 mg/kg, 5.5 and 6.5 h), compared with controls (no treatment, isoflurane, and placebo). Respiratory distress and pulse oximetry were assessed (for 12 or 48 h), and arterial blood gases were obtained at study termination (12 h). Microdissection of fixed lungs was done to assess airway obstruction by casts. Optimal intratracheal tPA treatment (0.7 mg/kg) completely eliminated mortality (0% at 48 h), and greatly improved morbidity in this nearly uniformly fatal disease model (90-100% mortality at 48 h). tPA normalized plastic bronchitis-associated hypoxemia, hypercarbia, and lactic acidosis, and improved respiratory distress (i.e., clinical scores) while decreasing airway fibrin casts. Intratracheal tPA diminished airway-obstructive fibrin-containing casts while improving clinical respiratory distress, pulmonary gas exchange, tissue oxygenation, and oxygen utilization in our model of severe chemically induced plastic bronchitis. Most importantly, mortality, which was associated with hypoxemia and clinical respiratory distress, was eliminated.
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Affiliation(s)
- Livia A Veress
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, CO, USA.
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25
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Shavadia J, Ibrahim Q, Sookram S, Brass N, Knapp D, Welsh RC. Bridging the gap for nonmetropolitan STEMI patients through implementation of a pharmacoinvasive reperfusion strategy. Can J Cardiol 2013; 29:951-9. [PMID: 23332092 DOI: 10.1016/j.cjca.2012.10.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 10/11/2012] [Accepted: 10/13/2012] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Timely primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI). However, universal access is limited outside metropolitan centres and portends worse outcomes for rural patients. This study evaluates the outcomes of STEMI patients treated in a metropolitan and nonmetroplitan setting within Vital Heart Response, an integrated reperfusion program developed to reduce reperfusion delay in Central and Northern Alberta. METHODS From October 2006 to March 2011, data on consecutive STEMI patients was prospectively recorded. Clinical characteristics, in-hospital management, and outcomes grouped by site of presentation are described. RESULTS There were 1990 metropolitan and 1602 nonmetropolitan STEMI patients. Metropolitan were older (62.7 vs 60.4 years; P < 0.001) and had more: angina (21.2% vs 16.5%; P < 0.001), dyslipidemia (45.3% vs 39.6%; P = 0.001), and hypertension (49.9% vs 46.6%; P = 0.047). The reperfusion strategy for metropolitan and nonmetropolitan: primary PCI (57.4% vs 22.9%; P < 0.001), fibrinolysis (26.3% vs 61.2%; P < 0.001), and no reperfusion (16.3% vs 15.9%; P = 0.855). First medical contact to reperfusion was delayed in nonmetropolitan with fibrinolysis and PCI, 8 and 125 minutes. A rescue PCI or coronary angiography within 24 hours was completed in 41.4% and 46.2%, respectively. Nonmetropolitan patients had fewer deaths (4.1% vs 6.8%; P = 0.001) with no difference in the composite outcome (death, reinfraction, congestive heart failure, cardiogenic shock) (16.8% vs 15.1%; P = 0.161) or major bleeding (7.9% vs 8.0%; P = 0.951). CONCLUSIONS Systematic application of a pharmacoinvasive strategy appears to be safe and effective for patients in whom a delay in mechanical reperfusion is anticipated.
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Affiliation(s)
- Jay Shavadia
- University of Alberta, Edmonton, Alberta, Canada
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Abella Álvarez A, Torrejón Pérez I, Enciso Calderón V, Hermosa Gelbard C, Sicilia Urban J, Ruiz Grinspan M, García Ureña M, Salinas Gabiña I, Mozo Martín T, Calvo Herranz E, Díaz Blázquez M, Gordo Vidal F. Proyecto UCI sin paredes. Efecto de la detección precoz de los pacientes de riesgo. Med Intensiva 2013; 37:12-8. [DOI: 10.1016/j.medin.2012.08.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Revised: 08/03/2012] [Accepted: 08/15/2012] [Indexed: 10/27/2022]
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Endothelin-B Receptors and Left Ventricular Dysfunction after Regional versus Global Ischaemia-Reperfusion in Rat Hearts. Cardiol Res Pract 2012; 2012:986813. [PMID: 22844633 PMCID: PMC3403336 DOI: 10.1155/2012/986813] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Revised: 05/23/2012] [Accepted: 06/01/2012] [Indexed: 11/20/2022] Open
Abstract
Background. Endothelin-1 (ET-1) is implicated in left ventricular dysfunction after ischaemia-reperfusion. ETA and ETB receptors mediate diverse actions, but it is unknown whether these actions depend on ischaemia type and duration. We investigated the role of ETB receptors after four ischaemia-reperfusion protocols in isolated rat hearts.
Methods. Left ventricular haemodynamic variables were measured in the Langendorff-perfused model after 40- and 20-minute regional or global ischaemia, followed by 30-minute reperfusion. Wild-type (n = 39) and ETB-deficient (n = 41) rats were compared. Infarct size was measured using fluorescent microspheres after regional ischaemia-reperfusion.
Results. Left ventricular dysfunction was more prominent in ETB-deficient rats, particularly after regional ischaemia. Infarct size was smaller (P = 0.006) in wild-type (31.5 ± 4.4%) than ETB-deficient (45.0 ± 7.3%) rats after 40 minutes of regional ischaemia-reperfusion. Although the recovery of left ventricular function was poorer after 40-minute ischaemia-reperfusion, end-diastolic pressure in ETB-deficient rats was higher after 20 than after 40 minutes of regional ischaemia-reperfusion.
Conclusion. ETB receptors exert cytoprotective effects in the rat heart, mainly after regional ischaemia-reperfusion. Longer periods of ischaemia suppress the recovery of left ventricular function after reperfusion, but the role of ETB receptors may be more important during the early phases.
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Management and Outcome of Acute Coronary Syndrome Patients in Relation to Prior History of Atrial Fibrillation. Can J Cardiol 2012; 28:443-9. [DOI: 10.1016/j.cjca.2011.12.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/24/2011] [Accepted: 12/24/2011] [Indexed: 12/22/2022] Open
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Cardiac Outcomes Through Digital Evaluation (CODE) STEMI Project: Prehospital Digitally-Assisted Reperfusion Strategies. Can J Cardiol 2012; 28:423-31. [DOI: 10.1016/j.cjca.2012.02.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 02/10/2012] [Accepted: 02/10/2012] [Indexed: 11/18/2022] Open
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Ivers NM, Schwalm JD, Grimshaw JM, Witteman H, Taljaard M, Zwarenstein M, Natarajan MK. Delayed educational reminders for long-term medication adherence in ST-elevation myocardial infarction (DERLA-STEMI): protocol for a pragmatic, cluster-randomized controlled trial. Implement Sci 2012; 7:54. [PMID: 22682691 PMCID: PMC3536678 DOI: 10.1186/1748-5908-7-54] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Accepted: 05/15/2012] [Indexed: 11/30/2022] Open
Abstract
Background Despite evidence-based recommendations supporting long-term use of cardiac medications in patients post ST-elevation myocardial infarction, adherence is known to decline over time. Discontinuation of cardiac medications in such patients is associated with increased mortality. Methods/design This is a pragmatic, cluster-randomized controlled trial with blinded outcome assessment and embedded qualitative process evaluation. Patients from one health region in Ontario, Canada who undergo a coronary angiogram during their admission for ST-elevation myocardial infarction and who survive their initial hospitalization will be included. Allocation of eligible patients to intervention or usual care will take place within one week after the angiogram using a computer-generated random sequence. To avoid treatment contamination, patients treated by the same family physician will be allocated to the same study arm. The intervention consists of recurrent, personalized, paper-based educational messages and reminders sent via post on behalf of the interventional cardiologist to the patient, family physician, and pharmacist urging long-term adherence to secondary prevention medications. The primary outcome is the proportion of patients who report in a phone interview taking all relevant classes of cardiac medications at twelve months. Secondary outcomes to be measured at three and twelve months include proportions of patients who report: actively taking each cardiac medication class of interest (item-by-item); stopping medications due to side effects; taking one or two or three medication classes concurrently; a perfect Morisky Medication Adherence Score for cardiac medication compliance; and having a discussion with their family physician about long-term adherence to cardiac medications. Self-reported measures of adherence will be validated using administrative data for prescriptions filled. Discussion This intervention is designed to be easily generalizable. If effective, it could be implemented broadly. If it does not change medication utilization, the process evaluation will offer insights regarding how such an intervention could be optimized in future. Trial registration Clinicaltrials.gov NCT01325116
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Affiliation(s)
- Noah M Ivers
- Family Practice Health Centre, Women's College Research Institute, Women's College Hospital, 76 Grenville Ave Toronto, Toronto, Ontario, Canada.
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31
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Ducas RA, Wassef AW, Jassal DS, Weldon E, Schmidt C, Grierson R, Tam JW. To transmit or not to transmit: how good are emergency medical personnel in detecting STEMI in patients with chest pain? Can J Cardiol 2012; 28:432-7. [PMID: 22681962 DOI: 10.1016/j.cjca.2012.04.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2012] [Revised: 04/03/2012] [Accepted: 04/03/2012] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND There is growing use of prehospital electrocardiograms (ECGs) in establishing early diagnosis of ST segment myocardial infarction (STEMI) to facilitate early reperfusion. This study aimed to determine the predictive value of prehospital ECGs interpreted by nonphysician emergency medical services (EMS) in chest pain presentations. METHODS In our city of 658,700 people, EMS/paramedics received 21 hours of instruction on STEMI management, ECG acquisition, and interpretation. Suspected STEMI ECGs were wirelessly transmitted to and discussed with a physician for possible therapy. ECGs deemed negative for STEMI by EMS were not transmitted; patients were transported to the closest hospital without prehospital physician involvement. RESULTS From July 21, 2008 to July 21, 2010, there were 5426 chest pain calls to EMS, 380 were suspected STEMI cases. The remaining ECGs were deemed negative for STEMI by EMS. To audit the nontransmitted ECGs we analyzed 323 consecutive patients over 2 selected months (January and June 2010) for comparison. Of nontransmitted cases there was 1 missed and 2 STEMIs that developed subsequently. Based on 380 transmitted and 323 nontransmitted cases, the sensitivity and specificity of EMS detecting STEMI were 99.6% and 67.6%, respectively. The positive and negative predictive values for STEMI were 59.5% and 99.7%, respectively. CONCLUSIONS Our findings demonstrate nonphysician EMS interpretation of STEMI on prehospital ECG has excellent sensitivity and high negative predictive value. This finding supports the use of prehospital ECGs interpreted by EMS to help identify and facilitate treatment of STEMI. These results may have broad implications on staffing models for first responder/EMS units.
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Fitchett DH, Theroux P, Brophy JM, Cantor WJ, Cox JL, Gupta M, Kertland H, Mehta SR, Welsh RC, Goodman SG. Assessment and Management of Acute Coronary Syndromes (ACS): A Canadian Perspective on Current Guideline-Recommended Treatment – Part 1: Non-ST–Segment Elevation ACS. Can J Cardiol 2011; 27 Suppl A:S387-401. [PMID: 22118042 DOI: 10.1016/j.cjca.2011.08.110] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 01/28/2023] Open
Affiliation(s)
- David H Fitchett
- St Michael's Hospital, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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