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Kumar D, Bardooli F, Chen WJ, Huang D, Sankardas MA, Ahmed WH, Liew HB, Gwon HC, Van Dorn B, Holmes T, Thompson A, Zhang S. Risk factors for mortality in post-myocardial infarction patients: insights from the improve SCA bridge study. Egypt Heart J 2024; 76:72. [PMID: 38849606 PMCID: PMC11161447 DOI: 10.1186/s43044-024-00505-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 06/01/2024] [Indexed: 06/09/2024] Open
Abstract
BACKGROUND Underutilization of implantable cardioverter defibrillators (ICD) to prevent sudden cardiac death (SCD) in post-myocardial infarction (MI) patients remains an issue across several geographies. A better understanding of risk factors for SCD in post-MI patients from regions with low ICD adoption rates will help identify those who will benefit from an ICD. This analysis assessed risk factors for all-cause and cardiovascular-related mortality in post-MI patients from the Improve Sudden Cardiac Arrest (SCA) Bridge Trial. RESULTS For the entire cohort, the overall 1-year mortality rate was 5.9% (88/1491) and 3.4% (51/1491) for all-cause and cardiovascular mortality, respectively, with 76.5% of all cardiac deaths being from SCD. A multivariate model determined increased age, reduced left ventricular ejection fraction (LVEF), increased time from myocardial infarction to hospital admission, being female, being from Southeast Asia (SEA), and having coronary artery disease to be significant risk factors for all-cause mortality. The risk factors for cardiovascular-related mortality revealed increased age, reduced LVEF, and being from SEA as significant risk factors. CONCLUSIONS We show several characteristics as being predictors of cardiovascular-related mortality in post-MI patients from the Improve SCA Bridge study. Patients who experience an MI and present with these characteristics would benefit from a referral to an electrophysiologist for further SCD risk stratification and management and possible subsequent ICD implantation to reduce unnecessary death.
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Affiliation(s)
- Dileep Kumar
- Mohammed Bin Khalifa Specialist Cardiac Centre, Awali, Bahrain.
- Phoenix Hospital, Abu Dhabi, United Arab Emirates.
| | - Fawaz Bardooli
- Mohammed Bin Khalifa Specialist Cardiac Centre, Awali, Bahrain
| | | | - Dejia Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | - Houng-Bang Liew
- Queen Elizabeth Hospital II Clinical Research Centre, Sabah, Malaysia
| | - Hyeon-Cheol Gwon
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | - Shu Zhang
- Fu Wai Hospital Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, Mainland, China
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Dong Y, Song X, Bo D, Wang H, Yang B, Yadav N, Chen Q, Xu R, Chen H, Ju W, Cao K, Chen M, Zhang F. Catheter ablation versus antiarrhythmic drug therapy for sustained ventricular tachycardia in patients with hypertrophic cardiomyopathy. BMC Cardiovasc Disord 2024; 24:255. [PMID: 38755595 PMCID: PMC11097463 DOI: 10.1186/s12872-024-03924-w] [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: 11/08/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Ventricular tachycardia (VT) is the primary cause of sudden cardiac death in patients with hypertrophic cardiomyopathy (HCM). However, the strategy for VT treatment in HCM patients remains unclear. This study is aimed to compare the effectiveness of catheter ablation versus antiarrhythmic drug (AAD) therapy for sustained VT in patients with HCM. METHODS A total of 28 HCM patients with sustained VT at 4 different centers between December 2012 and December 2021 were enrolled. Twelve underwent catheter ablation (ablation group) and sixteen received AAD therapy (AAD group). The primary outcome was VT recurrence during follow-up. RESULTS Baseline characteristics were comparable between two groups. After a mean follow-up of 31.4 ± 17.5 months, the primary outcome occurred in 35.7% of the ablation group and 90.6% of the AAD group (hazard ratio [HR], 0.29 [95%CI, 0.10-0.89]; P = 0.021). No differences in hospital admission due to cardiovascular cause (25.0% vs. 71.0%; P = 0.138) and cardiovascular cause-related mortality/heart transplantation (9.1% vs. 50.6%; P = 0.551) were observed. However, there was a significant reduction in the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation in ablation group as compared to that of AAD group (42.9% vs. 93.7%; HR, 0.34 [95% CI, 0.12-0.95]; P = 0.029). CONCLUSIONS In HCM patients with sustained VT, catheter ablation reduced the VT recurrence, and the composite endpoint of VT recurrence, hospital admission due to cardiovascular cause, cardiovascular cause-related mortality, or heart transplantation as compared to AAD.
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MESH Headings
- Humans
- Tachycardia, Ventricular/diagnosis
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/therapy
- Tachycardia, Ventricular/etiology
- Tachycardia, Ventricular/surgery
- Anti-Arrhythmia Agents/therapeutic use
- Anti-Arrhythmia Agents/adverse effects
- Catheter Ablation/adverse effects
- Catheter Ablation/mortality
- Male
- Female
- Middle Aged
- Cardiomyopathy, Hypertrophic/mortality
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/physiopathology
- Cardiomyopathy, Hypertrophic/surgery
- Cardiomyopathy, Hypertrophic/therapy
- Treatment Outcome
- Recurrence
- Time Factors
- Adult
- Retrospective Studies
- Risk Factors
- Aged
- Heart Rate
- China
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Affiliation(s)
- Yan Dong
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Xudong Song
- Department of Cardiology, ZhuJiang Hospital of Southern Medical University, Guangzhou, China
| | - Dan Bo
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Hongtao Wang
- Department of Cardiology, the Second Affiliated Hospital of Xi'an JiaoTong University, Xi'an, China
| | - Bo Yang
- Department of Cardiology, the First Hospital of Lanzhou University, Lanzhou, China
| | - Nishant Yadav
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Qiushi Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Ruochen Xu
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Hongwu Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Weizhu Ju
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Kejiang Cao
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Minglong Chen
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029
| | - Fengxiang Zhang
- Section of Pacing and Electrophysiology, Division of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, PR China, Guangzhou Road 300, 210029.
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Egas D, Rodriguez F, Jaswal A, Jeilan M, Milasinovic G, Al Fagih A. Burden of bradycardia and barriers to accessing bradycardia therapy in underserved countries. Eur Heart J Suppl 2023; 25:H1-H17. [PMID: 38046890 PMCID: PMC10689927 DOI: 10.1093/eurheartjsupp/suad125] [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] [Indexed: 12/05/2023]
Abstract
Bradycardia, a condition characterized by an abnormally slow heart rate, poses significant challenges in terms of diagnosis and treatment. While it is a concern world-wide, low- and middle-income countries (LMICs) face substantial barriers in accessing appropriate bradycardia therapy. This article aims to explore the global aetiology and incidence of bradycardia, compare the prevalence and management of the condition in high-income countries versus LMICs, identify the key reasons behind the disparities in access to bradycardia therapy in LMICs, and emphasize the urgent need to address these disparities to ensure equitable healthcare on a global scale.
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Affiliation(s)
- Diego Egas
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
- PUCE-TEC Technologies, Pontifical Catholic University of Ecuador, Quito 170143, Ecuador
| | - Francisco Rodriguez
- Impulso Especialistas en Enfermedades Cardíacas, Department of Cardiology and Electrophysiology, Metropolitano Hospital of Quito, Ecuador, Medical Towers Metropolitano Hospital, Office 214, Quito 170135, Ecuador
| | - Aparna Jaswal
- Department of Cardiac Pacing & Electropysiology, Fortis Escorts Heart Institute, New Delhi, Delhi 110025, India
| | - Mohamed Jeilan
- Section of Cardiology, Aga Khan University Hospital, Box 30270, Nairobi, Kenya
| | - Goran Milasinovic
- Referral Pacemaker Center, Clinical Centre of Serbia, 11000 Belgrade, Serbia
| | - Ahmed Al Fagih
- Electrophysiology Division, Prince Sultan Cardiac Center, As Sulimaniyah, Riyadh 13213, Saudi Arabia
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