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Fahim MAA, Salman A, Khan HA, Hasan SM, Bhojani MF, Aslam S, Haq AZU, Bejugam VR, Nasir BM, Gul W, Moeed A, Abdalla AS, Majid M, Asghar MS, Hasibuzzaman MA. Long-term outcomes of titanium-nitride-oxide coated stents and drug-eluting stents in acute coronary syndrome: A systematic review and meta-analysis. World J Cardiol 2024; 16:293-305. [PMID: 38817643 PMCID: PMC11135326 DOI: 10.4330/wjc.v16.i5.293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND In severe cases of coronary artery disease, percutaneous coronary intervention provide promising results. The stent used could be a drug-eluting stent (DES) or a titanium-nitride-oxide coated stent (TiNOS). AIM To compare the 5-year effectiveness and safety of the two stent types. METHODS The following systematic review and meta-analysis was conducted in accordance with the preferred reporting items for systematic reviews and meta-analysis guidelines, and PubMed/MEDLINE, Scopus, and Cochrane Central were searched from inception till August 2023. Primary outcomes were major adverse cardiac events (MACE), cardiac death, myocardial infarction (MI), cardiac death or MI, and ischemia-driven total lesion revascularization (ID-TLR). RESULTS Four randomized controlled trials (RCT), which analyzed a sum total of 3045 patients with acute coronary syndrome (ACS) after a median follow-up time of 5 years were included. Though statistically insignificant, an increase in the ID-TLR was observed in patients receiving TiNOSs vs DESs. In addition, MI, cardiac death and MI, and definite stent thrombosis (DST) were significantly decreased in the TiNOS arm. Baseline analysis revealed no significant results with meta-regression presenting non-ST elevated MI (NSTEMI) as a statistically significant covariate in the outcome of MACE. CONCLUSION TiNOS was found to be superior to DES in terms of MI, cardiac death or MI, and DST outcomes, however, the effect of the two stent types on ID-TLR and MACE was not significant. A greater number of studies are required to establish an accurate comparison of patient outcomes in TiNOS and DES.
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Affiliation(s)
| | - Afia Salman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Hira Anas Khan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Syed Muhammad Hasan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Muskan Fatima Bhojani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Sarah Aslam
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Amna Zia Ul Haq
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Vishal Reddy Bejugam
- Department of Internal Medicine, North Central Bronx Hospital, Bronx, NY 10467, United States
| | - Beena Muntaha Nasir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Wajiha Gul
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi 74200, Pakistan
| | - Abdelrahman S Abdalla
- Department of Urology, Center for Academic Medicine, Stanford University School of Medicine, Palo Alto, CA 33872, United States
| | - Muhammad Majid
- Department of Cardiovascular Imaging, Cleveland Clinic, Cleveland, OH 44195, United States
| | - Muhammad Sohaib Asghar
- Division of Nephrology and Hypertension, Mayo Clinic Rochester, Rochester, MN 55905, United States
| | - Md Al Hasibuzzaman
- Institute of Nutrition and Food Science, University of Dhaka, Dhaka 1000, Bangladesh.
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Jøns C, Bloch Thomsen PE, Riahi S, Smilde T, Bach U, Jacobsen PK, Táborský M, Faluközy J, Wiemer M, Christensen PD, Kónyi A, Schelfaut D, Bulava A, Grabowski M, Merkely B, Nuyens D, Mahajan R, Nagel P, Tilz R, Malczynski J, Steinwender C, Brachmann J, Serota H, Schrader J, Behrens S, Søgaard P. Arrhythmia monitoring and outcome after myocardial infarction (BIO|GUARD-MI): a randomized trial. Front Cardiovasc Med 2024; 11:1300074. [PMID: 38807948 PMCID: PMC11132184 DOI: 10.3389/fcvm.2024.1300074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 04/16/2024] [Indexed: 05/30/2024] Open
Abstract
Objectives Cardiac arrhythmias predict poor outcome after myocardial infarction (MI). We studied if arrhythmia monitoring with an insertable cardiac monitor (ICM) can improve treatment and outcome. Design BIO|GUARD-MI was a randomized, international open-label study with blinded outcome assessment. Setting Tertiary care facilities monitored the arrhythmias, while the follow-up remained with primary care physicians. Participants Patients after ST-elevation (STEMI) or non-ST-elevation MI with an ejection fraction >35% and a CHA2DS2-VASc score ≥4 (men) or ≥5 (women). Interventions Patients were randomly assigned to receive or not receive an ICM in addition to standard post-MI treatment. Device-detected arrhythmias triggered immediate guideline recommended therapy changes via remote monitoring. Main outcome measures MACE, defined as a composite of cardiovascular death or acute unscheduled hospitalization for cardiovascular causes. Results 790 patients (mean age 71 years, 72% male, 51% non-STEMI) of planned 1,400 pts were enrolled and followed for a median of 31.6 months. At 2 years, 39.4% of the device group and 6.7% of the control group had their therapy adapted for an arrhythmia [hazard ratio (HR) = 5.9, P < 0.0001]. Most frequent arrhythmias were atrial fibrillation, pauses and bradycardia. The use of an ICM did not improve outcome in the entire cohort (HR = 0.84, 95%-CI: 0.65-1.10; P = 0.21). In secondary analysis, a statistically significant interaction of the type of infarction suggests a benefit in the pre-specified non-STEMI subgroup. Risk factor analysis indicates that this may be connected to the higher incidence of MACE in patients with non-STEMI. Conclusions The burden of asymptomatic but actionable arrhythmias is large in post-infarction patients. However, arrhythmia monitoring with an ICM did not improve outcome in the entire cohort. Post-hoc analysis suggests that it may be beneficial in non-STEMI patients or other high-risk subgroups. Clinical Trial Registration [https://www.clinicaltrials.gov/ct2/show/NCT02341534], NCT02341534.
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Affiliation(s)
- Christian Jøns
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Sam Riahi
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tom Smilde
- Department of Cardiology, Scheperziekenhuis, Treant Zorggroep, Emmen, Netherlands
| | - Ulrich Bach
- Department of Cardiology, Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Peter Karl Jacobsen
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Miloš Táborský
- Department of Cardiology, Fakultní Nemocnice Olomouc, Olomouc, Czech Republic
| | | | - Marcus Wiemer
- Department of Cardiology, Johannes Wesling Universitätsklinik, Minden, Germany
| | | | - Attila Kónyi
- Heart Institute, The University of Pécs, Pécs, Hungary
| | - Dan Schelfaut
- Cardiovascular Centre, Onze Lieve Vrouw Clinic Aalst, Aalst, Belgium
| | - Alan Bulava
- Department of Cardiology, České Budějovice Hospital and Faculty of Health and Social Sciences, University of South Bohemia, České Budějovice, Czech Republic
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Béla Merkely
- Heart and Vascular Centre, Semmelweis University, Budapest, Hungary
| | | | - Rajiv Mahajan
- Department of Cardiology, Lyell McEwin Hospital, and Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia
| | - Patrick Nagel
- Department of Cardiology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Tilz
- Department of Cardiology, Universitätsklinikum Schleswig-Holstein - Campus Lübeck, Lübeck, Germany
| | | | | | | | - Harvey Serota
- Department of Cardiology, St. Louis Heart and Vascular, Bridgeton, MO, United States
| | | | - Steffen Behrens
- Department of Cardiology, Vivantes Humboldt-Klinikum and Klinikum Spandau, Berlin, Germany
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
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3
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Qureshi MN, Ahmed EN, Ahmed KA, Bashtawi E. Retrospective review of non-ST segment elevation acute coronary syndrome presenting to the emergency department of a major tertiary center in Saudi Arabia. Ann Saudi Med 2024; 44:1-10. [PMID: 38433430 PMCID: PMC10910079 DOI: 10.5144/0256-4947.2024.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/03/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) comprises a spectrum of diseases ranging from unstable angina (UA), non-ST elevation myocardial infarction (non-STEMI) and ST elevation myocardial infarction (STEMI). Treatment of ACS without STEMI (NSTEMI-ACS) can vary, depending on the severity of presentation and multiple other factors. OBJECTIVE Analyze the NSTEMI-ACS patients in our institution. DESIGN Retrospective observational. SETTING A tertiary care institution with accredited chest pain center. PATIENTS AND METHODS The travel time from ED booking to the final disposition for patients presenting with chest pain was retrieved over a period of 6 months. The duration of each phase of management was measured with a view to identify the factors that influence their management and time from the ED to their final destination. The data was analyzed using descriptive statistics. MAIN OUTCOME MEASURES Travel time from ED to final destination. SAMPLE SIZE 300 patients. RESULTS The majority of patients were males (64%) between 61 and 80 years of age (45%). The median disposition time (from ED booking to admission order by the cardiology team) was 5 hours and 19 minutes. Cardiology admissions took 10 hours and 20 minutes from ED booking to the inpatient bed. UA was diagnosed in 153 (51%) patients and non-STEMI in 52 (17%). Coronary catheterization was required in 79 (26%) patients, 24 (8%) had coronary artery bypass grafting (CABG) and 8 (3%) had both catheterization and CABG. CONCLUSION The time from ED booking to final destination for NSTEMI-ACS patients is delayed due to multiple factors, which caused significant delays in overall management. Additional interventional steps can help improve the travel times, diagnosis, management and disposition of these patients. LIMITATIONS Single center study done in a tertiary care center so the results from this study may not be extrapolated to other centers.
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Affiliation(s)
- Muhammad Nauman Qureshi
- From the Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Eman Nayaz Ahmed
- From the College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Eyad Bashtawi
- From the Department of Emergency Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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4
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Demir G, Karaca G, Ekmekci A, Safaei S, Kimiaei A, Emre A. White Blood Cell/Mean Platelet Volume Ratio as a Predictor of Long-Term Outcomes but Not Coronary Artery Disease Severity in Non-ST Elevation Myocardial Infarction Patients. Cureus 2023; 15:e51423. [PMID: 38299134 PMCID: PMC10828626 DOI: 10.7759/cureus.51423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2023] [Indexed: 02/02/2024] Open
Abstract
Background White blood cell count (WBC) and mean platelet volume (MPV) have been shown to be hematologic parameters of prognostic significance in acute coronary syndrome. We sought to determine the relationship between the WBC/MPV ratio (WMR), coronary artery disease (CAD) complexity, and long-term clinical outcomes in patients with non-ST elevation myocardial infarction (NSTEMI). Hypothesis WMR has a relationship with the complexity of CAD and long-term clinical outcomes in NSTEMI patients. Methods A total of 289 NSTEMI patients who underwent coronary angiography were divided into two groups according to the median WMR (>970 or ≤970). CAD complexity was assessed with the SYNTAX score. Results The WMR was not associated with the synergy between percutaneous coronary intervention (PCI) with Taxus and cardiac surgery (SYNTAX) score on multivariate linear regression analysis (ß=0.08, 95% CI = -0.76-2.21, p = 0.14). However, it was of prognostic significance on Kaplan-Meier survival analysis in overall patients (log-rank p = 0.03) and in patients with a SYNTAX Score <22 (log-rank p = 0.01). Follow-up data showed that major adverse cardiac events (MACE) (p = 0.02), death (p < 0.001), non-fatal MI (p = 0.03), ischemia-driven revascularization (p = 0.03), and heart failure (p = 0.04) were more frequent in the high WMR group. After adjustment for age, sex, eGFR, troponin levels, and the Global Registry of Acute Coronary Events (GRACE) score in Cox regression models, the association of high WMR with the cumulative incidence of MACE was preserved (overall patients (HR=1.85, 95% CI 1.1-3.12, p=0.02) and patients with a SYNTAX score <22 (HR=2.06, 95% CI 1.15-3.67, p=0.01). Conclusion The WMR was not related to CAD complexity, but it was associated with long-term clinical outcomes in patients with NSTEMI who underwent coronary angiography.
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Affiliation(s)
- Gizem Demir
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educational Research Hospital, Istanbul, TUR
| | - Gürkan Karaca
- Department of Cardiology, Bahçeşehir University, Istanbul, TUR
- Department of Cardiology, VM Medical Park Maltepe Hospital, Istanbul, TUR
| | - Ahmet Ekmekci
- Department of Cardiology, Bahçeşehir University, Istanbul, TUR
- Department of Cardiology, Medical Park Pendik Hospital, Istanbul, TUR
| | | | - Ali Kimiaei
- Department of Cardiology, Bahçeşehir University, Istanbul, TUR
| | - Ayşe Emre
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Educational Research Hospital, Istanbul, TUR
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5
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Jeon BK, Jang WJ, Park IH, Oh JH, Yang JH, Gwon HC, Ahn CM, Yu CW, Kim HJ, Bae JW, Kwon SU, Lee HJ, Lee WS, Jeong JO, Park SD. Impact of Acute Myocardial Infarction Type on Prognosis in Female Patients With Cardiogenic Shock. Am J Cardiol 2023; 206:116-124. [PMID: 37690149 DOI: 10.1016/j.amjcard.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023]
Abstract
There are limited data about mid-term prognosis according to acute myocardial infarction (AMI) type in female patients with AMI complicated by cardiogenic shock (CS). In this study, we evaluated the impact of AMI type on prognosis in female patients who underwent percutaneous coronary intervention (PCI) for AMI complicated by CS. A total of 184 female patients who underwent PCI for AMI complicated by CS were enrolled from 12 centers in the Republic of Korea. Patients were divided into 2 groups according to AMI type: the ST-segment elevation myocardial infarction (n = 114) and the non-ST-segment elevation myocardial infarction (n = 70) group. Primary outcome was a major adverse cardiac event (MACE) (defined as a composite of cardiac death, myocardial infarction, or repeat revascularization). Propensity-score matching analysis was performed to reduce selection bias and potential confounding factors. During 12-month follow-up, a total of 73 MACEs occurred (ST-segment elevation myocardial infarction group, 47 [41.2%] vs non-ST-segment elevation myocardial infarction group, 26 [37.1%], p = 0.643). Multivariate analysis revealed no significant difference in the incidence of MACE at 12 months between the 2 groups (adjusted hazard ratio 1.16, 95% confidence interval 0.70 to 2.37, p = 0.646). After propensity-score matching, the incidence of MACE at 12 months remained similar between the 2 groups (hazard ratio 1.31, 95% confidence interval 0.69 to 2.52, p = 0.413). The similarity in MACEs between the 2 groups was consistent across a variety of subgroups. In conclusion, after adjusting for baseline differences, AMI clinical type did not appear to increase the risk of MACEs at 12 months in female patients who underwent emergency PCI for AMI complicated by CS.
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Affiliation(s)
- Bo Kyung Jeon
- Department of Cardiology, Ewha Womans University Medical Center Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Woo Jin Jang
- Department of Cardiology, Ewha Womans University Medical Center Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
| | - Ik Hyun Park
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Ju Hyeon Oh
- Department of Cardiology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Cheol Woong Yu
- Division of Cardiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyun-Joong Kim
- Division of Cardiology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jang-Whan Bae
- Division of Cardiology, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Sung Uk Kwon
- Division of Cardiology, Ilsan Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jong Lee
- Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea
| | - Wang Soo Lee
- Division of Cardiology, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jin-Ok Jeong
- Division of Cardiology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University Hospital, Seoul, Republic of Korea
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6
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Doganay B, Celebi OO. Prognostic role of the left ventricular global function index in predicting major adverse cardiovascular events in acute coronary syndrome patients. Biomark Med 2023; 17:5-16. [PMID: 36942625 DOI: 10.2217/bmm-2023-0063] [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: 03/23/2023] Open
Abstract
Aim: This study aimed to evaluate the prognostic role of the left ventricular (LV) global function index (LVGFI) in predicting major adverse cardiovascular events in patients with acute coronary syndrome after long-term follow-up. Methods: This retrospective study included 718 patients with ST-elevated myocardial infarction (STEMI) and 781 patients with non-ST-elevated myocardial infarction (NSTEMI). The LVGFI was calculated on echocardiography with the following formula: (LV stroke volume/[LV cavity volume + LV myocardial volume]) × 100. Results: Mean LVGFI was higher in the NSTEMI group than in the STEMI group. Decreased LVGFI levels were independent predictors of major adverse cardiovascular events in both the STEMI and the NSTEMI group. Conclusion: Echocardiographic LVGFI may be a useful prognostic screening tool for acute coronary syndrome cohorts.
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Affiliation(s)
- Birsen Doganay
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
| | - Ozlem Ozcan Celebi
- Department of Cardiology, Ankara City Hospital, University District Bilkent Street No: 1, 06800, Ankara, Turkey
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7
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Chen L, Fan Y, Fang Z, Liu N. Long-term outcomes and predictors of patients with ST elevated versus non-ST elevated myocardial infarctions in non-obstructive coronary arteries: a retrospective study in Northern China. PeerJ 2023; 11:e14958. [PMID: 36890872 PMCID: PMC9987296 DOI: 10.7717/peerj.14958] [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: 09/12/2022] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
Background Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a heterogeneous disease entity with diverse etiologies and no uniform treatment protocols. Patients with MINOCA can be clinically classified into two groups based on whether they have an ST-segment elevation (STE) or non-ST segment elevation (NSTE), based on electrocardiogram (ECG) results, whose clinical prognosis is unclear. This study aimed to compare the outcomes and predictors of patients with STE and NSTE in the MINOCA population. Methods We collected the data for 196 patients with MINOCA (115 with STE and 81 with NSTE) in China. Clinical characteristics, prognoses, and predictors of major adverse cardiovascular events (MACE) were analyzed during the follow-up of all patients. Results The proportion of patients with STE was greater than that with NSTE in the MINOCA population. Patients with NSTE were older and had a higher incidence of hypertension. No differences were observed in the outcomes between the STE and NSTE groups during a median follow-up period of 49 (37,46) months. No significant differences were observed in those with MACE (24.35% vs 22.22%, P = 0.73) and those without MACE. The multivariable predictors of MACE in the NSTE groups were Killip grades ≥ 2 (HR 9.035, CI 95% [1.657-49.263], P = 0.011), reduced use of β-blockers during hospitalization (HR 0.238, CI 95% [0.072-0.788], P = 0.019), and higher levels of low-density lipoprotein cholesterol (LDL-C) (HR 2.267, CI 95% [1.008-5.097], P = 0.048); the reduced use of β-blockers during hospitalization was the only independent risk factor of MACE in the STE group. Conclusions There were differences between the clinical characteristics of patients with STE and NSTE in the MINOCA population, even though outcomes during follow-up were similar. Independent risk factors for major adverse cardiac events were not identical in the STE and NSTE groups, which could be attributable to the differences in disease pathogenesis.
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Affiliation(s)
- Lin Chen
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China.,Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Yinghong Fan
- Institute of Gastroenterology, Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China.,Pancreatic Center, Department of Gastroenterology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, Jiangsu Province, China
| | - Zhen Fang
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
| | - Ning Liu
- Department of Cardiology, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu Province, China
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8
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Pyka Ł, Hudzik B, Bartuś S, Buszman P, Gierlotka M, Wojakowski W, Hiczkiewicz J, Kleinrok A, Skrzypek M, Kuliczkowski W, Gąsior M. Anticoagulation for Atrial Fibrillation in Acute Coronary Syndrome Survivors Reduces Major Cardiovascular Events and Mortality. J Cardiovasc Pharmacol Ther 2023; 28:10742484231212106. [PMID: 38158229 DOI: 10.1177/10742484231212106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
The prevalence of atrial fibrillation (AF) in acute coronary syndrome (ACS) patients is increasing. Data on outcomes of anticoagulation in ACS patients with AF are lacking. The aim of our study was to investigate the prevalence of stroke, myocardial infarction, bleeding complications, and all-cause mortality in this population. PL-ACS and AMI-PL registries gather an all-comer population of ACS patients in Poland, exceeding half a million records. We have selected ACS survivors with concomitant AF on admission, divided them into subgroups with regard to the administered anticoagulation, and followed up with them for a 12-month period (n = 13,973). Subsequently, groups were propensity score matched for age, sex, ejection fraction, diabetes, heart failure, renal impairment, and type of ACS. The study population was divided with regard to the administration of anticoagulation. Anticoagulation was prescribed in 2,466 patients (17.6%). The (D)OAC+ patients were younger; however, comorbidities were more prevalent in this group. The 12-month follow-up showed that the (D)OAC+ patients had significantly lower rates of all-cause mortality, myocardial infarction, and ischemic stroke, with no significant increase in bleeding events. After matching, the study groups consisted of 2,194 patients each and showed no differences in baseline characteristics. The outcomes of the 12-month observation were similar to the findings before matching. This all-comer national registry analysis shows that the use of guideline-recommended therapy and anticoagulation in ACS survivors with AF is associated with a lower rate of all-cause mortality, recurrent myocardial infarction, and ischemic stroke.
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Affiliation(s)
- Łukasz Pyka
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Bartosz Hudzik
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
- Department of Cardiovascular Disease Prevention, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Katowice, Poland
| | - Stanisław Bartuś
- Second Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Buszman
- Department of Epidemiology, Faculty of Medical Sciences in Katowice, Medical University of Silesia in Katowice, Katowice, Poland
| | - Marek Gierlotka
- Department of Cardiology, University of Opole, Opole, Poland
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Diseases, Third Division of Cardiology, Medical University of Silesia, Katowice, Poland
| | - Jarosław Hiczkiewicz
- Clinical Department of Cardiology, Nowa Sól Multidisciplinary Hospital, Nowa Sól, Poland
| | - Andrzej Kleinrok
- Department of Cardiology, The Pope John Paul II Province Hospital of Zamość, Zamość, Poland
| | - Michał Skrzypek
- Department of Biostatistics, Faculty of Public Health in Bytom, Medical University of Silesia, Bytom, Poland
| | | | - Mariusz Gąsior
- Third Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
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9
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Nadarajah R, Ludman P, Appelman Y, Brugaletta S, Budaj A, Bueno H, Huber K, Kunadian V, Leonardi S, Lettino M, Milasinovic D, Gale CP, Budaj A, Dagres N, Danchin N, Delgado V, Emberson J, Friberg O, Gale CP, Heyndrickx G, Iung B, James S, Kappetein AP, Maggioni AP, Maniadakis N, Nagy KV, Parati G, Petronio AS, Pietila M, Prescott E, Ruschitzka F, Van de Werf F, Weidinger F, Zeymer U, Gale CP, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Emberson J, Erlinge D, Glikson M, Gray A, Kayikcioglu M, Maggioni AP, Nagy KV, Nedoshivin A, Petronio AP, Roos-Hesselink JW, Wallentin L, Zeymer U, Popescu BA, Adlam D, Caforio ALP, Capodanno D, Dweck M, Erlinge D, Glikson M, Hausleiter J, Iung B, Kayikcioglu M, Ludman P, Lund L, Maggioni AP, Matskeplishvili S, Meder B, Nagy KV, Nedoshivin A, Neglia D, Pasquet AA, Roos-Hesselink JW, Rossello FJ, Shaheen SM, Torbica A, Gale CP, Ludman PF, Lettino M, Bueno H, Huber K, Leonardi S, Budaj A, Milasinovic (Serbia) D, Brugaletta S, Appelman Y, Kunadian 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S, Popescu MI, Cozma A, Babes EE, Rus M, Ardelean A, Larisa R, Moisi M, Ban E, Buzle A, Filimon G, Dobreanu D, Lupu S, Mitre A, Rudzik R, Sus I, Opris D, Somkereki C, Mornos C, Petrescu L, Betiu A, Volcescu A, Ioan O, Luca C, Maximov D, Mosteoru S, Pascalau L, Roman C, Brie D, Crisan S, Erimescu C, Falnita L, Gaita D, Gheorghiu M, Levashov S, Redkina M, Novitskii N, Dementiev E, Baglikov A, Zateyshchikov D, Zubova E, Rogozhina A, Salikov A, Nikitin I, Reznik EV, Komissarova MS, Shebzukhova M, Shitaya K, Stolbova S, Larina V, Akhmatova F, Chuvarayan G, Arefyev MN, Averkov OV, Volkova AL, Sepkhanyan MS, Vecherko VI, Meray I, Babaeva L, Goreva L, Pisaryuk A, Potapov P, Teterina M, Ageev F, Silvestrova G, Fedulaev Y, Pinchuk T, Staroverov I, Kalimullin D, Sukhinina T, Zhukova N, Ryabov V, Kruchinkina E, Vorobeva D, Shevchenko I, Budyak V, Elistratova O, Fetisova E, Islamov R, Ponomareva E, Khalaf H, Shaimaa AA, Kamal W, Alrahimi J, Elshiekh A, Balghith M, Ahmed A, Attia N, Jamiel AA, Potpara T, Marinkovic M, Mihajlovic M, Mujovic N, Kocijancic A, Mijatovic Z, Radovanovic M, Matic D, Milosevic A, Savic L, Subotic I, Uscumlic A, Zlatic N, Antonijevic J, Vesic O, Vucic R, Martinovic SS, Kostic T, Atanaskovic V, Mitic V, Stanojevic D, Petrovic M. Cohort profile: the ESC EURObservational Research Programme Non-ST-segment elevation myocardial infraction (NSTEMI) Registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:8-15. [PMID: 36259751 DOI: 10.1093/ehjqcco/qcac067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 10/11/2022] [Indexed: 11/12/2022]
Abstract
AIMS The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Non-ST-segment elevation myocardial infarction (NSTEMI) Registry aims to identify international patterns in NSTEMI management in clinical practice and outcomes against the 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without ST-segment-elevation. METHODS AND RESULTS Consecutively hospitalised adult NSTEMI patients (n = 3620) were enrolled between 11 March 2019 and 6 March 2021, and individual patient data prospectively collected at 287 centres in 59 participating countries during a two-week enrolment period per centre. The registry collected data relating to baseline characteristics, major outcomes (in-hospital death, acute heart failure, cardiogenic shock, bleeding, stroke/transient ischaemic attack, and 30-day mortality) and guideline-recommended NSTEMI care interventions: electrocardiogram pre- or in-hospital, pre-hospitalization receipt of aspirin, echocardiography, coronary angiography, referral to cardiac rehabilitation, smoking cessation advice, dietary advice, and prescription on discharge of aspirin, P2Y12 inhibition, angiotensin converting enzyme inhibitor (ACEi)/angiotensin receptor blocker (ARB), beta-blocker, and statin. CONCLUSION The EORP NSTEMI Registry is an international, prospective registry of care and outcomes of patients treated for NSTEMI, which will provide unique insights into the contemporary management of hospitalised NSTEMI patients, compliance with ESC 2015 NSTEMI Guidelines, and identify potential barriers to optimal management of this common clinical presentation associated with significant morbidity and mortality.
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Affiliation(s)
- Ramesh Nadarajah
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC-Vrije Universiteit, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Salvatore Brugaletta
- Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Andrzej Budaj
- Department of Cardiology, Center of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland
| | - Hector Bueno
- Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Kurt Huber
- 3rd Medical Department, Cardiology and Intensive Care Medicine, Clinic Ottakring (Wilhelminenhospital), Vienna, Austria.,Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sergio Leonardi
- University of Pavia, Pavia, Italy.,Fondazione IRCCS Policlinico S.Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic and Vascular Department, San Gerardo Hospital, ASST-Monza, Monza, Italy
| | - Dejan Milasinovic
- Department of Cardiology, University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, LS2 9JT Leeds, UK.,Leeds Institute of Data Analytics, University of Leeds, LS2 9JT Leeds, UK.,Department of Cardiology, Leeds Teaching Hospitals NHS Trust, LS1 3EX Leeds, UK
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Impact of Obesity on Early In-Hospital Outcomes after Coronary Artery Bypass Grafting Surgery in Acute Coronary Syndrome: A Propensity Score Matching Analysis. J Clin Med 2022; 11:jcm11226805. [PMID: 36431281 PMCID: PMC9698701 DOI: 10.3390/jcm11226805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
Recent advances in perioperative care have considerably improved outcomes after coronary artery bypass graft (CABG) surgery. However, obesity can increase postoperative complication rates and can lead to increased morbidity and mortality. Between June 2011 and October 2019, a total of 1375 patients with acute coronary syndrome (ACS) underwent cardiac surgery and were retrospectively analyzed. Patients were divided into 2 groups: non-obese (body mass index (BMI) < 30 kg/m2, n = 967) and obese (BMI ≥ 30 kg/m2, n = 379). Underweight patients (n = 29) were excluded from the analysis. To compare the unequal patient groups, a propensity score-based matching (PSM) was applied (non-obese group (n = 372) vs. obese group (n = 372)). The mean age of the mentioned groups was 67 ± 10 (non-obese group) vs. 66 ± 10 (obese group) years, p = 0.724. All-cause in-hospital mortality did not significantly differ between the groups before PSM (p = 0.566) and after PSM (p = 0.780). The median length of ICU (p = 0.306 before PSM and p = 0.538 after PSM) and hospital stay (p = 0.795 before PSM and p = 0.131 after PSM) was not significantly higher in the obese group compared with the non-obese group. No significant differences regarding further postoperative parameters were observed between the unadjusted and the adjusted group. Obesity does not predict increased all-cause in-hospital mortality in patients undergoing CABG procedure. Therefore, CABG is a safe procedure for overweight patients.
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Inci S, Gul M, Elcik D, Aktas H, Yildirim O, Kelesoglu S, Kalay N. Identification of subclinical myocardial dysfunction by Speckle Tracking Imaging in patients with myocardial infarction with non-occlusive coronary arteries (MINOCA). THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:2099-2106. [PMID: 37726472 DOI: 10.1007/s10554-022-02602-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/16/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE The objective of this study was to investigate subclinical left ventricular dysfunction in patients diagnosed with myocardial infarction with non-occlusive coronary arteries (MINOCA). METHODS Thirty-five patients with MINOCA (average age 54.26 ± 12.24 years) and thirty-five patients with ischemia with non-obstructed coronary artery disease (INOCA) (average age 55.20 ± 8.36 years) were enrolled in the study. All clinical conditions that could affect left ventricular functions were considered exclusion criteria. Echocardiographic studies were conducted in the patient and control groups in the left lateral decubitus position using a medical ultrasound device (EPIQ 7, Philips Medical System, USA). The left ventricle was examined longitudinally with apical images of chamber 4-3-2 using the available software (QLAB 6.0). RESULTS There were no differences in age, blood pressure level, baseline echocardiogram measurements, and tissue Doppler parameters between the two groups. In two-dimensional speckle tracking echocardiography (2D-STE) measurements, left ventricular longitudinal strain and strain rate in systole, early and late diastole from apical 4-3-2 chamber and global measurements of each parameter were significantly decreased in the MINOCA group compared to the INOCA group (p < 0.05). A significant negative correlation was observed between the global longitudinal strain rate and the troponin I in the MINOCA patients group (r=-0.43 p = 0.009). CONCLUSIONS Our study showed that while standard echocardiographic parameters for patients diagnosed with MINOCA were normal, their left ventricular systolic and diastolic functions were reduced by the 2D-STE method.
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Affiliation(s)
- Sinan Inci
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Murat Gul
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey.
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
| | - Deniz Elcik
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Halil Aktas
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Oguz Yildirim
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Saban Kelesoglu
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Nihat Kalay
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
- Department of Cardiology, Faculty of Medicine, Erciyes University, Kayseri, Turkey
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Comparison of Clinical Outcomes after Non-ST-Segment and ST-Segment Elevation Myocardial Infarction in Diabetic and Nondiabetic Populations. J Clin Med 2022; 11:jcm11175079. [PMID: 36079008 PMCID: PMC9456669 DOI: 10.3390/jcm11175079] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/25/2022] [Accepted: 08/25/2022] [Indexed: 11/18/2022] Open
Abstract
Using a new-generation drug-eluting stent, we compared the 2-year clinical outcomes of patients with diabetes mellitus (DM) and non-DM concomitant with a non-ST-segment elevation myocardial infarction (NSTEMI) and an ST-segment elevation myocardial infarction (STEMI) who underwent percutaneous coronary intervention. A total of 11,798 patients with acute myocardial infarction were classified into two groups: DM (NSTEMI, n = 2399; STEMI, n = 2693) and non-DM (NSTEMI, n = 2694; STEMI, n = 4012). The primary clinical outcome was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction, or any coronary repeat revascularization. The secondary outcome was the occurrence of definite or probable stent thrombosis. In all the patients, both multivariable and propensity score-adjusted analyses revealed that the incidence rates of MACE (adjusted hazard ratio (aHR), 1.214; p = 0.006 and aHR, 1.298; p = 0.002, respectively), all-cause death, cardiac death (CD), and non-CD rate were significantly higher in the NSTEMI group than in the STEMI group. Additionally, among patients with NSTEMI, there was a higher non-CD rate (aHR, 2.200; p = 0.007 and aHR, 2.484; p = 0.004, respectively) in the DM group and a higher CD rate (aHR, 2.688; p < 0.001 and 2.882; p < 0.001, respectively) in the non-DM group. In this retrospective study, patients with NSTEMI had a significantly higher 2-year mortality rate than those with STEMI did. Furthermore, strategies to reduce the non-CD rate in patients with DM and the CD rate in patients without DM could be beneficial for those with NSTEMI.
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Martínez MJ, Rueda F, Labata C, Oliveras T, Montero S, Ferrer M, El Ouaddi N, Serra J, Lupón J, Bayés-Genís A, García-García C. Non-STEMI vs. STEMI Cardiogenic Shock: Clinical Profile and Long-Term Outcomes. J Clin Med 2022; 11:jcm11123558. [PMID: 35743628 PMCID: PMC9224589 DOI: 10.3390/jcm11123558] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/12/2022] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Cardiogenic shock (CS) is a severe complication of acute myocardial infarction (AMI). In AMI-CS, the ST segment deviation on ECG may be elevated (STEMI-CS) or non-elevated (NSTEMI-CS), which may influence prognosis. Our aim was to analyze the clinical profile, acute-phase prognosis, and long-term outcomes of CS relative to the ST pattern on admission. In a prospective registry of 4647 AMI patients admitted to the intensive cardiac care unit of a university hospital between 2010 and 2019, we compared the clinical characteristics, 30-days case fatality, and long-term outcomes of AMI-CS, based on the presence of ST-segment deviation. AMI-CS developed in 239 (5.1%) patients (26.4% women): 190 (79.5%) STEMI-CS and 49 (20.5%) NSTEMI-CS. The mean age was 69.7 years. The STEMI-CS patients had larger infarcts and more mechanical complications than the NSTEMI-CS patients. The NSTEMI-CS patients had a greater prevalence of hypertension, diabetes, peripheral vascular disease, previous cardiovascular comorbidities, three-vessel disease, and left main disease than the STEMI-CS patients. The STEMI-CS patients had higher 30-day mortality than the NSTEMI-CS (59.5% vs. 36.7%; p = 0.004), even after multivariable adjustment (HR 1.91; 95% CI 1.16–3.14), but no differences in mortality were observed at 3 years. In conclusion, the 30-day case-fatality is higher in STEMI-CS, but the long-term outcome is similar in both groups.
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Affiliation(s)
- María José Martínez
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- Cardiology Department, Hospital del Mar, 08003 Barcelona, Spain
- PhD Program, Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Ferran Rueda
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Carlos Labata
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Teresa Oliveras
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Santiago Montero
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Marc Ferrer
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Nabil El Ouaddi
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Jordi Serra
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
| | - Josep Lupón
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Antoni Bayés-Genís
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Cosme García-García
- Cardiology Department, Heart Institute, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain; (M.J.M.); (F.R.); (C.L.); (T.O.); (S.M.); (M.F.); (N.E.O.); (J.S.); (J.L.); (A.B.-G.)
- CIBER Enfermedades Cardiovasculares (CIBERCV), 28029 Madrid, Spain
- Department of Medicine, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-93-497-86-62; Fax: +34-93-497-89-39
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Lee SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Two-year outcomes between ST-elevation and non-ST-elevation myocardial infarction in patients with chronic kidney disease undergoing newer-generation drug-eluting stent implantation. Catheter Cardiovasc Interv 2021; 99:1022-1037. [PMID: 34962070 DOI: 10.1002/ccd.30049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND We evaluated the 2-year clinical outcomes of ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients with chronic kidney disease (CKD) who received newer-generation drug-eluting stents (DES). METHODS Overall, 18,875 acute myocardial infarction patients were divided into two groups: CKD (STEMI, n = 1707; NSTEMI, n = 1648) and non-CKD (STEMI, n = 8660; NSTEMI, n = 6860). The occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), any repeat coronary revascularization, and definite or probable stent thrombosis (ST), was evaluated. RESULTS After multivariable-adjusted analysis, in the CKD group, the MACE (adjusted hazard ratio [aHR]: 1.365, p = 0.004), all-cause death (aHR: 1.503, p = 0.004), noncardiac death (non-CD; aHR: 1.960, p = 0.004), and all-cause death or MI rates (aHR: 1.458, p = 0.002) were significantly higher in the NSTEMI group than in the STEMI group. In the non-CKD group, the non-CD rate (aHR: 1.78, p = 0.006) was also higher in the NSTEMI group. The CD, re-MI, any repeat revascularization, and ST rates were similar between groups. In the CKD group, from 6 months to 2 years after the index procedure, all-cause death, non-CD, and all-cause death or MI rates were significantly higher in the NSTEMI group than in the STEMI group. These results may be related to the higher non-CD rate in the NSTEMI group. CONCLUSIONS In the era of contemporary newer-generation DES, NSTEMI showed a relatively higher non-CD rate than STEMI in both CKD and non-CKD groups.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Kim YH, Her AY, Jeong MH, Kim BK, Hong SJ, Lee SJ, Ahn CM, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. ST-segment elevation versus non-ST-segment elevation myocardial infarction in current smokers after newer-generation drug-eluting stent implantation. Medicine (Baltimore) 2021; 100:e28214. [PMID: 34889307 PMCID: PMC8663858 DOI: 10.1097/md.0000000000028214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/21/2021] [Indexed: 01/05/2023] Open
Abstract
We compared the 2-year major clinical outcomes between ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) in patients who are current smokers who underwent successful percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents (DESs). The availability of data in this regard is limited.A total of 8357 AMI patients were included and divided into 2 groups: the STEMI group (n = 5124) and NSTEMI group (n = 3233). The primary endpoint was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (re-MI), or coronary repeat revascularization. The secondary endpoints were the cumulative incidences of the individual components of MACE and stent thrombosis (definite or probable).After propensity score-matched (PSM) analysis, 2 PSM groups (2250 pairs, C-statistics = 0.795) were generated. In the PSM patients, both for 1 month and at 2 years, the cumulative incidence of MACE (P = .183 and P = .655, respectively), all-cause death, cardiac death, re-MI, all-cause death or MI, any repeat revascularization, and stent thrombosis (P = .998 and P = .341, respectively) was not significantly different between the STEMI and NSTEMI groups. In addition, these results were confirmed using multivariate analysis.In the era of contemporary newer-generation DESs, both during 1 month and at 2 years after index PCI, the major clinical outcomes were not significantly different between the STEMI and NSTEMI groups confined to the patients who are current smokers. However, further research is needed to confirm these results.
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Affiliation(s)
- Yong Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Ae-Young Her
- Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Republic of Korea
| | - Myung Ho Jeong
- Cardiovascular Center, Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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Morawska I, Niemiec R, Stec M, Wrona K, Bańka P, Swinarew A, Wybraniec M, Mizia-Stec K. Total Occlusion of the Infarct-Related Artery in Non-ST-Elevation Myocardial Infarction (NSTEMI)-How Can We Identify These Patients? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1196. [PMID: 34833414 PMCID: PMC8617626 DOI: 10.3390/medicina57111196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Regardless of the improvement in key recommendations in non-ST-elevation myocardial infarction (NSTEMI), the prevalence of total occlusion (TO) of infarct-related artery (IRA), and the impact of TO of IRA on outcomes in patients with NSTEMI, remain unclear. Aim: The study aimed to assess the incidence and predictors of TO of IRA in patients with NSTEMI, and its clinical significance. Material and Methods: The study was a single-center retrospective cohort analysis of 399 consecutive patients with NSTEMI (293 male, mean age: 71 ± 10.1 years) undergoing percutaneous coronary intervention. The study population was categorized into patients with TO and non-TO of IRA on coronary angiography. In-hospital and one-year mortality were analyzed. Results: TO of IRA in the NSTEMI population occurred in 138 (34.6%) patients. Multivariate analysis identified the following independent predictors of TO of IRA: left ventricular ejection fraction (odds ratio (OR) 0.949, p < 0.001); family history of coronary artery disease (CAD) (OR 2.652, p < 0.001); and high-density lipoprotein (HDL) level (OR 0.972, p = 0.002). In-hospital and one-year mortality were significantly higher in the TO group than the non-TO group (2.8% vs. 1.1%, p = 0.007 and 18.1% vs. 6.5%, p < 0.001, respectively). The independent predictors of in-hospital mortality were: left ventricular ejection fraction (LVEF) at admission (OR 0.768, p = 0.004); and TO of IRA (OR 1.863, p = 0.005). Conclusions: In the population of patients with NSTEMI, TO of IRA represents a considerably frequent phenomenon, and corresponds with impaired outcomes. Therefore, the utmost caution should be paid to prevent delay of coronary angiography in NSTEMI patients with impaired left ventricular systolic function, metabolic disturbances, and a family history of CAD, who are at increased risk of TO of IRA.
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Affiliation(s)
- Irmina Morawska
- Upper Silesian Medical Centre, Students’ Scientific Society of the First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (I.M.); (R.N.); (M.S.)
| | - Rafał Niemiec
- Upper Silesian Medical Centre, Students’ Scientific Society of the First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (I.M.); (R.N.); (M.S.)
| | - Maria Stec
- Upper Silesian Medical Centre, Students’ Scientific Society of the First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (I.M.); (R.N.); (M.S.)
| | - Karolina Wrona
- Upper Silesian Medical Centre, First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (K.W.); (P.B.); (M.W.)
| | - Paweł Bańka
- Upper Silesian Medical Centre, First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (K.W.); (P.B.); (M.W.)
| | - Andrzej Swinarew
- Faculty of Computer Science and Material Science, Institute of Material Science, University of Silesia in Katowice, 40-055 Katowice, Poland;
| | - Maciej Wybraniec
- Upper Silesian Medical Centre, First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (K.W.); (P.B.); (M.W.)
| | - Katarzyna Mizia-Stec
- Upper Silesian Medical Centre, First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, 40-055 Katowice, Poland; (K.W.); (P.B.); (M.W.)
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Abdelhameed M, Hakim O, Mohamed A, Gadour E. Pattern and Outcome of Acute Non-ST-Segment Elevation Myocardial Infarction Seen in Adult Emergency Department of Al-Shaab Teaching Hospital: A prospective Observational Study in a Tertiary Cardiology Center. Cureus 2021; 13:e17981. [PMID: 34540510 PMCID: PMC8441114 DOI: 10.7759/cureus.17981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2021] [Indexed: 12/29/2022] Open
Abstract
Background Despite investments to improve the quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in non-ST elevation myocardial infarction (NSTEMI) care in the emergency department (ED). We aimed to describe the characteristics, management, and outcomes of NSTEMI. Methods A prospective single-center study enrolled 40 NSTEMI patients in Alshaab Teaching Hospital during the period from May to July 2021. Data regarding demographics, medical history, clinical presentations, laboratory investigation, Killip classifications, electrocardiography (ECG), echocardiogram, diagnostic coronary angiography (CAG), management strategies, medications used, and 30-days outcomes were collected. Results Among 40 patients, NSTEMI was common in the age groups from 56 to 70 years (60%) and males (67.5%; p=0.002). Diabetes (n=24; 60%) and hypertension (n=20; 50%) were the major cardiovascular disease (CVD) risk factors. In most of the cases, 29 (72%) had a late presentation (>6 hours; p=0.0001). In Killip classifications, 36 (90%) patients were Killip class I and four (10%) were Killip class II (p=0.005). No patients underwent risk score assessment during a hospital stay. All patients had sinus rhythm in ECG and 28 (70%) had T-wave inversion. An echocardiogram was performed for 36 (90%) patients, among them six (16.7%) patients had LV systolic dysfunction (p=.003). The median ejection fraction was 52% (ranged from 25-75%). Diagnostic CAG was performed for 38 (95%) patients and a stent was inserted for 23 (58%) of them. The major final management strategy among our study group was PCI in 23 (58%) patients. All patients received aspirin, clopidogrel, parenteral anticoagulant, and ACEi/ARBs, 38 (95%) had statin, 28 (70%) were given PPI, and seven (17.5%) received diuretics. As for 30-day outcomes, all patients survived, but ten (25%) patients were readmitted, and no in-hospital or 30-days mortality occurred. Conclusion NSTEMI predominantly affected male and older patients. Most of them had a delayed presentation to ED. Hypertension and DM were the major risk factors. All patients were in sinus rhythm and the main ECG abnormality was a T-wave inversion. Most of the patients received standard NSTEMI protocol with exception of risk stratification. PCI was the major final management strategy used. Albeit no in-hospital or 30-days mortality occurred, 25% were readmitted.
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Affiliation(s)
| | - Omran Hakim
- Emergency Medicine, Khartoum North Hospital, Khartoum, SDN
| | - Awad Mohamed
- Cardiology, Alshaab Teaching Hospital, Khartoum, SDN
| | - Eyad Gadour
- Gastroenterology and Hepatology, University Hospitals of Morecambe Bay NHS Foundation Trust, Lancaster, GBR
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Boytsov SA, Shakhnovich RM, Erlikh AD, Tereschenko SN, Kukava NG, Rytova YK, Pevsner DV, Reitblat OM, Konstantinov SL, Kletkina AS, Shirikova GA, Nedbaikin AM, Borisova TV, Makarov SA, Chesnokova LY, Bykov AN, Shilko YV, Nikolaev DS, Istomina TA, Eremin SA, Romakh IV, Platonov DY, Rabinovich RM, Veselova NA, Urvantseva IA, Zalototskaya YI, Kostina GV, Potapova AN, Dubrovina YA, Shedrova YA, Sodnomova LB, Donirova YS, Hkludeeva EA, Khegya DV, Ivanov KI, Stepanova NV, Philippov EV, Moseychuk KA, Devyatova LS, Kolcheva YG, Rachkova SA, Nazarova OA, Menshikova IG, Pogorelova NA, Sanabasova GK, Azarin OG, Sviridova AV, Zyazina VO, Ilyamakova NA, Kuklina YA, Pronin AA, Vajnshtejn IV, Ustyugov SA, Anohina AR, Gindler AI, Shchepinova LV, Grigoreva TV, Melnik II, Sotnikova MI, Kalashnikova MV, Khramtsova NA, Medvedeva NA, Vahrakova MV, Belousov OV, Doronkina OA, Reprinceva NV, Komarov AV, Lebedev SV, Belskaya EV. Registry of Acute Myocardial Infarction. REGION-MI - Russian Registry of Acute Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:41-51. [PMID: 34311687 DOI: 10.18087/cardio.2021.6.n1595] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
Aim To study features of diagnosis and treatment of acute myocardial infarction (AMI) in Russian hospitals, results of the treatment, and early and late outcomes (6 and 12 months after AMI diagnosis); to evaluate the consistence of the treatment with clinical guidelines; and to evaluate patients' compliance with the treatment.Material and methods The program was designed for 3 years, including 24 months for recruitment of patients to the study. The study will include 10, 000 patients hospitalized with a confirmed diagnosis (I21 according to ICD-10) of ST segment elevation acute myocardial infarction (MI) (STEMI) or non-ST segment elevation MI (NSTEMI) based on criteria of the European Society of Cardiology Guidelines on Forth Universal Definition of Myocardial Infarction (2018). The follow-up period was divided into three stages: observation during the stay in the hospital and at 6 and 12 months following inclusion into the registry. The primary endpoint included cardiac death, nonfatal MI during the hospitalization and after one-year follow-up. Secondary endpoints were 6-months and one-year incidence of repeated MI, heart failure, ischemic stroke, clinically significant hemorrhage, unscheduled revascularization after discharge from the hospital, and the proportion of patients who continue on statins, antiplatelet drugs, and drugs of other groups for 6 months and 1 year.Results The inclusion of patients into the registry started in 2020 and will continue for 24 months. By the time of the article publication (June, 2021), more than 2,000 patients will be included.Conclusion REGION-MI (Russian rEGIstry Of acute myocardial iNfarction) is a multicenter, retrospective and prospective observational cohort study that excludes any interference with the clinical practice. Results of the registry will help to analyze a real picture of medical care provided to patients with myocardial infarction and to schedule ways to improve the situation.
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Affiliation(s)
- S A Boytsov
- National Medical Scientific Center for Cardiology, Moscow
| | | | - A D Erlikh
- City Clinical Hospital №29 Named. N.E. Bauman" Department of Health of the City of Moscow, Moscow
| | | | - N G Kukava
- National Medical Scientific Center for Cardiology, Moscow
| | - Y K Rytova
- National Medical Scientific Center for Cardiology, Moscow
| | - D V Pevsner
- National Medical Scientific Center for Cardiology, Moscow
| | | | - S L Konstantinov
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | - A S Kletkina
- Belgorod Regional Clinical Hospital Named after Svyatitelya Iosafa, Belgorod
| | | | | | - T V Borisova
- Bryansk Regional Cardiologic Dispensary, Bryansk
| | - S A Makarov
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - L Yu Chesnokova
- Kuzbass Clinical Cardiology Dispensary Named after Academician L.S.Barbarash, Kemerovo
| | - A N Bykov
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - Yu V Shilko
- Sverdlovsk Regional Clinical Hospital № 1, Ekaterinburg
| | - D S Nikolaev
- Krasnoufimsk Regional Hospital № 1, Krasnoufimsk
| | - T A Istomina
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - S A Eremin
- Tambov Regional Clinical Hospital im. V. D. Babenko, Tambov
| | - I V Romakh
- Morshansk Central Regional Hospital, Morshansk
| | | | | | | | - I A Urvantseva
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - Yu I Zalototskaya
- The Khanty-Mansi Autonomous Okrug - Yugra Diagnostics and Cardiovascular Surgery Center (cardiology clinic), a public-sector entity, Surgut
| | - G V Kostina
- Yaroslavl Regional Clinical Hospital, Yaroslavl
| | | | | | | | - L B Sodnomova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - Yo S Donirova
- Ulan-Ude Republican Clinical Hospital Named After N.A. Semashko, Ulan-Ude
| | - E A Hkludeeva
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - D V Khegya
- Primorsaya regional clinical hospital № 1, Vladivostok
| | - K I Ivanov
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | - N V Stepanova
- The Republican Hospital №1 - The National Center of the Medicine, Yakutsk
| | | | | | | | | | | | - O A Nazarova
- Ivanovo Regional Clinical Hospital, Regional Vascular Center, Ivanovo
| | | | | | | | - O G Azarin
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | - Vi O Zyazina
- Voronezh Regional Clinical Hospital № 1, Voronezh
| | | | | | | | | | | | | | | | | | | | | | | | | | - N A Khramtsova
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | - N A Medvedeva
- Irkutsk Regional Clinical Hospital, Winner of the "Mark of the Honor", Irkutsk
| | | | | | | | | | | | | | - E V Belskaya
- Novomoskovsk City Clinical Hospital, Novomoskovsk
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Impact of preprocedural coronary flow grade on duration of dual antiplatelet therapy in acute myocardial infarction. Sci Rep 2021; 11:11735. [PMID: 34083627 PMCID: PMC8175426 DOI: 10.1038/s41598-021-91130-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 05/19/2021] [Indexed: 11/09/2022] Open
Abstract
We investigated the impact of pre-percutaneous coronary intervention (pre-PCI) thrombolysis in myocardial infarction (TIMI) flow grade (pre-TIMI) on 3-month (3-mo) and 12-mo of dual antiplatelet therapy (DAPT) in patients with acute myocardial infarction (AMI). This was a post hoc analysis of the TICO trial. A total of 2083 patients with AMI (pre-TIMI 0/1: n = 1143; pre-TIMI 2/3: n = 940) were evaluated. The primary outcome was the occurrence of net adverse clinical events (NACE), defined as a composite of TIMI major bleeding and major adverse cardiac and cerebrovascular events (MACCE) within 12-mo following PCI. The secondary outcomes were the occurrence of the individual components of TIMI bleedings and MACCE. In the pre-TIMI 0/1 group, the primary and second outcomes were not significantly different between the 3-mo and 12-mo DAPT groups. However, in the pre-TIMI 2/3 group, the occurrences of TIMI minor (adjusted hazard ratio [aHR]: 0.294; p = 0.016) and major or minor bleeding (aHR: 0.483; p = 0.014) on intention-to-treat analysis were significantly higher in the 12-mo than in the 3-mo DAPT group. The occurrence of MACCE was similar between the two groups. A higher bleeding tendency in 12-mo DAPT compared with 3-mo DAPT was more obvious in the pre-TIMI 2/3 group than in the pre-TIMI 0/1 group.Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02494895.
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Kim J, Song YB, Oh JH, Cho DK, Lee JB, Kim SH, Jeong JO, Bae JH, Kim BO, Cho JH, Suh IW, Kim DI, Park HK, Park JS, Choi WG, Lee WS, Choi KH, Park TK, Lee JM, Yang JH, Choi JH, Choi SH, Gwon HC, Doh JH, Hahn JY. Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction. Circ J 2021; 85:817-825. [PMID: 33431720 DOI: 10.1253/circj.cj-20-0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI).Methods and Results:As a post hoc analysis of the SMART-DATE trial, effects of ≥12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the ≥12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of ≥12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; Pinteraction=0.718). In addition, ≥12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; Pinteraction=0.885) patients. CONCLUSIONS Compared with 6-month DAPT, ≥12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ju-Hyeon Oh
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | | | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Nurse-managed education: the effectiveness of secondary prevention after acute coronary syndromes and the prevalence and predictors of dropout from a cardiac rehabilitation programme. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2021; 17:46-53. [PMID: 33868417 PMCID: PMC8039924 DOI: 10.5114/aic.2021.104767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 12/19/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Education programmes are now very often used to limit the consequences associated with a steady increase in the incidence of cardiovascular disease. It is important to assess the effectiveness of these programmes and the reasons why people drop out. Aim To evaluate the effects of intensive education of patients undergoing acute invasive cardiology procedures compared to the control group (patients educated in a classical way). Material and methods Randomized trial. Measurements of body weight and body composition: during hospital stay, at 45 and 180 days after acute coronary syndrome. We used a self-prepared questionnaire, LOR-T and a TANITA BC1000 body composition analyser. Results The sample consisted of 73 patients aged 48 to 89 years. Men constituted 58.9% of the participants. 43.8% of the respondents appeared for a follow-up visit after 45 days, and after 180 days 32.8% came. Body weight, body mass index (BMI), and health condition of the patients did not change significantly during the study. 67.1% of respondents dropped out from the nurse-managed cardiac education programme. People who were in better health, smoking, without comorbidities, having a heart attack, living far from the place of education more often dropped out from follow-up visits. Conclusions Patient education proved ineffective. Body weight, BMI, and health condition of the subjects, both at the time of inclusion and during the long-term evaluation, were very unfavourable.
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Montoy JCC, Shen YC, Brindis RG, Krumholz HM, Hsia RY. Impact of ST-Segment-Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non-ST-Segment-Elevation Myocardial Infarction. J Am Heart Assoc 2021; 10:e016932. [PMID: 33470136 PMCID: PMC7955417 DOI: 10.1161/jaha.120.016932] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Many communities have implemented systems of regionalized care to improve access to timely care for patients with ST-segment-elevation myocardial infarction. However, patients who are ultimately diagnosed with non-ST-segment-elevation myocardial infarctions (NSTEMIs) may also be affected, and the impact of regionalization programs on NSTEMI treatment and outcomes is unknown. We set out to determine the effects of ST-segment-elevation myocardial infarction regionalization schemes on treatment and outcomes of patients diagnosed with NSTEMIs. Methods and Results The cohort included all patients receiving care in emergency departments diagnosed with an NSTEMI at all nonfederal hospitals in California from January 1, 2005 to September 30, 2015. Data were analyzed using a difference-in-differences approach. The main outcomes were 1-year mortality and angiography within 3 days of the index admission. A total of 293 589 patients with NSTEMIs received care in regionalized and nonregionalized communities. Over the study period, rates of early angiography increased by 0.5 and mortality decreased by 0.9 percentage points per year among the overall population (95% CI, 0.4-0.6 and -1.0 to -0.8, respectively). Regionalization was not associated with early angiography (-0.5%; 95% CI, -1.1 to 0.1) or death (0.2%; 95% CI, -0.3 to 0.8). Conclusions ST-segment-elevation myocardial infarction regionalization programs were not statistically associated with changes in guideline-recommended early angiography or changes in risk of death for patients with NSTEMI. Increases in the proportion of patients with NSTEMI who underwent guideline-directed angiography and decreases in risk of mortality were accounted for by secular trends unrelated to regionalization policies.
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Affiliation(s)
| | - Yu-Chu Shen
- Graduate School of Defense Management, Naval Postgraduate School Monterey CA.,National Bureau of Economic Research Cambridge MA
| | - Ralph G Brindis
- Department of Medicine University of California, San Francisco CA.,Philip R. Lee Institute for Health Policy Studies University of California, San Francisco CA
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine Department of Internal Medicine Yale School of Medicine New Haven CT.,Department of Health Policy and Management Yale School of Public Health New Haven CT.,Center for Outcomes Research and Evaluation Yale-New Haven Hospital New Haven CT
| | - Renee Y Hsia
- Department of Emergency Medicine University of California, San Francisco CA.,Philip R. Lee Institute for Health Policy Studies University of California, San Francisco CA
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23
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Bouisset F, Ruidavets JB, Dallongeville J, Moitry M, Montaye M, Biasch K, Ferrières J. Comparison of Short- and Long-Term Prognosis between ST-Elevation and Non-ST-Elevation Myocardial Infarction. J Clin Med 2021; 10:jcm10020180. [PMID: 33430516 PMCID: PMC7826729 DOI: 10.3390/jcm10020180] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/23/2020] [Accepted: 12/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background: Available data comparing long-term prognosis according to the type of acute coronary syndrome (ACS) are scarce, contradictory, and outdated. Our aim was to compare short- and long-term mortality in ST-elevated (STEMI) and non-ST-elevated myocardial infarction (non-STEMI) ACS patients. Methods: Patients presenting with an inaugural ACS during the year 2006 and living in one of the three areas in France covered by the Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) registry were included. Results: A total of 1822 patients with a first ACS—1121 (61.5%) STEMI and 701 (38.5%) non-STEMI—were included in the study. At the 28-day follow-up, the mortality rates were 6.7% and 4.7% (p = 0.09) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 28-day probability of death was significantly lower for non-STEMI ACS patients (Odds Ratio = 0.58 (0.36–0.94), p = 0.03). At the 10-year follow-up, the death rates were 19.6% and 22.8% (p = 0.11) for STEMI and non-STEMI patients, respectively, and after adjustment of potential confounding factors, the 10-year probability of death did not significantly differ between non-STEMI and STEMI events (OR = 1.07 (0.83–1.38), p = 0.59). Over the first year, the mortality rate was 7.2%; it then decreased and stabilized at 1.7% per year between the 2nd and 10th year following ACS. Conclusion: STEMI patients have a worse vital prognosis than non-STEMI patients within 28 days following ACS. However, at the 10-year follow-up, STEMI and non-STEMI patients have a similar vital prognosis. From the 2nd year onwards following the occurrence of a first ACS, the patients become stable coronary artery disease patients with an annual mortality rate in the 2% range, regardless of the type of ACS they initially present with.
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Affiliation(s)
- Frédéric Bouisset
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
- Correspondence: ; Tel./Fax: +33-0561-323-318
| | | | - Jean Dallongeville
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Marie Moitry
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
- Department of Public Health, Strasbourg University Hospital, 67085 Strasbourg, France
| | - Michele Montaye
- Institut Pasteur de Lille, Department of Epidemiology and Public Health, Inserm-U1167, 59000 Lille, France; (J.D.); (M.M.)
| | - Katia Biasch
- Faculty of Medicine, Department of Epidemiology and Public Health, University of Strasbourg, 67081 Strasbourg, France; (M.M.); (K.B.)
| | - Jean Ferrières
- Department of Cardiology, Rangueil University Hospital, 31059 Toulouse, France;
- Department of Epidemiology, INSERM UMR 1027, 31000 Toulouse, France;
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Clinical Outcomes According to ECG Presentations in Infarct-Related Cardiogenic Shock in the Culprit Lesion Only PCI vs Multivessel PCI in Cardiogenic Shock Trial. Chest 2020; 159:1415-1425. [PMID: 33248059 DOI: 10.1016/j.chest.2020.10.089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/15/2020] [Accepted: 10/18/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The impact of ECG presentations of acute myocardial infarction (AMI) in cardiogenic shock is unknown. RESEARCH QUESTION In myocardial infarction with cardiogenic shock, is there a difference in the outcomes and effect of revascularization strategies between non-ST-segment elevation myocardial infarction (NSTEMI) and left bundle branch block myocardial infarction (LBBBMI) vs ST-segment elevation myocardial infarction (STEMI)? STUDY DESIGN AND METHODS Cardiogenic shock patients from the CULPRIT-SHOCK trial with NSTEMI or LBBBMI were compared with STEMI patients for 30-day and 1-year all-cause mortality. The interaction between ECG presentation and the effect of revascularization strategies on outcomes was evaluated. RESULTS Of 665 cardiogenic shock patients analyzed, 55.9% demonstrated STEMI, 29.3% demonstrated NSTEMI, and 14.7% demonstrated LBBBMI. Patients differed in mean age (68.0 years in STEMI patients, 71.0 years in NSTEMI patients, and 73.5 years in LBBBMI patients; P = .015), cardiovascular risk factors, and angiographic severity. No difference was found in the 30-day risk of death between NSTEMI and STEMI patients (48.7% vs 43.0%; adjusted OR [aOR], 1.05; 95% CI, 0.66-1.67; P = .85), nor between LBBBMI and STEMI patients (59.2% vs 43.0%; aOR, 1.31; 95% CI, 0.73-2.34; P = .36). Although the univariate risk of death by 1 year was higher in NSTEMI and LBBBMI patients compared with STEMI patients, ECG presentation was not an independent risk factor of mortality after adjustment (NSTEMI vs STEMI: 56.4% vs 46.8%; aOR, 1.21; 95% CI, 0.76-1.92; P = .42; LBBBMI vs STEMI: 69.4% vs 46.8%; aOR, 1.59; 95% CI, 0.89-2.84; P = .12). ECG presentation did not modify the effect of the revascularization strategy on 30-day and 1-year mortality (P = .91 and P = .97 for interaction). INTERPRETATION In patients with cardiogenic shock, NSTEMI and LBBBMI presentations reflect higher-risk profiles than STEMI presentations, but are not independent risk factors of mortality. ECG presentations did not modify the treatment effect, supporting culprit-lesion-only percutaneous coronary intervention as the preferred strategy across the AMI spectrum.
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25
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Xu B, Abdu FA, Liu L, Mohammed AQ, Yin G, Luo Y, Xu S, Lv X, Fan R, Che W. Clinical Outcomes and Predictors of ST-Elevation Versus Non-ST-Elevation Myocardial Infarction with Non-Obstructive Coronary Arteries. Am J Med Sci 2020; 360:686-692. [PMID: 32736830 DOI: 10.1016/j.amjms.2020.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 04/19/2020] [Accepted: 07/10/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) can be clinically categorized as ST-segment elevation (STE) and non-ST-segment elevation (NSTE), whose clinical prognosis are poorly understood. The aim of this study was to compare the clinical outcome and their predictors of patients with STE and NSTE in MINOCA population. METHODS A total of 265 patients with MINOCA (102 with STE, and 163 with NSTE) were consecutively collected. Clinical profile, prognosis, and predictors of all patients were assessed. RESULTS The proportion of patients with NSTE was greater than patients with STE in MINOCA population. Patients with NSTE were older and more likely to be female and had a higher incidence of atrial fibrillation. Both high density lipoprotein (HDL) and N-terminal pro-brain natriuretic peptide (NT-proBNP) were higher in the NSTE group. Patients with STE were more likely to have a history of smoking and a higher diastolic blood pressure. During the 1-year follow up, there were no differences in the outcomes between the STE and NSTE groups, with no significant differences in mortality and a similar rate of major adverse cardiovascular events (MACE) (20.9% vs 19.3%, P = 0.767). The multivariable predictors of MACE in the NSTE groups were age, lower level of total cholesterol, hypertension, and smoking history, whereas reduced left ventricular ejection fraction, and diabetes mellitus were the multivariable predictors of major adverse cardiac events in the STE group. CONCLUSIONS There were differences in the clinical profile between STE and NSTE in the MINOCA population, whereas the outcomes during the 1-year follow up were similar. The STE and NSTE groups had different predictive factors for major adverse cardiac events.
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Affiliation(s)
- Bin Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Medical College of Soochow University, Suzhou, China
| | - Fuad A Abdu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Lu Liu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Abdul-Quddus Mohammed
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Guoqing Yin
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanru Luo
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Siling Xu
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xian Lv
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Rui Fan
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wenliang Che
- Department of Cardiology, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China; Department of Cardiology, Shanghai Tenth People's Hospital Chongming branch, Shanghai, China.
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26
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Optical coherence tomography versus intravascular ultrasound for culprit lesion assessment in patients with acute myocardial infarction. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:145-152. [PMID: 32636898 PMCID: PMC7333203 DOI: 10.5114/aic.2020.96057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/27/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction In patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) the implanted stent may not fully cover the whole intravascular ultrasound (IVUS)-derived thin-cap fibroatheroma (TCFA) related to the culprit lesion (CL). Aim Whether this phenomenon is more pronounced when optical coherence tomography (OCT) assessment of the CL is performed is not known. Material and methods Thus, we aimed to assess CLs in 40 patients with AMI treated with PCI, using VH (virtual histology)-IVUS and OCT before and after intervention. The results were blinded to the operator and PCI was done under angiography guidance. Results Uncovered lipid-rich plaques were identified in the stent reference segments of 23 (57.5%) patients: in 13 (32.5%) of them in the distal reference segment and in 19 (47.5%) of them in the proximal reference segment. In 9 of them (22.5%) lipid plaques were found in both reference segments. In 36 (90%) patients OCT confirmed lipid plaques identified as VH-derived TCFA by VH-IVUS in the reference segments of the stented segment. However, OCT confirmed that only in 2 (5%) patients were uncovered lipid plaques true TCFA as defined by histology. Comparing IVUS and OCT qualitative characteristics of the stented segments OCT detected more thrombus protrusions and proximal and distal stent edge dissections compared to IVUS (92.5 vs. 55%, p = 0.001; 20% vs. 7.5%, p = 0.03 and 25% vs. 5%, p < 0.001, respectively). Conclusions Due to its superior resolution, OCT identifies TCFA more precisely. OCT more often shows remaining problems related to stent implantation than IVUS after angiographically guided PCI.
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27
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Milionis H. Prior Stroke/Transient Ischemic Attack Worsens Outcome After an Acute Coronary Syndrome. Angiology 2019; 71:301-302. [DOI: 10.1177/0003319719896479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Haralampos Milionis
- Department of Internal Medicine, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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28
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Ge Z, Baber U, Claessen BE, Chandrasekhar J, Chandiramani R, Li SX, Sartori S, Kini AS, Rao SV, Weiss S, Henry TD, Kapadia S, Muhlestein B, Strauss C, Toma C, DeFranco A, Effron MB, Keller S, Baker BA, Pocock S, Dangas G, Mehran R. Associations between use of prasugrel vs clopidogrel and outcomes by type of acute coronary syndrome: an analysis from the PROMETHEUS registry. J Thromb Thrombolysis 2019; 48:42-51. [PMID: 30924052 DOI: 10.1007/s11239-019-01842-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We sought to investigate the utilization of prasugrel and its association with outcomes relative to clopidogrel in three typical subgroups of ACS in a real-world setting. Prasugrel is superior to clopidogrel for reducing risk of ischemic events in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI), but is associated with an increased risk of bleeding complications. PROMETHEUS was a retrospective multicenter observational study of 19,913 ACS patients undergoing PCI from 8 centers in the United States between 2010 and 2013. Major adverse cardiovascular events (MACE) were defined as a composite of all-cause mortality, myocardial infarction, stroke or unplanned revascularization. The study cohort included 3285 (16.5%) patients with ST-segment elevation myocardial infarction (STEMI), 5412 (27.2%) patients with NSTEMI and 11,216 (56.3%) patients with unstable angina (UA). The frequency of prasugrel use at discharge was highest in STEMI and lowest in UA patients, 27.3% versus 22.2% versus 18.9% (p < 0.001). Use of prasugrel vs clopidogrel was associated with a lower rate of MACE in STEMI, NSTEMI, or UA at 1 year, but the differences were attenuated for all groups except for patients with UA (adjusted HR 0.81, 95% CI 0.69-0.94, p = 0.006) after propensity adjusted analysis. After adjustment, there was no difference in bleeding risk between prasugrel and clopidogrel for all groups at 1 year. STEMI patients were more likely to receive prasugrel compared to NSTEMI and UA patients. Prasugrel was associated with reduced adverse outcomes compared with clopidogrel in unadjusted analyses, findings that were largely attenuated upon adjustment and suggest preferential use of prasugrel in low vs high risk patients.
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Affiliation(s)
- Zhen Ge
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Usman Baber
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Shawn X Li
- Geisel School of Medicine Dartmouth, Lebanon, NH, USA
| | | | | | - Sunil V Rao
- The Duke Clinical Research Institute, Durham, NC, USA
| | | | | | | | | | | | - Catalin Toma
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | | | - Mark B Effron
- Eli Lilly and Company, Indianapolis, IN, USA
- Ochsner Medical Center, John Ochsner Heart and Vascular Institute, New Orleans, LA, USA
| | | | | | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - George Dangas
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029-6574, USA.
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29
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Berg DD, Wiviott SD, Braunwald E, Guo J, Im K, Kashani A, Gibson CM, Cannon CP, Morrow DA, Bhatt DL, Mega JL, O'Donoghue ML, Antman EM, Newby LK, Sabatine MS, Giugliano RP. Modes and timing of death in 66 252 patients with non-ST-segment elevation acute coronary syndromes enrolled in 14 TIMI trials. Eur Heart J 2019; 39:3810-3820. [PMID: 30239711 DOI: 10.1093/eurheartj/ehy556] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 08/20/2018] [Indexed: 12/22/2022] Open
Abstract
Aims Although presenting features and early sequelae of non-ST-segment elevation acute coronary syndromes (NSTE-ACS) are well described, less is known about longer-term risks and modes of death. The purpose of this study was to characterize modes of death following NSTE-ACS in clinical trial populations. Methods and results We evaluated 66 252 patients with NSTE-ACS enrolled in 14 Thrombolysis in Myocardial Infarction (TIMI) trials, examining baseline characteristics and modes and timing of death. Of the 66 252 patients followed for a median of 372 (interquartile range 218-521) days, 3147 (4.8%) died by the time of last follow-up. Of the 2606 patients (82.8%) with known modes of death, 75.1% were related to a cardiovascular (CV) event, 3.0% were related to a bleeding event (including intracranial haemorrhage), and 21.8% were related to a non-CV/non-bleeding event. The most common modes of CV death were sudden death (SD) and recurrent myocardial infarction (MI) (36.4% and 23.4%, respectively, of CV deaths). The proportion of CV deaths related to recurrent MI was higher in the first 30 days than it was after 30 days following NSTE-ACS (30.6% vs. 18.7%), whereas the proportion of SD was lower in the first 30 days than after 30 days (21.6% vs. 46.2%). Conclusion Sudden death represents the largest proportion of CV deaths after 30 days among patients enrolled in CV clinical trials with NSTE-ACS. Further investigations aimed at defining the epidemiology of SD and developing specific therapies and management approaches to reduce SD following NSTE-ACS may be critical to reducing late mortality.
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Affiliation(s)
- David D Berg
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Stephen D Wiviott
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Eugene Braunwald
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Jianping Guo
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - KyungAh Im
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Amir Kashani
- Houston Methodist Hospital, 18400 Katy Freeway Suite 600, Houston, TX, USA
| | - C Michael Gibson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, USA
| | - Christopher P Cannon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 70 Francis Street, Boston, MA, USA
| | - David A Morrow
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 70 Francis Street, Boston, MA, USA
| | - Jessica L Mega
- Verily Life Sciences, 269 E Grand Avenue, South San Francisco, CA, USA
| | - Michelle L O'Donoghue
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Elliott M Antman
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - L Kristin Newby
- Department of Medicine, Duke Clinical Research Institute, Duke University School of Medicine, 2400 Pratt St, Durham, NC, USA
| | - Marc S Sabatine
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
| | - Robert P Giugliano
- TIMI Study Group, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 60 Fenwood Road, Suite 7022, Boston, MA, USA
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30
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Bęćkowski M, Kowalik I, Jaworski K, Dąbrowski R, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Karwowski J, Drygas W, Szwed H. Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women. Curr Probl Cardiol 2019; 46:100508. [PMID: 31898981 DOI: 10.1016/j.cpcardiol.2019.100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P < 0.001), and onset-to-balloon time was shorter (8.9 vs 15.2 hours, P < 0.0001) in this group. Younger women presented with a lower Killip class at admission (class I at admission: 92.7% vs 86.2%, P < 0.001). The dominant type of ACS in the younger cohort was ST-segment elevation myocardial infarction (STEMI) (42% vs 26.1%), localized mainly in the anterior wall (47.7% vs 36.1%, P < 0.001), with a higher percentage of total occlusion of infarct-related artery (TIMI 0, 45.2% vs 36.1%) and left anterior descending artery engagement for all (33.5% vs 26.5%, P < 0.001). Drug-eluting stents were often used in the younger patients (43.3% vs 38.2%, P = 0.003) without significant differences in percutaneous coronary intervention numbers. Pharmacotherapy was used less in younger women. The 30-day and 2-year mortality in young women was lower than in the older cohort. The clinical course of ACS in younger women differed in comparison to older women. Younger women had a higher occurrence of typical chest pain, STEMI, and left anterior descending artery engagement. Except STEMI patients young women received faster revascularization, however with no significant differences in invasive treatment. Pharmacotherapy was inadequate in younger women and that resulted in a lower usage of the beta-blockers, angiotensin-converting enzyme inhibitors, and statins in that group. Short- and long-term mortality was low, regardless of the type of ACS.
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Correlation between the serum procalcitonin level and the extension and severity of coronary artery disease in patients with non-ST-segment elevation myocardial infarction. Cardiovasc Endocrinol Metab 2019; 8:62-66. [PMID: 31588429 DOI: 10.1097/xce.0000000000000165] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 01/28/2019] [Indexed: 11/26/2022]
Abstract
Research has shown correlations between some, but not all, inflammatory mediators and coronary atherosclerosis burden. Conflicting results have been reported on the correlation between the serum procalcitonin (PCT) level and the severity and extension of coronary artery disease (CAD). We evaluated the correlation between PCT and the severity and extension of CAD in patients with non-ST-elevation myocardial infarction (NSTEMI). Patients and methods In this prospective cross-sectional study, the serum PCT level was measured 48 h after hospital admission in 131 patients with a diagnosis of NSTEMI. All the patients underwent selective coronary angiography, and the severity and extension of their CAD was evaluated with the Gensini score. The study population was assigned to two groups on the basis of the median of the Gensini score: those with a score higher than the median and those with a score lower than the median. Results There was no statistically significant difference with regard to the serum PCT level between the two groups (P = 0.511). In the multivariable logistic regression analysis, after adjustment for the potential confounders, the serum PCT level was not a determinant of the Gensini score (P = 0.502). Conclusion The second 24-h postadmission serum PCT level was not correlated with the severity and extension of CAD according to the Gensini score in our patients with NSTEMI.
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Ye F, Winchester D, Jansen M, Lee A, Silverstein B, Stalvey C, Khuddus M, Mazza J, Yale S. Assessing Prognosis of Acute Coronary Syndrome in Recent Clinical Trials: A Systematic Review. Clin Med Res 2019; 17:11-19. [PMID: 31160474 PMCID: PMC6546278 DOI: 10.3121/cmr.2019.1433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/21/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022]
Abstract
There is no recent comprehensive overview of contemporary clinical trials assessing short and long-term outcomes in patients with acute coronary syndrome (ACS). This paper reviews factors from recent clinical trials that influenced prognosis in patients with ACS. Cochrane and PubMed databases were screened systematically for clinical trials published in the English literature reporting on ACS prognosis. Two authors independently screened titles, abstracts, and full text. Studies meeting inclusion criteria evaluated the impact of modern practice on prognosis. In vitro and animal models studies, conference abstracts, imaging studies, and review articles were excluded. Disagreement in inclusion criteria was resolved by consensus. A large study of 8,859 patients showed no difference in all-cause mortality between 31 days and 2 years in patients with ST segment elevation myocardial infarction (STEMI) compared to those with non-ST segment elevation myocardial infarction (NSTEMI) or stable ischemic heart disease (SIHD). Other studies showed a significant increase in all-cause mortality in patients with STEMI within the first 30 days, with NSTEMI patients exhibiting a higher mortality rate compared to those with SIHD during the 2-year follow-up period. Our review found that women have a poorer short-term prognosis compared to men. Additionally, reports from patients receiving comprehensive and coordinated care showed longer survival rates. In view of the improved prognosis demonstrated for patients suffering from ACS, assessing prognosis in patients represents a formidable task in modern practice. Our review highlights the need for further evidence-based studies evaluating long-term outcomes on diagnostic and treatment strategies.
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Affiliation(s)
- Fan Ye
- Graduate Medical Education, University of Central Florida College of Medicine, Orlando, FL USA
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL USA
| | - David Winchester
- Department of Cardiology, University of Florida College of Medicine, Gainesville, FL USA
| | | | - Arthur Lee
- The Cardiac and Vascular Institute, Gainesville, FL USA
| | | | - Carolyn Stalvey
- Department of General Internal Medicine, University of Florida College of Medicine, Gainesville, FL USA
| | | | - Joseph Mazza
- Marshfield Clinic Research Institute, Marshfield, WI USA
| | - Steven Yale
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL USA
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Konttila KK, Koivula K, Eskola MJ, Martiskainen M, Huhtala H, Virtanen VK, Mikkelsson J, Järvelä K, Niemelä KO, Karhunen PJ, Nikus KC. Poor long-term outcome in acute coronary syndrome in a real-life setting: Ten-year outcome of the TACOS study. Cardiol J 2019; 28:302-311. [PMID: 30994181 DOI: 10.5603/cj.a2019.0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 02/21/2019] [Accepted: 03/28/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Long-term outcome of the three categories of acute coronary syndrome (ACS) in real-life patient cohorts is not well known. The objective of this study was to survey the 10-year outcome of an ACS patient cohort admitted to a university hospital and to explore factors affecting the outcome. METHODS A total of 1188 consecutive patients (median age 73 years) with ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI) or unstable angina pectoris (UA) in 2002-2003 were included and followed up for ≥ 10 years. RESULTS Mortality for STEMI, NSTEMI and UA patients during the follow-up period was 52.5%, 69.9% and 41.0% (p < 0.001), respectively. In multivariable Cox regression analysis, only age and creatinine level at admission were independently associated with patient outcome in all the three ACS categories when analyzed separately. CONCLUSIONS All the three ACS categories proved to have high mortality rates during long-term followup in a real-life patient cohort. NSTEMI patients had worse outcome than STEMI and UA patients during the whole follow-up period. Our study results indicate clear differences in the prognostic significance of various demographic and therapeutic parameters within the three ACS categories.
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Affiliation(s)
- Kaari K Konttila
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | | | | | - Mika Martiskainen
- Faculty of Medicine and Health Technology, Tampere University, Tampere
| | - Heini Huhtala
- Faculty of Social Sciences, Tampere University, Finland
| | | | | | - Kati Järvelä
- Heart Center, Tampere University Hospital, Finland
| | | | - Pekka J Karhunen
- Faculty of Medicine and Health Technology, Tampere University and Fimlab Laboratories Tampere University Hospital, Tampere, Finland
| | - Kjell C Nikus
- Heart Center, Tampere University Hospital and Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.
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Lin CF, Chang YH, Chi NF, Chen IMI, Liu HY, Chien LN. Percutaneous coronary intervention in patients hospitalized for non-ST-elevation myocardial infarction and the risk of postdischarge ischemic stroke at 6-month, 1-year, and 3-year follow-ups. Heart Vessels 2019; 34:1132-1139. [PMID: 30830314 DOI: 10.1007/s00380-019-01367-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 01/11/2019] [Indexed: 11/26/2022]
Abstract
Percutaneous coronary intervention (PCI) is suggested for treating patients with non-ST-elevation myocardial infarction (NSTEMI) to reduce adverse cardiovascular events. However, the short- and long-term effects of PCI on the risk of postdischarge ischemic stroke (IS) in patients hospitalized for NSTEMI remain unclear. This study investigated the association of PCI on the risk of postdischarge IS in patients hospitalized for NSTEMI at different period follow-ups. A population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching (PSM) was used to select 6079 pairs of the patients with NSTEMI treated invasively by PCI (received PCI during hospitalization) and initial conservative strategy (did not receive PCI during hospitalization) with similar baseline characteristics for evaluation. After adjustment for patients' clinical variables and the duration of dual antiplatelet therapy, PCI was associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups [adjusted hazard ratio (aHR) = 0.41, 95% confidence interval (CI) = 0.26-0.67, p < 0.001; aHR = 0.61, 95% CI 0.43-0.86, p = 0.004; and aHR = 0.69, 95% CI 0.54-0.89, p = 0.005respectively]. In the patients who had a CHA2DS2-VASc score of ≥2, PCI was also associated with a decreased risk of postdischarge IS at 6-month, 1-year, and 3-year follow-ups (aHR = 0.54, 95% CI 0.36-0.83, p = 0.005; aHR = 0.72, 95% CI 0.52-1.00, p = 0.048; and aHR =0.73, 95% CI 0.58-0.91, p = 0.005, respectively). These findings suggested that PCI might reduce the risk of postdischarge IS in patients hospitalized for NSTEMI.
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Affiliation(s)
- Chao-Feng Lin
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- Ph.D. Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University and Academia Sinica, Taipei, Taiwan
| | - Ya-Hui Chang
- Department of Pharmacy, MacKay Memorial Hospital, Taipei, Taiwan
| | - Nai-Fang Chi
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - I-M Ing Chen
- Department of Medicine, School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hung-Yi Liu
- Health and Clinical Research Data Center, School of public health, Taipei Medical University, Taipei, Taiwan
| | - Li-Nien Chien
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.
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Abstract
BACKGROUND Adherence to guidelines for the initial treatment of ST-Segment Elevation Myocardial Infarction has been thoroughly studied, whereas the study of emergency department (ED) adherence to guidelines for Non-ST-Segment Elevation Myocardial Infarction-Acute Coronary Syndrome (NSTEMI-ACS) has been much scarcer. The recommended guidelines for the initial prompt workup and treatment of NSTEMI-ACS remains a challenge. AIM We studied adherence to guidelines for NSTEMI in the ED. METHODS A single-center, retrospective study of consecutive patients with NSTEMI admitted to a tertiary hospital and discharged alive between March 2013 and March 2014. ED records were manually reviewed for adherence to prespecified parameters. Cases with sudden death, shock, or type-II NSTEMI were excluded. Canadian Triage and Acuity Scale score system was used for triage in the ED. RESULTS Adherence rates were 33.3%/24.6% of 240 patients for ECG/troponin obtained within 10/60 minutes receptively and 31.3% for anticoagulation within 15 minutes from diagnosis of ACS. Females were less likely to undergo electrocardiography (P = 0.009) or troponin-level tests within the specified timeframe (P = 0.043). Many cardiovascular risk markers were missed. Global Registry of Acute Coronary Events score was not used to risk stratify patients. CONCLUSIONS Prompt identification and early medical treatment of NSTEMI in the ED is lacking. Better computerized medical history assembly, attention to typical and atypical clinical presentation, and the employment of an appropriate cardiologic risk stratification method may unblind the treating teams at the point of care and improve adherence to NSTEMI guidelines.
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36
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Kim YH, Her AY, Jeong MH, Kim BK, Lee SY, Hong SJ, Shin DH, Kim JS, Ko YG, Choi D, Hong MK, Jang Y. Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI. Atherosclerosis 2019; 280:166-173. [DOI: 10.1016/j.atherosclerosis.2018.11.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/06/2018] [Accepted: 11/22/2018] [Indexed: 01/17/2023]
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Roos A, Sartipy U, Ljung R, Holzmann MJ. Relation of Chronic Myocardial Injury and Non-ST-Segment Elevation Myocardial Infarction to Mortality. Am J Cardiol 2018; 122:1989-1995. [PMID: 30314814 DOI: 10.1016/j.amjcard.2018.09.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 08/19/2018] [Accepted: 09/05/2018] [Indexed: 11/30/2022]
Abstract
The prognosis in patients with chest pain and chronic myocardial injury compared with patients with non-ST-segment elevation myocardial infarction (NSTEMI) is unknown. This study aims to investigate differences in long-term outcomes. Patients with chest pain at Karolinska University Hospital, Sweden from 2011 to 2014, who had stable high-sensitivity cardiac troponin T (hs-cTnT) levels were compared with patients with NSTEMI. We estimated hazard ratios with 95% confidence intervals for the risk of all-cause mortality, myocardial infarction, and heart failure at different hs-cTnT levels using patients with NSTEMI as referent. A total of 20,387 patients were included, of whom 927 had NSTEMI. Among 19,460 patients with stable hs-cTnT levels, 1,528 had chronic myocardial injury defined as stable hs-cTnT levels > 14 ng/L. Mean follow-up was 3.2 years. Patients with hs-cTnT levels of <5 and 5 to 9 ng/L had a lower risk, while patients with chronic myocardial injury with hs-cTnT levels of 30 to 49 and ≥50 ng/L had a higher risk of death (adjusted hazard ratios, 95% confidence intervals: 1.65, 1.30 to 2.10 and 2.13, 1.60 to 2.84, respectively) compared with patients with NSTEMI. Patients with hs-cTnT levels <15 ng/L had a lower risk of heart failure, with no difference in risk at higher hs-cTnT levels. All stable hs-cTnT levels were associated with a lower risk of myocardial infarction (MI). In conclusion, patients with chest pain and stable hs-cTnT levels 10 to 29 ng/L have a similar risk, and those with chronic myocardial injury with hs-cTnT levels of ≥30 ng/L have an increased risk of long-term all-cause mortality compared with patients with NSTEMI.
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Affiliation(s)
- Andreas Roos
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden.
| | - Ulrik Sartipy
- Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Rickard Ljung
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Martin J Holzmann
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Functional area of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden
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Grey C, Jackson R, Schmidt M, Ezzati M, Asaria P, Exeter DJ, Kerr AJ. One in four major ischaemic heart disease events are fatal and 60% are pre-hospital deaths: a national data-linkage study (ANZACS-QI 8). Eur Heart J 2018; 38:172-180. [PMID: 28158544 DOI: 10.1093/eurheartj/ehv524] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 08/20/2015] [Accepted: 09/17/2015] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of this study is to determine proportions of major ischaemic heart disease (IHD) events that are fatal and where they occur, in an era of rapidly falling IHD mortality. Methods and Results Individual person linkage of national data sets identified all IHD hospitalizations and deaths in New Zealand from December 2008 to November 2010. Outcome measures were proportions of people: (i) hospitalized with IHD and alive at 28 days; (ii) hospitalized with IHD and died within 28 days; (iii) hospitalized for a non-IHD cause and died from IHD within 28 days; and (iv) not hospitalized and died from IHD. Three event definitions were used [broad-balanced: IHD deaths and IHD hospitalizations, unbalanced: IHD deaths and myocardial infarction (MI) hospitalizations, and narrow-balanced: MI deaths and MI hospitalizations]. About 37 867 IHD hospitalizations and 9409 IHD deaths were identified using the broad IHD definition. Approximately one-quarter of IHD events were fatal: 4% were deaths within 28 days of an IHD hospitalization, 6% were IHD deaths within 28 days of a non-IHD hospitalization, and 14% were non-hospitalized IHD deaths. Using different event definitions, overall case fatality varied from 24–25% (broad and narrow balanced) to 37–39% (unbalanced), whereas the proportion of all deaths that were non-hospitalized was approximately 60%. Forty per cent of deaths were first-ever events that manifested as non-hospitalized IHD deaths. Conclusion About one-quarter of IHD are fatal, although the proportion is dependent on disease definitions and age. About 60% of all IHD deaths occur out of hospital, and of these 60% are in people not previously hospitalized for IHD.
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Affiliation(s)
- Corina Grey
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1010, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1010, New Zealand
| | - Morten Schmidt
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus, Denmark
| | - Majid Ezzati
- MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London W2 1PG, UK
| | - Perviz Asaria
- Department of Epidemiology and Biostatistics, Imperial College School of Public Health, London W2 1PG, UK
| | - Daniel J Exeter
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland 1010, New Zealand
| | - Andrew J Kerr
- Counties Manukau District Health Board, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand
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39
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Shahrbaf MA, Mahjoob MP, Khaheshi I, Akbarzadeh MA, Barkhordari E, Naderian M, Tajrishi FZ. The role of air pollution on ST-elevation myocardial infarction: a narrative mini review. Future Cardiol 2018; 14:301-306. [PMID: 29932738 DOI: 10.2217/fca-2017-0078] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
ST-elevation myocardial infarction (STEMI) is one of the potential causes of death worldwide. In spite of substantial advances in its diagnosis and treatment, STEMI is still considered as a major public health dilemma in developed and particularly developing countries. One of the triggering factors of STEMI is supposed to be air pollutants like gaseous pollutants including, sulfur dioxide, nitric dioxide, carbon monoxide, ozone and particulate matters (PM) including, PM under 2.5 µm (PM2.5) and PM under 10 µm (PM10). Air pollution can trigger STEMI with various mechanisms such as increasing inflammatory factors and changing the heart rate or blood viscosity. In this article, we aimed to explore research in the field and discuss the relationship between air pollution and STEMI.
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Affiliation(s)
- Mohammad Amin Shahrbaf
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Parsa Mahjoob
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran, Iran, 1998734383
| | - Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elham Barkhordari
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology & Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Biswas S, Andrianopoulos N, Papapostolou S, Noaman S, Duffy SJ, Lefkovits J, Brennan A, Walton A, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D, Chan W. Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:318-327. [DOI: 10.1093/ehjqcco/qcy009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/20/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stavroula Papapostolou
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antony Walton
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Australia
- School of Medicine, Deakin University, Ballarat, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
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Teng HI, Sung SH, Huang SS, Pan JP, Lin SJ, Chan WL, Lee WL, Lu TM, Wu CH. The impact of successful revascularization of coronary chronic total occlusions on long-term clinical outcomes in patients with non-ST-segment elevation myocardial infarction. J Interv Cardiol 2018; 31:302-309. [PMID: 29495125 DOI: 10.1111/joic.12501] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 01/11/2018] [Accepted: 01/18/2018] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES The purpose of this study was to assess the long-term clinical impact of revascularization of coronary concomitant coronary chronic total occlusion (CTO) in patients with Non-ST-segment elevation myocardial infarction (NSTEMI). BACKGROUND CTO is associated with poorer prognosis in patients with NSTEMI. The evidence of revascularization of CTO in patients with NSTEMI is still conflicting. METHODS Consecutive patients with NSTEMI and CTO who underwent percutaneous coronary intervention (PCI) within 72 h of admission from 2006 to 2015 were retrospectively recruited and analyzed. A total of 967 patients underwent PCI for NSTEMI. Among them, 106 (11%) patients had concomitant CTO and were recruited for analysis. CTO lesions were revascularized successfully in 67 (63.2%) patients (successful CTO PCI group), while the CTO in the remaining 39 patients were either not attempted or failed (No/failed CTO PCI group). RESULTS The 30-day cardiac death and major adverse cardiac events (MACE) were significantly lower in the successful CTO PCI group (both cardiac death and MACE were 3% vs 30%, P < 0.001, respectively). A landmark analysis set at 30th day for 30-day survivals was performed. After a mean of 2.5-year follow-up, the long-term cardiac death was still significantly lower (16.9% vs 42.3%, P < 0.001), whereas the MACE showed a trend toward lower incidence (26.2% vs 40.7%, P = 0.051) in the successful CTO PCI group. In multivariate Cox regression analysis, successful revascularization of CTO is an independent protective predictor for long-term cardiac death (HR 0.310, 95% CI, 0.109-0.881, P = 0.028) in all population and in propensity-score matched cohort (P = 0.007). CONCLUSIONS Successful revascularization of CTO was associated with reduced risk of long-term cardiac death in patients with NSTEMI and concomitant CTO.
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Affiliation(s)
- Hsin-I Teng
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Sung Huang
- Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ju-Pin Pan
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan
| | - Shing-Jong Lin
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medical Research and Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wan-Leong Chan
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Lieng Lee
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tse-Min Lu
- Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Health Care and Management Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hsueh Wu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, and Cardiovascular Research Institute, National Yang-Ming University, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
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42
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Alvarez-Alvarez B, Abou Jokh Casas C, Garcia Acuña JM, Cid Alvarez B, Agra Bermejo RM, Cordero Fort A, Rodríguez Mañero M, Gude Sampedro F, González-Juanatey JR. Temporal trends between association of evidence-based treatment and outcomes in patients with non-ST-elevation myocardial infarction. Int J Cardiol 2018; 260:1-6. [PMID: 29506939 DOI: 10.1016/j.ijcard.2018.02.110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 02/12/2018] [Accepted: 02/26/2018] [Indexed: 01/22/2023]
Affiliation(s)
- Belén Alvarez-Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Charigan Abou Jokh Casas
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Jose María Garcia Acuña
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Belén Cid Alvarez
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Rosa María Agra Bermejo
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alberto Cordero Fort
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Cardiology Department, Hospital Universitario de San Juan, Alicante, Spain
| | - Moisés Rodríguez Mañero
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Gude Sampedro
- Epidemiology Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | - José R González-Juanatey
- Cardiology Department, Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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43
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Lin CF, Chang YH, Chi NF, Chuang MT, Chien LN. Effect of early percutaneous coronary intervention on one-year risk of pneumonia and pneumonia-related adverse outcomes in patients with acute myocardial infarction. EUROINTERVENTION 2018; 13:1705-1713. [PMID: 28414655 DOI: 10.4244/eij-d-16-00840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to investigate the association between early percutaneous coronary intervention (PCI) and pneumonia risk in patients with acute myocardial infarction (AMI) by using Taiwan's National Health Insurance Research Database (NHIRD). METHODS AND RESULTS In total, 4,732 patients with non-ST-elevation myocardial infarction (NSTEMI) and 5,465 with ST-elevation myocardial infarction (STEMI) who had received PCI during AMI hospitalisation (early PCI) were evaluated. Patients who did not receive PCI during AMI hospitalisation (deferred PCI) were matched through propensity score matching. The incidence rates (per 100 person-months) of pneumonia hospitalisation, pneumonia-related respiratory failure, and pneumonia-related death associated with early PCI in patients with NSTEMI were 0.36 (95% confidence interval [CI]: 0.32-0.42), 0.12 (95% CI: 0.10-0.16), and 0.08 (95% CI: 0.06-0.11), respectively. In patients with STEMI, the incidence rates (per 100 person-months) of the aforementioned adverse events were 0.16 (95% CI: 0.13-0.20), 0.04 (95% CI: 0.03-0.06), and 0.02 (95% CI: 0.01-0.04), respectively. After adjustment for patients' clinical variables, early PCI was associated with reduced risks of pneumonia hospitalisation (adjusted hazard ratio [aHR] 0.54, 95% CI: 0.43-0.68, p<0.001), pneumonia-related respiratory failure (aHR 0.54, 95% CI: 0.35-0.84, p=0.006), and pneumonia-related death (aHR 0.29, 95% CI: 0.17-0.52, p<0.001) in patients with NSTEMI. In patients with STEMI, early PCI was beneficial for pneumonia hospitalisation (aHR 0.62, 95% CI: 0.45- 0.86, p=0.004). CONCLUSIONS Early PCI might reduce the risk of pneumonia hospitalisation in patients with AMI.
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Affiliation(s)
- Chao-Feng Lin
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
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Akbarzadeh MA, Khaheshi I, Sharifi A, Yousefi N, Naderian M, Namazi MH, Safi M, Vakili H, Saadat H, Alipour Parsa S, Nickdoost N. The association between exposure to air pollutants including PM 10, PM 2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration and the relative risk of developing STEMI: A case-crossover design. ENVIRONMENTAL RESEARCH 2018; 161:299-303. [PMID: 29178978 DOI: 10.1016/j.envres.2017.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 10/18/2017] [Accepted: 11/15/2017] [Indexed: 05/25/2023]
Abstract
BACKGROUND Unfavorable associations between air pollution and myocardial infarction are broadly investigated in recent studies and some of them revealed considerable associations; however, controversies exists between these investigations with regard to culprit components of air pollution and significance of correlation between myocardial infarction risk and air pollution. METHODS The association between exposure to PM10, PM2.5, ozone, carbon monoxide, sulfur dioxide, and nitrogen dioxide concentration of background air that residents of Tehran, the capital city of Iran, which is ranked as the most air polluted city of Iran and the relative risk of developing ST-elevation myocardial infarction (STEMI) were investigated by a case-crossover design. Our study included 208 patients admitted with a diagnosis of STEMI and undergone primary percutaneous intervention. Air pollutant concentration was averaged in 24-h windows preceding the time of onset of myocardial infarction for the case period. Besides, the mean level of each element of air pollution of the corresponding time in one week, two weeks and three weeks before onset of myocardial infarction, was averaged separately for each day as one control periods. Thus, 624 control periods were included in our investigation such that. Each patient is matched and compared with him/herself. RESULTS The mean level of PM10 in case periods (61.47µg/m3) was significantly higher than its level in control periods (57.86µg/m3) (P-value = 0.019, 95% CI: 1.002-1.018, RR = 1.010). Also, the mean level of PM2.5 in case periods (95.40µg/m3) was significantly higher than that in control days (90.88µg/m3) (P-value = 0.044, 95% CI: 1.001-1.011, RR = 1.006). The level of other components including NO2, SO2, CO and O3 showed no significant differences between case and control periods. A 10µg/m3 increase in PM10 and PM2.5 would result in 10.10% and 10.06% increase in STEMI event, respectively. Furthermore, the results of sub-group analysis showed that older patients (equal or more than 60 year-old), diabetic patients, non-hypertensive ones and patients with more than one diseased vessel may be more vulnerable to the harmful effect of particular matters including PM10 and PM2.5 on development of STEMI. CONCLUSION Air pollution is a worldwide pandemic with great potential to cause terrible events especially cardiovascular ones. PM2.5 and PM10 are amongst ambient air pollutant with a high risk of developing STEMI. Thus, more restrictive legislations should be applied to define a safe level of indoor and outdoor air pollutant production.
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Affiliation(s)
- Mohammad Ali Akbarzadeh
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Isa Khaheshi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran.
| | - Amirsina Sharifi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Yousefi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Mohammadreza Naderian
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran; Cardiac Outcome Research and Education (CORE), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Hasan Namazi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Morteza Safi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Hossein Vakili
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Habibollah Saadat
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Saeed Alipour Parsa
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
| | - Negin Nickdoost
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Modarres Hospital, Kaj square, Sa'adat Abad Ave, Tehran 1998734383, Iran
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Tajstra M, Hawranek M, Desperak P, Ciślak A, Gąsior M. Gap in gender parity: gender disparities in incidence and clinical impact of chronic total occlusion in non-infarct artery in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease. Oncotarget 2017; 8:79137-79146. [PMID: 29108293 PMCID: PMC5668026 DOI: 10.18632/oncotarget.16134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/03/2017] [Indexed: 12/02/2022] Open
Abstract
A chronic total occlusion in a non-infarct-related artery is an independent predictor of mortality in non-ST elevation myocardial infarction. There are no mortality data about the impact of a chronic total occlusion in patients with non-ST elevation myocardial infarction according to gender. The purpose of this study was to evaluate the prevalence of the chronic total occlusion in in men and women and examine its impact on clinical outcomes. Data from consecutive patients with multivessel coronary artery disease treated in a high-volume center between 2006 and 2012 were included in a prospective registry and divided according to gender and the presence of chronic total occlusion. All of the analyzed patients were followed up for at least 24 months, with all-cause mortality defined as the primary endpoint. Among the 515 patients who fulfilled the inclusion criteria, 32.8% were female. In the female arm, the 24-month mortality for the groups with and without chronic total occlusion was similar (18.9% and 14.7%, respectively; p = 0.47). In contrast, in the male arm, the occurrence of chronic total occlusion was associated with higher 24-month mortality (24.3% vs. 13.4%; p = 0.009). Multivariate analysis of the male arm revealed a trend toward a positive association between the occurrence of chronic total occlusion and 24-month mortality (HR 1.62; 95% CI 0.93–2.83; p = 0.087). The presence of chronic total occlusion in men is associated with an adverse long-term prognosis, whereas in women this effect was not observed.
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Affiliation(s)
- Mateusz Tajstra
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Hawranek
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Piotr Desperak
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Aneta Ciślak
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
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Fanaroff AC, Roe MT, Clare RM, Lokhnygina Y, Navar AM, Giugliano RP, Wiviott SD, Tershakovec AM, Braunwald E, Blazing MA. Competing Risks of Cardiovascular Versus Noncardiovascular Death During Long-Term Follow-Up After Acute Coronary Syndromes. J Am Heart Assoc 2017; 6:JAHA.117.005840. [PMID: 28923989 PMCID: PMC5634257 DOI: 10.1161/jaha.117.005840] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Understanding the relative risk of cardiovascular versus noncardiovascular death is important for designing clinical trials. These risks may differ depending on patient age, sex, and type of acute coronary syndrome (ACS). Methods and Results IMPROVE‐IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial) was a randomized controlled trial of simvastatin plus either ezetimibe or placebo following stabilized ACS. Cause of death was adjudicated by an independent committee. We compared the cumulative incidence of cardiovascular and noncardiovascular death for patients with unstable angina/non‐ST‐segment elevation myocardial infarction (UA/NSTEMI) and ST‐segment elevation myocardial infarction (STEMI), in those <65 and ≥65 years old, and males and females, over 7 years of follow‐up. Of 18 131 patients, the presenting event was STEMI for 5190 (29%) and UA/NSTEMI for 12 941 (71%); 10 173 (56%) patients were <65 years old and 7971 (44%) were ≥65 years old at presentation. UA/NSTEMI patients were older than STEMI patients, with more cardiovascular and noncardiovascular risk factors. In STEMI patients, the cumulative incidence of cardiovascular death was higher for ∼4 years following the index event, after which noncardiovascular death predominated. In UA/NSTEMI patients, the cumulative incidence of cardiovascular death remained higher than noncardiovascular death over the full follow‐up period. Patients ≥65 years old and <65 years old had a higher incidence of cardiovascular death than noncardiovascular death over the entirety of follow‐up. Female patients had a higher incidence of cardiovascular death than noncardiovascular death for ∼6 years following the index event; male patients had a higher incidence of cardiovascular death than noncardiovascular death over the entirety of follow‐up. Conclusions Among post‐ACS patients enrolled in a long‐term clinical trial, the relative incidence of cardiovascular and noncardiovascular death differed based on type of ACS presentation and sex, but not age. These findings further delineate long‐term prognosis after ACS and should inform the design of future cardiovascular outcomes trials.
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Affiliation(s)
- Alexander C Fanaroff
- Duke Clinical Research Institute, Durham, NC .,Division of Cardiology, Duke University, Durham, NC
| | - Matthew T Roe
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University, Durham, NC
| | | | | | - Ann Marie Navar
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University, Durham, NC
| | - Robert P Giugliano
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Stephen D Wiviott
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | - Eugene Braunwald
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael A Blazing
- Duke Clinical Research Institute, Durham, NC.,Division of Cardiology, Duke University, Durham, NC
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Fokkema ML, James SK, Albertsson P, Aasa M, Åkerblom A, Calais F, Eriksson P, Jensen J, Schersten F, de Smet BJ, Sjögren I, Tornvall P, Lagerqvist B. Outcome after percutaneous coronary intervention for different indications: long-term results from the Swedish Coronary Angiography and Angioplasty Registry (SCAAR). EUROINTERVENTION 2017; 12:303-11. [PMID: 26485732 DOI: 10.4244/eijy15m10_07] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIMS The aim of this study was to evaluate clinical outcome for different indications for PCI in an unselected, nationwide PCI population at short- and long-term follow-up. METHODS AND RESULTS We evaluated clinical outcome up to six years after PCI in all patients undergoing a PCI procedure for different indications in Sweden between 2006 and 2010. A total of 70,479 patients were treated for stable coronary artery disease (CAD) (21.0%), unstable angina (11.0%), non-ST-elevation myocardial infarction (NSTEMI) (36.6%) and ST-elevation myocardial infarction (STEMI) (31.4%). Mortality was higher in STEMI patients at one year after PCI (9.6%) compared to NSTEMI (4.7%), unstable angina (2.2%) and stable CAD (2.0%). At one year after PCI until the end of follow-up, the adjusted mortality risk (one to six years after PCI) and the risk of myocardial infarction were comparable between NSTEMI and STEMI patients and lower in patients with unstable angina and stable CAD. The adjusted risk of stent thrombosis and heart failure was highest in STEMI patients. CONCLUSIONS The risk of short-term mortality, heart failure and stent thrombosis is highest for STEMI patients after PCI. Therapies to reduce stent thrombosis and heart failure appear to be most important in decreasing mortality in patients with STEMI or NSTEMI undergoing PCI.
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Affiliation(s)
- Marieke L Fokkema
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Medium platelet volume as a noninvasive predictor of chronic total occlusion in non-infarct artery in patients with non-ST-segment elevation myocardial infarction and multivessel coronary artery disease. Int J Cardiol 2016; 228:594-598. [PMID: 27888750 DOI: 10.1016/j.ijcard.2016.11.261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic total occlusion (CTO) in a noninfarct-related artery (non-IRA) is an independent predictor of mortality in non-ST elevation myocardial infarction (NSTEMI). Mean platelet volume (MPV) is associated with cardiovascular events in NSTEMI. Little is known about the predictors of non-IRA-CTO in patients with NSTEMI. The purpose of this study was to evaluate the relationship between the presence of non-IRA-CTO with MPV level in patients with NSTEMI and multivessel coronary artery disease (MVCAD). METHODS Data of consecutive patients with NSTEMI and MVCAD treated in high-volume PCI center between 2006 and 2012 and included in the prospective registry were divided according to the presence of CTO and analyzed. RESULTS In the group of 685 patients fulfilling the inclusion criteria, 308 (45%) patients had CTO (CTO+), and in 377 (55%) patients CTO was not observed (CTO-). The MPV level on admission was significantly higher in the CTO+ group than in the CTO- group (P<0.0001). In the multivariate analysis of the entire study population, independent predictors of occurrence of CTO were medium platelet volume (MPV; per 1fL more; odds ratio [OR] 1.34; 95% confidence interval [CI] 1.15-1.57; P=0.0002) together with left ventricular ejection fraction and prior MI. CONCLUSIONS MPV at admission is independently associated with more frequent occurrence of non-IRA CTO in patients with NSTEMI and MVCAD.
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Characterisation of Myocardial Injury via T1 Mapping in Early Reperfused Myocardial Infarction and its Relationship with Global and Regional Diastolic Dysfunction. Heart Lung Circ 2016; 25:1094-1106. [DOI: 10.1016/j.hlc.2016.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 03/28/2016] [Indexed: 01/31/2023]
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50
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Dondo TB, Hall M, Timmis AD, Yan AT, Batin PD, Oliver G, Alabas OA, Norman P, Deanfield JE, Bloor K, Hemingway H, Gale CP. Geographic variation in the treatment of non-ST-segment myocardial infarction in the English National Health Service: a cohort study. BMJ Open 2016; 6:e011600. [PMID: 27406646 PMCID: PMC4947744 DOI: 10.1136/bmjopen-2016-011600] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES To investigate geographic variation in guideline-indicated treatments for non-ST-elevation myocardial infarction (NSTEMI) in the English National Health Service (NHS). DESIGN Cohort study using registry data from the Myocardial Ischaemia National Audit Project. SETTING All Clinical Commissioning Groups (CCGs) (n=211) in the English NHS. PARTICIPANTS 357 228 patients with NSTEMI between 1 January 2003 and 30 June 2013. MAIN OUTCOME MEASURE Proportion of eligible NSTEMI who received all eligible guideline-indicated treatments (optimal care) according to the date of guideline publication. RESULTS The proportion of NSTEMI who received optimal care was low (48 257/357 228; 13.5%) and varied between CCGs (median 12.8%, IQR 0.7-18.1%). The greatest geographic variation was for aldosterone antagonists (16.7%, 0.0-40.0%) and least for use of an ECG (96.7%, 92.5-98.7%). The highest rates of care were for acute aspirin (median 92.8%, IQR 88.6-97.1%), and aspirin (90.1%, 85.1-93.3%) and statins (86.4%, 82.3-91.2%) at hospital discharge. The lowest rates were for smoking cessation advice (median 11.6%, IQR 8.7-16.6%), dietary advice (32.4%, 23.9-41.7%) and the prescription of P2Y12 inhibitors (39.7%, 32.4-46.9%). After adjustment for case mix, nearly all (99.6%) of the variation was due to between-hospital differences (median 64.7%, IQR 57.4-70.0%; between-hospital variance: 1.92, 95% CI 1.51 to 2.44; interclass correlation 0.996, 95% CI 0.976 to 0.999). CONCLUSIONS Across the English NHS, the optimal use of guideline-indicated treatments for NSTEMI was low. Variation in the use of specific treatments for NSTEMI was mostly explained by between-hospital differences in care. Performance-based commissioning may increase the use of NSTEMI treatments and, therefore, reduce premature cardiovascular deaths. TRIAL REGISTRATION NUMBER NCT02436187.
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Affiliation(s)
- T B Dondo
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - M Hall
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - A D Timmis
- The National Institute for Health Biomedical Research Unit, Barts Health, London, UK
| | - A T Yan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - P D Batin
- Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - G Oliver
- National Health Service cardiac service user, West Yorkshire, UK
| | - O A Alabas
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
| | - P Norman
- School of Geography, University of Leeds, Leeds, UK
| | - J E Deanfield
- National Institute for Cardiovascular Outcomes Research, University College London, London, UK
| | - K Bloor
- Department of Health Sciences, University of York, York, UK
| | - H Hemingway
- The Farr Institute, University College London, London, UK
| | - C P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, Leeds, UK
- York Teaching Hospital NHS Foundation Trust, York, UK
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