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Fernández MS, Silva Melchor L, Martínez-Sellés M, Viana Tejedor A, Aguilar R, Lopez de Sa Areses E, Martín Asenjo R. Early approach to LDL-related risk after acute coronary syndrome: The OPTA Project. Expert Rev Cardiovasc Ther 2023:1-6. [PMID: 37144281 DOI: 10.1080/14779072.2023.2211266] [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: 05/06/2023]
Abstract
INTRODUCTION Hyperlipidemia is the main underlying cause of atherosclerotic cardiovascular disease. Reducing low-density lipoprotein (LDL) cholesterol to recommended targets after an acute coronary syndrome (ACS) is of utmost importance as it is associated with a reduction of mortality and further cardiovascular events. Unfortunately, there are considerable gaps between guideline recommendations and clinical practice. In addition, the approach to treatment of this population is very heterogeneous, even in specialized cardiovascular units. Some easy-to-implement strategies may help to optimize the management of these patients. AREAS COVERED The OPTA Project was developed to identify these gaps and to provide recommendations to improve and harmonize the management of patients with ACS, with a specific focus on lipids. EXPERT OPINION Five areas of interest were defined: 1) evaluation of cardiovascular risk at admission, 2) development of a strategy to effectively and rapidly reduce LDL cholesterol levels, 3) determining LDL cholesterol goals (<55 mg/dL or stricter) and follow-up, 4) data collection during hospitalization, and 5) standardized discharge report. Specific recommendations are given to reduce inequalities, following the targets "the lower, the better" and "the earlier, the better".
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Affiliation(s)
| | - Lorenzo Silva Melchor
- Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda-Madrid, Spain
| | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañon, CIBERCV, Universidad Europea, Universidad Complutense, Madrid, Spain
| | - Ana Viana Tejedor
- Department of Cardiology, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain
| | - Rio Aguilar
- Department of Cardiology. Hospital Universitario de la Princesa, Universidad Autonoma de Madrid, Spain
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Tizón-Marcos H, Toloba A, Subirana Cachinero I, Elosua R, Sionis A, Fernández-Avilés F, Bueno H, Carrillo A, Bayés A, Sánchez PL, Roqué M, Milà L, Elorriaga A, Vaquero J, Fernández-Bergés D, Bosch D, Alameda J, Martí Almor J, Jiménez-Navarro M, Martínez L, Sanchis J, Sánchez E, Rubert C, Ruiz-Valdepeñas L, Rodríguez M, Lozano Í, Abu-Assi E, González VB, Marrugat J. Long-term outcomes of extended DAPT in a real-life cohort of consecutive STEMI patients. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022:S1885-5857(22)00324-3. [PMID: 36539185 DOI: 10.1016/j.rec.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Dual antiplatelet therapy (DAPT) duration after ST-segment elevation myocardial infarction (STEMI) remains a matter of debate. METHODS We analyzed the effect of DAPT on 5-year all-cause mortality, cardiovascular mortality, and cardiovascular readmission or mortality in a cohort of 1-year survivor STEMI patients. RESULTS A total of 3107 patients with the diagnosis of STEMI were included: 93% of them were discharged on DAPT, a therapy that persisted in 275 high-risk patients at 5 years. Cardiovascular mortality in patients on single antiplatelet therapy vs DAPT at 5 years was 1.4% vs 3.6% (P <.01), respectively, whereas noncardiovascular mortality was 3.3% vs 5.8% (P=.049) at 5 years. Cardiovascular readmission or mortality in patients with single antiplatelet therapy vs DAPT was 11.4% vs 46.5% (P <.001). Extended DAPT was independently associated with worse 5-year all-cause mortality (HR, 2.16; 95%CI, 1.40-3.33), cardiovascular mortality (HR, 2.83; 95%CI, 1.37-5.84), and cardiovascular readmission or mortality (HR, 5.20; 95%CI, 3.96-6.82). These findings were confirmed in propensity score matching and inverse probability weighting analyses. CONCLUSIONS Our results suggest the hypothesis that, in 1-year STEMI survivors, extending DAPT up to 5 years in high-risk patients does not improve their long-term prognosis.
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Affiliation(s)
- Helena Tizón-Marcos
- Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
| | - Andrea Toloba
- Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain
| | - Isaac Subirana Cachinero
- Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Roberto Elosua
- Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Alessandro Sionis
- Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu I Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Francisco Fernández-Avilés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Héctor Bueno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Andrés Carrillo
- Servicio de Cardiología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Antoni Bayés
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Pedro L Sánchez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario Salamanca, Salamanca, Spain
| | - Mercè Roqué
- Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Laia Milà
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitari Vall d' Hebron, Barcelona, Spain
| | - Ane Elorriaga
- Servicio de Cardiología, Hospital Universitario de Basurto, Bilbao, Spain
| | - Jessica Vaquero
- Servicio de Cardiología, Hospital Universitario Araba sede Txagorritxu, Vitoria-Gasteiz, Spain
| | | | - Daniel Bosch
- Servicio de Cardiología, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Javier Alameda
- Servicio de Cardiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Luis Martínez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario La Fe, Valencia, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico Universitario, Fundación para la Investigación del Hospital Clínico de la Comunidad Valenciana (INCLIVA), Universitat de València, Valencia, Spain
| | - Esther Sánchez
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Catalina Rubert
- Servicio de Cardiología, Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - Luis Ruiz-Valdepeñas
- Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Marcos Rodríguez
- Servicio de Cardiología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Íñigo Lozano
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Emad Abu-Assi
- Servicio de Cardiología, Complejo Hospitalario Universidad de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Vicente Bertomeu González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Medicina Clínica, Universidad Miguel Hernández, Alicante, Spain
| | - Jaume Marrugat
- Institut Hospital del Mar d'Investigacions Mediques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
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Marrugat J, Subirana I, Dégano IR. Up to which regional level can we analyze health care quality? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:783-785. [PMID: 35787948 DOI: 10.1016/j.rec.2022.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Jaume Marrugat
- Institut Hospital del Mar d'Investigacions Mèdiques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Isaac Subirana
- Institut Hospital del Mar d'Investigacions Mèdiques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Irene R Dégano
- Institut Hospital del Mar d'Investigacions Mèdiques, IMIM, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Facultat de Medicina, Universitat de Vic-Universitat Central de Catalunya (Uvic-UCC), Vic, Barcelona, Spain
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5
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Solano-López J, Zamorano JL, Pardo Sanz A, Amat-Santos I, Sarnago F, Gutiérrez Ibañes E, Sanchis J, Rey Blas JR, Gómez-Hospital JA, Santos Martínez S, Maneiro-Melón NM, Mateos Gaitán R, González D'Gregorio J, Salido L, Mestre JL, Sanmartín M, Sánchez-Recalde Á. Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:985-993. [PMID: 32839121 PMCID: PMC7832619 DOI: 10.1016/j.rec.2020.07.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 12/29/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic. METHODS This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model. RESULTS In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P <.001] and 15.2% vs 1.8% [P=.001], respectively). GRACE score> 140 (OR, 23.45; 95%CI, 2.52-62.51; P=.005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; P=.02) were independent predictors of in-hospital death. CONCLUSIONS During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.
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Affiliation(s)
- Jorge Solano-López
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - José Luis Zamorano
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Pardo Sanz
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain
| | - Fernando Sarnago
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Enrique Gutiérrez Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Juan Ramón Rey Blas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario La Paz, Madrid, Spain
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra Santos Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, Spain
| | | | - Roberto Mateos Gaitán
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Jessika González D'Gregorio
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, Spain
| | - Luisa Salido
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - José L Mestre
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Marcelo Sanmartín
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ángel Sánchez-Recalde
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
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Solano-López J, Zamorano JL, Pardo Sanz A, Amat-Santos I, Sarnago F, Gutiérrez Ibañes E, Sanchis J, Rey Blas JR, Gómez-Hospital JA, Santos Martínez S, Maneiro-Melón NM, Mateos Gaitán R, González D'Gregorio J, Salido L, Mestre JL, Sanmartín M, Sánchez-Recalde Á. [Risk factors for in-hospital mortality in patients with acute myocardial infarction during the COVID-19 outbreak]. Rev Esp Cardiol 2020; 73:985-993. [PMID: 32963419 PMCID: PMC7498230 DOI: 10.1016/j.recesp.2020.07.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/20/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION AND OBJECTIVES Despite advances in treatment, patients with acute myocardial infarction (AMI) still exhibit unfavorable short- and long-term prognoses. In addition, there is scant evidence about the clinical outcomes of patients with AMI and coronavirus disease 2019 (COVID-19). The objective of this study was to describe the clinical presentation, complications, and risk factors for mortality in patients admitted for AMI during the COVID-19 pandemic. METHODS This prospective, multicenter, cohort study included all consecutive patients with AMI who underwent coronary angiography in a 30-day period corresponding chronologically with the COVID-19 outbreak (March 15 to April 15, 2020). Clinical presentations and outcomes were compared between COVID-19 and non-COVID-19 patients. The effect of COVID-19 on mortality was assessed by propensity score matching and with a multivariate logistic regression model. RESULTS In total, 187 patients were admitted for AMI, 111 with ST-segment elevation AMI and 76 with non-ST-segment elevation AMI. Of these, 32 (17%) were diagnosed with COVID-19. GRACE score, Killip-Kimball classification, and several inflammatory markers were significantly higher in COVID-19-positive patients. Total and cardiovascular mortality were also significantly higher in COVID-19-positive patients (25% vs 3.8% [P < .001] and 15.2% vs 1.8% [P = .001], respectively). GRACE score > 140 (OR, 23.45; 95%CI, 2.52-62.51; P = .005) and COVID-19 (OR, 6.61; 95%CI, 1.82-24.43; P = .02) were independent predictors of in-hospital death. CONCLUSIONS During this pandemic, a high GRACE score and COVID-19 were independent risk factors associated with higher in-hospital mortality.Full English text available from:www.revespcardiol.org/en.
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Affiliation(s)
- Jorge Solano-López
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - José Luis Zamorano
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Ana Pardo Sanz
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Ignacio Amat-Santos
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, España
| | - Fernando Sarnago
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario 12 de Octubre, Madrid, España
| | - Enrique Gutiérrez Ibañes
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Juan Sanchis
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, España
| | - Juan Ramón Rey Blas
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Joan Antoni Gómez-Hospital
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
- Departamento de Cardiología, Hospital Universitario Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Sandra Santos Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Instituto de Ciencias del Corazón (ICICOR), Valladolid, España
| | | | - Roberto Mateos Gaitán
- Departamento de Cardiología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, España
| | - Jessika González D'Gregorio
- Departamento de Cardiología Intervencionista, Hospital Clínic i Universitari de València - Instituto de Investigación Sanitaria INCLIVA, Valencia, España
| | - Luisa Salido
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - José L Mestre
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Marcelo Sanmartín
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
| | - Ángel Sánchez-Recalde
- Departamento de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, España
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Fernández-Bergés D, Degano IR, Gonzalez Fernandez R, Subirana I, Vila J, Jiménez-Navarro M, Perez-Fernandez S, Roqué M, Bayes-Genis A, Fernandez-Aviles F, Mayorga A, Bertomeu-Gonzalez V, Sanchis J, Rodríguez Esteban M, Sanchez-Hidalgo A, Sanchez-Insa E, Elorriaga A, Abu Assi E, Nuñez A, Garcia Ruiz JM, Morrondo Valdeolmillos P, Bosch-Portell D, Lekuona I, Carrillo-Lopez A, Zamora A, Vega-Hernandez B, Alameda Serrano J, Rubert C, Ruiz-Valdepeñas L, Quintas L, Rodríguez-Padial L, Vaquero J, Martinez Dolz L, Barrabes JA, Sanchez PL, Sionis A, Martí-Almor J, Elosua R, Lidon RM, Garcia-Dorado D, Marrugat J. Benefit of primary percutaneous coronary interventions in the elderly with ST segment elevation myocardial infarction. Open Heart 2020; 7:openhrt-2019-001169. [PMID: 32747454 PMCID: PMC7402007 DOI: 10.1136/openhrt-2019-001169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 04/21/2020] [Accepted: 06/02/2020] [Indexed: 02/01/2023] Open
Abstract
Objective Primary percutaneous coronary intervention (P-PCI) has demonstrated its efficacy in patients with ST segment elevation myocardial infarction (STEMI). However, patients with STEMI ≥75 years receive less P-PCI than younger patients despite their higher in-hospital morbimortality. The objective of this analysis was to determine the effectiveness of P-PCI in patients with STEMI ≥75 years. Methods We included 979 patients with STEMI ≥75 years, from the ATención HOspitalaria del Síndrome coronario study, a registry of 8142 consecutive patients with acute coronary syndrome admitted at 31 Spanish hospitals in 2014–2016. We calculated a propensity score (PS) for the indication of P-PCI. Patients that received or not P-PCI were matched by PS. Using logistic regression, we compared the effectiveness of performing P-PCI versus non-performance for the composite primary event, which included death, reinfarction, acute pulmonary oedema or cardiogenic shock during hospitalisation. Results Of the included patients, 81.5 % received P-PCI. The matching provided two groups of 169 patients with and without P-PCI. Compared with its non-performance, P-PCI presented a composite event OR adjusted by PS of 0.55 (95% CI 0.34 to 0.89). Conclusions Receiving a P-PCI was significantly associated with a reduced risk of major intrahospital complications in patients with STEMI aged 75 years or older.
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Affiliation(s)
- Daniel Fernández-Bergés
- Unidad de Investigación, Hospital Don Benito-Villanueva, Don Benito, Spain .,Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain
| | - Irene R Degano
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain
| | | | - Isaac Subirana
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | - Joan Vila
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBERESP de Epidemiologia y Salud Publica, Barcelona, Spain
| | | | - Silvia Perez-Fernandez
- CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Institut Hospital del Mar d'Investigacions Mediques, Barcelona, Spain
| | | | - Antoni Bayes-Genis
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | - Antonio Mayorga
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Madrid, Spain
| | | | - Juan Sanchis
- Cardiology Department, Hospital Clinico Universitario, INCLIVA, Universitat de València, Valencia, Spain
| | - Marcos Rodríguez Esteban
- Department of Cardiology, Hospital Universitario Nuestra Senora de la Candelaria, Santa Cruz de Tenerife, Spain
| | | | - Esther Sanchez-Insa
- Department of Cardiology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Ane Elorriaga
- Department of Cardiology, Hospital Universitario de Basurto, Bilbao, Bilbao, Spain
| | - Emad Abu Assi
- Department of Cardiology, Hospital Álvaro Junqueiro de Vigo, Pontevedra, Vigo, Spain
| | - Alberto Nuñez
- Department of Cardiology, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | | | | | - Daniel Bosch-Portell
- Department of Cardiology, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain
| | - Iñaki Lekuona
- Department of Cardiology, Hospital Galdakao-Usansolo, Galdacano, Spain
| | | | | | | | | | | | | | | | | | - Jessica Vaquero
- Hospital Universitario Araba sede Txagorritxu, Vitoria-Gasteiz, Spain
| | | | - Jose A Barrabes
- Department of Cardiology, University Hospital Vall d'Hebron, Barcelona, Spain
| | - Pedro L Sanchez
- Department of Cardiology, Hospital Universitario Salamanca, Salamanca, Spain
| | - Alessandro Sionis
- Intensive Cardiac Care Unit, Cardiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute IIB-Sant Pau, Universitat de Barcelona, Barcelona, Spain
| | - Julio Martí-Almor
- Department of Medicine, Department of Cardiology, Hospital del Mar. Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Roberto Elosua
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain.,Universitat de Vic, Barcelona, Spain
| | | | | | - Jaume Marrugat
- Institut Hospital del Mar d' Investigacions Mediques, Barcelona, Spain.,CIBER Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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