1
|
Inoue K, Chieh JTW, Yeh LC, Chiang SJ, Phrommintikul A, Suwanasom P, Kasim S, Ahmad B, Idrose AM, Salleh FM, Oyamada S, Hirano Y, Ouchi S, Terakura M, Yokoyama N, Kozuma K, Nanasato M, Higuchi R, Yumoto K, Fukuzawa T, Shimada I, Giannitsis E, Twerenbold R, Minamino T. An international, stepped wedge, cluster-randomized trial investigating the 0/1-h algorithm in suspected acute coronary syndrome in Asia: the rational of the DROP-Asian ACS study. Trials 2022; 23:986. [PMID: 36476401 PMCID: PMC9727900 DOI: 10.1186/s13063-022-06907-4] [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: 03/26/2022] [Accepted: 11/09/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND More than half of the world's population lives in Asia. With current life expectancies in Asian countries, the burden of cardiovascular disease is increasing exponentially. Overcrowding in the emergency departments (ED) has become a public health problem. Since 2015, the European Society of Cardiology recommends the use of a 0/1-h algorithm based on high-sensitivity cardiac troponin (hs-cTn) for rapid triage of patients with suspected non-ST elevation acute coronary syndrome (NSTE-ACS). However, these algorithms are currently not recommended by Asian guidelines due to the lack of suitable data. METHODS The DROP-Asian ACS is a prospective, stepped wedge, cluster-randomized trial enrolling 4260 participants presenting with chest pain to the ED of 12 acute care hospitals in five Asian countries (UMIN; 000042461). Consecutive patients presenting with suspected acute coronary syndrome between July 2022 and Apr 2024 were included. Initially, all clusters will apply "usual care" according to local standard operating procedures including hs-cTnT but not the 0/1-h algorithm. The primary outcome is the incidence of major adverse cardiac events (MACE), the composite of all-cause death, myocardial infarction, unstable angina, or unplanned revascularization within 30 days. The difference in MACE (with one-sided 95% CI) was estimated to evaluate non-inferiority. The non-inferiority margin was prespecified at 1.5%. Secondary efficacy outcomes include costs for healthcare resources and duration of stay in ED. CONCLUSIONS This study provides important evidence concerning the safety and efficacy of the 0/1-h algorithm in Asian countries and may help to reduce congestion of the ED as well as medical costs.
Collapse
Affiliation(s)
- Kenji Inoue
- grid.482668.60000 0004 1769 1784Department of Cardiovascular Biology and Medicine, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Jack Tan Wei Chieh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Lim Chiw Yeh
- grid.419385.20000 0004 0620 9905Department of Cardiology, National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Shuo-Ju Chiang
- grid.410769.d0000 0004 0572 8156Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Yangming Branch, Taipei, Taiwan
| | - Arintaya Phrommintikul
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Pannipa Suwanasom
- grid.7132.70000 0000 9039 7662Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiangmai, Thailand
| | - Sazzli Kasim
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Bakhtiar Ahmad
- grid.412259.90000 0001 2161 1343Division of Cardiology, Hospital Al-Sultan Abdullah, University Teknologi MARA, Kuala Lumpur, Malaysia
| | - Alzamani Mohammad Idrose
- grid.412516.50000 0004 0621 7139Division of Emergency, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Farina Mohd Salleh
- grid.419388.f0000 0004 0646 931XDivision of Emergency, Institut Jantung Negara, Kuala Lumpur, Malaysia
| | | | - Yohei Hirano
- grid.482669.70000 0004 0569 1541Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shohei Ouchi
- Department of Cardiovascular Biology and Medicine, Juntendo Urayasu Hospital, Chiba, Japan
| | - Moriyuki Terakura
- grid.264706.10000 0000 9239 9995Department of Emergency, Teikyo University School of Medicine, Tokyo, Japan
| | - Naoyuki Yokoyama
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Ken Kozuma
- grid.264706.10000 0000 9239 9995Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Mamoru Nanasato
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Ryosuke Higuchi
- grid.413411.2Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Kazuhiko Yumoto
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | - Tomoyuki Fukuzawa
- grid.410819.50000 0004 0621 5838Department of Cardiology, Yokohama Rosai Hospital, Kanagawa, Japan
| | | | - Evangelos Giannitsis
- grid.5253.10000 0001 0328 4908Department of Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Raphael Twerenbold
- grid.13648.380000 0001 2180 3484Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Tohru Minamino
- grid.258269.20000 0004 1762 2738Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| |
Collapse
|
2
|
Temporal trends in diagnosis, treatment, and outcome for non-ST-segment elevation acute coronary syndrome in three regions of China, 2008-2015. Chin Med J (Engl) 2021; 134:1997-1999. [PMID: 34387613 PMCID: PMC8382473 DOI: 10.1097/cm9.0000000000001664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
3
|
Sharma R, Kumar P, Prashanth SP, Belagali Y. Dual Antiplatelet Therapy in Coronary Artery Disease. Cardiol Ther 2020; 9:349-361. [PMID: 32804330 PMCID: PMC7584687 DOI: 10.1007/s40119-020-00197-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 12/17/2022] Open
Abstract
Acute coronary syndrome (ACS) is principally driven by platelet aggregation. Dual antiplatelet therapy (DAPT) has demonstrated a reduction in recurrent ischemic events. The newer antiplatelets ticagrelor and prasugrel have demonstrated superiority over clopidogrel. While prasugrel demonstrated benefit in patients scheduled for percutaneous intervention (PCI), benefits of ticagrelor were seen irrespective of the treatment strategy. Current guidelines recommend the use of DAPT for 1 year in all patients with ACS. Ticagrelor 60 mg is recommended for up to 3 years in high-risk patients. DAPT and Predicting Bleeding Complications in Patients Undergoing Stent Implantation and Subsequent Dual Antiplatelet Therapy (PRECISE DAPT) scores are tools to support decision-making in deciding duration of dual antiplatelet therapy.
Collapse
Affiliation(s)
- Raghav Sharma
- Interventional Cardiologist, Meditrina Hospital Civil Hospital, Ambala Cantt, Haryana, India
| | - Prathap Kumar
- Interventional Cardiologist, Meditrina Hospital, Ayoor road, Ayathil, Kollam, Kerala, India
| | - S P Prashanth
- Medical Affairs Division, AstraZeneca, Rachenahalli, Bangalore, India
| | - Yogesh Belagali
- Medical Affairs Division, AstraZeneca, Rachenahalli, Bangalore, India.
| |
Collapse
|
4
|
Vu HT, Pham HM, Nguyen HT, Nguyen QN, Do LD, Pham NM, Norman R, Huxley RR, Lee CM, Reid CM. Novel insights into clinical characteristics and in-hospital outcomes of patients undergoing percutaneous coronary intervention in Vietnam. IJC HEART & VASCULATURE 2020; 31:100626. [PMID: 32944609 PMCID: PMC7481132 DOI: 10.1016/j.ijcha.2020.100626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/17/2020] [Accepted: 08/21/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about percutaneous coronary intervention (PCI) practices and outcomes in low-and middle-income nations, despite its rapid uptake across Asia. For the first time, we report on clinical characteristics and in-hospital outcomes for patients undergoing PCI at a leading cardiac centre in Vietnam. METHODS Information on characteristics, treatments, and outcomes of patients undergoing PCI was collected into the first PCI registry through direct interviews using a standardised form, medical record abstraction, and reading PCI imaging data on secured disks. Subgroup analysis was also conducted to explore gender differences. RESULTS Between September 2017 and May 2018, 1022 patients undergoing PCI were recruited from a total of 1041 procedures. The mean age was 68.3 years and two thirds were male. While 54.4% of patients presented with acute coronary syndromes, the rate of ST-elevation myocardial infarction was 14.5%. The majority of lesions were classified as type B2 and C and the radial artery was the most common access location for PCI (79.2%). The use of drug-eluting stents was universal and the angiographic success rate was 99.4%. Cardiac complications following PCI were rare with the exception of major bleeding (2.0%). Female patients were older with relatively more comorbidities and a higher incidence of major bleeding than males (p < 0.05). CONCLUSIONS Findings of this study provide an opportunity to benchmark current PCI practices in Vietnam, identify possible care gaps and potentially inform the adoption of treatment guidelines as well as use of prevention strategies.
Collapse
Key Words
- ACC/AHA, American College of Cardiology/American Heart Association
- ACS, Acute coronary syndrome
- APAC, Asia-Pacific
- CABG, Coronary artery bypass grafts
- CHD, Coronary heart disease
- Clinical characteristic
- DAPT, Dual-anti platelet therapy
- DES, Drug eluting stent
- ECG, Electrocardiogram
- GRACE, Global Registry of Acute Coronary Events
- MI, Myocardial infarction
- NSTEMI, Non-ST-elevation myocardial infraction
- Outcomes, Vietnam
- PCI, Percutaneous coronary intervention
- Percutaneous coronary intervention
- STEMI, ST-elevation myocardial infraction
- UA, Unstable angina
- VNHI, Vietnam National Heart Institute
Collapse
Affiliation(s)
- Hoa T.T. Vu
- School of Public Health, Curtin University, Perth, Australia
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam
| | - Hung M. Pham
- Vietnam National Heart Institute, Hanoi, Viet Nam
| | | | | | - Loi D. Do
- Vietnam National Heart Institute, Hanoi, Viet Nam
| | - Ngoc M. Pham
- School of Public Health, Curtin University, Perth, Australia
- Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Viet Nam
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Richard Norman
- School of Public Health, Curtin University, Perth, Australia
| | - Rachel R. Huxley
- School of Public Health, Curtin University, Perth, Australia
- College of Science, Health and Engineering, La Trobe University, Melbourne, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Crystal M.Y. Lee
- School of Public Health, Curtin University, Perth, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, Australia
| | | |
Collapse
|
5
|
Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. Int J Cardiol 2020; 315:1-8. [DOI: 10.1016/j.ijcard.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/28/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
|
6
|
Zheng B, Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Pocock SJ, Nhan VT, Alonso Garcia A, Chin CT, Jiang J, Jan S, Vega AM, Hayashi N, Ong TK. Long-term antithrombotic management patterns in Asian patients with acute coronary syndrome: 2-year observations from the EPICOR Asia study. Clin Cardiol 2020; 43:999-1008. [PMID: 32618009 PMCID: PMC7462192 DOI: 10.1002/clc.23400] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Despite guideline recommendations, dual antiplatelet therapy (DAPT) is frequently used for longer than 1 year after an acute coronary syndrome (ACS) event. In Asia, information on antithrombotic management patterns (AMPs), including DAPT post discharge, is sparse. This analysis evaluated real‐world AMPs up to 2 years post discharge for ACS. Hypothesis There is wide variability in AMP use for ACS management in Asia. Methods EPICOR Asia (NCT01361386) is a prospective observational study of patients discharged after hospitalization for an ACS in eight countries/regions in Asia, followed up for 2 years. Here, we describe AMPs used and present an exploratory analysis of characteristics and outcomes in patients who received DAPT for ≤12 months post discharge compared with >12 months. Results Data were available for 12 922 patients; of 11 639 patients discharged on DAPT, 2364 (20.3%) received DAPT for ≤12 months and 9275 (79.7%) for >12 months, with approximately 60% still on DAPT at 2 years. Patients who received DAPT for >12 months were more likely to be younger, obese, lower Killip class, resident in India (vs China), and to have received invasive reperfusion. Clinical event rates during year 2 of follow‐up were lower in patients with DAPT >12 vs ≤12 months, but no causal association can be implied in this non‐randomized study. Conclusions Most ACS patients remained on DAPT up to 1 year, in accordance with current guidelines, and over half remained on DAPT at 2 years post discharge. Patients not on DAPT at 12 months are a higher risk group requiring careful monitoring.
Collapse
Affiliation(s)
- Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong, SAR, China
| | | | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand
| | - Stuart J Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | | | - Chee Tang Chin
- Department of Cardiology, National Heart Centre, Singapore, Singapore
| | - Jie Jiang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| |
Collapse
|
7
|
Zhang S, Wang W, Sawhney JPS, Krittayaphong R, Kim HS, Nhan VT, Lee SWL, Ong TK, Chin CT, Pocock SJ, Huo Y, Qian J, Ge J. Antithrombotic management and long-term outcomes following percutaneous coronary intervention for acute coronary syndrome in Asia. Int J Cardiol 2020; 310:16-22. [PMID: 32192746 DOI: 10.1016/j.ijcard.2020.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiovascular diseases account for approximately half of all deaths in Asia. The present analysis aimed to evaluate characteristics, antithrombotic management patterns (AMPs), and outcomes in patients with acute coronary syndrome (ACS) who underwent in-hospital percutaneous coronary intervention (PCI) and survived to hospital discharge, using data from the EPICOR Asia registry (NCT01361386). METHODS Two-year post-discharge follow-up data were analyzed from 8757 ACS PCI patients from EPICOR Asia (218 centers, eight countries). Major adverse cardiovascular events (MACE; death, non-fatal myocardial infarction [MI], non-fatal ischemic stroke), PCI characteristics, and AMPs were recorded. For MACE, time - to - event was analyzed using Cox regression. RESULTS Primary PCI was performed in 62.0% of ST-segment elevation MI (STEMI), 38.7% of non-STEMI (NSTEMI), and 24.2% of unstable angina (UA) patients. At 12 months, 88.1% of patients were on dual antiplatelet therapy (DAPT), with no differences by index event. Most (61.5%) still received DAPT at 2 years. Two-year incidences of mortality, composite MACE, and bleeding were 3.6%, 6.2%, and 6.6%, respectively. Risk of death and MACE was increased with STEMI and NSTEMI vs. UA. Patients from East Asia showed lower mortality and more bleeding vs. Southeast Asia/India. CONCLUSIONS Many patients in EPICOR Asia underwent PCI and received DAPT up to 2 years post-discharge. These real-world findings improve our understanding of AMP impact on outcomes in Asian patients with ACS undergoing PCI.
Collapse
Affiliation(s)
- Shuning Zhang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | | | - Hyo-Soo Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | | | | | | | | | - Stuart J Pocock
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China.
| |
Collapse
|
8
|
Irawati S, Dharma S, Taxis K, Nguyen T, Nursyarofah N, Wilffert B, Hak E. Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country. Glob Heart 2020; 15:8. [PMID: 32489781 PMCID: PMC7218801 DOI: 10.5334/gh.394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 10/23/2019] [Indexed: 01/06/2023] Open
Abstract
Background and aims Acute ST-elevation myocardial infarction (STEMI) is a potentially fatal presentation of coronary artery disease (CAD). Evidence of the impact of acute pharmacological interventions in non-reperfused STEMI patients on subsequent events is limited. We aimed to assess the association between adherence to guideline-recommended preventive medications and in-hospital mortality among this high-risk patient population. Methods We conducted a cohort study using data obtained from the Jakarta Acute Coronary Syndrome (JAC) Registry database from a tertiary care academic hospital in Indonesia. We included 1132 of 2694 patients with STEMI recorded between 1 January 2014 and 31 December 2016 who did not undergo acute reperfusion therapy. Adherence to guideline-recommended preventive medications was defined as the combined administration of aspirin, clopidogrel, anticoagulants and statins after hospital admission. The main outcome measure was in-hospital mortality. Results Overall, 778 of 1132 patients (69%) received the combination of preventive medications. The guideline non-adherent group had significantly more patients with earlier onset of STEMI, higher Killip class and thrombolysis in myocardial infarction (TIMI) score. After adjustments for measured characteristics using logistic regression modeling, exposure to the combination of preventive therapies was associated with a statistically significant lower risk for in-hospital mortality (adjusted odds ratio: 0.46, 95% confidence interval: 0.30-0.70). Conclusions Adherence to guideline-recommended preventive medications was associated with lower risk of in-hospital mortality in non-reperfused STEMI patients. The predictors of not receiving these medications need to be confirmed in future research.
Collapse
Affiliation(s)
- Sylvi Irawati
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
- Center for Medicines Information and Pharmaceutical Care, Faculty of Pharmacy, Universitas Surabaya, Surabaya, ID
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, ID
| | - Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, ID
| | - Katja Taxis
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
| | - Thang Nguyen
- Department of Pharmacology and Clinical Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, VN
| | - Nunung Nursyarofah
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, ID
| | - Bob Wilffert
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
- University of Groningen, Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, Groningen, NL
| | - Eelko Hak
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology and -Economics, Groningen, NL
| |
Collapse
|
9
|
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.
Collapse
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.
| |
Collapse
|
10
|
Bueno H, Rossello X, Pocock S, Van de Werf F, Chin CT, Danchin N, Lee SWL, Medina J, Vega A, Huo Y. Regional variations in hospital management and post-discharge mortality in patients with non-ST-segment elevation acute coronary syndrome. Clin Res Cardiol 2018; 107:836-844. [PMID: 29663124 DOI: 10.1007/s00392-018-1254-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/10/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Therapeutic variability not explained by patient clinical characteristics is a potential source of avoidable morbidity and mortality. We aimed to explore regional variability in the management and mortality of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). METHODS AND RESULTS 11,931 NSTE-ACS hospital survivors enrolled in two prospective registries: EPICOR [5625 patients, 555 hospitals, 20 countries in Europe (E) and Latin America (LA), September 2010-March 2011] and EPICOR Asia (6306 patients, 218 hospitals, 8 countries, June 2011-May 2012) were compared among eight pre-defined regions: Northern E (NE), Southern E (SE), Eastern E (EE); Latin America (LA); China (CN), India (IN), South-East Asia (SA), and South Korea, Hong Kong and Singapore (KS). Patient characteristics differed between regions: mean age (lowest 59 years, IN; highest 65.9 years, SE), diabetes (21.4% NE; 35.5% IN) and smoking (32% NE; 62% IN). Variations in dual antiplatelet therapy at discharge (lowest 83.1%, IN; highest 97.5%, SA), coronary angiography (53.9% SA; 90.6% KS), percutaneous coronary intervention (35.8% SA; 78.6% KS) and coronary artery bypass graft (0.7% KS; 5.7% NE) were observed. Unadjusted 2-year mortality ranged between 3.8% in KS and 11.7% in SE. Two-year, risk-adjusted mortality rates ranged between 5.1% (95% confidence interval 2.9-7.3%) in KS to 10.5% (8.3-12.7%) in LA. CONCLUSION Wide regional variations in patient features, hospital care, coronary revascularization and post-discharge mortality are present among patients hospitalized for NSTE-ACS. Focused regional interventions to improve the quality of care for NSTE-ACS patients are still needed.
Collapse
Affiliation(s)
- Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain. .,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain. .,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernandez Almagro, 3, 28029, Madrid, Spain.,London School of Hygiene and Tropical Medicine, London, UK.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine, London, UK
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou and René Descartes University, Paris, France
| | | | - Jesús Medina
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Ana Vega
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Yong Huo
- Beijing University First Hospital, Beijing, China
| |
Collapse
|
11
|
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.
Collapse
Affiliation(s)
- Chao-Feng Lin
- Division of Cardiology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | | | | | | | | |
Collapse
|
12
|
Eccleston D. Unveiling the elephant in the room: The dilemma of patients managed medically after Non-ST-segment Elevation Acute Coronary Syndromes. Int J Cardiol 2017; 243:103-104. [DOI: 10.1016/j.ijcard.2017.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Accepted: 05/31/2017] [Indexed: 11/30/2022]
|
13
|
Pocock SJ, Huo Y, Van de Werf F, Newsome S, Chin CT, Vega AM, Medina J, Bueno H. Predicting two-year mortality from discharge after acute coronary syndrome: An internationally-based risk score. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2017; 8:727-737. [PMID: 28777005 DOI: 10.1177/2048872617719638] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Long-term risk of post-discharge mortality associated with acute coronary syndrome remains a concern. The development of a model to reliably estimate two-year mortality risk from hospital discharge post-acute coronary syndrome will help guide treatment strategies. METHODS EPICOR (long-tErm follow uP of antithrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (EPICOR Asia, NCT01361386) are prospective observational studies of 23,489 patients hospitalized for an acute coronary syndrome event, who survived to discharge and were then followed up for two years. Patients were enrolled from 28 countries across Europe, Latin America and Asia. Risk scoring for two-year all-cause mortality risk was developed using identified predictive variables and forward stepwise Cox regression. Goodness-of-fit and discriminatory power was estimated. RESULTS Within two years of discharge 5.5% of patients died. We identified 17 independent mortality predictors: age, low ejection fraction, no coronary revascularization/thrombolysis, elevated serum creatinine, poor EQ-5D score, low haemoglobin, previous cardiac or chronic obstructive pulmonary disease, elevated blood glucose, on diuretics or an aldosterone inhibitor at discharge, male sex, low educational level, in-hospital cardiac complications, low body mass index, ST-segment elevation myocardial infarction diagnosis, and Killip class. Geographic variation in mortality risk was seen following adjustment for other predictive variables. The developed risk-scoring system provided excellent discrimination (c-statistic=0.80, 95% confidence interval=0.79-0.82) with a steep gradient in two-year mortality risk: >25% (top decile) vs. ~1% (bottom quintile). A simplified risk model with 11 predictors gave only slightly weaker discrimination (c-statistic=0.79, 95% confidence interval =0.78-0.81). CONCLUSIONS This risk score for two-year post-discharge mortality in acute coronary syndrome patients ( www.acsrisk.org ) can facilitate identification of high-risk patients and help guide tailored secondary prevention measures.
Collapse
Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China
| | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Simon Newsome
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ana Maria Vega
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Jesús Medina
- Medical Evidence and Observational Research, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| |
Collapse
|
14
|
Jan S, Lee SWL, Sawhney JPS, Ong TK, Chin CT, Kim HS, Krittayaphong R, Nhan VT, Itoh Y, Huo Y. Catastrophic health expenditure on acute coronary events in Asia: a prospective study. Bull World Health Organ 2016; 94:193-200. [PMID: 26966330 PMCID: PMC4773930 DOI: 10.2471/blt.15.158303] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/24/2015] [Accepted: 12/04/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate out-of-pocket costs and the incidence of catastrophic health expenditure in people admitted to hospital with acute coronary syndromes in Asia. METHODS Participants were enrolled between June 2011 and May 2012 into this observational study in China, India, Malaysia, Republic of Korea, Singapore, Thailand and Viet Nam. Sites were required to enrol a minimum of 10 consecutive participants who had been hospitalized for an acute coronary syndrome. Catastrophic health expenditure was defined as out-of-pocket costs of initial hospitalization > 30% of annual baseline household income, and it was assessed six weeks after discharge. We assessed associations between health expenditure and age, sex, diagnosis of the index coronary event and health insurance status of the participant, using logistic regression models. FINDINGS Of 12,922 participants, 9370 (73%) had complete data on expenditure. The mean out-of-pocket cost was 3237 United States dollars. Catastrophic health expenditure was reported by 66% (1984/3007) of those without insurance versus 52% (3296/6366) of those with health insurance (P < 0.05). The occurrence of catastrophic expenditure ranged from 80% (1055/1327) in uninsured and 56% (3212/5692) of insured participants in China, to 0% (0/41) in Malaysia. CONCLUSION Large variation exists across Asia in catastrophic health expenditure resulting from hospitalization for acute coronary syndromes. While insurance offers some protection, substantial numbers of people with health insurance still incur financial catastrophe.
Collapse
Affiliation(s)
- Stephen Jan
- George Institute for Global Health, King George V Building, 83-117 Missenden Road, Camperdown, NSW 2050, Australia
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | | | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|