1
|
Zhang KP, Guo QC, Mu N, Liu CH. Establishment and validation of nomogram model for predicting major adverse cardiac events in patients with acute ST-segment elevation myocardial infarction based on glycosylated hemoglobin A1c to apolipoprotein A1 ratio: An observational study. Medicine (Baltimore) 2024; 103:e38563. [PMID: 38875361 PMCID: PMC11175862 DOI: 10.1097/md.0000000000038563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2024] Open
Abstract
The objective of the current study is to assess the usefulness of HbA1cAp ratio in predicting in-hospital major adverse cardiac events (MACEs) among acute ST-segment elevation myocardial infarction (STEMI) patients that have undergone percutaneous coronary intervention (PCI). Further, the study aims to construct a ratio nomogram for prediction with this ratio. The training cohort comprised of 511 STEMI patients who underwent emergency PCI at the Huaibei Miners' General Hospital between January 2019 and May 2023. Simultaneously, 384 patients treated with the same strategy in First People's Hospital of Hefei formed the validation cohort during the study period. LASSO regression was used to screen predictors of nonzero coefficients, multivariate logistic regression was used to analyze the independent factors of in-hospital MACE in STEMI patients after PCI, and nomogram models and validation were established. The LASSO regression analysis demonstrated that systolic blood pressure, diastolic blood pressure, D-dimer, urea, and glycosylated hemoglobin A1c (HbA1c)/apolipoprotein A1 (ApoA1) were significant predictors with nonzero coefficients. Multivariate logistic regression analysis was further conducted to identify systolic blood pressure, D-dimer, urea, and HbA1c/ApoA1 as independent factors associated with in-hospital MACE after PCI in STEMI patients. Based on these findings, a nomogram model was developed and validated, with the C-index in the training set at 0.77 (95% CI: 0.723-0.817), and the C-index in the validation set at 0.788 (95% CI: 0.734-0.841), indicating excellent discrimination accuracy. The calibration curves and clinical decision curves also demonstrated the good performance of the nomogram models. In patients with STEMI who underwent PCI, it was noted that a higher HbA1c of the ApoA1 ratio is significantly associated with in-hospital MACE. In addition, a nomogram is constructed having considered the above-mentioned risk factors to provide predictive information on in-hospital MACE occurrence in these patients. In particular, this tool is of great value to the clinical practitioners in determination of patients with a high risk.
Collapse
Affiliation(s)
- Kang-Ping Zhang
- Department of Cardiology, Huaibei Miners' General Hospital, Huaibei, Anhui, China
| | - Qiong-Chao Guo
- Department of Cardiology, The First People's Hospital of Hefei, Anhui, Hefei, China
| | - Nan Mu
- Department of Cardiology, Huaibei Miners' General Hospital, Huaibei, Anhui, China
| | - Chong-Hui Liu
- Department of Cardiology, Huaibei Miners' General Hospital, Huaibei, Anhui, China
| |
Collapse
|
2
|
Fang C, Chen Z, Zhang J, Jin X, Yang M. Construction and evaluation of nomogram model for individualized prediction of risk of major adverse cardiovascular events during hospitalization after percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:1050785. [PMID: 36620648 PMCID: PMC9810984 DOI: 10.3389/fcvm.2022.1050785] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background Emergency percutaneous coronary intervention (PCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) helps to reduce the occurrence of major adverse cardiovascular events (MACEs) such as death, cardiogenic shock, and malignant arrhythmia, but in-hospital MACEs may still occur after emergency PCI, and their mortality is significantly increased once they occur. The aim of this study was to investigate the risk factors associated with MACE during hospitalization after PCI in STEMI patients, construct a nomogram prediction model and evaluate its effectiveness. Methods A retrospective analysis of 466 STEMI patients admitted to our hospital from January 2018 to June 2022. According to the occurrence of MACE during hospitalization, they were divided into MACE group (n = 127) and non-MACE group (n = 339), and the clinical data of the two groups were compared; least absolute shrinkage and selection operator (LASSO) regression was used to screen out the predictors with non-zero coefficients, and multivariate Logistic regression was used to analyze STEMI Independent risk factors for in-hospital MACE in patients after emergency PCI; a nomogram model for predicting the risk of in-hospital MACE in STEMI patients after PCI was constructed based on predictive factors, and the C-index was used to evaluate the predictive performance of the prediction model; the Bootstrap method was used to repeat sampling 1,000 Internal validation was carried out for the second time, the Hosmer-Lemeshow test was used to evaluate the model fit, and the calibration curve was drawn to evaluate the calibration degree of the model. Receiver operating characteristic (ROC) curves were drawn to evaluate the efficacy of the nomogram model and thrombolysis in myocardial infarction (TIMI) score in predicting in-hospital MACE in STEMI patients after acute PCI. Results The results of LASSO regression showed that systolic blood pressure, diastolic blood pressure, Killip grade II-IV, urea nitrogen and left ventricular ejection fraction (LVEF), IABP, NT-ProBNP were important predictors with non-zero coefficients, and multivariate logistic regression analysis was performed to analyze that Killip grade II-IV, urea nitrogen, LVEF, and NT-ProBNP were independent factors for in-hospital MACE after PCI in STEMI patients; a nomogram model for predicting the risk of in-hospital MACE after PCI in STEMI patients was constructed with the above independent predictors, with a C-index of 0.826 (95% CI: 0.785-0.868) having a good predictive power; the results of H-L goodness of fit test showed χ2 = 1.3328, P = 0.25, the model calibration curve was close to the ideal model, and the internal validation C-index was 0.818; clinical decision analysis also showed that the nomogram model had a good clinical efficacy, especially when the threshold probability was 0.1-0.99, the nomogram model could bring clinical net benefits to patients. The nomogram model predicted a greater AUC (0.826) than the TIMI score (0.696) for in-hospital MACE after PCI in STEMI patients. Conclusion Urea nitrogen, Killip class II-IV, LVEF, and NT-ProBNP are independent factors for in-hospital MACE after PCI in STEMI patients, and nomogram models constructed based on the above factors have high predictive efficacy and feasibility.
Collapse
Affiliation(s)
- Caoyang Fang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,Department of Cardiology, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Zhenfei Chen
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,*Correspondence: Zhenfei Chen,
| | - Jinig Zhang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| | - Xiaoqin Jin
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China,Department of Cardiology, Hefei Second People’s Hospital Affiliated to Bengbu Medical College, Hefei, Anhui, China
| | - Mengsi Yang
- Department of Cardiology, The Second People’s Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China
| |
Collapse
|
3
|
Zheng S, Zhao F, Yang R, Wu W, Liu H, Ma W, Xu F, Han D, Lyu J. Using Restricted Cubic Splines to Study the Trajectory of Systolic Blood Pressure in the Prognosis of Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:740580. [PMID: 34568468 PMCID: PMC8460999 DOI: 10.3389/fcvm.2021.740580] [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: 07/13/2021] [Accepted: 08/10/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Acute myocardial infarction (AMI) is still the most serious manifestation of coronary artery disease. Systolic blood pressure (SBP) is the best predictor of blood pressure in AMI. Thus, its influence on AMI is necessary to be explored. Methods: A total of 4,277 patients with AMI were extracted from the Medical Information Mart for Intensive Care database. Chi-square test or Student's t-test was used to judge differences between groups, and Cox regression was used to identify factors that affect AMI prognosis. SBP was classified as low (<90 mmHg), normal (90-140 mmHg), or high (>140 mmHg), and a non-linear test was performed. Meaningful variables were incorporated into models for sensitivity analysis. Patient age was classified as low and high for subgroup analysis, and the cutoff value of the trajectory was identified. P < 0.05 indicates statistical significance. Results: The effect of SBP on the prognosis of patients with AMI is non-linear. The risks in models 1-3 with low SBP are 6.717, 4.910, and 3.080 times those of the models with normal SBP, respectively. The risks in models 1-3 with high SBP are 1.483, 1.637, and 2.937 times those of the models with normal SBP, respectively. The cutoff point (95% confidence interval) of the trajectory is 114.489 mmHg (111.275-117.702 mmHg, all P < 0.001). Conclusions: SBP has a non-linear effect on AMI prognosis. Low and high SBP show risks, and the risk of low SBP is obviously greater than that of high SBP.
Collapse
Affiliation(s)
- Shuai Zheng
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China.,School of Public Health, Shaanxi University of Chinese Medicine, Xianyang, China
| | - Fengzhi Zhao
- Intensive Care Unit, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Rui Yang
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Wentao Wu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Hui Liu
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Wen Ma
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Fengshuo Xu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Didi Han
- School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, China
| |
Collapse
|
4
|
Labib S, Kassem HH, Kandil H. Peri-Procedural Blood Pressure Changes and Their Relationship with MACE in Patients Undergoing Percutaneous Coronary Intervention: A Cross-Sectional Study. Integr Blood Press Control 2020; 13:187-195. [PMID: 33335422 PMCID: PMC7736835 DOI: 10.2147/ibpc.s268848] [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: 08/04/2020] [Accepted: 11/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Peri-procedural blood-pressure (BP) changes were investigated and correlated to Major adverse cardiovascular events (MACE) as predictor of outcome for patients undergoing percutaneous coronary intervention (PCI); whether acute coronary syndrome (Unstable angina, or MI; STEMI or NSTEMI) or scheduled for elective PCI. Methods Resting BP in the 204 recruited patients undergoing PCI throughout 2018 was measured thrice – in the ward before transferring to the cardiac catheterization lab (cath lab), in the cath lab, and after transfer to the recovery room. Patients were categorized based on their systolic and diastolic BP peri-procedural difference as systolic (SBP): with a large difference (>20 mmHg, n=47), with a small difference (≤20 mmHg, n=157) (shock patients excluded); diastolic (DBP): with a large difference (>10 mmHg, n=65), and with a small difference (≤10 mmHg, n=139). The primary end-points were MACE including all-cause mortality, non-fatal myocardial infarction, and stroke during the hospital stay. The Mann–Whitney U and Chi-square tests were used to analyze the data accordingly (p<0.005). Results Within the category of MACE, cardiac mortality was the only adverse cardiac event encountered in the study sample. Cardiac mortality was significantly higher in both the large SBP-difference group versus the other group (10.6% vs 0.6%, p=0.003) and the large DBP-difference group versus the small-difference group (7.7% vs 0.7%, p=0.013). Conclusion Peri-procedural systolic and diastolic BP differences, greater than 20 mmHg and 10 mmHg, respectively, correlated with MACE in all patients undergoing PCI.
Collapse
Affiliation(s)
- Susan Labib
- Department of Cardiology, Cairo University, Cairo, Egypt
| | | | - Hossam Kandil
- Department of Cardiology, Cairo University, Cairo, Egypt
| |
Collapse
|
5
|
Wang R, Mei B, Liao X, Lu X, Yan L, Lin M, Zhong Y, Chen Y, You T. Determination of risk factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction after percutaneous coronary intervention. BMC Cardiovasc Disord 2017; 17:243. [PMID: 28899364 PMCID: PMC5596504 DOI: 10.1186/s12872-017-0660-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/10/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND To determine the factors affecting the in-hospital prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) after percutaneous coronary intervention (PCI), and to establish its prognostic discriminant model. METHODS A total of 701 consecutive STEMI patients undergoing PCI were enrolled in this study. The patients were divided into two groups, good prognosis and poor prognosis, based on whether the patient had adverse outcomes (death or heart function ≥ grade III) at discharge. Demographic and basic clinical characteristics, diagnosis at admission (e.g., ventricular function, complications, or hyperlipidemia), and biomedical indicators (e.g., blood count, basal metabolism and biochemical composition, blood lipid and glucose levels, myocardial biomarkers, and coagulation) were collected and analyzed. RESULTS We determined 22 factors as risk factors for the in-hospital prognosis of STEMI patients after PCI: age, cardiac function during hospitalization, complications, history of diabetes mellitus, et al., among which the history of diabetes, uric acid, urea nitrogen, and activated partial thromboplastin time (APTT) were independent risk factors. CONCLUSION We identified four independent risk factors for the in-hospital prognosis of STEMI patients after PCI and generated a prognostic model to predict the adverse outcomes of these patients.
Collapse
Affiliation(s)
- Rui Wang
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Biqi Mei
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xinlong Liao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Xia Lu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Lulu Yan
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Man Lin
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yao Zhong
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| | - Yili Chen
- Department of Cardiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080 China
| | - Tianhui You
- School of Nursing, Guangdong Pharmaceutical University, Guangzhou, 510310 China
| |
Collapse
|
6
|
Bordejevic DA, Caruntu F, Mornos C, Olariu I, Petrescu L, Tomescu MC, Citu I, Mavrea A, Pescariu S. Prognostic impact of blood pressure and heart rate at admission on in-hospital mortality after primary percutaneous intervention for acute myocardial infarction with ST-segment elevation in western Romania. Ther Clin Risk Manag 2017; 13:1061-1068. [PMID: 28883734 PMCID: PMC5574681 DOI: 10.2147/tcrm.s141312] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background The purpose of this retrospective study was to evaluate the prognostic impact of systolic blood pressure (SBP) and heart rate (HR) on in-hospital mortality in ST-segment elevation acute myocardial infarction (STEMI) patients, after primary percutaneous intervention (PCI). Patients and methods The study included 294 patients admitted for STEMI. They were divided into five groups according to the SBP at admission: group I, <105 mmHg; group II, 105–125 mmHg; group III, 126–140 mmHg; group IV, 141–158 mmHg; and group V, ≥159 mmHg. Increased HR was defined as ≥80 beats per minute (bpm). In-hospital death was defined as all-cause death during admission and classified into cardiac and noncardiac death. Results Among the 294 patients admitted for STEMI, 218 (74%) were men. The mean age was 62±17 years. In-hospital mortality rate was 6% (n=18), with 11 (3.7%) deaths having cardiac causes. The highest mortality was registered in group I (n=9, 16%, P=0.018). Compared to the other groups, group I patients were older (P=0.033), more often smokers (P=0.026), and had a history of myocardial infarction (P=0.003), systemic hypertension (P=0.023), diabetes (P=0.041), or chronic kidney disease (P=0.0200). They more often had a HR ≥80 bpm (P=0.028) and a Killip class 3 or 4 at admission (P=0.020). The peak creatine phosphokinase-MB level was significantly higher in this group (P=0.005), while the angiographic findings more often identified as culprit lesions were the right coronary artery (P=0.005), the left main trunk (P=0.040), or a multivessel coronary artery disease (P=0.044). Multivariate analysis showed that group I patients had a significantly higher risk for both all-cause death (P=0.006) and cardiac death (P=0.003). Patients with HR ≥80 bpm also had higher mortality rates (P=0.0272 for general mortality and P=0.0280 for cardiac mortality). Conclusion The present study suggests that SBP <105 mmHg and HR ≥80 bpm at admission of STEMI patients are associated with a higher risk of in-hospital death, even after primary PCI.
Collapse
Affiliation(s)
| | | | - Cristian Mornos
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Ioan Olariu
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | - Lucian Petrescu
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| | | | | | | | - Sorin Pescariu
- Cardiology Department, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania
| |
Collapse
|
7
|
Chin KY, Michel L, Qin CX, Cao N, Woodman OL, Ritchie RH. The HNO donor Angeli’s salt offers potential haemodynamic advantages over NO or dobutamine in ischaemia–reperfusion injury in the rat heart ex vivo. Pharmacol Res 2016; 104:165-75. [DOI: 10.1016/j.phrs.2015.12.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/12/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
|
8
|
Vaicekavičius E, Vasiliauskas D, Navickas R, Milvidaitė I, Unikas R, Venclovienė J, Kubilius R. Impact of hypertension on postreperfusion left ventricular recovery in patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease. MEDICINA-LITHUANIA 2015; 51:38-45. [PMID: 25744774 DOI: 10.1016/j.medici.2015.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the impact of admission systolic blood pressure (ASBP) and left ventricular (LV) mass on the postreperfusion LV recovery in patients with ST-segment elevation myocardial infarction (STEMI) and concomitant coronary multivessel disease (MVD). MATERIALS AND METHODS A retrospective analysis of 12-month postreperfusion LV recovery was performed in 104 patients after primary percutaneous coronary intervention (PPCI). Patients with elevated ASBP (>140mmHg) were assigned to the first group (n=58); with normal ASBP (<140mmHg), to the second group (n=46); with increased myocardial mass index (MMI) (>100g/m(2)), to the third group (n=70); and with normal MMI (<100g/m(2)), to the fourth group (n=34). Severity of MVD was evaluated by the Syntax score. The LV recovery was assessed by evolution of quantitative characteristics of electrocardiography (QRS score, ST score, ECG STEMI stage) and echocardiography (LV ejection fraction, volume and mass indices) registered before and after PPCI, at discharge, and after 1, 6, and 12 months. RESULTS There were no significant differences in the baseline QRS and ST scores, ECG STEMI stage, LVEF, MMI, and Syntax score comparing all the patients' groups. The serial ECG criteria showed only a very small impact of ASBP on postreperfusion LV recovery. Only ECG STEMI stage progression was slower in the patients with elevated ASBP. In patients with different MMI, the QRS and ST scores were higher and ECG STEMI stage was lower in patients with increased MMI. LVEF after 1 year was significantly lower in the third group as compared to the fourth group (42.58%±8.25% vs. 46.8%±7.13%, P=0.018). CONCLUSION Postreperfusion LV recovery was more related not to ASBP but to the increased LV mass assessed by echocardiography in patients with STEMI and MVD.
Collapse
Affiliation(s)
- Edvardas Vaicekavičius
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Donatas Vasiliauskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramūnas Navickas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Irena Milvidaitė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ramūnas Unikas
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Jonė Venclovienė
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Raimondas Kubilius
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| |
Collapse
|
9
|
The association between elevated admission systolic blood pressure in patients with acute coronary syndrome and favorable early and late outcomes. ACTA ACUST UNITED AC 2015; 9:97-103. [DOI: 10.1016/j.jash.2014.11.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 11/24/2014] [Accepted: 11/25/2014] [Indexed: 12/22/2022]
|
10
|
Huang B, Yang Y, Zhu J, Liang Y, Tan H. Clinical characteristics and short-term outcomes in patients with elevated admission systolic blood pressure after acute ST-elevation myocardial infarction: a population-based study. BMJ Open 2014; 4:e005097. [PMID: 24928589 PMCID: PMC4067817 DOI: 10.1136/bmjopen-2014-005097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Prognostic value of lower admission systolic blood pressure (SBP) in patients with acute myocardial infarction has been confirmed, but the impact of elevated admission SBP on short-term outcomes has been evaluated only by a limited number of studies and they have reported conflicting results. The aim of our study was to investigate the characteristics and short-term outcomes in patients with elevated admission SBP after ST-elevation myocardial infarction (STEMI). DESIGN A population-based, observational study. SETTING The multicentre registry in China. PARTICIPANTS A total of 7510 consecutive patients with STEMI were registered. Patients were divided into three groups according to admission SBP: normal admission SBP (100-139 mm Hg), modestly elevated admission SBP (140-179 mm Hg) and excessively elevated admission SBP (≥180 mm Hg). The primary outcomes were 7-day and 30-day all-cause mortality, major adverse cardiac events (MACE) and bleeding rate. RESULTS Of 6591 patients, 4182 (63.5%) had normal admission SBP, 2187 (33.2%) modestly elevated admission SBP and 222 (3.4%) excessively elevated admission SBP. Patients with elevated admission SBP had a high-risk profile, such as were more likely to be older, with more concomitant cardiovascular morbidities, presenting with more events of anterior myocardial infarction and less reperfusion treatment. However, 7-day and 30-day all-cause mortality, MACE and bleeding rate were comparable among groups (all p>0.05). Survival curves and MACE curves were similar among groups (p=0.377 and 0.375, respectively). After multivariate adjustment, elevated admission SBP was not associated with increased risk of short-term death and bleeding, and MACE was comparable with normal admission SBP. CONCLUSIONS Although those with elevated admission SBP after STEMI were at a higher risk for cardiovascular events, they did not have poorer short-term outcomes compared with patients with normal admission SBP.
Collapse
Affiliation(s)
- Bi Huang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yanmin Yang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Jun Zhu
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Yan Liang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Huiqiong Tan
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| |
Collapse
|
11
|
Usefulness of a surface cooling device (Arctic Sun®) for therapeutic hypothermia following cardiac arrest. J Cardiol 2013; 63:46-52. [PMID: 23906526 DOI: 10.1016/j.jjcc.2013.06.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/08/2013] [Accepted: 06/19/2013] [Indexed: 11/23/2022]
Abstract
AIMS Cardio-pulmonary resuscitation and therapeutic hypothermia (TH) have improved the neurological outcomes of patients who have suffered sudden cardiac arrest; however, the benefits of and differences between cooling devices remain unclear. The aim of this study was to clarify the significance of the Arctic Sun(®) for surface cooling in patients treated with TH. METHODS Fifty-one patients (60.2±14.2 years, 42 males and 9 females) who experienced cardiogenic cardiac arrest, including both shockable and non-shockable cardiac arrest, were enrolled in this study. Forty patients were treated with TH using the Arctic Sun 2000(®) for surface cooling, while the other 11 patients were treated with TH using conventional standard cooling blankets. The patients' clinical courses during TH and the neurological outcomes were compared between the two groups. RESULTS The body temperature before TH was not significantly different between the two groups; however, the minimal body temperature during TH was significantly lower in the patients cooled with conventional standard blankets than in those cooled using the Arctic Sun 2000(®). The rates of catecholamine administration, left ventricular ejection fraction, and mechanical support were not significantly different between the two groups; however, the maximum infusion dose of dobutamine was significantly lower in the patients with the Arctic Sun 2000(®) than in those treated with standard cooling blankets. CONCLUSIONS The use of TH with the Arctic Sun 2000(®) following cardiac arrest is safe and effective in precisely maintaining the target body temperature, and can be used to reduce the infusion dose of dobutamine to treat heart failure during TH.
Collapse
|
12
|
Prognostic impact of pulse pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction. Heart Vessels 2012; 28:434-41. [DOI: 10.1007/s00380-012-0277-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 07/27/2012] [Indexed: 11/26/2022]
|
13
|
Shiraishi J, Kohno Y, Sawada T, Hashimoto S, Ito D, Kimura M, Matsui A, Yokoi H, Arihara M, Irie H, Hyogo M, Shima T, Nakamura T, Matoba S, Yamada H, Matsumuro A, Shirayama T, Kitamura M, Furukawa K, Matsubara H. Prognostic impact of systolic blood pressure at admission on in-hospital outcome after primary percutaneous coronary intervention for acute myocardial infarction. J Cardiol 2012; 60:139-44. [DOI: 10.1016/j.jjcc.2012.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 02/09/2012] [Accepted: 02/20/2012] [Indexed: 12/20/2022]
|
14
|
Morisawa D, Higuchi Y, Iwakura K, Okamura A, Date M, Ohmiya S, Shibuya M, Fujii K. Predictive factors for successful weaning from percutaneous cardiopulmonary support in patients with cardiogenic shock complicating acute myocardial infarction. J Cardiol 2012; 60:350-4. [PMID: 22819038 DOI: 10.1016/j.jjcc.2012.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 06/12/2012] [Accepted: 06/15/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND PURPOSE Percutaneous cardiopulmonary support (PCPS) is useful in the rescue of patients who have experienced severe cardiogenic shock. We investigated the predictive factors of survival among patients with cardiogenic shock requiring PCPS. METHODS AND SUBJECTS We enrolled 29 patients (21 men and 8 women, 73 ± 10 years old) with circulatory collapse complicating acute myocardial infarction (AMI) requiring PCPS. Fifteen patients could be weaned from PCPS and survived for more than 1 month (group A), while the other 14 patients could not (group B). We investigated the initial PCPS settings, and performed the appropriate laboratory tests. Hemodynamic data and arterial base excess (BE) values were recorded throughout the PCPS treatment. RESULTS There was no difference in the laboratory test results or the left ventricular ejection fraction between the groups at the start of PCPS. PCPS flow (l/min) was significantly lower in group A than in group B at the 24th hour of PCPS (2.26 ± 0.36 and 2.54 ± 0.41, respectively). There were no differences in blood pressure between the groups. During the 24-h period prior to the end of PCPS, BE remained almost normal in group A. In group B, BE decreased continuously throughout the same period. BE values were significantly lower compared to those obtained in group A 12h prior to the end of PCPS. CONCLUSIONS A reduction in PCPS flow without hemodynamic collapse may allow for successful weaning from PCPS. BE may be a potent factor in determining when to terminate PCPS.
Collapse
Affiliation(s)
- Daisuke Morisawa
- Division of Cardiology, Sakurabashi Watanabe Hospital, Osaka, Japan
| | | | | | | | | | | | | | | |
Collapse
|