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Evbayekha E, Ezenna C, Ohikhuai EE, Erebor OD, Tran MH, Ejike AC, Okobi O, Cooper J. Predictors of Arrhythmias In the Population Hospitalized for SARS-CoV-2. Curr Probl Cardiol 2024:102792. [PMID: 39137880 DOI: 10.1016/j.cpcardiol.2024.102792] [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: 08/05/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Studies exploring predictors of arrhythmias in the population primarily hospitalized for SARS-CoV-2 (COVID-19) are scarce. Understanding this is crucial for risk stratification and appropriate management. METHODS Using the 2020 National Inpatient Sample (NIS) database, we identified primary admissions for COVID-19. A 'greedy neighbor' 1:1 propensity-score matching (PSM) accounted for baseline differences. Then, multivariable logistic regression models were employed to account for confounders and estimate the probability of arrhythmia. RESULTS There were a total of 1,058,815 admissions for COVID-19 (mean age 64.3 years ±16.8), 47.2% female, 52.5% (107698) White, 18.5% (37973) Blacks, and 20.7% (42,447) Hispanics. Atrial fibrillation was the most prevalent arrhythmia, 15.1% (31,942). After PSM, 166,405 arrhythmia hospitalizations were matched to 166,405 hospitalizations without arrhythmia. Sick sinus syndrome 4.9 (4.4-5.5), dyslipidemia 1.2 (1.2-1.3), cardiac arrest 1.3 (1.1-1.4), invasive mechanical ventilation 1.9 (1.8-2.0) and obesity 1.3 (1.2-1.4), (p<0.0001, all) were all independent predictors of arrhythmias. CONCLUSIONS Our analysis revealed a notable proportion of hospitalized COVID-19 patients with arrhythmias. Dyslipidemia, obesity, sick sinus syndrome, invasive mechanical ventilation, and cardiac arrest were independent predictors of arrhythmias.
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Affiliation(s)
| | - Chidubem Ezenna
- Department of Internal Medicine, University of Massachusetts-Baystate Medical Center, Springfield, MA, USA
| | | | - Osahon Daniel Erebor
- Department of Internal Medicine, Mthatha Regional Hospital, Mthatha, Eastern Cape, South Africa
| | | | | | | | - Jonas Cooper
- Department of Electrophysiology, St. Luke's Hospital, St. Louis, MO, USA
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Evbayekha E, Antia A, Dixon B, Reiss C, LaRue S. Predictors of mortality and burden of arrhythmias in endstage heart failure. Curr Probl Cardiol 2024; 49:102541. [PMID: 38521289 DOI: 10.1016/j.cpcardiol.2024.102541] [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: 03/20/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Heart failure (HF) is a significant cause of morbidity and mortality in the United States, contributing to approximately 1 in 8 deaths. Individuals with end-stage HF (eHF) experience debilitating symptoms leading to poor quality of life (QoL). METHODS We used the ICD-10 code for eHF (I5084) from the National Inpatient Sample (NIS) (2016-2020) to identify all patients with eHF. We used a multivariable logistic regression model to adjust for confounders and estimate the mortality probability in each arrhythmia cohort. Our primary outcome was in-hospital mortality risk in each group. A p-value of 0.05 was deemed significant. RESULTS There were 22,703 hospitalizations with eHF (mean age 67 years ±16). Men represented 66.5 % (15,091) of the population. In this cohort, 59 % (13,018) were Caucasians, 27.2 % (6,017) were Blacks, 8.7 % (1,924) were Hispanics, and 2.9 % (505) were Asians. Of these individuals, 50.4 % (11,434) had atrial fibrillation (AFIB). The majority of the arrhythmia subgroups had independent associations with mortality, with adjusted odds ratio (aOR) for VFIB 5.8 (4.6-7.1), AFIB 4.3 (3.9-4.5), SVT 1.9 (1.6-2.4), and VT 1.2 (1.1-1.4), p < 0.0001, each. CONCLUSION This analysis revealed that approximately half of the hospitalized population with end-stage heart failure are burdened with atrial fibrillation. Ventricular and atrial fibrillation, supraventricular tachycardia, and ventricular tachycardia each carried an independent mortality risk, with ventricular fibrillation having the highest risk.
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Abdul khalek E, Abdel-Khalek El-Bahnasy H, Alshahat Omar M, Ibrahim Elraghy M, Ahmed Dabash TA, S. Berengy M, Abozid E, Reihan MS. Heart Failure and Echocardiography Derived Myocardial Wall Stress Link in Diabetic Cases with Acute Myocardial Infarction Managed by Revascularization. Med J Islam Repub Iran 2024; 38:3. [PMID: 38434228 PMCID: PMC10907044 DOI: 10.47176/mjiri.38.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Indexed: 03/05/2024] Open
Abstract
Background Diabetes is associated with left ventricular remodeling. Myocardial wall stress is a measurable factor connected to the ventricular breadth and force and is related to myocardial thickness; it can be measured by echocardiography. The present study aimed to assess the link between heart failure (HF) and echocardiography-derived myocardial wall stress in diabetic patients with ST elevation myocardial infarction (STEMI) who were managed with revascularization. Methods This study was a comparative prospective study that took place between February 2022 and February 2023. It included 100 diabetic patients presented with STEMI and managed by percutaneous coronary intervention (PCI). Patients were selected from the cardiology departments at Al-Azhar University Hospital, Damietta, Egypt. During the hospital stay, patients were checked for HF symptoms and signs. They were also observed for 3 months after discharge for detection of HF. Those who did not develop HF were assigned to group I, and those with HF were assigned to group II. Results The mean value of end-systolic wall stress (ESWS) was 77.09 ± 12.22 and 97 ± 13.44, and the mean value of end-diastolic wall stress (EDWS) was 12.61 ± 2.76 and 15.87 ± 2.86 in groups I and II respectively, with significant differences between the 2 groups. The cutoff point to detect HF was 88 KPa for ESWS and 13.5 KPa for EDWS, with a sensitivity of 70% and 79% and a specificity of 80% and 61% for ESWS and EDWS, respectively. Conclusion Elevated left ventricle (LV) myocardial stress is related to increased HF in diabetic patients whose HF was managed by PCI after STEMI. LV wall stress is a potentially helpful risk stratification tool using routine echocardiography to determine the treatment plane according to the risk status.
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Affiliation(s)
- Elshazly Abdul khalek
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | | | - Mohamad Alshahat Omar
- Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Mohamed Ibrahim Elraghy
- Department of Cardiology, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | | | - Mahmoud S. Berengy
- Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Elsayed Abozid
- Department of Internal Medicine, Damietta Faculty of Medicine, Al-Azhar University, Damietta, Egypt
| | - Muhammad Saad Reihan
- Department of Cardiology, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
- Department of Medicine, Medicine Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
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Rivera FB, Salva F, Gonzales JS, Cha SW, Tang S, Lumbang GNO, Kaur G, Planek I, Lara-Breitinger K, Dela Cruz M, Suboc TMB, Collado FMS, Enriquez JR, Shah N, Volgman AS. Sex differences in trends and outcomes of acute myocardial infarction with mechanical complications in the United States. Expert Rev Cardiovasc Ther 2024; 22:111-120. [PMID: 38284754 DOI: 10.1080/14779072.2024.2311707] [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: 07/26/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Mechanical complications (MC) are rare but significant sequelae of acute myocardial infarction (AMI). Current data on sex differences in AMI with MC is limited. METHODS We queried the National Inpatient Sample database to identify adult patients with the primary diagnosis of AMI and MC. The main outcome of interest was sex difference in-hospital mortality. Secondary outcomes were sex differences in the incidence of acute kidney injury (AKI), major bleeding, use of inotropes, permanent pacemaker implantation (PPMI), performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), surgery (VSD repair and MV surgery), pericardiocentesis, use of mechanical circulatory support (MCS), ischemic stroke, and mechanical ventilation. RESULTS Among AMI-MC cohort, in-hospital mortality was higher among females compared to males (41.24% vs 28.13%: aOR 1.39. 95% CI 1.079-1.798; p = 0.01). Among those who had VSD, females also had higher in-hospital mortality compared to males (56.7% vs 43.1%: aOR 1.74, 95% CI 1.12-2.69; p = 0.01). Females were less likely to receive CABG compared to males (12.03% vs 20%: aOR 0.49 95% CI 0.345-0.690; p < 0.001). CONCLUSION Despite the decreasing trend in AMI admission, females had higher risk of MC and associated mortality. Significant sex disparities still exist in AMI treatment.
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Affiliation(s)
| | - Faye Salva
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | | | - Sung Whoy Cha
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | - Samantha Tang
- Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines
| | | | - Gurleen Kaur
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Isabel Planek
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | - Mark Dela Cruz
- Division of Cardiology, Rush University Medical Center, Chicago, IL, USA
| | | | | | - Jonathan R Enriquez
- Department of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, MO, USA
| | - Nishant Shah
- Division of Cardiology, Duke University Medical Center, Durham, NC, USA
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Agarwal MA, AlMahmeed W, Butler J. Cardiac Biomarkers in Dyspnea Hospitalizations - Still Breathing Not Predictively. Cardiology 2023; 149:51-54. [PMID: 37883930 PMCID: PMC10836920 DOI: 10.1159/000534369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/28/2023]
Affiliation(s)
- Manyoo A. Agarwal
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Wael AlMahmeed
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX, USA
- University of Mississippi, Jackson, MS, USA
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Liang J, Zhang Z. Predictors of in-hospital heart failure in patients with acute anterior wall ST-segment elevation myocardial infarction. Int J Cardiol 2023; 375:104-109. [PMID: 36638919 DOI: 10.1016/j.ijcard.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/14/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heart failure (HF) is a severe complication of acute ST-segment elevation myocardial infarction (STEMI). Its incidence is associated with myocardial infarction location, and it occurs frequently after acute anterior wall STEMI due to the larger infarct size. However, predictors of in-hospital HF in patients with acute anterior wall STEMI are inadequately defined. We aimed to determine potential predictors of HF in patients with acute anterior wall STEMI during hospitalization. METHODS A total of 714 consecutive patients who were diagnosed with acute anterior wall STEMI and underwent primary percutaneous coronary intervention (pPCI) between January 2013 to August 2019 were enrolled retrospectively. We assigned the patients to HF and non-HF groups. The clinical parameters were subjected to univariate analysis and logistic regression analysis to obtain the independent predictors. RESULTS Among the 714 patients enrolled in the present study (mean age 61.0 ± 13.8 years, men 80.7%), 387 (54.2%) had in-hospital HF. According to a multivariate logistic regression analysis, ventricular fibrillation (VF, OR: 5.66, 95% CI: 2.25-14.23, P < 0.001) was the most striking independent predictor of in-hospital HF. Community-acquired pneumonia (CAP, OR: 4.72, 95% CI: 2.44-9.10, P < 0.001), age (OR: 1.03, 95% CI: 1.01-1.04, P < 0.001), left ventricular ejection fraction (LVEF, OR: 0.96, 95% CI: 0.93-0.97, P < 0.001), and peak N-terminal pro-brain natriuretic peptide (NT-pro-BNP, OR: 1.06, 95% CI: 1.02-1.11, P = 0.006) were also independently associated with in-hospital HF. CONCLUSION VF, CAP, age, LVEF, and peak NT-pro-BNP were independently associated with in-hospital HF in patients with acute anterior wall STEMI.
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Affiliation(s)
- Jingkang Liang
- Department of Health Management Center, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China.
| | - Zenghui Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510000, China
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Abe T, Olanipekun T, Adedinsewo D, Ogunmoroti O, Udongwo N, Effoe V, Rice B, Onuorah I, Ghali JK, Mehta PK, Michos ED. Trends and Outcomes of ST-Segment-Elevation Myocardial Infarction Among Young Women in the United States. J Am Heart Assoc 2023; 12:e026811. [PMID: 36847058 PMCID: PMC10111456 DOI: 10.1161/jaha.122.026811] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Background Although there has been a decrease in the incidence of ST-segment-elevation myocardial infarction (STEMI) in the United States, this trend might be stagnant or increasing in young women. We assessed the trends, characteristics, and outcomes of STEMI in women aged 18 to 55 years. Methods and Results We identified 177 602 women aged 18 to 55 with the primary diagnosis of STEMI from the National Inpatient Sample during years 2008 to 2019. We performed trend analyses to assess hospitalization rates, cardiovascular disease (CVD) risk factor profile, and in-hospital outcomes stratified by three age subgroups (18-34, 35-44, and 45-55 years). We found STEMI hospitalization rates were decreased in the overall study cohort from 52 per 100 000 hospitalizations in 2008 to 36 per 100 000 in 2019. This was driven by decreased proportion of hospitalizations in women aged 45 to 55 years (74.2% to-71.7%; P<0.001). Proportion of STEMI hospitalizationincreased in women aged 18-34 (4.7%-5.5%; P<0.001) and 35-44 years (21.2%-22.7%; P<0.001). The prevalence of traditional and non-traditional female-specific or female-predominant CVD risk factors increased in all age subgroups. The adjusted odds of in-hospital mortality in the overall study cohort and age subgroups were unchanged throughout the study period. Additionally, we observed an increase in the adjusted odds of cardiogenic shock, acute stroke, and acute kidney injury in the overall cohort over the study period. Conclusions STEMI hospitalizations are increasing among women aged <45 years, and in-hospital mortality has not changed over the past 12 years in women aged <55 years. Future studies on the optimization of risk assessment and management of STEMI in young women are urgently needed.
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Affiliation(s)
- Temidayo Abe
- Division of Cardiology, Department of Medicine Vanderbilt University School of Medicine Nashville TN
| | - Titilope Olanipekun
- Division of Cardiology, Department of Medicine Vanderbilt University School of Medicine Nashville TN
| | | | - Oluseye Ogunmoroti
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
| | - Ndausung Udongwo
- Division of General Internal Medicine, Department of Medicine Jersey Shore University Medical Center Neptune NJ
| | - Valery Effoe
- Division of Cardiology, Department of Medicine Morehouse School of Medicine Atlanta GE
| | - Bria Rice
- Division of General Internal Medicine, Department of Medicine Mayo Clinic School of Graduate Medical Education Phoenix AZ
| | - Ifeoma Onuorah
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GE
| | - Jalal K Ghali
- Division of Cardiology, Department of Medicine Morehouse School of Medicine Atlanta GE
| | - Puja K Mehta
- Division of Cardiology, Department of Medicine, and Emory Women's Heart Center, Center for Heart Disease Prevention Emory University School of Medicine Atlanta GE
| | - Erin D Michos
- Division of Cardiology, Department of Medicine Johns Hopkins School of Medicine Baltimore MD
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ST-Elevation Myocardial Infarction Outcomes: A United States Nationwide Emergency Departments Cohort Study. J Emerg Med 2022; 62:306-315. [PMID: 35058097 DOI: 10.1016/j.jemermed.2021.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 09/18/2021] [Accepted: 10/12/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Literature regarding trends in incidence and mortality of ST-elevation myocardial infarction (STEMI) in emergency departments (EDs) is limited. OBJECTIVE To study the trends of incidence and mortality of STEMI. METHODS Using the National Emergency Department Sample database in the United States, we identified all ED encounters for patients presenting with STEMI using International Classification of Diseases codes. A linear p-trend was used to assess the trends. RESULTS Out of the 973 million ED encounters represented, 641,762 (65/100,000; mean age 69 [59-81] years, 35.8% female) adult patients were recorded with STEMI. Among the major complications associated with STEMI, a total of 49,401 (7.7%) had cardiac complications, which included acute heart failure (n = 9361, 1.6%), ventricular tachycardia or fibrillation (n = 12,267, 1.91%), conduction block (n = 20,165, 3.1%), and cardiogenic shock (n = 7608, 1.2%). There were 5675 (0.9%) patients recorded with cerebrovascular events, which included acute ischemic stroke among 5205 (0.8%) patients and 470 (0.1%) with transient ischemic attack. Acute kidney injury was recorded for 10,082 (1.6%) patients. The trend for incidence of STEMI in the ED had decreased from 7.76/10,000 in 2011 to 4.07/10,000 in 2018 (linear p-trend 0.0006). However, the yearly mortality of STEMI related to ED encounters had remained relatively steady: 7.56% in 2011 to 7.50% in 2018 (linear p-trend 0.2364). CONCLUSION Despite the fact that the number of patients presenting to the ED with STEMI has been decreasing, the mortality trends have remained steady. Further research of in-hospital STEMI may yield opportunities to reduce the risk of complications, improve patient outcomes and decrease health care burden.
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Marcusohn E, Zukermann R, Kerner A, Roguin A, Kobo O. Long-term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:E655-E660. [PMID: 34259378 DOI: 10.1002/ccd.29870] [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: 04/02/2021] [Revised: 06/19/2021] [Accepted: 07/02/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention (PCI). METHODS A Retrospective cohort study of all adult patients who underwent PCI in a large tertiary care center from January 2002 to August 2020. RESULTS A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247 (1.9%) patients; 70 with inflammatory bowel disease (IBD) and 173 with autoimmune rheumatic diseases (AIRD). The composite endpoint of mortality, acute coronary syndrome (ACS) or admission due to acute heart failure was similar at 30 days and more frequent in the inflammatory disease group (42.8% in AIRD group, 35.7% in the IBD group and 29.6% in the noninflammatory group, p < 0.0001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. Readmission due to ACS was also increases at 30 days in the AIRD group compared to the noninflammatory group (0.6% vs. 0.1%, p < 0.001) and 1 year (37.6% for the AIRD group, 34.3% in the IBD group and 25.5% in the noninflammatory group (p < 0.0001). Patients with inflammatory diseases were found to have a significantly increased risk congestive heart failure admissions at 1 year in a subgroup analysis of patients with myocardial infarction. CONCLUSION Patients with AIRD and IBD are at higher risk for cardiovascular events in long-term follow up once diagnosed with CAD and treated with PCI.
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Affiliation(s)
- Erez Marcusohn
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Robert Zukermann
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel
| | - Arthur Kerner
- Department of Cardiology, Rambam Health Care Campus, Haifa, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel.,Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Hadera, Israel
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Grochulska A, Glowinski S, Bryndal A. Cardiac Rehabilitation and Physical Performance in Patients after Myocardial Infarction: Preliminary Research. J Clin Med 2021; 10:jcm10112253. [PMID: 34067480 PMCID: PMC8196956 DOI: 10.3390/jcm10112253] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/18/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Cardiovascular diseases, in particular, myocardial infarction (MI), are the main threats to human health in modern times. Cardiac rehabilitation (CR), and especially increased physical activity, significantly prevent the consequences of MI. The aim of this study was to assess physical performance in patients after MI before and after CR. (2) Methods: 126 patients after MI were examined. They were admitted to the cardiac rehabilitation ward twice: in the 3rd month after MI, and then in the 6th month after the last rehabilitation session. CR lasted 20 treatment days (4 weeks with 5 treatment days and 2 days’ break). The exercise stress test on the treadmill and a 6-minute walk test (6MWT) were used to assess physical performance. Patients were assigned to an appropriate rehabilitation model due to their health condition. (3) Results: In the studied group, the exercise stress test time and the metabolic equivalent of task (MET), the maximal oxygen consumption (VO2max), and 6MWT score increased significantly (p = 0.0001) at two time-points of observation. (4) Conclusion: CR significantly improves physical performance in patients after MI.
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Affiliation(s)
- Agnieszka Grochulska
- Department of Physiotherapy, Institute of Health Sciences, Slupsk Pomeranian University, 76200 Slupsk, Poland;
| | - Sebastian Glowinski
- Department of Mechatronics and Automatics, Faculty of Mechanical Engineering, Koszalin University of Technology, 75453 Koszalin, Poland;
| | - Aleksandra Bryndal
- Department of Physiotherapy, Institute of Health Sciences, Slupsk Pomeranian University, 76200 Slupsk, Poland;
- Correspondence: ; Tel.: +48-59-840-5912
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11
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Świątkiewicz I, Magielski P, Kubica J. C-Reactive Protein as a Risk Marker for Post-Infarct Heart Failure over a Multi-Year Period. Int J Mol Sci 2021; 22:ijms22063169. [PMID: 33804661 PMCID: PMC8003799 DOI: 10.3390/ijms22063169] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/07/2021] [Accepted: 03/16/2021] [Indexed: 12/14/2022] Open
Abstract
Inflammatory activation during acute ST-elevation myocardial infarction (STEMI) can contribute to post-infarct heart failure (HF). This study aimed to determine prognostic value of high-sensitivity C-reactive protein concentration (CRP) for HF over a long-term follow-up in 204 patients with a first STEMI undergoing guideline-based therapies including percutaneous coronary intervention. CRP was measured at admission, 24 h (CRP24), discharge (CRPDC), and one month (CRP1M) after index hospitalization for STEMI. Within a median period of 5.6 years post-index hospitalization for STEMI, hospitalization for HF (HFH) which is a primary endpoint, occurred in 24 patients (11.8%, HF+ group). During the study, 8.3% of HF+ patients died vs. 1.7% of patients without HFH (HF- group) (p = 0.047). CRP24, CRPDC, and CRP1M were significantly higher in HF+ compared to HF- group. The median CRP1M in HF+ group was 2.57 mg/L indicating low-grade systemic inflammation, in contrast to 1.54 mg/L in HF- group. CRP1M ≥ 2 mg/L occurred in 58.3% of HF+ vs. 42.8% of HF- group (p = 0.01). Kaplan–Meier analysis showed decreased probability of survival free from HFH in patients with CRP24 (p < 0.001), CRPDC (p < 0.001), and CRP1M (p = 0.03) in quartile IV compared to lower quartiles. In multivariable analysis, CRPDC significantly improved prediction of HFH over a multi-year period post-STEMI. Persistent elevation in CRP post STEMI aids in risk stratification for long-term HF and suggests that ongoing cardiac and low-grade systemic inflammation promote HF development despite guideline-based therapies.
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Affiliation(s)
- Iwona Świątkiewicz
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (P.M.); (J.K.)
- Division of Cardiovascular Medicine, University of California San Diego, La Jolla, CA 92037, USA
- Correspondence: ; Tel.: +1-(858)-246-2510
| | - Przemysław Magielski
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (P.M.); (J.K.)
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Nicolaus Copernicus University in Toruń, Collegium Medicum in Bydgoszcz, 85-094 Bydgoszcz, Poland; (P.M.); (J.K.)
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Kwak MJ, Avritscher E, Holmes HM, Jantea R, Flores R, Rianon N, Chung TH, Balan P, Dhoble A. Delirium Among Hospitalized Older Adults With Acute Heart Failure Exacerbation. J Card Fail 2021; 27:453-459. [PMID: 33347994 DOI: 10.1016/j.cardfail.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/30/2020] [Accepted: 12/08/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Delirium among older adults hospitalized with acute heart failure is associated with increased mortality. However, studies concomitantly assessing the association of delirium with both clinical and economic outcomes in this population, such as mortality, hospital cost, or length of stay, are lacking. METHODS AND RESULTS We conducted a retrospective observational study using National Inpatient Sample data from 2011 to 2014. Using multivariable logistic regression, we assessed the association of delirium with in-hospital mortality, then estimated the incremental hospital cost and excessive length of stay adjusting for demographic and clinical factors using multivariable generalized linear regression. The association of other medical complications on clinical and economic outcomes was also assessed. A total of 568,565 (weighted N = 2,826,131) hospitalizations of patients 65 years or older with acute heart failure from 2011 to 2014 were included in the final analysis. The reported prevalence of delirium was 4.53%. After multivariable adjustment, delirium was associated with a 2.35-fold increase in the odds of in-hospital mortality (95% confidence interval [CI] 2.23-2.47), which was lower than the odds ratio for sepsis/septicemia (5.36; 95% CI, 5.02-5.72) or respiratory failure (4.53; 95% CI, 4.38-4.69), but similar to that for acute kidney injury (2.39; 95% CI, 2.31-2.48) and higher than for non-ST elevation myocardial infarct (1.57; 95% CI, 1.46-1.68). Delirium increased the total hospital cost by $4,262 (95% CI, $4,002-4,521) and the length of stay by 1.73 days (95% CI, 1.68-1.78), which was slightly lower than, but similar to, acute kidney injury ($4,771; 95% CI, $4,644-4,897) and 1.82 days (95% CI, 1.79-1.84), and higher than non-ST elevation myocardial infarct ($1,907; 95% CI, $1,629-2,185) and 0.31 days (95% CI, 0.25-0.37). CONCLUSIONS Delirium was associated with increased in-hospital mortality, total hospital cost, and length of stay, and the magnitude of the effect was similar to that for acute kidney injury. Enhanced efforts to prevent delirium are needed to decrease its adverse impact on clinical and economic outcomes for hospitalized older adults with acute heart failure.
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Affiliation(s)
- Min Ji Kwak
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Elenir Avritscher
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Holly M Holmes
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Rachel Jantea
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Renee Flores
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nahid Rianon
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas; Department of Family and Community Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Tong Han Chung
- Healthcare Transformation Initiatives, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Prakash Balan
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Abhijeet Dhoble
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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13
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Pendyal A, Rothenberg C, Scofi JE, Krumholz HM, Safdar B, Dreyer RP, Venkatesh AK. National Trends in Emergency Department Care Processes for Acute Myocardial Infarction in the United States, 2005 to 2015. J Am Heart Assoc 2020; 9:e017208. [PMID: 33047624 PMCID: PMC7763391 DOI: 10.1161/jaha.120.017208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/16/2020] [Indexed: 01/14/2023]
Abstract
Background Despite investments to improve quality of emergency care for patients with acute myocardial infarction (AMI), few studies have described national, real-world trends in AMI care in the emergency department (ED). We aimed to describe trends in the epidemiology and quality of AMI care in US EDs over a recent 11-year period, from 2005 to 2015. Methods and Results We conducted an observational study of ED visits for AMI using the National Hospital Ambulatory Medical Care Survey, a nationally representative probability sample of US EDs. AMI visits were classified as ST-segment-elevation myocardial infarction (STEMI) and non-STEMI. Outcomes included annual incidence of AMI, median ED length of stay, ED disposition type, and ED administration of evidence-based medications. Annual ED visits for AMI decreased from 1 493 145 in 2005 to 581 924 in 2015. Estimated yearly incidence of ED visits for STEMI decreased from 1 402 768 to 315 813. The proportion of STEMI sent for immediate, same-hospital catheterization increased from 12% to 37%. Among patients with STEMI sent directly for catheterization, median ED length of stay decreased from 62 to 37 minutes. ED administration of antithrombotic and nonaspirin antiplatelet agents rose for STEMI (23%-31% and 10%-27%, respectively). Conclusions National, real-world trends in the epidemiology of AMI in the ED parallel those of clinical registries, with decreases in AMI incidence and STEMI proportion. ED care processes for STEMI mirror evolving guidelines that favor high-intensity antiplatelet therapy, early invasive strategies, and regionalization of care.
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Affiliation(s)
- Akshay Pendyal
- Novant Health Heart and Vascular InstituteCharlotteNC
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
| | - Craig Rothenberg
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | - Jean E. Scofi
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | - Harlan M. Krumholz
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
- Section of Cardiovascular MedicineDepartment of Internal MedicineYale School of MedicineNew HavenCT
- Department of Health Policy and ManagementYale School of Public HealthNew HavenCT
| | - Basmah Safdar
- Department of Emergency MedicineYale School of MedicineNew HavenCT
| | - Rachel P. Dreyer
- Department of Emergency MedicineYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
| | - Arjun K. Venkatesh
- National Clinician Scholars ProgramYale School of MedicineNew HavenCT
- Department of Emergency MedicineYale School of MedicineNew HavenCT
- Center for Outcomes Research and EvaluationYale–New Haven HospitalNew HavenCT
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14
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Jain N, Agarwal MA, Jalal D, Dokun AO. Individuals with Peripheral Artery Disease (PAD) and Type 1 Diabetes Are More Likely to Undergo Limb Amputation than Those with PAD and Type 2 Diabetes. J Clin Med 2020; 9:E2809. [PMID: 32878057 PMCID: PMC7563979 DOI: 10.3390/jcm9092809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/16/2020] [Accepted: 08/28/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Limited data exist comparing how type 1 diabetes mellitus (DM) and type 2 DM may have differential effects on peripheral artery disease (PAD) severity. We aimed to study the association of type of DM with the procedure utilized in hospitalizations with a diagnosis of PAD. METHODS We used the national inpatient sample databases from 2003 to 2014 to identify hospitalizations with a diagnosis of PAD and type 1 or type 2 DM. Logistic regression was utilized to evaluate the association between type of DM and procedure utilized (amputation-overall, major, endovascular revascularization, surgical revascularization). RESULTS We identified 14,012,860 hospitalizations with PAD diagnosis and DM, 5.6% (n = 784,720) had type 1 DM. The patients with type 1 DM were more likely to present with chronic limb-threatening ischemia (CLTI) (45.2% vs. 32.0%), ulcer (25.9% vs. 17.7%), or complicated ulcer (16.6% vs. 10.5%) (all p < 0.001) when compared to those with type 2 DM. Type 1 DM was independently and significantly associated with more amputation procedures (adjusted odds ratio = 1.12, 95% confidence interval [CI] I 1.08 to 1.16, p < 0.001). Overall, in-hospital mortality did not differ between the individuals with type 1 and type 2 DM. The overall mean (95% CI) length of stay (in days) was 6.6 (6.5 to 6.6) and was significantly higher for type 1 DM (7.8 [7.7 to 8.0]) when compared to those with type 2 DM (6.5 [6.4 to 6.6]). CONCLUSION We observed that individuals with PAD and type 1 DM were more likely to present with CLTI and ulcer and undergo amputation when compared to those with PAD and type 2 diabetes. Further studies are needed to better understand the underlying mechanisms behind these findings and to identify novel interventions to reduce the risk of amputation in patients with type 1 DM.
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Affiliation(s)
- Nidhi Jain
- Torrance Memorial Physician Network, Torrance, CA 90505, USA;
| | - Manyoo A. Agarwal
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
- Division of Cardiovascular Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Diana Jalal
- Division of Nephrology, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa, IA 52242, USA;
| | - Ayotunde O. Dokun
- Division of Endocrinology and Metabolism, Department of Medicine, Carver College of Medicine, University of Iowa, Iowa, IA 52242, USA
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15
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Agarwal MA, Jain N, Podila PSB, Varadarajan V, Patel B, Shah M, Garg L, Khouzam RN, Ibebuogu U, Reed GL, Dagogo-Jack S. Association of history of heart failure with hospital outcomes of hyperglycemic crises: Analysis from a University hospital and national cohort. J Diabetes Complications 2020; 34:107466. [PMID: 31735638 DOI: 10.1016/j.jdiacomp.2019.107466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 09/05/2019] [Accepted: 10/01/2019] [Indexed: 12/28/2022]
Abstract
AIMS The impact of a history of heart failure (HF) on the outcomes of hospitalization for hyperglycemic crises (diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome) is unknown. We aimed to test the hypothesis that a history of HF has a deleterious impact on the outcomes of hospitalization for hyperglycemic crises. METHODS We used two different datasets: National Inpatient Sample database 2003-2014 and a single University hospital cohort 2007-2017, to identify all adult hospitalizations with a primary diagnosis of hyperglycemic crises. Multivariable regression models were used to analyze the outcomes of in-hospital mortality, length of hospital stay and transfer to nursing home or similar short-term facility between HF and no-HF hospitalizations. RESULTS Of the 1, 570,726 hyperglycemic crises related hospitalizations, a history of HF was present in 57, 520 (3.6%) hospitalizations. After multivariable risk-adjustment, HF group had a higher observed in-hospital mortality [0.4% vs. 0.2%; adjusted odds ratio (AOR) = 1.7, 95% CI 1.4 to 2.0, P < .001] and transfer to nursing home or similar short-term facility (3.9 vs. 2.8%, AOR = 1.4, 95% CI 1.3 to 1.5, P < .001) compared with no-HF group. Mean length of hospital stay [6.5 vs. 3.5 days; P < .001] was also higher for HF group than no-HF group. Data from the smaller University hospital cohort showed similar findings. CONCLUSIONS Patients with a history of HF may be an under-recognized high-risk group among patients hospitalized for hyperglycemic crisis. Additional studies are warranted to clarify risk elements and optimize the inpatient care of individuals with hyperglycemic crises.
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Affiliation(s)
- Manyoo A Agarwal
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Cardiovascular Medicine, Department of Internal Medicine, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA.
| | - Nidhi Jain
- Division of Endocrinology and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
| | | | | | - Brijesh Patel
- Division of Cardiovascular Medicine, Lehigh Valley Healthcare Network, Philadelphia, PA, USA
| | - Mahek Shah
- Division of Cardiovascular Medicine, Lehigh Valley Healthcare Network, Philadelphia, PA, USA
| | - Lohit Garg
- Division of Cardiovascular Medicine, Lehigh Valley Healthcare Network, Philadelphia, PA, USA
| | - Rami N Khouzam
- Division of Cardiovascular Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Uzoma Ibebuogu
- Division of Cardiovascular Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Guy L Reed
- Department of Internal Medicine, University of Arizona Medical School-Phoenix, AZ, USA
| | - Samuel Dagogo-Jack
- Department of Internal Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Division of Endocrinology and Metabolism, University of Tennessee Health Science Center, Memphis, TN, USA
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16
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Sattler K, El-Battrawy I, Gietzen T, Kummer M, Lang S, Zhou XB, Behnes M, Borggrefe M, Akin I. Improved Outcome of Cardiogenic Shock Triggered by Takotsubo Syndrome Compared With Myocardial Infarction. Can J Cardiol 2019; 36:860-867. [PMID: 32249068 DOI: 10.1016/j.cjca.2019.10.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Cardiogenic shock (CS) is a severe complication of myocardial infarction (MI) or of takotsubo syndrome (TTS). For both diseases, CS is related to a worse long-term outcome. The outcome of CS has not been studied in a direct comparison of patients with MI and patients with TTS. METHODS Mortality and cardiovascular complications were compared in patients presenting with CS based on MI or TTS between 2003 and 2017 during a follow-up of 5 years. A total of 138 patients with TTS and 532 patients with MI were included. Of these, 66 patients with MI and 25 patients with TTS developed CS (12% vs 18%, P = 0.08). RESULTS Patients with MI and CS had more often malignant arrhythmias (74% vs 28%, P < 0.01), and need for resuscitation (80% vs 24%, P < 0.01) or death (71% vs 24%, P < 0.01) than patients with TTS and CS during the first 30 days. Although the overall rate of death remained higher in MI than in TTS (75.8% vs 52%, log rank, P < 0.01), deaths occurred in TTS constantly throughout the follow-up time, but not in MI. The incidence of heart failure increased in MI but not in TTS (31.8% vs 4%, P < 0.01) during follow-up. CONCLUSIONS Patients with MI and CS have a worse prognosis than patients with TTS and CS. This is driven by cardiovascular events or death during the first 30 days after the index event. However, patients with TTS and CS show high mortality as well, especially during long-term follow-up.
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Affiliation(s)
- Katherine Sattler
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ibrahim El-Battrawy
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK, Partner Site, Heidelberg-Mannheim, Mannheim, Germany.
| | - Thorsten Gietzen
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Marvin Kummer
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK, Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Xiao-Bo Zhou
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Behnes
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK, Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; DZHK, Partner Site, Heidelberg-Mannheim, Mannheim, Germany
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Subahi A, Abdullah A, Yassin AS, Abubakar H, Abugroun A, Eigbire G, Salama A, Wahab A, Abulawi A, Kanaan E, Javed A, Elder M, Kaki A, Alweis R, Mohamad T. Impact and Outcomes of Patients with Congestive Heart Failure Complicating Non-ST-Segment Elevation Myocardial Infarction,Results from a Nationally-Representative United States Cohort. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:659-662. [DOI: 10.1016/j.carrev.2018.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 08/04/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022]
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Massey HT, Choi JH, Maynes EJ, Tchantchaleishvili V. Temporary support strategies for cardiogenic shock: extracorporeal membrane oxygenation, percutaneous ventricular assist devices and surgically placed extracorporeal ventricular assist devices. Ann Cardiothorac Surg 2019; 8:32-43. [PMID: 30854310 DOI: 10.21037/acs.2018.11.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The majority of clinical pathways and paradigms utilized in the treatment and management of cardiogenic shock with temporary mechanical circulatory support (MCS) are largely based on individual physician intuition and ad hoc problem-solving. Substantial mortality gains in the acute myocardial infarction cardiogenic shock (AMI-CS) population were observed with the reported outcomes of the SHOCK trial in 1999 compared to previous populations with AMI-CS. Nonetheless even in the age of percutaneous coronary intervention (PCI) of the infarct related artery, survival rates continue to be only approximately 50%. The conventional focus since the SHOCK trial has centered on revascularization strategies and the subsequent medical management of these patients post-PCI with ever diminishing returns. Perhaps we have hit the "glass ceiling" with current strategies and it is time to explore novel strategies to salvage not only the heart but more importantly the patient and potentially more of both. Going forward, researchers need to focus on developing a systematic approach to problem solving in utilizing MCS for patients with cardiogenic shock. Effective methodologies that are evidence based will help physicians in their decision-making when considering temporary MCS for patients.
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Affiliation(s)
- Howard Todd Massey
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jae Hwan Choi
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Elizabeth J Maynes
- Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA
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Dahal K, Hendrani A, Sharma SP, Singireddy S, Mina G, Reddy P, Dominic P, Modi K. Aldosterone Antagonist Therapy and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Without Heart Failure: A Systematic Review and Meta-analysis. JAMA Intern Med 2018; 178:913-920. [PMID: 29799995 PMCID: PMC6145720 DOI: 10.1001/jamainternmed.2018.0850] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
IMPORTANCE Treatment with aldosterone antagonists is recommended and has been shown to have beneficial effects in patients with ST-segment elevation myocardial infarction (STEMI) and left ventricular ejection fraction (LVEF) less than 40%. However, the role of aldosterone antagonists in patients with ejection fraction greater than 40% or without congestive heart failure is not well known. OBJECTIVES To perform a systematic review and meta-analysis using standard techniques to determine the role of therapy with aldosterone antagonists in this patient population. DATA SOURCES PubMed, Embase, CINAHL, and Cochrane Central databases were searched and a manual search for relevant references from the selected articles and published reviews was performed from database inception through June 2017. STUDY SELECTION Randomized clinical trials that evaluated treatment with aldosterone antagonists in patients with STEMI without clinical heart failure or LVEF greater than 40% were included. DATA EXTRACTION AND SYNTHESIS Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were used to conduct and report the meta-analysis, which used a random-effects model. Two investigators independently performed the database search and agreed on the final study selection. A manual search was performed for relevant references from the selected articles and published reviews. MAIN OUTCOMES AND MEASURES The outcomes analyzed were mortality, new congestive heart failure, recurrent myocardial infarction, ventricular arrhythmia, and changes in LVEF, serum potassium level, and creatinine level at follow-up. RESULTS In all, 10 randomized clinical trials with a total of 4147 unique patients were included in the meta-analysis. In patients who presented with STEMI without heart failure, treatment with aldosterone antagonists compared with control was associated with lower risk of mortality (2.4% vs 3.9%; odds ratio [OR], 0.62; 95% CI, 0.42-0.91; P = .01) and similar risks of myocardial infarction (1.6% vs 1.5%; OR, 1.03; 95% CI, 0.57-1.86; P = .91), new congestive heart failure (4.3% vs 5.4%; OR, 0.82; 95% CI, 0.56-1.20; P = .31), and ventricular arrhythmia (4.1% vs 5.1%; OR, 0.76; 95% CI, 0.45-1.31; P = .33). Similarly, treatment with aldosterone antagonists compared with control was associated with a small yet significant increase in LVEF (mean difference, 1.58%; 95% CI, 0.18%-2.97%; P = .03), a small increase in serum potassium level (mean difference, 0.07 mEq/L; 95% CI, 0.01-0.13 mEq/L; P = .02), and no change in serum creatinine level (standardized mean difference, 1.4; 95% CI, -0.43 to 3.24; P = .13). CONCLUSIONS AND RELEVANCE Treatment with aldosterone antagonists is associated with a mortality benefit in patients with STEMI with LVEF greater than 40% or without heart failure.
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Affiliation(s)
- Khagendra Dahal
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Aditya Hendrani
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Sharan P Sharma
- Department of Medicine, LRGHealthcare, University of New England, Laconia, New Hampshire
| | - Sampath Singireddy
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - George Mina
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Pratap Reddy
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Paari Dominic
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
| | - Kalgi Modi
- Division of Cardiology, Department of Medicine, Louisiana State University Health Sciences Center, Shreveport
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Outcomes of Impella 5.0 in Cardiogenic Shock. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:254-260. [DOI: 10.1097/imi.0000000000000535] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective The aim of the study was to comprehensively summarize the survival outcomes and complications of Impella 5.0 (Abiomed Inc, Danvers, MA USA) use in patients with cardiogenic shock (CS). Methods We performed a literature review for relevant studies by searching in Medline, Medline In-Process, EMBASE, and the CENTRAL bibliographic databases on April 30, 2017. Nonoverlapping studies with 10 patients or more supported for cardiogenic shock with Impella 5.0 or Impella left direct were included. Data on patient characteristics, indication of support, and outcomes were extracted. A random effect was used to pool the various outcomes. Results This meta-analysis included six studies totaling 163 patients (mean ± SD age = 56.3 ± 12.0, male 81%). Indications for support included 88 (54.0%) for acute on chronic decompensated heart failure, 35 (21.5%) for postcardiotomy cardiogenic shock, 27 (16.6%) for acute myocardial infarction complicated by cardiogenic shock, and, 13 (8.0%) for cardiogenic shock due to other reasons. Survival to next therapy was 73.5% in patients supported for acute on chronic decompensated heart failure. The survival to device explant among patients supported for postcardiotomy cardiogenic shock or acute myocardial infarction complicated by cardiogenic shock was 90.2%, and of those, myocardial recovery was achieved in 73.8%. The overall estimated survival to discharge, 30, 180, and 365 days was 73.5%, 72.6%, 62.7%, and 58.4%, respectively. Patients supported for postcardiotomy cardiogenic shock had the highest heart recovery among survivors to explant (92.1%) and highest survival at 30 (89.5%) and 365 days (69.5%). Conclusions Impella 5.0/LD is associated with favorable survival outcomes and higher rate of myocardial recovery in patients with cardiogenic shock.
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