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Wang S, Zhang Y, Qi D, Wang X, Zhu Z, Yang W, Li M, Hu D, Gao C. Age shock index and age-modified shock index are valuable bedside prognostic tools for postdischarge mortality in ST-elevation myocardial infarction patients. Ann Med 2024; 56:2311854. [PMID: 38325361 PMCID: PMC10851812 DOI: 10.1080/07853890.2024.2311854] [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: 09/21/2023] [Accepted: 01/25/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND The incidence of mortality is considerable after ST-elevation myocardial infarction (STEMI) hospitalization; risk assessment is needed to guide postdischarge management. Age shock index (SI) and age modified shock index (MSI) were described as useful prognosis instruments; nevertheless, their predictive effect on short and long-term postdischarge mortality has not yet been sufficiently confirmed. METHODS This analysis included 3389 prospective patients enrolled from 2016 to 2018. Endpoints were postdischarge mortality within 30 days and from 30 days to 1 year. Hazard ratios (HRs) were evaluated by Cox proportional-hazards regression. Predictive performances were assessed by area under the curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI) and decision curve analysis (DCA) and compared with TIMI risk score and GRACE score. RESULTS The AUCs were 0.753, 0.746 for age SI and 0.755, 0.755 for age MSI for short- and long-term postdischarge mortality. No significant AUC differences and NRI were observed compared with the classic scores; decreased IDI was observed especially for long-term postdischarge mortality. Multivariate analysis revealed significantly higher short- and long-term postdischarge mortality for patients with high age SI (HR: 5.44 (2.73-10.85), 5.34(3.18-8.96)), high age MSI (HR: 4.17(1.78-9.79), 5.75(3.20-10.31)) compared to counterparts with low indices. DCA observed comparable clinical usefulness for predicting short-term postdischarge mortality. Furthermore, age SI and age MSI were not significantly associated with postdischarge prognosis for patients who received fibrinolysis. CONCLUSIONS Age SI and age MSI were valuable instruments to identify high postdischarge mortality with comparable predictive ability compared with the classic scores, especially for events within 30 days after hospitalization.
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Affiliation(s)
- Shan Wang
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - You Zhang
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Datun Qi
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Xianpei Wang
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhongyu Zhu
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Yang
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Muwei Li
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
| | - Dayi Hu
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Institute of Cardiovascular Disease, Peking University People’s Hospital, Beijing, China
| | - Chuanyu Gao
- Department of Cardiology, Heart Center of Henan Provincial People’s Hospital, Central China Fuwai Hospital, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
- Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China
- Henan Key Lab for Prevention and Control of Coronary Heart Disease, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, China
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Yokoyama M, Iyama K, Honda T, Maekawa K, Baba K, Akashi R, Hayakawa K, Maemura K, Tasaki O. Attitude of Emergency Medical Technicians Toward Electrocardiogram - Needs of Electrocardiogram Training Courses and Other Learning Opportunities. Circ J 2024; 88:1315-1321. [PMID: 37704439 DOI: 10.1253/circj.cj-23-0469] [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: 09/15/2023]
Abstract
BACKGROUND Early intervention in prehospital settings is important for treating patients with acute coronary syndrome (ACS). Emergency medical technicians (EMTs) are the essential first responders who treat these patients, and their current attitudes towards electrocardiograms (ECGs) have not been identified. This study investigated the awareness of EMTs of ECGs to shorten hospital arrival time, improving patient prognosis.Methods and Results: An anonymous questionnaire survey, with 27 statements about ECG and ACS response, was administered to 395 EMTs. The statements were related to interest, motivation, learning status, confidence, and norms pertaining to ECGs, a sense of perceived behavioral control, and training courses. The primary outcome was the perception of EMTs that their interpretation of an ECG affected patient prognosis (Statement [S] 1). Participants assigned scores for each statement using a scale ranging from 1 (strongly disagree) to 10 (strongly agree). The mean score for S1 was 7.09. Mean scores for statements regarding confidence and learning status were 3.96 and 3.53, respectively. The participants had a positive impression of training courses (score >5.5). CONCLUSIONS The EMTs experience was that their interpretation of an ECG could affect the prognosis of patients with ACS. Conversely, they lacked confidence reading ECGs, but were willing to attend ECG training courses. Therefore, efficient training programs need to be established to achieve a better prognosis for ACS patients.
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Affiliation(s)
| | - Keita Iyama
- Acute and Critical Care Center, Nagasaki University Hospital
- Department of Cardiovascular Medicine, Nagasaki Habor Medical Center
| | | | | | - Kensho Baba
- Department of Cardiovascular Medicine, Nagasaki Habor Medical Center
| | - Ryohei Akashi
- Department of Cardiovascular Medicine, Nagasaki University Hospital
| | - Koichi Hayakawa
- Acute and Critical Care Center, Nagasaki University Hospital
- Emergency and Critical Care Center, Nagasaki Habor Medical Center
| | - Koji Maemura
- Department of Cardiovascular Medicine, Nagasaki University Hospital
| | - Osamu Tasaki
- Acute and Critical Care Center, Nagasaki University Hospital
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Saha A, Li S, de Lemos JA, Pandey A, Bhatt DL, Fonarow GC, Nallamothu BK, Wang TY, Navar AM, Peterson E, Matsouaka RA, Bavry AA, Das SR, Grodin JL, Khera R, Drazner MH, Kumbhani DJ. Characteristics of High-Performing Hospitals in Cardiogenic Shock Following Acute Myocardial Infarction. Am J Cardiol 2024; 221:19-28. [PMID: 38583700 DOI: 10.1016/j.amjcard.2024.04.002] [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: 10/21/2023] [Revised: 03/06/2024] [Accepted: 04/01/2024] [Indexed: 04/09/2024]
Abstract
Cardiogenic shock after acute myocardial infarction (AMI-CS) carries significant mortality despite advances in revascularization and mechanical circulatory support. We sought to identify the process-based and structural characteristics of centers with lower mortality in AMI-CS. We analyzed 16,337 AMI-CS cases across 440 centers enrolled in the National Cardiovascular Data Registry's Chest Pain-MI Registry, a retrospective cohort database, between January 1, 2015, and December 31, 2018. Centers were stratified across tertiles of risk-adjusted in-hospital mortality rate (RAMR) for comparison. Risk-adjusted multivariable logistic regression was also performed to identify hospital-level characteristics associated with decreased mortality. The median participant age was 66 (interquartile range 57 to 75) years, and 33.0% (n = 5,390) were women. The median RAMR was 33.4% (interquartile range 26.0% to 40.0%) and ranged from 26.9% to 50.2% across tertiles. Even after risk adjustment, lower-RAMR centers saw patients with fewer co-morbidities. Lower-RAMR centers performed more revascularization (92.8% vs 90.6% vs 85.9%, p <0.001) and demonstrated better adherence to associated process measures. Left ventricular assist device capability (odds ratio [OR] 0.78 [0.67 to 0.92], p = 0.002), more frequent revascularization (OR 0.93 [0.88 to 0.98], p = 0.006), and higher AMI-CS volume (OR 0.95 [0.91 to 0.99], p = 0.009) were associated with lower in-hospital mortality. However, several such characteristics were not more frequently observed at low-RAMR centers, despite potentially reflecting greater institutional experience or resources. This may reflect the heterogeneity of AMI-CS even after risk adjustment. In conclusion, low-RAMR centers do not necessarily exhibit factors associated with decreased mortality in AMI-CS, which may reflect the challenges in performing outcomes research in this complex population.
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Affiliation(s)
- Amit Saha
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Shuang Li
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - James A de Lemos
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ambarish Pandey
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Gregg C Fonarow
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Diseases, University of Michigan, Ann Arbor, Michigan
| | - Tracy Y Wang
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Ann Marie Navar
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Eric Peterson
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Roland A Matsouaka
- Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Anthony A Bavry
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Sandeep R Das
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Justin L Grodin
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rohan Khera
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut; Department of Biostatistics, Section of Health Informatics, Yale School of Public Health, New Haven, Connecticut; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Mark H Drazner
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Dharam J Kumbhani
- Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
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Birdal O, İpek E, Saygı M, Doğan R, Pay L, Tanboğa IH. Cluster analysis of clinical, angiographic, and laboratory parameters in patients with ST-segment elevation myocardial infarction. Lipids Health Dis 2024; 23:166. [PMID: 38835073 DOI: 10.1186/s12944-024-02128-7] [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: 01/07/2024] [Accepted: 04/30/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION ST-segment elevation myocardial infarction (STEMI) represents the most harmful clinical manifestation of coronary artery disease. Risk assessment plays a beneficial role in determining both the treatment approach and the appropriate time for discharge. Hierarchical agglomerative clustering (HAC), a machine learning algorithm, is an innovative approach employed for the categorization of patients with comparable clinical and laboratory features. The aim of the present study was to investigate the role of HAC in categorizing STEMI patients and to compare the results of these patients. METHODS A total of 3205 patients who were diagnosed with STEMI at the university hospital emergency clinic between 2015 and 2023 were included in the study. The patients were divided into 2 different phenotypic disease clusters using the HAC method, and their outcomes were compared. RESULTS In the present study, a total of 3205 STEMI patients were included; 2731 patients were in cluster 1, and 474 patients were in cluster 2. Mortality was observed in 147 (5.4%) patients in cluster 1 and 108 (23%) patients in cluster 2 (chi-square P value < 0.01). Survival analysis revealed that patients in cluster 2 had a significantly greater risk of death than patients in cluster 1 did (log-rank P < 0.001). After adjustment for age and sex in the Cox proportional hazards model, cluster 2 exhibited a notably greater risk of death than did cluster 1 (HR = 3.51, 95% CI = 2.71-4.54; P < 0.001). CONCLUSION Our study showed that the HAC method may be a potential tool for predicting one-month mortality in STEMI patients.
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Affiliation(s)
- Oğuzhan Birdal
- Department of Cardiology, Ataturk University, Erzurum, 25240, Turkey.
| | - Emrah İpek
- Department of First Aid and Emergency, Health Services Vocational School, Nisantasi University, Istanbul, 34360, Turkey
| | - Mehmet Saygı
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, 34764, Turkey
| | - Remziye Doğan
- Department of Cardiology, Hisar Intercontinental Hospital, Istanbul, 34764, Turkey
| | - Levent Pay
- Department of Cardiology, Ardahan State Hospital, Ardahan, 75000, Turkey
| | - Ibrahim Halil Tanboğa
- Department of Cardiology and Biostatistics, Nisantasi University, Istanbul, 34360, Turkey
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Yiadom MYAB, Gong W, Bloos SM, Bunney G, Kabeer R, Pasao MA, Rodriguez F, Baugh CW, Mills AM, Gavin N, Podolsky SR, Salazar GA, Patterson B, Mumma BE, Tanski ME, Liu D. Shorter Door-to-ECG Time Is Associated with Improved Mortality in STEMI Patients. J Clin Med 2024; 13:2650. [PMID: 38731180 PMCID: PMC11084706 DOI: 10.3390/jcm13092650] [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: 03/19/2024] [Revised: 04/09/2024] [Accepted: 04/16/2024] [Indexed: 05/13/2024] Open
Abstract
Background: Delayed intervention for ST-segment elevation myocardial infarction (STEMI) is associated with higher mortality. The association of door-to-ECG (D2E) with clinical outcomes has not been directly explored in a contemporary US-based population. Methods: This was a three-year, 10-center, retrospective cohort study of ED-diagnosed patients with STEMI comparing mortality between those who received timely (<10 min) vs. untimely (>10 min) diagnostic ECG. Among survivors, we explored left ventricular ejection fraction (LVEF) dysfunction during the STEMI encounter and recovery upon post-discharge follow-up. Results: Mortality was lower among those who received a timely ECG where one-week mortality was 5% (21/420) vs. 10.2% (26/256) among those with untimely ECGs (p = 0.016), and in-hospital mortality was 6.0% (25/420) vs. 10.9% (28/256) (p = 0.028). Data to compare change in LVEF metrics were available in only 24% of patients during the STEMI encounter and 46.5% on discharge follow-up. Conclusions: D2E within 10 min may be associated with a 50% reduction in mortality among ED STEMI patients. LVEF dysfunction is the primary resultant morbidity among STEMI survivors but was infrequently assessed despite low LVEF being an indication for survival-improving therapy. It will be difficult to assess the impact of STEMI care interventions without more consistent LVEF assessment.
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Affiliation(s)
- Maame Yaa A. B. Yiadom
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA; (G.B.); (R.K.); (M.A.P.)
| | - Wu Gong
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN 37203, USA; (W.G.); (D.L.)
| | - Sean M. Bloos
- Tulane University School of Medicine, 1430 Tulane Ave., New Orleans, LA 70112, USA;
| | - Gabrielle Bunney
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA; (G.B.); (R.K.); (M.A.P.)
| | - Rana Kabeer
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA; (G.B.); (R.K.); (M.A.P.)
| | - Melissa A. Pasao
- Department of Emergency Medicine, Stanford University, 900 Welch Road, Ste 350, Palo Alto, CA 94304, USA; (G.B.); (R.K.); (M.A.P.)
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, 6453 Quarry Rd., Palo Alto, CA 94304, USA;
| | - Christopher W. Baugh
- Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard University, 75 Francis Street, Boston, MA 02115, USA;
| | - Angela M. Mills
- Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, 622 W 168th St., New York, NY 10032, USA;
| | - Nicholas Gavin
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave., New York, NY 10029, USA;
| | - Seth R. Podolsky
- Department of Dean Administration, Oregon Health & Sciences University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA;
| | - Gilberto A. Salazar
- Department of Emergency Medicine Parkland Hospital, University of Texas Southwestern Medical Center—Dallas, 5323 Harry Hines Boulevard E4.300, Dallas, TX 75390, USA;
| | - Brian Patterson
- Department of Emergency Medicine, University of Wisconsin—Madison, 800 University Bay Dr Suite 310, Madison, WI 53705, USA;
| | - Bryn E. Mumma
- Department of Emergency Medicine, University of California at Davis, 2245 45th St., Sacramento, CA 95817, USA
| | - Mary E. Tanski
- Department of Emergency Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd., Portland, OR 97239, USA;
| | - Dandan Liu
- Department of Biostatistics, Vanderbilt University Medical Center, 2525 West End Avenue, Suite 1100, Nashville, TN 37203, USA; (W.G.); (D.L.)
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Mao Q, Zhang X, Yang J, Kong Q, Cheng H, Yu W, Cao X, Li Y, Li C, Liu L, Ding Z. HSPA12A acts as a scaffolding protein to inhibit cardiac fibroblast activation and cardiac fibrosis. J Adv Res 2024:S2090-1232(24)00025-0. [PMID: 38219869 DOI: 10.1016/j.jare.2024.01.012] [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: 09/19/2023] [Revised: 12/12/2023] [Accepted: 01/09/2024] [Indexed: 01/16/2024] Open
Abstract
INTRODUCTION Cardiac fibrosis is the main driver for adverse remodeling and progressive functional decline in nearly all types of heart disease including myocardial infarction (MI). The activation of cardiac fibroblasts (CF) into myofibroblasts is responsible for cardiac fibrosis. Unfortunately, no ideal approach for controlling CF activation currently exists. OBJECTIVES This study investigated the role of Heat shock protein A12A (HSPA12A), an atypical member of the HSP70 family, in CF activation and MI-induced cardiac fibrosis. METHODS Primary CF and Hspa12a knockout mice were used in the experiments. CF activation was indicated by the upregulation of myofibroblast characters including alpha-Smooth muscle actin (αSMA), Collagen, and Fibronectin. Cardiac fibrosis was illustrated by Masson's trichrome and picrosirius staining. Cardiac function was examined using echocardiography. Glycolytic activity was indicated by levels of extracellular lactate and the related protein expression. Protein stability was examined following cycloheximide and MG132 treatment. Protein-protein interaction was examined by immunoprecipitation-immunoblotting analysis. RESULTS HSPA12A displayed a high expression level in quiescent CF but showed a decreased expression in activated CF, while ablation of HSPA12A in mice promoted CF activation and cardiac fibrosis following MI. HSPA12A overexpression inhibited the activation of primary CF through inhibiting glycolysis, while HSPA12A knockdown showed the opposite effects. Moreover, HSPA12A upregulated the protein expression of transcription factor p53, by which mediated the HSPA12A-induced inhibition of glycolysis and CF activation. Mechanistically, this action of HSPA12A was achieved by acting as a scaffolding protein to bind p53 and ubiquitin specific protease 10 (USP10), thereby promoting the USP10-mediated p53 protein stability and the p53-medicated glycolysis inhibition. CONCLUSION The present study provided clear evidence that HSPA12A is a novel endogenous inhibitor of CF activation and cardiac fibrosis. Targeting HSPA12A in CF could represent a promising strategy for the management of cardiac fibrosis in patients.
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Affiliation(s)
- Qian Mao
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiaojin Zhang
- Department of Geriatrics, Jiangsu Provincial Key Laboratory of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Jinna Yang
- Department of Geriatrics, Jiangsu Provincial Key Laboratory of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qiuyue Kong
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Hao Cheng
- Department of Anesthesiology, The First Affiliated Hospital with Wannan Medical College, Wuhu, China
| | - Wansu Yu
- Department of Geriatrics, Jiangsu Provincial Key Laboratory of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Xiaofei Cao
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Yuehua Li
- Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, China
| | - Chuanfu Li
- Departments of Surgery, East Tennessee State University, Johnson City, TN 37614, USA
| | - Li Liu
- Department of Geriatrics, Jiangsu Provincial Key Laboratory of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China; Key Laboratory of Targeted Intervention of Cardiovascular Disease, Collaborative Innovation Center for Cardiovascular Disease Translational Medicine, Nanjing Medical University, China
| | - Zhengnian Ding
- Department of Anesthesiology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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Colantonio LD, Wang Z, Jones J, Dhalwani NN, Shannon ED, Liu C, Kalich BA, Muntner P, Rosenson RS, Bittner V. Low-Density Lipoprotein Cholesterol Testing Following Myocardial Infarction Hospitalization Among Medicare Beneficiaries. JACC. ADVANCES 2024; 3:100753. [PMID: 38939806 PMCID: PMC11198160 DOI: 10.1016/j.jacadv.2023.100753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/26/2023] [Accepted: 10/13/2023] [Indexed: 06/29/2024]
Abstract
Background Low-density lipoprotein cholesterol (LDL-C) is used to guide lipid-lowering therapy after a myocardial infarction (MI). Lack of LDL-C testing represents a missed opportunity for optimizing therapy and reducing cardiovascular risk. Objectives The purpose of this study was to estimate the proportion of Medicare beneficiaries who had their LDL-C measured within 90 days following MI hospital discharge. Methods We conducted a retrospective cohort study of Medicare beneficiaries ≥66 years of age with an MI hospitalization between 2016 and 2020. The primary analysis used data from all beneficiaries with fee-for-service coverage and pharmacy benefits (532,767 MI hospitalizations). In secondary analyses, we used data from a 5% random sample of beneficiaries with fee-for-service coverage without pharmacy benefits (10,394 MI hospitalizations), and from beneficiaries with Medicare Advantage (176,268 MI hospitalizations). The proportion of beneficiaries who had their LDL-C measured following MI hospital discharge was estimated accounting for the competing risk of death. Results In the primary analysis (mean age 76.9 years, 84.4% non-Hispanic White), 29.9% of beneficiaries had their LDL-C measured within 90 days following MI hospital discharge. Among Hispanic, Asian, non-Hispanic White, and non-Hispanic Black beneficiaries, the 90-day postdischarge LDL-C testing was 33.8%, 32.5%, 30.0%, and 26.0%, respectively. Postdischarge LDL-C testing within 90 days was highest in the Middle Atlantic (36.4%) and lowest in the West North Central (23.4%) U.S. regions. In secondary analyses, the 90-day postdischarge LDL-C testing was 26.9% among beneficiaries with fee-for-service coverage without pharmacy benefits, and 28.6% among beneficiaries with Medicare Advantage coverage. Conclusions LDL-C testing following MI hospital discharge among Medicare beneficiaries was low.
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Affiliation(s)
- Lisandro D. Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Zhixin Wang
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jenna Jones
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Nafeesa N. Dhalwani
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Erin D. Shannon
- Center for Observational Research, Amgen Inc, Thousand Oaks, California, USA
| | - Cici Liu
- ICON Clinical Research Inc, Blue Bell, Pennsylvania, USA
| | | | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Robert S. Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vera Bittner
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Rodríguez-Ramos MA, Santos-Medina M, Dueñas-Herrera A, Prohías Martínez JA, Rivas-Estany E. A collaborative approach to develop indicators for quality of care for ST segment Elevation Myocardial Infarction in networks without coronary intervention: A position paper. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:91-100. [PMID: 37599539 DOI: 10.3233/jrs-220057] [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] [Indexed: 08/22/2023]
Abstract
BACKGROUND Data about performance measures (PM) in patients with ST segment Elevation Myocardial Infarction (STEMI) in low- and middle-income countries is really scarce. One of the reasons is the lack of appropriate measures for these scenarios where coronary intervention is not the standard treatment. OBJECTIVE This study aimed to develop a set of PM and quality markers for patients with STEMI in these countries. METHODS Two investigators systematically reviewed existing guidelines and scientific literature to identify potential PM by referring to documents searched through PubMed from 2010 through 2019, using terms "Myocardial Infarction", "STEMI", "quality indicator", and "performance measure". A modified Delphi technique, involving multidisciplinary panel interview, was used. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 5 (highest) during three rounds. All indicators that received a median score ≥4.5, in final round without significant disagreement were included as PM. RESULTS Through the consensus-building process, 84 potential indicators were found, of which 10 were proposed as performance measures and 2 as quality metrics, as follows: Pre-Hospital Electrocardiogram; Patients with reperfusion therapy; Pre-hospital Reperfusion; Ischemic time less than 120 minutes; System delay time less than 90 minutes; In-hospital Mortality; Complete in-hospital Treatment; Complete in-hospital Treatment in patients with Heart Failure; 30 day-Re-admissions; 30 day-mortality; Patients with in-hospital stress test performed; and, Patients included in rehabilitation programs. CONCLUSION This document provides the official set of PM of attention in ST segment Elevation Myocardial Infarction of the Cuban Society of Cardiology and Cuban National Group of Cardiology.
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Affiliation(s)
| | | | - Alfredo Dueñas-Herrera
- Department of Preventive Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | | | - Eduardo Rivas-Estany
- Department of Preventive Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
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Mahmoud MS, Hassan AKM. Adherence to Quality Indicators for ST-Elevation Myocardial Infarction Management: An Egyptian Experience. Curr Probl Cardiol 2024; 49:102035. [PMID: 37586446 DOI: 10.1016/j.cpcardiol.2023.102035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
Coronary artery disease remains a significant health problem, especially in developing countries. Adherence to guideline-directed therapy improves the quality of care. In this study we assessed adherence to quality indicators (QIs) for ST-elevation myocardial infarction (STEMI) management in our center as an example from a developing country. Our study included 870 STEMI patients who were admitted to our center (Assiut University Heart Hospital, Egypt) and eligible for primary percutaneous coronary intervention during the period from January 2022 to December 2022. Fifteen QIs were studied. The results show that our center is closely adherent to STEMI management guidelines. However, the most important gaps were related to time delays. The mean of first medical contact (FMC) to electrocardiogram (ECG) time was 13.2 ± 16.1 minutes and arrival time to ECG time was 12.8 ± 3.9 minutes. The mean of FMC to device time for total patients was 61.2 ± 42.8 minutes. However, that for patients transferred from non-PCI capable center was 108.2 ± 63.5 minutes compared to patients presented directly to our center (mean arrival time to a device was around Mean 49.6 ± 22.5 minutes). This resulted in only 77% of patients having FMC to device time < 90 minutes. Regarding guideline-directed medical therapy, we are adherent by more than 90%. In-hospital mortality was 1.1%. So we conclued that many centers in developing countries are closely adherent to QIs of STEMI management. However, there are still some limitations including delays in transportation, a limited number of primary PCI centers, absence of a well-established network of communication between centers, and financial issues.
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Affiliation(s)
- Marwan S Mahmoud
- Department of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut, Egypt.
| | - Ayman K M Hassan
- Department of Cardiology, Assiut University Heart Hospital, Assiut University, Assiut, Egypt
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10
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Inoue A, Mizobe M, Takahashi J, Funakoshi H. Factors for delays in door-to-balloon time ≤ 90 min in an electrocardiogram triage system among patients with ST-segment elevation myocardial infarction: a retrospective study. Int J Emerg Med 2023; 16:77. [PMID: 37919686 PMCID: PMC10621087 DOI: 10.1186/s12245-023-00562-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Door to balloon time is a crucial factor of mortality in patients with ST-segment elevation myocardial infarction. However, the factors that contribute to failure of achieving door to balloon time ≤ 90 min in an electrocardiogram triage system remain unknown. METHODS This single-center retrospective observational study collected data from consecutive patients with ST-segment elevation myocardial infarction from April 2016 to March 2021. The primary outcome was the failure to achieve door to balloon time ≤ 90 min. A multivariate logistic regression model was performed to predict factors associated with failure to achieve door to balloon time ≤ 90 min. RESULTS In total, 190 eligible patients were included. Of these, the 139 (73.2%) patients with door to balloon time ≤ 90 min were significantly younger compared to those with door to balloon time > 90 min (p = 0.02). However, there was no significant difference in sex and timing of hospital arrival between the door to balloon time ≤ 90 and > 90 min groups. Presence of chest pain and ambulance usage were significantly more frequent in patients with door to balloon time ≤ 90 min (p ≤ 0.01, p = 0.02, respectively). Multivariate analysis showed that absence of chest pain (adjusted odds ratio 4.76; 95% confidence interval, 2.04-11.1; p < 0.01) and non-ambulance usage (adjusted odds ratio 3.53; 95% confidence interval, 1.57-7.94; p < 0.01) are predictive factors of failure to achieve door to balloon time ≤ 90 min. CONCLUSION Patients without chest pain as the chief complaint or non-ambulance usage were significantly associated with the failure to achieve door to balloon time ≤ 90 min.
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Affiliation(s)
- Atsuhito Inoue
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
| | - Michiko Mizobe
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Jin Takahashi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
| | - Hiraku Funakoshi
- Department of Emergency and Critical Care Medicine, Tokyobay Urayasu Ichikawa Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan
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11
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Taniguchi FP, Bernardez-Pereira S, Ribeiro ALP, Morgan L, Curtis AB, Taubert K, Albuquerque DCD, Smith SC, Paola AAVD. A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil. Arq Bras Cardiol 2023; 120:e20230375. [PMID: 38055374 DOI: 10.36660/abc.20230375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/16/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND A Nationwide Initiative to Improve Cardiology Quality: The Best Practice in Cardiology Program in Brazil ACEI/ARB: angiotensin-converting enzyme inhibitor/angiotensin receptor blocker; LVEF: left ventricular ejection fraction; LVSD: left ventricular systolic dysfunction; AF: atrial fibrillation; PT/INR: prothrombin time/international normalized ratio. BACKGROUND Despite significant progress in improving the quality of cardiovascular care, persistent gaps remain in terms of inconsistent adherence to guideline recommendations. OBJECTIVE This study evaluates the effects of implementing a quality improvement program adapted from the American Heart Association's Get with the Guidelines™ initiative on adherence to guideline-directed medical therapy for acute coronary syndrome (ACS), atrial fibrillation (AF), and heart failure (HF). METHODS We examined demographics, quality measures, and short-term outcomes in patients hospitalized with ACS, AF, and HF enrolled in the Best Practice in Cardiology (BPC) Program from 2016 to 2022. RESULTS This study included 12,167 patients in 19 hospitals in Brazil. Mean age was 62.5 [53.8-71] y/o; 61.1% were male, 68.7% had hypertension, 32.0% diabetes mellitus, and 24.1% had dyslipidemia. Composite score had a sustainable performance in the period from baseline to the last quarter: 65.8±36.2% to 73± 31.2% for AF (p=0.024), 81.0± 23.6% to 89.9 ± 19.3% for HF (p<0.001), and from 88.0 ± 19.1 to 91.2 ±14.9 for ACS (p<0.001). CONCLUSIONS The BPC program is a quality improvement program in Brazil in which real-time data, obtained using cardiology guideline metrics, were implemented in a quality improvement program resulting in an overall sustained improvement in AF, HF, and ACS management.
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Affiliation(s)
| | | | | | | | - Anne B Curtis
- University at Buffalo - The State University of New York, Buffalo, New York - EUA
| | | | | | - Sidney C Smith
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina - EUA
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12
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You JS, Cho J, Shin HJ, Beom JH. Baseline eGFR cutoff for increased risk of post-contrast acute kidney injury in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction in the emergency department. PLoS One 2023; 18:e0293598. [PMID: 37883518 PMCID: PMC10602274 DOI: 10.1371/journal.pone.0293598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Acute myocardial infarction is an acute-stage disease that requires prompt diagnosis and treatment. Primary percutaneous coronary intervention (pPCI) for ST-elevation myocardial infarction (STEMI) is a high-risk factor for post-contrast acute kidney injury (PC-AKI). This retrospective cohort study analyzed the data of 754 patients with STEMI who underwent pPCI and were integrated into the Fast Interrogation Rule for STEMI critical pathway program between 2015 and 2019. We aimed to determine the optimal cutoff baseline eGFR for identifying a high risk of PC-AKI after multivariable adjustment with statistically significant risk factors. We also compared the incidence rates of PC-AKI between the previous and current diagnostic criteria. The probability of PC-AKI increased when the baseline estimated glomerular filtration rate (eGFR) was ≤ 79mL/min/1.73 m2. The optimal cutoff baseline eGFR for high risk of PC-AKI was found to be an eGFR of ≤ 61 mL/min/1.73 m2 after multivariable adjustment. The current diagnostic criteria more accurately identified the patient group with impaired renal function. Our results have clinically significant implications for identifying patients at a high risk of developing PC-AKI, especially before and after the use of contrast agents in patients who require PCI for STEMI in the emergency department.
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Affiliation(s)
- Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, Yonsei University College of Medicine, Gangnam Severance Hospital, Seoul, Republic of Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jung Shin
- Department of Biomedical Systems Informatics, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin Ho Beom
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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13
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Vukašinović A, Klisic A, Ostanek B, Kafedžić S, Zdravković M, Ilić I, Sopić M, Hinić S, Stefanović M, Bogavac-Stanojević N, Marc J, Nešković AN, Kotur-Stevuljević J. Redox Status and Telomere-Telomerase System Biomarkers in Patients with Acute Myocardial Infarction Using a Principal Component Analysis: Is There a Link? Int J Mol Sci 2023; 24:14308. [PMID: 37762611 PMCID: PMC10531660 DOI: 10.3390/ijms241814308] [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: 08/04/2023] [Revised: 09/09/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023] Open
Abstract
In the present study, we examined redox status parameters in arterial and venous blood samples, its potential to predict the prognosis of acute myocardial infarction (AMI) patients assessed through its impact on the comprehensive grading SYNTAX score, and its clinical accuracy. Potential connections between common blood biomarkers, biomarkers of redox status, leukocyte telomere length, and telomerase enzyme activity in the acute myocardial infarction burden were assessed using principal component analysis (PCA). This study included 92 patients with acute myocardial infarction. Significantly higher levels of advanced oxidation protein products (AOPP), superoxide anion (O2•-), ischemia-modified albumin (IMA), and significantly lower levels of total oxidant status (TOS) and total protein sulfhydryl (SH-) groups were found in arterial blood than in the peripheral venous blood samples, while biomarkers of the telomere-telomerase system did not show statistical significance in the two compared sample types (p = 0.834 and p = 0.419). To better understand the effect of the examined biomarkers in the AMI patients on SYNTAX score, those biomarkers were grouped using PCA, which merged them into the four the most contributing factors. The "cholesterol-protein factor" and "oxidative-telomere factor" were independent predictors of higher SYNTAX score (OR = 0.338, p = 0.008 and OR = 0.427, p = 0.035, respectively), while the ability to discriminate STEMI from non-STEMI patients had only the "oxidative-telomere factor" (AUC = 0.860, p = 0.008). The results show that traditional cardiovascular risk factors, i.e., high total cholesterol together with high total serum proteins and haemoglobin, are associated with severe disease progression in much the same way as a combination of redox biomarkers (pro-oxidant-antioxidant balance, total antioxidant status, IMA) and telomere length.
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Affiliation(s)
- Aleksandra Vukašinović
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Aleksandra Klisic
- Faculty of Medicine, University of Montenegro, 81000 Podgorica, Montenegro
- Center for Laboratory Diagnostics, Primary Health Care Center, 81000 Podgorica, Montenegro
| | - Barbara Ostanek
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Srdjan Kafedžić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Marija Zdravković
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Ivan Ilić
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Miron Sopić
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Saša Hinić
- Department of Cardiology, Clinical Hospital Center Bezanijska Kosa, 11070 Belgrade, Serbia;
| | - Milica Stefanović
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
| | - Nataša Bogavac-Stanojević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
| | - Janja Marc
- Department of Clinical Biochemistry, Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia; (B.O.); (J.M.)
| | - Aleksandar N. Nešković
- Department of Cardiology, Clinical Hospital Center Zemun, 11070 Belgrade, Serbia; (S.K.); (I.I.); (M.S.); (A.N.N.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jelena Kotur-Stevuljević
- Department of Medical Biochemistry, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia; (A.V.); (M.S.); (N.B.-S.); (J.K.-S.)
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14
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Wang W, Sun Y, Mo DG, Li T, Yao HC. Circulating IGF-1 and IGFBP-2 may be biomarkers for risk stratification in patients with acute coronary syndrome: A prospective cohort study. Nutr Metab Cardiovasc Dis 2023; 33:1740-1747. [PMID: 37414657 DOI: 10.1016/j.numecd.2023.05.030] [Citation(s) in RCA: 1] [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: 02/18/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND AND AIM The involvement of insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein-2 (IGFBP-2) following acute coronary syndrome (ACS) is rarely studied in clinical practice. Therefore, we sought to evaluate the relationship between IGF-1 and IGFBP-2 concentrations at admission and risk stratification based on the Thrombolysis in Myocardial Infarction (TIMI) risk score in patients with ACS. METHODS AND RESULTS In all, 304 patients diagnosed with ACS were included in this study. Plasma IGF-1 and IGFBP-2 were measured using commercially available ELISA kits. The TIMI risk score was calculated and the study population was stratified into high (n = 65), medium (n = 138), and low (n = 101) risk groups. Levels of IGF-1 and IGFBP-2 were analyzed for their predictive ability of risk stratification based on the TIMI risk scores. Correlation analysis showed that IGF-1 levels were negatively correlated with TIMI risk levels (r = -0.144, p = 0.012), while IGFBP-2 levels were significantly and positively correlated with TIMI risk levels (r = 0.309, p < 0.001). In multivariate logistic regression analysis, IGF-1 (odds ratio [OR]: 0.995; 95% confidence interval [CI]: 0.990-1.000; p = 0.043) and IGFBP-2 (OR: 1.002; 95%CI: 1.001-1.003; p < 0.001) were independent predictors of high TIMI risk levels. In receiver operating characteristic curves, the area under the curve values for IGF-1 and IGFBP-2 in the prediction of high TIMI risk levels were 0.605 and 0.723, respectively. CONCLUSIONS IGF-1 and IGFBP-2 levels are excellent biomarkers for risk stratification in patients with ACS, which provides further guidance for clinicians to identify patients at high risk and to lower their risk.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, Shandong, 250012, PR China; Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, 252000, PR China
| | - Ying Sun
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, 252000, PR China
| | - De-Gang Mo
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, 252000, PR China
| | - Tai Li
- Department of Nursing, Liaocheng Vocational & Technical College, Liaocheng, 252000, PR China
| | - Heng-Chen Yao
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, Shandong, 250012, PR China; Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, Shandong, 252000, PR China.
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15
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Yang BSK, Jang M, Lee KJ, Kim BJ, Han MK, Kim JT, Choi KH, Cha JK, Kim DH, Kim DE, Ryu WS, Park JM, Kang K, Lee SJ, Kim JG, Oh MS, Yu KH, Lee BC, Hong KS, Cho YJ, Choi JC, Park TH, Lee KB, Kwon JH, Kim WJ, Sohn SI, Hong JH, Lee J, Lee SH, Lee JS, Lee J, Gorelick PB, Bae HJ. Comparison of Hospital Performance in Acute Ischemic Stroke Based on Mortality and Functional Outcome in South Korea. Circ Cardiovasc Qual Outcomes 2023; 16:554-565. [PMID: 37465993 DOI: 10.1161/circoutcomes.122.009653] [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: 10/05/2022] [Accepted: 06/14/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Recent evidence suggests a correlation between modified Rankin Scale-based measures, an outcome measure commonly used in acute stroke trials, and mortality-based measures used by health agencies in the evaluation of hospital performance. We aimed to examine whether the 2 types of measures are interchangeable in relation to evaluation of hospital performance in acute ischemic stroke. METHODS Five outcome measures, unfavorable functional outcome (3-month modified Rankin Scale score ≥2), death or dependency (3-month modified Rankin Scale score ≥3), 1-month mortality, 3-month mortality, and 1-year mortality, were collected for 8292 individuals who were hospitalized for acute ischemic stroke between January 2014 and May 2015 in 14 hospitals participating in the Clinical Research Collaboration for Stroke in Korea - National Institute of Health registry. Hierarchical regression models were used to calculate per-hospital risk-adjusted outcome rates for each measure. Hospitals were ranked and grouped based on the risk-adjusted outcome rates, and the correlations between the modified Rankin Scale-based and mortality-based ranking and their intermeasure reliability in categorizing hospital performance were analyzed. RESULTS The comparison between the ranking based on the unfavorable functional outcome and that based on 1-year mortality resulted in a Spearman correlation coefficient of -0.29 and Kendall rank coefficient of -0.23, and the comparison of grouping based on these 2 types of ranks resulted in a weighted kappa of 0.123 for the grouping in the top 33%/middle 33%/bottom 33% and 0.25 for the grouping in the top 20%/middle 60%/bottom 20%, respectively. No significant correlation or similarity in grouping capacities were found between the rankings based on the functional outcome measures and those based on the mortality measures. CONCLUSIONS This study shows that regardless of clinical correlation at an individual patient level, functional outcome-based measures and mortality-based measures are not interchangeable in the evaluation of hospital performance in acute ischemic stroke.
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Affiliation(s)
- Bosco Seong Kyu Yang
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Minuk Jang
- Department of Neurology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea (M.-J.)
| | - Keon-Joo Lee
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
- Department of Neurology, Korea University Guro Hospital, Seoul, Republic of Korea (K.-J.L.)
| | - Beom Joon Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Moon-Ku Han
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
| | - Joon-Tae Kim
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Kang-Ho Choi
- Department of Neurology, Chonnam National University Hospital, Gwangju, Republic of Korea (J.-T.K., K.-H.C.)
| | - Jae-Kwan Cha
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Dae-Hyun Kim
- Department of Neurology, Dong-A University Hospital, Busan, Republic of Korea (J.-K.C., D.-H.K.)
| | - Dong-Eog Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.)
| | - Wi-Sun Ryu
- Department of Neurology, Dongguk University Ilsan Hospital, Goyang, Republic of Korea (D.-E.K., W.-S.R.)
| | - Jong-Moo Park
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University, Seoul, Republic of Korea (J.-M.P.)
| | - Kyusik Kang
- Department of Neurology, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul, Republic of Korea (K.K.)
| | - Soo Joo Lee
- Department of Neurology, Eulji University Hospital, Daejeon, Republic of Korea (S.J.L.)
| | - Jae Guk Kim
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Mi-Sun Oh
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Kyung-Ho Yu
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Byung-Chul Lee
- Department of Neurology, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea (J.G.K., M.-S.O., K.-H.Y., B.-C.L.)
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H., Y.-J.C.)
| | - Yong-Jin Cho
- Department of Neurology, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea (K.-S.H., Y.-J.C.)
| | - Jay Chol Choi
- Department of Neurology, Jeju National University Hospital, Republic of Korea (J.C.C.)
| | - Tai Hwan Park
- Department of Neurology, Seoul Medical Center, Republic of Korea (T.H.P.)
| | - Kyung Bok Lee
- Department of Neurology, Soonchunhyang University Hospital, College of Medicine, Seoul, Republic of Korea (K.B.L.)
| | - Jee-Hyun Kwon
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Wook-Joo Kim
- Department of Neurology, Ulsan University Hospital, University of Ulsan College of Medicine, Republic of Korea (J.-H.K., W.-J.K.)
| | - Sung Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Jeong-Ho Hong
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea (S.I.S., J.-H.H.)
| | - Jun Lee
- Department of Neurology, Yeungnam University Medical Center, Daegu, Republic of Korea (J.L.)
| | - Sang-Hwa Lee
- Department of Neurology, Hallym University Chuncheon Sacred Heart Hospital, South Korea (S.-H.L.)
| | - Ji Sung Lee
- Clinical Research Center, Asan Medical Center, Seoul, Republic of Korea (J.S.L.)
| | - Juneyoung Lee
- Department of Biostatistics, Korea University, Seoul (J.L.)
| | - Philip B Gorelick
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL (P.B.G.)
| | - Hee-Joon Bae
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (B.S.K.Y., K.-J.L., B.J.K., M.-K.H., H.-J.B.)
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16
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Kohashi K, Nakano M, Isshiki T, Maeno Y, Tanimoto S, Asano T, Masuda N, Hayashi K, Sasaki S, Shintani Y, Saito T, Kitamura T, Kagiyama K, Oguni T, Ohta M, Miyashita K, Miyazaki I, Tanaka S, Watanabe K, Ogata N. Clinical Efficacy of Pre-Hospital Electrocardiogram Transmission in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction. Int Heart J 2023; 64:535-542. [PMID: 37460322 DOI: 10.1536/ihj.22-633] [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: 08/01/2023]
Abstract
Rapid reperfusion by primary percutaneous coronary intervention (pPCI) is an established strategy for the treatment of patients with ST-segment elevation myocardial infarction (STEMI). Pre-hospital electrocardiogram (PH-ECG) transmission by the emergency medical services (EMS) facilitates timely reperfusion in these patients. However, evidence regarding the clinical benefits of PH-ECG in individual hospitals is limited.This retrospective, observational study investigated the clinical efficacy of PH-ECG in STEMI patients who underwent pPCI. Of a total of 382 consecutive STEMI patients, 237 were enrolled in the study and divided into 2 groups: a PH-ECG group (n = 77) and non-PH-ECG group (n = 160). Door-to-balloon time (D2BT) was significantly shorter in the PH-ECG group (66 [52-80] min), compared to the non-PH-ECG group (70 [57-88] minutes, P = 0.01). The 30-day all-cause mortality rate was 6% in the PH-ECG group, which was significantly lower than that in the non-PH-ECG group (16%) (P = 0.037, hazard ratio [HR]: 0.38, 95% CI: 0.15-0.98). This trend was particularly evident in severely ill patients when stratified by GRACE score.The use of PH-ECG improved the survival rate of STEMI patients undergoing pPCI due to the improved pre-arrival preparation based on the EMS information. Coordination between EMS and PCI-capable institutes is essential for the management of PH-ECG.
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Affiliation(s)
| | | | | | - Yoshio Maeno
- Department of Cardiology, Ageo Central General Hospital
| | | | - Takaaki Asano
- Department of Cardiology, Ageo Central General Hospital
| | - Naoki Masuda
- Department of Cardiology, Ageo Central General Hospital
| | | | | | | | | | | | | | - Tetsuya Oguni
- Department of Cardiology, Ageo Central General Hospital
| | - Masayuki Ohta
- Department of Cardiology, Ageo Central General Hospital
| | | | | | - Sayuri Tanaka
- Department of Cardiology, Ageo Central General Hospital
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Moiz A, Eisenberg MJ. Initiation of Varenicline in People Hospitalized for Acute Coronary Syndrome Who Smoke. Circulation 2023; 147:1869-1871. [PMID: 37335826 DOI: 10.1161/circulationaha.123.064257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- Areesha Moiz
- From the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (A.M., M.J.E.)
| | - Mark J Eisenberg
- From the Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, QC, Canada (A.M., M.J.E.)
- Faculty of Medicine and Health Sciences, Departments of Epidemiology, Biostatistics and Occupational Health, and Division of Cardiology, Jewish General Hospital, McGill University, Montreal, QC, Canada (M.J.E.)
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18
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Qin L, Qi Q, Aikeliyaer A, Hou WQ, Zuo CX, Ma X. Machine learning algorithm can provide assistance for the diagnosis of non-ST-segment elevation myocardial infarction. Postgrad Med J 2023; 99:442-454. [PMID: 37294714 DOI: 10.1136/postgradmedj-2021-141329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/28/2022] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Our aim was to use the constructed machine learning (ML) models as auxiliary diagnostic tools to improve the diagnostic accuracy of non-ST-elevation myocardial infarction (NSTEMI). MATERIALS AND METHODS A total of 2878 patients were included in this retrospective study, including 1409 patients with NSTEMI and 1469 patients with unstable angina pectoris. The clinical and biochemical characteristics of the patients were used to construct the initial attribute set. SelectKBest algorithm was used to determine the most important features. A feature engineering method was applied to create new features correlated strongly to train ML models and obtain promising results. Based on the experimental dataset, the ML models of extreme gradient boosting, support vector machine, random forest, naïve Bayesian, gradient boosting machines and logistic regression were constructed. Each model was verified by test set data, and the diagnostic performance of each model was comprehensively evaluated. RESULTS The six ML models based on the training set all play an auxiliary role in the diagnosis of NSTEMI. Although all models taken for comparison performed differences, the extreme gradient boosting ML model performed the best in terms of accuracy rate (0.95±0.014), precision rate (0.94±0.011), recall rate (0.98±0.003) and F-1 score (0.96±0.007) in NSTEMI. CONCLUSIONS The ML model constructed based on clinical data can be used as an auxiliary tool to improve the accuracy of NSTEMI diagnosis. According to our comprehensive evaluation, the performance of the extreme gradient boosting model was the best.
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Affiliation(s)
- Lian Qin
- Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Quan Qi
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, China
| | - Ainiwaer Aikeliyaer
- Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
| | - Wen Qing Hou
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, China
| | - Chang Xin Zuo
- College of Information Science and Technology, Shihezi University, Shihezi, Xinjiang, China
| | - Xiang Ma
- Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, Urumqi, Xinjiang, China
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Cao Y, Redd MA, Fang C, Mizikovsky D, Li X, Macdonald PS, King GF, Palpant NJ. New Drug Targets and Preclinical Modelling Recommendations for Treating Acute Myocardial Infarction. Heart Lung Circ 2023:S1443-9506(23)00139-7. [PMID: 37230806 DOI: 10.1016/j.hlc.2022.12.015] [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: 09/05/2022] [Revised: 11/28/2022] [Accepted: 12/15/2022] [Indexed: 05/27/2023]
Abstract
Acute myocardial infarction (AMI) is the leading cause of morbidity and mortality worldwide and the primary underlying risk factor for heart failure. Despite decades of research and clinical trials, there are no drugs currently available to prevent organ damage from acute ischaemic injuries of the heart. In order to address the increasing global burden of heart failure, drug, gene, and cell-based regeneration technologies are advancing into clinical testing. In this review we highlight the burden of disease associated with AMI and the therapeutic landscape based on market analyses. New studies revealing the role of acid-sensitive cardiac ion channels and other proton-gated ion channels in cardiac ischaemia are providing renewed interest in pre- and post-conditioning agents with novel mechanisms of action that may also have implications for gene- and cell-based therapeutics. Furthermore, we present guidelines that couple new cell technologies and data resources with traditional animal modelling pipelines to help de-risk drug candidates aimed at treating AMI. We propose that improved preclinical pipelines and increased investment in drug target identification for AMI is critical to stem the increasing global health burden of heart failure.
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Affiliation(s)
- Yuanzhao Cao
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Meredith A Redd
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Chen Fang
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Dalia Mizikovsky
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Xichun Li
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia
| | - Peter S Macdonald
- Cardiopulmonary Transplant Unit, St Vincent's Hospital, Sydney, NSW, Australia
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia; Australian Research Council Centre of Excellence for Innovations in Peptide and Protein Science, The University of Queensland, Brisbane, Qld, Australia
| | - Nathan J Palpant
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Qld, Australia.
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20
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Ozaki AF, Ko DT, Chong A, Fang J, Atzema CL, Austin PC, Stukel TA, Tu K, Udell JA, Naimark D, Booth GL, Jackevicius CA. Prescribing patterns and factors associated with sodium-glucose cotransporter-2 inhibitor prescribing in patients with diabetes mellitus and atherosclerotic cardiovascular disease. CMAJ Open 2023; 11:E494-E503. [PMID: 37311594 DOI: 10.9778/cmajo.20220039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter-2 (SGLT2) inhibitors are cardioprotective agents in patients with type 2 diabetes mellitus and atherosclerotic cardiovascular disease (CVD). Since little is known about their uptake in atherosclerotic CVD, we examined SGLT2 inhibitor prescribing trends and identified potential disparities in prescribing patterns. METHODS We conducted an observational study using linked population-based health data in Ontario, Canada, from April 2016 to March 2020 of patients aged 65 years or older with concomitant type 2 diabetes and atherosclerotic CVD. To examine prevalent prescribing of SGLT2 inhibitors (canagliflozin, dapagliflozin and empagliflozin), we constructed 4 cross-sectional yearly cohorts from Apr. 1 to Mar. 31 (2016/17, 2017/18, 2018/19 and 2019/20). We estimated prevalent SGLT2 inhibitor prescribing by year and by subgroups, and identified factors associated with SGTL2 inhibitor prescribing using multivariable logistic regression. RESULTS There were 208 303 patients in our overall cohort (median age 74.0 yr [interquartile range 68.0-80.0 yr], 132 196 [63.5%] male). Although SGLT2 inhibitor prescribing increased over time, from 7.0% to 20.1%, statin prescribing was initially 10-fold higher and later threefold higher than SGLT2 inhibitor prescribing. In 2019/20, SGLT2 inhibitor prescribing was roughly 50% lower among those aged 75 years or older than among those younger than 75 years (12.9% v. 28.3%, p < 0.001) and in women than in men (15.3% v. 22.9%, p < 0.001). Age 75 years or older, female sex, history of heart failure and kidney disease, and low income were independent factors of lower SGLT2 inhibitor prescribing. Among physician specialists, visits to endocrinologists and family physicians were stronger factors of SGLT2 inhibitor prescribing than cardiologist visits. INTERPRETATION We found that 1 in 5 patients with diabetes and atherosclerotic CVD were prescribed SGLT2 inhibitors in 2019/20, whereas statins were prescribed for 4 of every 5 patients. Although SGLT2 inhibitor prescribing increased over the study period, disparities in adoption by age, sex, socioeconomic status, comorbidities and physician specialty remained.
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Affiliation(s)
- Aya F Ozaki
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Dennis T Ko
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Alice Chong
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Jiming Fang
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Clare L Atzema
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Peter C Austin
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Therese A Stukel
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Karen Tu
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Jacob A Udell
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - David Naimark
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Gillian L Booth
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif
| | - Cynthia A Jackevicius
- University of California, Irvine (Ozaki), Irvine, Calif.; ICES Central (Ko, Chong, Fang, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); University of Toronto (Ko, Atzema, Austin, Stukel, Tu, Udell, Naimark, Booth, Jackevicius); Sunnybrook Health Sciences Centre (Ko, Atzema, Naimark); University Health Network (Tu, Udell, Naimark); Women's College Hospital (Udell, Naimark); Unity Health Toronto (Booth), Toronto, Ont.; Western University of Health Sciences (Jackevicius), Pomona, Calif.; Veterans Affairs Greater Los Angeles Healthcare System (Jackevicius), Los Angeles, Calif.
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Wang W, Yu K, Zhao SY, Mo DG, Liu JH, Han LJ, Li T, Yao HC. The impact of circulating IGF-1 and IGFBP-2 on cardiovascular prognosis in patients with acute coronary syndrome. Front Cardiovasc Med 2023; 10:1126093. [PMID: 36970368 PMCID: PMC10036580 DOI: 10.3389/fcvm.2023.1126093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/22/2023] [Indexed: 03/12/2023] Open
Abstract
BackgroundWhile insulin-like growth factor 1 (IGF-1) exerts a cardioprotective effect in the setting of atherosclerosis, insulin-like growth factor binding protein 2 (IGFBP-2) is involved in metabolic syndrome. Although IGF-1 and IGFBP-2 are known to be predictors for mortality in patients with heart failure, their use in clinic as prognostic biomarkers for acute coronary syndrome (ACS) requires investigation. We evaluated the relationship between IGF-1 and IGFBP-2 levels at admission and the risk of major adverse cardiovascular events (MACEs) in patients with ACS.MethodsA total of 277 ACS patients and 42 healthy controls were included in this prospective cohort study. Plasma samples were obtained and analyzed at admission. Patients were followed for MACEs after hospitalization.ResultsAmong patients who suffered acute myocardial infarction, plasma levels of IGF-1 and IGFBP-2 were lower and higher, respectively, as compared to healthy controls (both p < 0.05). The mean follow-up period was 5.22 (1.0–6.0) months and MACEs incidence was 22.4% (62 of 277 patients). Kaplan–Meier survival analysis revealed that patients with low IGFBP-2 levels had a greater event-free survival rate than patients with high IGFBP-2 levels (p < 0.001). Multivariate Cox proportional hazards analysis revealed IGFBP-2, but not IGF-1, to be a positive predictor of MACEs (hazard ratio 2.412, 95% CI 1.360–4.277; p = 0.003).ConclusionOur findings suggest that high IGFBP-2 levels are associated with the development of MACEs following ACS. Moreover, IGFBP-2 is likely an independent predictive marker of clinical outcomes in ACS.
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Affiliation(s)
- Wei Wang
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, China
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Kang Yu
- Department of Laboratory Medicine, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Shou-Yong Zhao
- Department of Laboratory Medicine, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - De-Gang Mo
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Jia-Hui Liu
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Li-Jinn Han
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
| | - Tai Li
- Department of Nursing, Liaocheng Vocational & Technical College, Liaocheng, China
| | - Heng-Chen Yao
- Department of Cardiology, Liaocheng People's Hospital, Shandong University, Jinan, China
- Department of Cardiology, Liaocheng People's Hospital Affiliated to Shandong First Medical University, Liaocheng, China
- Correspondence: Heng-Chen Yao
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22
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Gao G, Zheng T, Lan B, Hui W, Chen S, Yuan Z, Wu Y, Chiang JYL, Chen T. Effect of in-hospital evolocumab therapy on lipoprotein(a) in patients with acute myocardial infarction: a retrospective cohort study and a propensity score matching analysis. CARDIOLOGY PLUS 2023; 8:46-52. [PMID: 37187811 PMCID: PMC10179980 DOI: 10.1097/cp9.0000000000000036] [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: 12/12/2022] [Accepted: 02/25/2023] [Indexed: 03/29/2023] Open
Abstract
Elevated lipoprotein(a) is associated with an increased risk of atherosclerotic cardiovascular disease. Evolocumab, a proprotein convertase subtilisin/kexin type 9 inhibitor, has been shown to reduce lipoprotein(a). However, the effect of evolocumab on lipoprotein(a) in patients with acute myocardial infarction (AMI) is poorly studied. This study aims to investigate the change in lipoprotein(a) under evolocumab therapy in patients with AMI. Methods This retrospective cohort analysis included a total of 467 AMI patients with LDL-C level >2.6 mmol/L upon admission, among whom 132 received in-hospital evolocumab (140 mg every 2 weeks) plus statin (20 mg atorvastatin or 10 mg rosuvastatin per day) and the remaining 335 received statin only. Lipid profiles at 1-month follow-up were compared between the two groups. A propensity score matching analysis was also conducted based on age, sex, and baseline lipoprotein(a) at a 1:1 ratio using a 0.02 caliper. Results At the 1-month follow-up, the lipoprotein(a) level decreased from 27.0 (17.5, 50.6) mg/dL to 20.9 (9.4, 52.5) mg/dL in evolocumab plus statin group, but increased from 24.5 (13.2, 41.1) mg/dL to 27.9 (14.8, 58.6) mg/dL in statin only group. The propensity score matching analysis included 262 patients (131 in each group). In subgroup analysis of the propensity score matching cohort stratified by the baseline lipoprotein(a) at cutoff values of 20 and 50 mg/dL, the absolute change in lipoprotein(a) was -4.9 (-8.5, -1.3), -5.0 (-13.9, 1.9), -0.2 (-9.9, 16.9) mg/dL in three subgroups in evolocumab plus statin group, and 0.9 (-1.7, 5.5), 10.7 (4.6, 21.9), 12.2 (2.9, 35.6) mg/dL in three subgroups in statin only group. In comparison to statin only group, evolocumab plus statin group had lower lipoprotein(a) level at 1 month in all subgroups (P < 0.05). Conclusions In-hospital initiation of evolocumab on a background statin therapy reduced lipoprotein(a) level at 1-month follow-up in patients with AMI. Evolocumab plus statin therapy inhibited the increase in lipoprotein(a) in statin only therapy, regardless of the baseline lipoprotein(a) level.
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Affiliation(s)
- Ge Gao
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Tao Zheng
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Beidi Lan
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Weiying Hui
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Shi Chen
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Zuyi Yuan
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - Yue Wu
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
| | - John Y. L. Chiang
- Integrative Medical Sciences, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Tao Chen
- Department of Cardiology, the First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
- Key Laboratory of Environment and Genes Related to Diseases, Ministry of Education, Xi’an Jiaotong University, Xi’an 710061, China
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23
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Sakagami A, Soeda T, Saito Y, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Dai K, Morita T, Shimizu W, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Wake M, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Tobaru T, Saku K, Oshima S, Miyamoto Y, Ogawa H, Ishihara M. Clinical impact of beta-blockers at discharge on long-term clinical outcomes in patients with non-reduced ejection fraction after acute myocardial infarction. J Cardiol 2023; 81:83-90. [PMID: 35995686 DOI: 10.1016/j.jjcc.2022.08.002] [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] [Received: 03/28/2022] [Revised: 07/12/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Beta-blockers are associated with several clinical benefits in patients with reduced left ventricular ejection fraction (REF) after acute myocardial infarction (AMI), such as lower rates of mortality, recurrence of myocardial infarction, and heart failure. However, the long-term prognosis of beta-blockers has rarely been investigated in patients with non-REF after AMI. This study aimed to investigate the clinical benefits of beta-blockers in these patients. METHODS A total of 3281 consecutive patients who were hospitalized within 48 h after AMI were registered in the J-MINUET study. Patients who underwent primary percutaneous coronary intervention (PCI) and had a left ventricular ejection fraction ≥40 % were enrolled, and patients who died during admission were excluded. Included patients were divided into two groups according to the prescription of beta-blockers at discharge. Their characteristics and clinical outcomes were compared. RESULTS The number of AMI patients treated with beta-blockers was 1353 (70.4 %). Patients who received beta-blockers were younger and had a higher incidence of hypertension, dyslipidemia, and ST-segment elevation myocardial infarction than those who did not receive beta-blockers. The peak creatine kinase level after primary PCI was significantly higher in patients who received beta-blockers. These patients also had a lower incidence of a composite of all-cause death, myocardial infarction, and stroke compared to those that did not receive beta-blockers (7.3 % vs. 11.9 %, p = 0.001). Multivariate analysis showed that beta-blocker use was an independent factor for better clinical outcomes. CONCLUSIONS The J-MINUET study revealed the clinical benefit of beta-blockers in AMI patients with non-REF after primary PCI.
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Affiliation(s)
- Azusa Sakagami
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan.
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Japan
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan
| | - Kazuo Kimura
- Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University, Sagamihara, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kazuteru Fujimoto
- Department of Cardiology, National Hospital Organization, Kumamoto Medical Center, Kumamoto, Japan
| | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takashi Morita
- Division of Cardiology, Osaka General Medical Center, Osaka, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan
| | - Atsushi Hirohata
- Department of Cardiovascular Medicine, The Sakakibara Heart Institute of Okayama, Okayama, Japan
| | - Yasuhiro Morita
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Teruo Inoue
- Center for Advanced Medical Science Research, Dokkyo Medical University, Tochigi, Japan
| | - Atsunori Okamura
- Department of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | - Toshiaki Mano
- Cardiovascular Center, Kansai Rosai Hospital, Amagasaki, Japan
| | - Minoru Wake
- Department of Cardiology, Okinawa Chubu Hospital, Uruma, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Yoshisato Shibata
- Department of Cardiology, Miyazaki Medical Association Hospital, Miyazaki, Japan
| | - Mafumi Owa
- Department of Cardiovascular Medicine, Suwa Red Cross Hospital, Suwa, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Hiroshi Funayama
- Division of Cardiovascular Medicine, Saitama Medical Center Jichi Medical University, Saitama, Japan
| | - Nobuaki Kokubu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University, Sapporo, Japan
| | - Ken Kozuma
- Department of Cardiology, Teikyo University, Tokyo, Japan
| | - Shiro Uemura
- Department of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Tetsuya Tobaru
- Department of Cardiology, Sakakibara Heart Institute, Tokyo, Japan
| | - Keijiro Saku
- Department of Cardiology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shigeru Oshima
- Department of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masaharu Ishihara
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Kanaoka K, Iwanaga Y, Nakai M, Nishioka Y, Myojin T, Kubo S, Okada K, Soeda T, Noda T, Sakata Y, Miyamoto Y, Saito Y, Imamura T. Hospital- and Patient-Level Analysis of Quality Indicators in Acute Coronary Syndrome Care: A Nationwide Database Study. Can J Cardiol 2022; 39:515-523. [PMID: 36503027 DOI: 10.1016/j.cjca.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND This study aimed to clarify the variations in the quality of care provided to patients with acute coronary syndrome (ACS) and to investigate the association between quality of care and mortality at both hospital and patient levels with the use of a nationwide database. METHODS Patients with ACS who underwent percutaneous coronary intervention (PCI) from April 2014 to March 2018 were included from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. Twelve quality indicators (QIs) available from administrative data and the association of the QIs with all-cause mortality were investigated. RESULTS From the analysis of 216,436 patients from 1215 hospitals, adherence to PCI on admission day, aspirin use on arrival, P2Y12 inhibitor use, and left ventricular function assessment were high (median proportion > 90%), and adherence to outpatient cardiac rehabilitation was low (median proportion < 10%). At the hospital level, acute-phase composite QI score was associated with reduced risk-adjusted 30-day mortality (β = -0.92 [95% confidence interval -1.19 to -0.65]; P < 0.001). At the patient level, all acute-phase and subacute-phase QIs were inversely associated with 30-day and 2-year mortalities, respectively (all P < 0.001). CONCLUSIONS Substantial variations in ACS care were observed in the current nationwide database. High adherence to the QI sets was associated with significant survival gains at both hospital and patient levels. Multilevel approach in QI assessment may be effective for improvement of survival in this population.
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Affiliation(s)
- Koshiro Kanaoka
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Yoshitaka Iwanaga
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michikazu Nakai
- Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yuichi Nishioka
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan; Department of Transformative System for Medical Information, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tsunenari Soeda
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yoshihiro Miyamoto
- Open Innovation Center, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshihiko Saito
- Department of Cardiovascular Medicine, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management, and Policy, Nara Medical University, Kashihara, Nara, Japan.
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Kontos MC, de Lemos JA, Deitelzweig SB, Diercks DB, Gore MO, Hess EP, McCarthy CP, McCord JK, Musey PI, Villines TC, Wright LJ. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2022; 80:1925-1960. [PMID: 36241466 PMCID: PMC10691881 DOI: 10.1016/j.jacc.2022.08.750] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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26
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Kobo O, Moledina SM, Mohamed MO, Sinnarajah A, Simon J, Sun LY, Slawnych M, Fischman DL, Roguin A, Mamas MA. Palliative Care Use in Patients With Acute Myocardial Infarction and Do-Not-Resuscitate Status From a Nationwide Inpatient Cohort. Mayo Clin Proc 2022; 98:569-578. [PMID: 36372598 DOI: 10.1016/j.mayocp.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To examine the predictors, treatments, and outcomes of the use of palliative care in patients hospitalized with acute myocardial infarction (AMI) who had a do-not-resuscitate (DNR) order. PATIENTS AND METHODS Using the National (Nationwide) Inpatient Sampling database for 2015-2018, we examined the predictors, in-hospital procedures, and outcomes of palliative care recipients among patients with AMI who had a DNR order. RESULTS We identified 339,270 admissions with AMI that had a DNR order, including patients who received palliative care (n=113,215 [33.4%]). Compared with patients who did not receive palliative care, these patients were more frequently younger (median age, 81 vs 83 years; P<.001), were less likely to be female (50.9% [57,626 of 113,215] vs 54.7% [123,652 of 226,055]; P<.001), and were more likely to present with cardiac arrest (11.6% [13,133 of 113,215] vs 6.9% [15,598 of 226,055]; P<.001). Patients were more likely to receive palliative care at a large (odds ratio [OR], 1.47; 95% CI, 1.44 to 1.50) or teaching (OR, 2.10; 95% CI, 2.04 to 2.16) hospitals compared with small or rural ones. Patients receiving palliative care were less likely to be treated invasively, with reduced rates of invasive coronary angiography (OR, 0.46; 95% CI, 0.45 to 0.47) and percutaneous coronary intervention (OR, 0.47; 95% CI, 0.45 to 0.48), and were more likely to die in the hospital (52.4% [59,325 of 113,215] vs 22.9% [51,766 of 226,055]). CONCLUSION In patients who had a DNR status and were hospitalized and received a diagnosis of AMI, only one-third received palliative care.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel; Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Saadiq M Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK
| | | | - Jessica Simon
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Slawnych
- Libin Cardiovascular Institute and Division of Palliative Care, University of Calgary, Calgary, Alberta, Canada; Department of Oncology, University of Calgary, Calgary, Alberta, Canada
| | - David L Fischman
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Keele University, Keele, UK; Department of Cardiology, Thomas Jefferson University, Philadelphia, PA.
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27
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Mo DG, Wang CS, Liu JH, Li T. The predictive value of eosinophil levels on no-reflow in patients with STEMI following PCI: a retrospective cohort study. Sci Rep 2022; 12:17862. [PMID: 36284176 PMCID: PMC9596413 DOI: 10.1038/s41598-022-22988-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/21/2022] [Indexed: 01/20/2023] Open
Abstract
In patients with acute ST-elevation myocardial infarction (STEMI), it is essential to restore myocardial perfusion as soon as possible. However, a considerable proportion of patients have no-reflow. No-reflow increases the risk of major adverse cardiac events and even death. The role of blood eosinophil count in predicting no-reflow in STEMI patients has not been determined, particularly after primary percutaneous coronary intervention (pPCI). The present study aimed to evaluate the predictive value of eosinophil counts for no-reflow in patients with STEMI who underwent pPCI. A total of 674 STEMI patients who underwent pPCI were enrolled. The subjects were divided into two groups according to eosinophil counts for primary analysis and with or without T2DM for secondary analysis. Logistic regression analysis was used to determine whether eosinophil count was an independent predictor of no-reflow in the entire cohort, and subgroup and receiver operating characteristic (ROC) curves were explored to evaluate its predictive value. DeLong's test was used to compare the area under curves of the three ROC curves. The low eosinophil count was an independent predictor for no-reflow in whole cohort (adjusted OR: 2.012, 95% CI 1.242-3.259, p = 0.004) and in patients with T2DM (adjusted OR: 4.312, 95% CI 1.878-9.900, p = 0.001). In patients without T2DM, hemoglobin, but not low eosinophil count, was an independent predictor of no-reflow. The results of the ROC curve analysis revealed that a low eosinophil count had moderate predictive efficiency for predicting no-reflow in patients with T2DM, and the power was superior to all populations and patients without T2DM. Our data suggest that decreased eosinophil count was an independent risk factor for no-reflow in patients with STEMI who underwent pPCI, especially in T2DM patients, which provides guidance for clinicians to identify patients at a higher risk of developing no-reflow and lowering their risk.
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Affiliation(s)
- De-Gang Mo
- grid.460018.b0000 0004 1769 9639Department of Cardiology, Shandong First Medical University, Jinan, 250118 People’s Republic of China
| | - Chun-Song Wang
- grid.415912.a0000 0004 4903 149XDepartment of Cardiology, Liaocheng People’s Hospital Affiliated to Shandong First Medical University, Liaocheng, 252000 People’s Republic of China
| | - Jia-Hui Liu
- grid.460018.b0000 0004 1769 9639Department of Cardiology, Shandong First Medical University, Jinan, 250118 People’s Republic of China
| | - Tai Li
- Department of Nursing, Liaocheng Vocational and Technical College, Liaocheng, 252000 People’s Republic of China
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Clinical Characteristics and In-Hospital Mortality in Patients with STEMI during the COVID-19 Outbreak in Thailand. Biomedicines 2022; 10:biomedicines10112671. [PMID: 36359191 PMCID: PMC9688010 DOI: 10.3390/biomedicines10112671] [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: 09/22/2022] [Revised: 10/15/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Nowadays, current evidence on the effects of the COVID-19 outbreak on ST-elevation myocardial infarction (STEMI) patients is discrepant. The aim of this study was to compare and identify any changes in STEMI patients between the pre-COVID-19 period and during the COVID-19 outbreak. Methods: We conducted a retrospective cohort study to evaluate consecutive STEMI patients admitted from 1 September 2018 to 30 September 2021. We designated 14 March 2020 as the commencement of the COVID-19 outbreak in Thailand. Results: A total of 513 consecutive STEMI patients were included in this study: 330 (64%) admitted during the pre-COVID-19 outbreak period and 183 (36%) admitted during the COVID-19 outbreak. There was a significant 45% decline in the number of STEMI cases admitted during the COVID-19 outbreak period. During the outbreak, STEMI patients had significantly increased intra-aortic balloon pump (IABP) insertion (23% vs. 15%, p-value = 0.004), higher high-sensitivity troponin T level (11,150 vs. 5213, p-value < 0.001), and lower pre- and post-PCI TIMI flow. The time-to-diagnosis (59 vs. 7 min, p-value < 0.001), pain-to-first medical contact (FMC) time (250 vs. 214 min, p-value = 0.020), FMC-to-wire-crossing time (39 vs. 23 min, p-value < 0.001), and pain-to-wire-crossing time (292 vs. 242 min, p-value = 0.005) were increased in STEMI patients during the outbreak compared with pre-outbreak. There was no statistical difference in in-hospital mortality between both periods (p-value = 0.639). Conclusions: During the COVID-19 outbreak, there was a significant decline in the total number of admitted STEMI cases. Unfortunately, the time-to-diagnosis, pain-to-FMC time, FMC-to-wire-crossing time, and pain-to-wire-crossing time were significantly delayed during the COVID-19 outbreak. However, in-hospital mortality showed no significant differences between these two time periods. Highlights: 45% decline in the number of STEMI cases admitted and a significant delay in the treatment timeline during the COVID-19 outbreak. In-hospital mortality showed no significant difference between these two periods. Our study will motivate healthcare professionals to optimize treatments, screenings, and infectious control protocols to reduce the time from the onset of chest pain to wire crossing in STEMI patients during the outbreak.
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Tschugguel W. A transitive perspective on the relief of psychosomatic symptoms. Front Psychol 2022; 13:821566. [PMID: 36317186 PMCID: PMC9616690 DOI: 10.3389/fpsyg.2022.821566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
A key element of successful psychotherapy for the treatment of psychosomatic disorders is that patients recognize and change the meaning of their experiences. Such changes are brought about by appropriate verbal referencing of symptoms currently experienced within a given narrative. The present theoretical paper argues that changes are not based on better, more adaptive narratives per se, but on the transition (or linkage) process itself that is experienced between different narratives. This view is theoretically justified in various ways: first, it is accounted for through contemporary spatiotemporal neuroscience, which aims to connect mental and structural aspects via a common dynamic property or, according to Northoff, the "common currency" of a brain's orientation along its embeddedness in its contextual world, i.e., body and environment. Second, it is justified through the physics concept of "spontaneous symmetry breaking," which is used analogously to "suffering from symptoms." If the sufferer is willing to experience a process of "going back," that is, moving away from the previous narrative (or aspect) by verbally relating to the felt aspects of the symptom in question (i.e., approaching its meaning), they are moving toward symmetry or an underlying dynamic alignment with their world context. Clinical predictions are derived from the theoretical arguments.
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Affiliation(s)
- Walter Tschugguel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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30
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Huang X, Yang S, Chen X, Zhao Q, Pan J, Lai S, Ouyang F, Deng L, Du Y, Chen J, Hu Q, Guo B, Liu J. Development and validation of a clinical predictive model for 1-year prognosis in coronary heart disease patients combine with acute heart failure. Front Cardiovasc Med 2022; 9:976844. [PMID: 36312262 PMCID: PMC9609152 DOI: 10.3389/fcvm.2022.976844] [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: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The risk factors for acute heart failure (AHF) vary, reducing the accuracy and convenience of AHF prediction. The most common causes of AHF are coronary heart disease (CHD). A short-term clinical predictive model is needed to predict the outcome of AHF, which can help guide early therapeutic intervention. This study aimed to develop a clinical predictive model for 1-year prognosis in CHD patients combined with AHF. Materials and methods A retrospective analysis was performed on data of 692 patients CHD combined with AHF admitted between January 2020 and December 2020 at a single center. After systemic treatment, patients were discharged and followed up for 1-year for major adverse cardiovascular events (MACE). The clinical characteristics of all patients were collected. Patients were randomly divided into the training (n = 484) and validation cohort (n = 208). Step-wise regression using the Akaike information criterion was performed to select predictors associated with 1-year MACE prognosis. A clinical predictive model was constructed based on the selected predictors. The predictive performance and discriminative ability of the predictive model were determined using the area under the curve, calibration curve, and clinical usefulness. Results On step-wise regression analysis of the training cohort, predictors for MACE of CHD patients combined with AHF were diabetes, NYHA ≥ 3, HF history, Hcy, Lp-PLA2, and NT-proBNP, which were incorporated into the predictive model. The AUC of the predictive model was 0.847 [95% confidence interval (CI): 0.811–0.882] in the training cohort and 0.839 (95% CI: 0.780–0.893) in the validation cohort. The calibration curve indicated good agreement between prediction by nomogram and actual observation. Decision curve analysis showed that the nomogram was clinically useful. Conclusion The proposed clinical prediction model we have established is effective, which can accurately predict the occurrence of early MACE in CHD patients combined with AHF.
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Affiliation(s)
- Xiyi Huang
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Shaomin Yang
- Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Qiang Zhao
- Department of Cardiovascular Medicine, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Shaofen Lai
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Jiacheng Chen
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,*Correspondence: Baoliang Guo,
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,Jiemei Liu,
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Zhao X, Zhao G, Zhou M, Wang G, Ma C, Smith SC, Fonarow GC, Morgan L, Que B, Ai H, Liu J, Zhao D, Nie S. Early ACEI/ARB use and in-hospital outcomes of acute myocardial infarction patients with systolic blood pressure <100 mmHg and undergoing percutaneous coronary intervention: Findings from the CCC-ACS project. Front Cardiovasc Med 2022; 9:1003442. [PMID: 36247421 PMCID: PMC9558728 DOI: 10.3389/fcvm.2022.1003442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/05/2022] [Indexed: 12/05/2022] Open
Abstract
Background Few studies have evaluated whether acute myocardial infarction (AMI) patients with relatively low blood pressure benefit from early ACEI/ARB use in the era of percutaneous coronary intervention (PCI). Objectives This study evaluated the associations of ACEI/ARB use within 24 h of admission with in-hospital outcomes among AMI patients with SBP < 100 mmHg and undergoing PCI. Methods This study was based on the Improving Care for Cardiovascular Disease in China-ACS project, a collaborative registry and quality improvement project of the American Heart Association and the Chinese Society of Cardiology. Between November 2014 and December 2019, a total of 94,623 patients with AMI were enrolled. Of them, 4,478 AMI patients with SBP < 100 mmHg and undergoing PCI but without clinically diagnosed cardiogenic shock at admission were included. Multivariable logistic regression and propensity score-matching analysis were used to evaluate the association between early ACEI/ARB use and in-hospital major adverse cardiac events (MACEs), a combination of all-cause death, cardiogenic shock, and cardiac arrest. Results Of AMI patients, 24.41% (n = 1,093) were prescribed ACEIs/ARBs within 24 h of admission. Patients with early ACEI/ARB use had a significantly lower rate of MACEs than those without ACEI/ARB use (1.67% vs. 3.66%, p = 0.001). In the logistic regression analysis, early ACEI/ARB use was associated with a 45% lower risk of MACEs (odds ratio: 0.55, 95% CI: 0.33-0.93; p = 0.027). Further propensity score-matching analysis still showed that patients with early ACEI/ARB use had a lower rate of MACEs (1.96% vs. 3.93%, p = 0.009). Conclusion This study found that among AMI patients with an admission SBP < 100 mmHg undergoing PCI, early ACEI/ARB use was associated with better in-hospital outcomes. Additional studies of the early use of ACEIs/ARBs in AMI patients with relatively low blood pressure are warranted.
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Affiliation(s)
- Xuedong Zhao
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Guanqi Zhao
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Mengge Zhou
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Ge Wang
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Changsheng Ma
- Division of Cardiology, Arrhythmia Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Sidney C. Smith
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gregg C. Fonarow
- Division of Cardiology, Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA, United States
| | - Louise Morgan
- Department of International Quality Improvement, American Heart Association, Dallas, TX, United States
| | - Bin Que
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Hui Ai
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jing Liu
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Dong Zhao
- The Key Laboratory of Remodeling-Related Cardiovascular Diseases, Ministry of Education, Department of Epidemiology, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Capital Medical University, Beijing, China
| | - Shaoping Nie
- Division of Cardiology, Center for Coronary Artery Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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32
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Ho PM, O’Donnell CI, McCreight M, Bavry AA, Bosworth HB, Girotra S, Grossman PM, Helfrich C, Latif F, Lu D, Matheny M, Mavromatis K, Ortiz J, Parashar A, Ratliff DM, Grunwald GK, Gillette M, Jneid H. Multifaceted Intervention to Improve P2Y12 Inhibitor Adherence After Percutaneous Coronary Intervention: A Stepped Wedge Trial. J Am Heart Assoc 2022; 11:e024342. [PMID: 35766258 PMCID: PMC9333389 DOI: 10.1161/jaha.121.024342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background P2Y12 inhibitor medications are critical following percutaneous coronary intervention (PCI); however, adherence remains suboptimal. Our objective was to assess the effectiveness of a multifaceted intervention to improve P2Y12 inhibitor adherence following PCI. Methods and Results This was a modified stepped wedge trial of 52 eligible hospitals, of which 15 were randomly selected and agreed to participate (29 hospitals declined, and 8 eligible hospitals were not contacted). At each intervention hospital, patient recruitment occurred for 6 months and enrolled patients were followed up for 1 year after PCI. Three control groups were used: patients at intervention hospitals undergoing PCI (1) before the intervention period (preintervention); (2) after the intervention period (postintervention); or (3) at the 8 hospitals not contacted (concurrent controls). The intervention consisted of 4 components: (1) P2Y12 inhibitor delivered to patients' bedside after PCI; (2) education on importance of P2Y12 inhibitors; (3) automated reminder telephone calls to refill medication; and (4) outreach to patients if they delayed refilling P2Y12 inhibitor. The primary outcomes were as follows: (1) proportion of patients with delays filling P2Y12 inhibitor at hospital discharge and (2) proportion of patients who were adherent in the year after PCI using pharmacy refill data. Primary analysis compared intervention with preintervention control patients. There were 1377 (intent-to-treat) potentially eligible patients, of whom 803 (per protocol) were approached at intervention sites versus 5910 preintervention, 2807 postintervention, and 4736 concurrent control patients. In the intent-to-treat analysis, intervention patients were less likely to delay filling P2Y12 at hospital discharge (-3.4%; 98.3% CI, -1.2% to -5.6%) and more likely to be adherent to P2Y12 (4.1%; 98.3% CI, 1.0%-7.1%) at 1 year, but had more clinical events (3.2%; 98.3% CI, 2.3%-4.1%) driven by repeated PCI compared with preintervention patients. In post hoc analysis looking at myocardial infarction, stroke, and death, intervention patients had lower event rates compared with preintervention patients (-1.7%; 98.3% CI, -2.3% to -1.1%). Conclusions A 4-component intervention targeting P2Y12 inhibitor adherence was difficult to implement. The intervention produced mixed results. It improved P2Y12 adherence, but there was also an increase in repeat PCI. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01609842.
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Affiliation(s)
- P. Michael Ho
- Cardiology SectionRocky Mountain Regional VA Medical CenterAuroraCO,Department of MedicineUniversity of Colorado School of MedicineAuroraCO,Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Marina McCreight
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO
| | | | - Hayden B. Bosworth
- Departments of Population Health Science, Medicine, Psychiatry, School of NursingDuke University School of MedicineDurhamNC,Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)Durham VAMCDurhamNC
| | - Saket Girotra
- University of Iowa Carver College of MedicineIowa CityIA,Iowa City Veterans Affairs Medical CenterIowa CityIA
| | | | - Christian Helfrich
- Seattle‐Denver Center of Innovation for Veteran Centered and Value Driven CarePuget Sound Health Care SystemSeattleWA
| | - Faisal Latif
- Oklahoma City VA Health Care SystemOklahoma CityOK,University of Oklahoma Health Sciences CenterOklahoma CityOK
| | - David Lu
- Washington DC VA Medical CenterWashingtonDC
| | - Michael Matheny
- Geriatric ResearchEducation, and Clinical Care CenterTennessee Valley Healthcare System VANashvilleTN,Department of Biomedical InformaticsVanderbilt University Medical CenterNashvilleTN
| | | | - Jose Ortiz
- VA Northeast Ohio Healthcare SystemClevelandOH
| | - Amitabh Parashar
- Virginia Tech Carilion School of MedicineRoanokeVA,Salem VA Medical CenterSalemVA
| | | | - Gary K. Grunwald
- Denver‐Seattle Center of Innovation for Veteran Centered and Value Driven CareRocky Mountain Regional VA Medical CenterAuroraCO,University of Colorado School of Public HealthAuroraCO
| | - Michael Gillette
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
| | - Hani Jneid
- Baylor College of MedicineHoustonTX,Michael E. DeBakey VA Medical CenterHoustonTX
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Shoji S, Yamaji K, Sandhu AT, Ikemura N, Shiraishi Y, Inohara T, Heidenreich PA, Amano T, Ikari Y, Kohsaka S. Regional variations in the process of care for patients undergoing percutaneous coronary intervention in Japan. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100425. [PMID: 35308578 PMCID: PMC8928076 DOI: 10.1016/j.lanwpc.2022.100425] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Measuring the quality of care has been central for improving the outcomes of patients undergoing percutaneous coronary intervention (PCI). This study described the performance rates and regional variations in quality metrics for PCI using a representative national Japanese registry. Methods Overall, 760,854 patients across 714 institutions (2016-2018) were analysed. Quality metrics included preprocedural antiplatelet therapy use, door-to-balloon time ≤90 min for ST-elevation myocardial infarction, transradial approach, and preprocedural noninvasive stress testing for elective cases in 47 Japanese prefectures. Coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) were also evaluated. Factors associated with preprocedural testing rates were evaluated using multivariable linear regression. Findings Rates of preprocedural antiplatelet therapy use were high with low variations (96·4% [94·7-97·2%]), but there was still substantial room for improvement in the rates of door-to-balloon time (74·7% [71·2-78·9%]) and transradial approach use (70·9% [65·1-73·4%]). Rates of preprocedural noninvasive stress testing were low with substantial variation (36·6% [27·1-49·7%]). Additionally, we found substantial variations in CCTA (50·0% [39·5-55·1%]) and FFR measurement (15·7% [113·-18·3%]) rates. The number of scintigraphy scanners/ prefecture was associated with the performance of noninvasive stress testing (13·4% [95% CI, 2·45-24·4%] increase for every 1/100,000 population increase in scanners). Interpretations We observed substantial regional variation in the use of preprocedural testing, and its performance was directly related to nuclear-scanner availability. These findings suggest the need for targeted efforts in improving testing rates, whether by optimising resource allocation or additional education or feedback mechanisms. Funding This study was funded by the Japan Society for the Promotion of Science (Grant Nos. 20H03915, 16H05215, 16KK0186, and 20K22883) and by the Ministry of Health, Labor and Welfare Grants-in-Aid for Scientific Research Program (Grant No. 21FA1015). The J-PCI registry is led and supported by the Japanese Association of Cardiovascular Intervention and Therapeutics.
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Affiliation(s)
- Satoshi Shoji
- Department of Cardiology, Hino Municipal Hospital, Tokyo, Japan
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Alexander T. Sandhu
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA
| | - Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yasuyuki Shiraishi
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Taku Inohara
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Paul A. Heidenreich
- Department of Medicine, Division of Cardiovascular Medicine, Stanford, CA, USA
- Medical Service, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Aichi, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Kanagawa, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Corresponding author.
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Rana JS, Virani SS, Moffet HH, Liu JY, Coghlan LA, Vasadia J, Ballantyne CM, Karter AJ. Association of Low-Density Lipoprotein Testing After an Atherosclerotic Cardiovascular Event with Subsequent Statin Adherence and Intensification. Am J Med 2022; 135:603-606. [PMID: 34861203 PMCID: PMC9081243 DOI: 10.1016/j.amjmed.2021.11.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aimed to evaluate associations between outpatient low-density lipoprotein cholesterol (LDL-C) testing and subsequent statin adherence and intensification in patients after an atherosclerotic cardiovascular (ASCVD) event. METHODS This was a longitudinal study of adult members of Kaiser Permanente Northern California hospitalized with an ASCVD event (myocardial infarction or stroke) during January 01, 2016, to December 31, 2017, with follow-up through December 31, 2019. Outcomes were statin adherence (estimated using continuous medication gap [CMG]) and intensification (defined by an increased dose or switch to a higher-intensity statin) based on pharmacy dispensing. The exposure of interest was first outpatient LDL-C test after an ASCVD event. Baseline for follow-up was LDL-C test date or a date assigned using incidence density sampling. Multivariate logistic regression models were specified to estimate the odds ratios for statin adherence or intensification among those with vs without an LDL-C test, with adjustment for age, sex, race/ethnicity, smoking, hypertension, diabetes, body mass index, and estimated glomerular filtration rate. RESULTS There were 19,604 adults hospitalized with ASCVD, including 7054 adults not on high-intensity statins. The mean age was 69.5 years and 33.0% were female. Prevalence of good adherence (continuous medication gap ≤20%) was significantly higher (80.2% vs 75.9%; odds ratio 1.38; 95% confidence interval, 1.28-1.49; P <.001) among participants who had an LDL-C test compared with participants who did not. LDL-C testing was associated with significantly higher rates of treatment intensification (16.1% vs 10.7%; odds ratio 1.51; 95% confidence interval,1.29-1.76; P <0.001). CONCLUSIONS Low-density lipoprotein cholesterol testing is recommended for patients with a history of ASCVD and may be a high-value and low-cost intervention to improve adherence and statin management.
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Affiliation(s)
- Jamal S Rana
- Department of Cardiology, Kaiser Permanente Northern California, Oakland; Division of Research, Kaiser Permanente Northern California, Oakland; Department of Medicine, University of California San Francisco.
| | - Salim S Virani
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
| | - Howard H Moffet
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Jennifer Y Liu
- Division of Research, Kaiser Permanente Northern California, Oakland
| | - Landis A Coghlan
- Department of Adult and Family Medicine, Kaiser Permanente Northern California, Santa Clara
| | - Jitesh Vasadia
- Department of Cardiology, Kaiser Permanente Northern California, Santa Rosa
| | - Christie M Ballantyne
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Tex; Michael E. DeBakey Veterans Affairs Medical Center, Houston, Tex
| | - Andrew J Karter
- Division of Research, Kaiser Permanente Northern California, Oakland; Department of Health Systems and Population Health, University of Washington, Seattle, Calif; Department of General Internal Medicine, University of California, San Francisco
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Li L, Zhang X, Wang Y, Yu X, Jia H, Hou J, Li C, Zhang W, Yang W, Liu B, Lu L, Tan N, Yu B, Li K. A Novel Risk Score to Predict In-Hospital Mortality in Patients With Acute Myocardial Infarction: Results From a Prospective Observational Cohort. Front Cardiovasc Med 2022; 9:840485. [PMID: 35463775 PMCID: PMC9021415 DOI: 10.3389/fcvm.2022.840485] [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: 12/21/2021] [Accepted: 02/18/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives The aim of this study was to develop and validate a novel risk score to predict in-hospital mortality in patients with acute myocardial infarction (AMI) using the Heart Failure after Acute Myocardial Infarction with Optimal Treatment (HAMIOT) cohort in China. Methods The HAMIOT cohort was a multicenter, prospective, observational cohort of consecutive patients with AMI in China. All participants were enrolled between December 2017 and December 2019. The cohort was randomly assigned (at a proportion of 7:3) to the training and validation cohorts. Logistic regression model was used to develop and validate a predictive model of in-hospital mortality. The performance of discrimination and calibration was evaluated using the Harrell’s c-statistic and the Hosmer-Lemeshow goodness-of-fit test, respectively. The new simplified risk score was validated in an external cohort that included independent patients with AMI between October 2019 and March 2021. Results A total of 12,179 patients with AMI participated in the HAMIOT cohort, and 136 patients were excluded. In-hospital mortality was 166 (1.38%). Ten predictors were found to be independently associated with in-hospital mortality: age, sex, history of percutaneous coronary intervention (PCI), history of stroke, presentation with ST-segment elevation, heart rate, systolic blood pressure, initial serum creatinine level, initial N-terminal pro-B-type natriuretic peptide level, and PCI treatment. The c-statistic of the novel simplified HAMIOT risk score was 0.88, with good calibration (Hosmer–Lemeshow test: P = 0.35). Compared with the Global Registry of Acute Coronary Events risk score, the HAMIOT score had better discrimination ability in the training (0.88 vs. 0.81) and validation (0.82 vs. 0.72) cohorts. The total simplified HAMIOT risk score ranged from 0 to 121. The observed mortality in the HAMIOT cohort increased across different risk groups, with 0.35% in the low risk group (score ≤ 50), 3.09% in the intermediate risk group (50 < score ≤ 74), and 14.29% in the high risk group (score > 74). Conclusion The novel HAMIOT risk score could predict in-hospital mortality and be a valid tool for prospective risk stratification of patients with AMI. Clinical Trial Registration [https://clinicaltrials.gov], Identifier: [NCT03297164].
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Affiliation(s)
- Lulu Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiling Zhang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yini Wang
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xi Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haibo Jia
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Chunjie Li
- Department of Emergency, Tianjin Chest Hospital, Tianjin, China
| | - Wenjuan Zhang
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Wei Yang
- Department of Cardiology, Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin Liu
- Department of Cardiology, The Second Hospital of Jilin University, Changchun, China
| | - Lixin Lu
- Department of Cardiology, Daqing Long Nan Hospital, Daqing, China
| | - Ning Tan
- Department of Cardiology, Guangdong General Hospital, Guangzhou, China
| | - Bo Yu
- Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China
- Bo Yu,
| | - Kang Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, Harbin, China
- *Correspondence: Kang Li,
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Tertulien T, Roberts MB, Eaton CB, Cene CW, Corbie-Smith G, Manson JE, Allison M, Nassir R, Breathett K. Association between race/ethnicity and income on the likelihood of coronary revascularization among postmenopausal women with acute myocardial infarction: Women's health initiative study. Am Heart J 2022; 246:82-92. [PMID: 34998968 PMCID: PMC8918000 DOI: 10.1016/j.ahj.2021.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 11/22/2021] [Accepted: 12/25/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Historically, race, income, and gender were associated with likelihood of receipt of coronary revascularization for acute myocardial infarction (AMI). Given public health initiatives such as Healthy People 2010, it is unclear whether race and income remain associated with the likelihood of coronary revascularization among women with AMI. METHODS Using the Women's Health Initiative Study, hazards ratio (HR) of revascularization for AMI was compared for Black and Hispanic women vs White women and among women with annual income <$20,000/year vs ≥$20,000/year over median 9.5 years follow-up(1993-2019). Proportional hazards models were adjusted for demographics, comorbidities, and AMI type. Results were stratified by revascularization type: percutaneous coronary intervention and coronary artery bypass grafting(CABG). Trends by race and income were compared pre- and post-2010 using time-varying analysis. RESULTS Among 5,284 individuals with AMI (9.5% Black, 2.8% Hispanic, and 87.7% White; 23.2% <$20,000/year), Black race was associated with lower likelihood of receiving revascularization for AMI compared to White race in fully adjusted analyses [HR:0.79(95% Confidence Interval:[CI]0.66,0.95)]. When further stratified by type of revascularization, Black race was associated with lower likelihood of percutaneous coronary intervention for AMI compared to White race [HR:0.72(95% CI:0.59,0.90)] but not for CABG [HR:0.97(95%CI:0.72,1.32)]. Income was associated with lower likelihood of revascularization [HR:0.90(95%CI:0.82,0.99)] for AMI. No differences were observed for other racial/ethnic groups. Time periods (pre/post-2010) were not associated with change in revascularization rates. CONCLUSION Black race and income remain associated with lower likelihood of revascularization among patients presenting with AMI. There is a substantial need to disrupt the mechanisms contributing to race, sex, and income disparities in AMI management.
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Chen Z, Wu J, Li S, Liu C, Ren Y. Inhibition of Myocardial Cell Apoptosis Is Important Mechanism for Ginsenoside in the Limitation of Myocardial Ischemia/Reperfusion Injury. Front Pharmacol 2022; 13:806216. [PMID: 35300297 PMCID: PMC8921549 DOI: 10.3389/fphar.2022.806216] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/09/2022] [Indexed: 12/25/2022] Open
Abstract
Ischemic heart disease has a high mortality, and the recommended therapy is reperfusion. Nevertheless, the restoration of blood flow to ischemic tissue leads to further damage, namely, myocardial ischemia/reperfusion injury (MIRI). Apoptosis is an essential pathogenic factor in MIRI, and ginsenosides are effective in inhibiting apoptosis and alleviating MIRI. Here, we reviewed published studies on the anti-apoptotic effects of ginsenosides and their mechanisms of action in improving MIRI. Each ginsenoside can regulate multiple pathways to protect the myocardium. Overall, the involved apoptotic pathways include the death receptor signaling pathway, mitochondria signaling pathway, PI3K/Akt signaling pathway, NF-κB signaling pathway, and MAPK signaling pathway. Ginsenosides, with diverse chemical structures, regulate different apoptotic pathways to relieve MIRI. Summarizing the effects and mechanisms of ginsenosides contributes to further mechanism research studies and structure–function relationship research studies, which can help the development of new drugs. Therefore, we expect that this review will highlight the importance of ginsenosides in improving MIRI via anti-apoptosis and provide references and suggestions for further research in this field.
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Affiliation(s)
- Zhihan Chen
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jingping Wu
- Department of Medical Cosmetology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sijing Li
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Caijiao Liu
- School of Acupuncture Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yulan Ren
- School of Chinese Classics, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Ullal AJ, Holmes DN, Lytle BL, Matsouaka RA, Sheng S, Desai NR, Curtis AB, Fang MC, McCabe PJ, Fonarow GC, Russo AM, Lewis WR, Heidenreich PA, Piccini JP, Turakhia MP, Perino AC, On Behalf Of The Gwtg-Afib Working Group. Achievement and quality measure attainment in patients hospitalized with atrial fibrillation: Results from The Get With The Guidelines - Atrial Fibrillation (GWTG-AFIB) registry. Am Heart J 2022; 245:90-99. [PMID: 34932998 DOI: 10.1016/j.ahj.2021.12.002] [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] [Received: 03/08/2021] [Revised: 12/01/2021] [Accepted: 12/08/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND The Get With The Guidelines - Atrial Fibrillation (GWTG-AFIB) Registry uses achievement and quality measures to improve the care of patients with atrial fibrillation (AF). We sought to evaluate overall and site-level variation in attainment of these measures among sites participating in the GWTG-AFIB Registry. METHODS From the GWTG-AFIB registry, we included patients with AF admitted between 1/3/2013 and 6/30/2019. We described patient-level attainment and variation in attainment across sites of 6 achievement measures with 1) defect-free scores (percent of patients with all eligible measures attained), and 2) composite opportunity scores (percent of all eligible patient measures attained). We also described attainment of 11 quality measures at the patient-level. RESULTS Among 80,951 patients hospitalized for AF (age 70±13 years, 47.0% female; CHA2DS2-VASc 3.6±1.8) at 132 sites. Site-level defect-free scores ranged from 4.7% to 85.8% (25th, 50th, 75th percentile: 32.7%, 52.1%, 64.4%). Composite opportunity scores ranged from 39.4% to 97.5% (25th, 50th, 75th: 68.1%, 80.3%, 87.1%). Attainment was notably low for the following quality measures: 1) aldosterone antagonist prescription when ejection fraction ≤35% (29% of those eligible); and 2) avoidance of antiplatelet therapy with OAC in patients without coronary/peripheral artery disease (81% of those eligible). CONCLUSIONS Despite high overall attainment of care measures across GWTG-AFIB registry sites, large site variation was present with meaningful opportunities to improve AF care beyond OAC prescription, including but not limited to prescription of aldosterone antagonists in those with AF and systolic dysfunction and avoidance of non-indicated adjunctive antiplatelet therapy.
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Key Words
- ACC, American College of Cardiology
- AF, atrial fibrillation
- AFL, atrial flutter
- AHA, American Heart Association
- CI, confidence interval, eGFR, estimate glomerular filtration rate
- CKD, chronic kidney disease
- GWTG-AFIB, Get With The Guidelines® – Atrial Fibrillation
- HRS, Heart Rhythm Society
- OAC, oral anticoagulation
- OR, odds ratio
- QI, quality improvement
- atrial fibrillation
- performance
- quality
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Barrabés JA, Soriano-Colomé T, Ferreira-González I. When Time Is Not Muscle, Yet It Still May Be Important. J Am Coll Cardiol 2022; 79:324-326. [DOI: 10.1016/j.jacc.2021.11.037] [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: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
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Abstract
We applied the 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR chest pain guidelines to a case of a 76-year-old woman with no known coronary disease presenting to the emergency department with acute chest pain and an intermediate probability of acute coronary syndrome. Her workup per the guidelines involved rapid electrocardiogram, high-sensitivity troponins, nuclear stress testing, and eventually coronary invasive angiography. (Level of Difficulty: Advanced.)
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Zhao D, Yao C. Pragmatic Clinical Studies: An Emerging Clinical Research Discipline for Improving Evidence-Based Practice of Cardiovascular Diseases in Asia. Korean Circ J 2022; 52:401-413. [PMID: 35656900 PMCID: PMC9160648 DOI: 10.4070/kcj.2022.0100] [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: 03/26/2022] [Accepted: 04/13/2022] [Indexed: 11/11/2022] Open
Abstract
Pragmatic clinical studies, as an emerging clinical research discipline, include a wide range of studies that are largely embedded with routine clinical practice aiming to evaluate comparative effectiveness and safety of different clinical intervention strategies. In this review, we described the evolution of the conceptual framework of pragmatic clinical studies, shared perspectives on the importance of pragmatic clinical studies for cardiovascular diseases as a complement to conventional randomized controlled trials, as well as highlighted the specific importance of pragmatic clinical research in improving evidence-based practice for cardiovascular disease managements in Asia. Pragmatic clinical studies, an emerging clinical research discipline, include a wide range of studies that are largely embedded with routine clinical practice and aim to evaluate the comparative effectiveness and safety of different clinical intervention strategies. Increased availability and quality of electronic medical/health records drives the development of pragmatic clinical studies. In this review, we describe evolution of the conceptual framework of pragmatic clinical studies and share perspectives on the importance of pragmatic clinical studies in evidence-based practice for cardiovascular diseases, as a complement to conventional randomized controlled trials. We also highlight specific needs of pragmatic clinical studies in improving evidence-based practice for cardiovascular disease in Asian countries. The main challenges of pragmatic clinical studies are discussed briefly in this review.
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Affiliation(s)
- Dong Zhao
- Capital Medical University Beijing Anzhen Hospital-Beijing Institute of Heart, Lung & Blood Vessel Diseases, Beijing, China
| | - Chen Yao
- Peking University Clinical Research Institute. Peking University First Hospital, Beijing, China
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Chang KY, Chiu N, Aggarwal R. In-Hospital Mortality for Inpatient Percutaneous Coronary Interventions in the United States. Am J Cardiol 2021; 159:30-35. [PMID: 34503823 DOI: 10.1016/j.amjcard.2021.08.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/18/2022]
Abstract
Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.
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Affiliation(s)
- Katie Y Chang
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Nicholas Chiu
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Rahul Aggarwal
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
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Chen J, Shen J, Cai D, Wei T, Qian R, Zeng C, Lyu L. Estimated plasma volume status (ePVS) is a predictor for acute myocardial infarction in-hospital mortality: analysis based on MIMIC-III database. BMC Cardiovasc Disord 2021; 21:530. [PMID: 34749646 PMCID: PMC8573972 DOI: 10.1186/s12872-021-02338-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Estimated plasma volume status (ePVS) has been reported that associated with poor prognosis in heart failure patients. However, no researchinvestigated the association of ePVS and prognosis in patients with acute myocardial infarction (AMI). Therefore, we aimed to determine the association between ePVS and in-hospital mortality in AMI patients. Methods and results We extracted AMI patients data from MIMIC-III database. A generalized additive model and logistic regression model were used to demonstrate the association between ePVS levels and in-hospital mortality in AMI patients. Kaplan–Meier survival analysis was used to pooled the in-hospital mortality between the various group. ROC curve analysis were used to assessed the discrimination of ePVS for predicting in-hospital mortality. 1534 eligible subjects (1004 males and 530 females) with an average age of 67.36 ± 0.36 years old were included in our study finally. 136 patients (73 males and 63 females) died in hospital, with the prevalence of in-hospital mortality was 8.9%. The result of the Kaplan–Meier analysis showed that the high-ePVS group (ePVS ≥ 5.28 mL/g) had significant lower survival possibility in-hospital admission compared with the low-ePVS group (ePVS < 5.28 mL/g). In the unadjusted model, high-level of ePVS was associated with higher OR (1.09; 95% CI 1.06–1.12; P < 0.001) compared with low-level of ePVS. After adjusted the vital signs data, laboratory data, and treatment, high-level of ePVS were also associated with increased OR of in-hospital mortality, 1.06 (95% CI 1.03–1.09; P < 0.001), 1.05 (95% CI 1.01–1.08; P = 0.009), 1.04 (95% CI 1.01–1.07; P = 0.023), respectively. The ROC curve indicated that ePVS has acceptable discrimination for predicting in-hospital mortality. The AUC value was found to be 0.667 (95% CI 0.653–0.681). Conclusion Higher ePVS values, calculated simply from Duarte’s formula (based on hemoglobin/hematocrit) was associated with poor prognosis in AMI patients. EPVS is a predictor for predicting in-hospital mortality of AMI, and could help refine risk stratification. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02338-2.
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Affiliation(s)
- Jun Chen
- Zhejiang Chinese Medical University, Hangzhou, 310000, Zhejiang, China
| | - Jiayi Shen
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000, Zhejiang, China
| | - Dongsheng Cai
- Zhejiang University of Medical College, Hangzhou, 310000, Zhejiang, China
| | - Tiemin Wei
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000, Zhejiang, China
| | - Renyi Qian
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000, Zhejiang, China
| | - Chunlai Zeng
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000, Zhejiang, China
| | - Lingchun Lyu
- Lishui Central Hospital, The Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, 323000, Zhejiang, China. .,Department of Cardiology, Lishui Central Hospital and The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, 323000, China.
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Tanner MA, Maitz CA, Grisanti LA. Immune cell β 2-adrenergic receptors contribute to the development of heart failure. Am J Physiol Heart Circ Physiol 2021; 321:H633-H649. [PMID: 34415184 PMCID: PMC8816326 DOI: 10.1152/ajpheart.00243.2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
β-Adrenergic receptors (βARs) regulate normal and pathophysiological heart function through their impact on contractility. βARs are also regulators of immune function where they play a unique role depending on the disease condition and immune cell type. Emerging evidence suggests an important role for the β2AR subtype in regulating remodeling in the pathological heart; however, the importance of these responses has never been examined. In heart failure, catecholamines are elevated, leading to chronic βAR activation and contributing to the detrimental effects in the heart. We hypothesized that immune cell β2AR plays a critical role in the development of heart failure in response to chronic catecholamine elevations through their regulation of immune cell infiltration. To test this, chimeric mice were generated by performing bone marrow transplant (BMT) experiments using wild-type (WT) or β2AR knockout (KO) donors. WT and β2ARKO BMT mice were chronically administered the βAR agonist isoproterenol. Immune cell recruitment to the heart was examined by histology and flow cytometry. Numerous changes in immune cell recruitment were observed with isoproterenol administration in WT BMT mice including proinflammatory myeloid populations and lymphocytes with macrophages made up the majority of immune cells in the heart and which were absent in β2ARKO BMT animal. β2ARKO BMT mice had decreased cardiomyocyte death, hypertrophy, and interstitial fibrosis following isoproterenol treatment, culminating in improved function. These findings demonstrate an important role for immune cell β2AR expression in the heart's response to chronically elevated catecholamines.NEW & NOTEWORTHY Immune cell β2-adrenergic receptors (β2ARs) are important for proinflammatory macrophage infiltration to the heart in a chronic isoproterenol administration model of heart failure. Mice lacking immune cell β2AR have decreased immune cell infiltration to their heart, primarily proinflammatory macrophage populations. This decrease culminated to decreased cardiac injury with lessened cardiomyocyte death, decreased interstitial fibrosis and hypertrophy, and improved function demonstrating that β2AR regulation of immune responses plays an important role in the heart's response to persistent βAR stimulation.
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Affiliation(s)
- Miles A Tanner
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
| | - Charles A Maitz
- Department of Veterinary Medicine and Surgery, University of Missouri, College of Veterinary Medicine, Columbia, Missouri
| | - Laurel A Grisanti
- Department of Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, Missouri
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Raparelli V, Pilote L, Dang B, Behlouli H, Dziura JD, Bueno H, D’Onofrio G, Krumholz HM, Dreyer RP. Variations in Quality of Care by Sex and Social Determinants of Health Among Younger Adults With Acute Myocardial Infarction in the US and Canada. JAMA Netw Open 2021; 4:e2128182. [PMID: 34668947 PMCID: PMC8529414 DOI: 10.1001/jamanetworkopen.2021.28182] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
IMPORTANCE Quality of care of young adults with acute myocardial infarction (AMI) may depend on health care systems in addition to individual-level factors such as biological sex and social determinants of health (SDOH). OBJECTIVE To examine whether the quality of in-hospital and postacute care among young adults with AMI differs between the US and Canada and whether female sex and adverse SDOH are associated with a low quality of care. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort analysis used data from 2 large cohorts of young adults (aged ≤55 years) receiving in-hospital and outpatient care for AMI at 127 centers in the US and Canada. Data were collected from August 21, 2008, to April 30, 2013, and analyzed from July 12, 2019, to March 10, 2021. EXPOSURES Sex, SDOH, and health care system. MAIN OUTCOMES AND MEASURES Opportunity-based quality-of-care score (QCS), determined by dividing the total number of quality indicators of care received by the total number for which the patient was eligible, with low quality of care defined as the lowest tertile of the QCS. RESULTS A total of 4048 adults with AMI (2345 women [57.9%]; median age, 49 [interquartile range, 44-52] years; 3004 [74.2%] in the US) were included in the analysis. Of 3416 patients with in-hospital QCS available, 1061 (31.1%) received a low QCS, including more women compared with men (725 of 2007 [36.1%] vs 336 of 1409 [23.8%]; P < .001) and more patients treated in the US vs Canada (962 of 2646 [36.4%] vs 99 of 770 [12.9%]; P < .001). Conversely, low quality of post-AMI care (748 of 2938 [25.5%]) was similarly observed for both sexes, with a higher prevalence in the US (678 of 2346 [28.9%] vs 70 of 592 [11.8%]). In adjusted analyses, female sex was not associated with low QCS for in-hospital (odds ratio [OR], 1.05; 95% CI, 0.87-1.28) and post-AMI (OR, 1.07; 95% CI, 0.88-1.30) care. Conversely, being treated in the US was associated with low in-hospital (OR, 2.93; 95% CI, 2.16-3.99) and post-AMI (OR, 2.67; 95% CI, 1.97-3.63) QCS, regardless of sex. Of all SDOH, only employment was associated with higher quality of in-hospital care (OR, 0.72; 95% CI, 0.59-0.88). Finally, only in the US, low quality of in-hospital care was associated with a higher 1-year cardiac readmissions rate (234 of 962 [24.3%]). CONCLUSIONS AND RELEVANCE These findings suggest that beyond sex, health care systems and SDOH that depict social vulnerability are associated with quality of AMI care. Taking into account SDOH among young adults with AMI may improve quality of care and reduce readmissions, especially in the US.
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Affiliation(s)
- Valeria Raparelli
- Department of Translation Medicine, University of Ferrara, Ferrara, Italy
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Louise Pilote
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of Clinical Epidemiology, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
- Division of General Internal Medicine, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Brian Dang
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Centre for Outcomes Research and Evaluation, McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - James D. Dziura
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Hector Bueno
- Centro Nactional de Investigaciones Cardiovasculares, Madrid, Spain
- Cardiology Department, Hospital Universitario 12 de Octubre, Instituto de Investigacion Sanitaria Hospital 12 de Octubre, Madrid, Spain
- Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares, Madrid, Spain
| | - Gail D’Onofrio
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale–New Haven Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Rachel P. Dreyer
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale–New Haven Health, New Haven, Connecticut
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Weng D, Ding J, Sharma A, Yanek L, Xun H, Spaulding EM, Osuji N, Huynh PP, Ogunmoroti O, Lee MA, Demo R, Marvel FA, Martin SS. Heart rate trajectories in patients recovering from acute myocardial infarction: A longitudinal analysis of Apple Watch heart rate recordings. CARDIOVASCULAR DIGITAL HEALTH JOURNAL 2021; 2:270-281. [PMID: 35265918 PMCID: PMC8890343 DOI: 10.1016/j.cvdhj.2021.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Using mobile health, vital signs such as heart rate (HR) can be used to assess a patient’s recovery process from acute events including acute myocardial infarction (AMI). Objective We aimed to characterize clinical correlates associated with HR change in the subacute period among patients recovering from AMI. Methods HR measurements were collected from 91 patients (4447 HR recordings) enrolled in the MiCORE study using the Apple Watch and Corrie smartphone application. Mixed regression models were used to estimate the associations of patient-level characteristics during hospital admission with HR changes over 30 days postdischarge. Results The mean daily HR at admission was 78.0 beats per minute (bpm) (95% confidence interval 76.1 to 79.8), declining 0.2 bpm/day (-0.3 to -0.1) under a linear model of HR change. History of coronary artery bypass graft, history of depression, or being discharged on anticoagulants was associated with a higher admission HR. Having a history of hypertension, type 2 diabetes mellitus (T2DM), or hyperlipidemia was associated with a slower decrease in HR over time, but not with HR during admission. Conclusion While a declining HR was observed in AMI patients over 30 days postdischarge, patients with hypertension, T2DM, or hyperlipidemia showed a slower decrease in HR relative to their counterparts. This study demonstrates the feasibility of using wearables to model the recovery process of patients with AMI and represents a first step in helping pinpoint patients vulnerable to decompensation.
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Affiliation(s)
- Daniel Weng
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jie Ding
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa Yanek
- Department of Medicine, Johns Hopkins University School of Medicine, Biostatistics, Epidemiology, and Data Management Core Faculty, Baltimore, Maryland
| | - Helen Xun
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Erin M. Spaulding
- Johns Hopkins University School of Nursing, Baltimore, Maryland
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Ngozi Osuji
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pauline P. Huynh
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oluseye Ogunmoroti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthias A. Lee
- Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
| | - Ryan Demo
- Johns Hopkins University Whiting School of Engineering, Baltimore, Maryland
| | - Francoise A. Marvel
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Seth S. Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Address reprint requests and correspondence: Dr Seth S. Martin, Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Carnegie 591, 600 N Wolfe St, Baltimore, MD 21287.
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McCarthy CP, Kolte D, Kennedy KF, Pandey A, Raber I, Oseran A, Wadhera RK, Vaduganathan M, Januzzi JL, Wasfy JH. Hospitalizations and Outcomes of T1MI Observed Before and After the Introduction of MI Subtype Codes. J Am Coll Cardiol 2021; 78:1242-1253. [PMID: 34531025 DOI: 10.1016/j.jacc.2021.07.034] [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: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND International Classification of Disease (ICD)-10 coding of type 1 myocardial infarction (MI) is used for reimbursement, value-based programs, and clinical research. OBJECTIVES This study sought to determine whether the introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with changes in hospitalizations for ICD-10 codes now attributed to type 1 MI. METHODS Using the Nationwide Readmissions Database, we identified patients with ICD-10 codes now attributed to type 1 MI between January 2016 and December 2018. Patients were stratified according to the timing of their event in relation to the introduction of the type 2 and types 3-5 MI codes on October 1, 2017. RESULTS There were 2,680,323 hospitalizations for ICD-10 codes now attributed to type 1 MI; after adjustment for seasonality, there was a 13.7% decline in hospitalizations after the introduction of the new subtype codes. Patients with ICD-10 codes now attributed to type 1 MI after the coding change were less likely to be female, had lower prevalence of several cardiovascular and noncardiovascular comorbidities, and had higher rates of coronary angiography and revascularization. After introduction of the new codes, there was a positive deflection in the slope of risk-adjusted in-hospital mortality (0.007%; P <0.001) and a negative deflection in risk-adjusted 30-day readmission (-0.002%; P = 0.05) for patients with ICD-10 codes now attributed to type 1 MI. CONCLUSIONS The introduction of ICD-10 codes for type 2 and types 3-5 MI was associated with a decrease in hospitalizations for ICD-10 codes now attributed to type 1 MI and changes in the observed characteristics and treatment patterns of these patients.
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Affiliation(s)
- Cian P McCarthy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Dhaval Kolte
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kevin F Kennedy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ambarish Pandey
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Inbar Raber
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Oseran
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Rishi K Wadhera
- Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James L Januzzi
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jason H Wasfy
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
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Chacón-Díaz M, Hernández-Vásquez A, Vargas-Fernández R, Bendezu-Quispe G. Study protocol of the PEruvian Registry of ST-segment Elevation Myocardial Infarction II (PERSTEMI-II) study. PLoS One 2021; 16:e0257618. [PMID: 34534262 PMCID: PMC8448363 DOI: 10.1371/journal.pone.0257618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) is the most prevalent cardiovascular disease globally and is considered a public health problem. In Peru, MI is the second leading cause of death at the national level, with a mortality rate that exceeds 10% in the hospital setting. The study aims to determine the clinical and epidemiological characteristics of ST-segment elevation myocardial infarction (STEMI) in tertiary care facilities belonging to the Peruvian public health system. METHODS AND ANALYSIS This will be a prospective, observational, multicenter study, with baseline and two follow-up assessments: at admission to the health service, and 30 days and 12 months after admission. This multicenter study will be conducted in 27 hospitals located in the main cities of Peru. The patients included in the study will be over 18 years of age, of either sex, and will have been admitted to the health facility with a diagnosis of acute coronary syndrome with ST-segment elevation. The Kaplan-Meier method will be used to estimate the cumulative in-hospital mortality of patients at 30 days and 12 months of follow-up, and the log-rank test will be used to evaluate the differences between the survival curves between reperfused and non-reperfused patients. Subsequently, to evaluate the risk factors for successful reperfusion and cardiovascular adverse events, generalized linear models of the binomial family with log link function will be used to estimate the bivariate and multivariate relative risk (RR) with their respective 95% confidence intervals. This project was approved by the Ethics and Research Committee of the National Cardiovascular Institute (Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo"-INCOR [in Spanish]; Approval report 21/2019-CEI). DISCUSSION Among the strengths, the observational design will allow the inclusion of a large sample of patients, which will significantly contribute to the knowledge base on STEMI in Peru. It should be noted that this study is the first to examine the clinical-epidemiological characteristics of STEMI in high-resolution hospital centers in Peru with follow-up one year after the event, providing knowledge of these observable characteristics in daily clinical routine. Likewise, the multicenter nature of the study will increase the external validity of the findings. In terms of limitations, the observational design of the study can only describe associations and not causality. Furthermore, since data from medical records will be used, there could be imprecision in the data.
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Affiliation(s)
| | - Akram Hernández-Vásquez
- Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Guido Bendezu-Quispe
- Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru
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Raparelli V, Benea D, Nunez Smith M, Behlouli H, Murphy TE, D’Onofrio G, Pilote L, Dreyer RP. Impact of Race on the In-Hospital Quality of Care Among Young Adults With Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e021408. [PMID: 34431311 PMCID: PMC8649291 DOI: 10.1161/jaha.121.021408] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022]
Abstract
Background The extent to which race influences in-hospital quality of care for young adults (≤55 years) with acute myocardial infarction (AMI) is largely unknown. We examined racial disparities in in-hospital quality of AMI care and their impact on 1-year cardiac readmission. Methods and Results We used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study enrolling young Black and White US adults with AMI (2008-2012). An in-hospital quality of care score (QCS) was computed (standard AMI quality indicators divided by the total a patient is eligible for). Multivariable logistic regression was performed to identify factors associated with the lowest QCS tertile, including interactions between race and social determinants of health. Among 2846 young adults with AMI (median 48 years [interquartile range 44-52], 67.4% women, 18.8% Black race), Black individuals, especially women, exhibited a higher prevalence of cardiac risk factors and social determinants of health and were more likely to experience a non-ST-segment-elevation myocardial infarction than White individuals. Black individuals were more likely in the lowest QCS tertile than White individuals (40.8% versus 34.7%; P=0.003). The association between Black race and low QCS (odds ratio [OR], 1.25; 95% CI, 1.02-1.54) was attenuated by adjustment for confounders. Employment was independently associated with better QCS, especially among Black participants (OR, 0.76; 95% CI, 0.62-0.92; P-interaction=0.02). Black individuals experienced a higher rate of 1-year cardiac readmission (29.9% versus 20.0%; P<0.0001). Conclusions Black individuals with AMI received lower in-hospital quality of care and exhibited a higher rate of cardiac readmissions than White individuals. Black individuals had a lower quality of care if unemployed, highlighting the intersection of race and social determinants of health.
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Affiliation(s)
- Valeria Raparelli
- Department of Translational MedicineUniversity of FerraraFerraraItaly
- Faculty of NursingUniversity of AlbertaEdmontonAlbertaCanada
| | - Diana Benea
- Centre for Outcomes Research and EvaluationMcGill University Health Centre Research InstituteMontrealQCCanada
| | | | - Hassan Behlouli
- Centre for Outcomes Research and EvaluationMcGill University Health Centre Research InstituteMontrealQCCanada
| | - Terrence E. Murphy
- Program on AgingDepartment of Internal MedicineYale School of MedicineNew HavenCT
| | - Gail D’Onofrio
- Department of Emergency MedicineUniversity School of MedicineNew HavenCT
| | - Louise Pilote
- Centre for Outcomes Research and EvaluationMcGill University Health Centre Research InstituteMontrealQCCanada
- Divisions of Clinical Epidemiology and General Internal MedicineMcGill University Health Centre Research InstituteMontrealQCCanada
| | - Rachel P. Dreyer
- Department of Emergency MedicineUniversity School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale‐New Haven HospitalNew HavenCT
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Pedrosa RBDS, Gallani MCBJ, Rodrigues RCM. Impact of a Theory-based Intervention to Promote Medication Adherence in Patients With a History of Myocardial Infarction. J Cardiovasc Nurs 2021; 37:E1-E10. [PMID: 34483292 DOI: 10.1097/jcn.0000000000000854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient discontinuation of cardioprotective medications after a cardiac ischemic event commonly occurs early after hospital discharge. Theory-based interventions could be effective in promoting better patient self-regulation of health-related behaviors and positive intentions to adhere to the recommended medical regimen. OBJECTIVE The aim of this study was to evaluate the potential efficacy and feasibility of a theory-based intervention to promote adherence to cardioprotective medications. METHODS In this mixed-methods quasi-experimental study with 3 time points, we recruited 45 participants with a positive intention to adhere and a history of myocardial infarction. They were recruited in primary care units in Brazil. Data collection occurred in 2 waves (Tb and T60). The intervention consisted of developing action and coping plans, delivered in a 30-minute face-to-face session, with face-to-face reinforcement at a 30-day interval. Quantitative data were submitted to descriptive, Wilcoxon, and McNemar analyses; qualitative data were submitted to content analysis. RESULTS An increase in the proportion of patients adhering to medications at the end of follow-up was found (T60 - Tb, +60.0%; P < .001). In addition, a significant reduction was found for blood pressure (T60 - Tb, -8.6 mm Hg; P < .001), heart rate (T60 - Tb, -6.6 bpm; P < .001), and low-density lipoprotein (T60 - Tb, -6.2 mg/dL; P < .05). Qualitative results revealed that the intervention was feasible, with an attrition rate of zero. The intervention was found to be easy to apply to patients' daily lives, and there was adequate time for implementation. CONCLUSIONS Our data confirm the potential efficacy of a theory-based intervention on the promotion of adherence to cardioprotective medications and on the related clinical end points, as well as its feasibility in the clinical context (Universal Trial Number: U1111-1189-9967).
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Affiliation(s)
- Rafaela Batista Dos Santos Pedrosa
- Rafaela Batista dos Santos Pedrosa, RN, PhD Professor Doctor, School of Nursing, Universidade Estadual de Campinas, São Paulo, Brazil. Maria Cecília Bueno Jayme Gallani, RN, PhD Professor Titular, Faculté des Sciences Infirmières, Université Laval, Québec City, Québec, Canada. Roberta Cunha Matheus Rodrigues, RN, PhD Professor Titular, School of Nursing, Universidade Estadual de Campinas, São Paulo, Brazil
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