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Liu C, Guo M, Cui Y, Wu M, Chen H. Incidence and predictors of left ventricular function change following ST-segment elevation myocardial infarction. Front Cardiovasc Med 2023; 10:1079647. [PMID: 37063963 PMCID: PMC10098331 DOI: 10.3389/fcvm.2023.1079647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/13/2023] [Indexed: 04/03/2023] Open
Abstract
AimThe purpose of the study was to assess the incidence and predictors of left ventricular function change in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI.Methods312 patients with STEMI who received primary percutaneous coronary intervention (PCI) between January 2015 and December 2016 were consecutively enrolled in this study. Multiple logistic regression analysis was used to evaluate independent predictors of left ventricular ejection fraction (LVEF) improvement after long-term follow-up.ResultsWe finally analyzed the LVEF change in 186 patients from baseline to follow-up. The mean age was 61.3 ± 12.5 years, with 78.5% being male. The median duration of follow-up after STEMI was 1,021 (389–1,947) days. 54.3% had a decrease in LVEF and 45.7% experienced an improvement in LV function after primary PCI through long-term follow-up. Logistic regression analysis showed lower peak troponin I, non-anterior STEMI, lower baseline LVEF, and no previous myocardial infarction history were independently associated with LVEF improvement.Conclusion54.3% of patients with STEMI undergoing primary PCI had a decrease in LVEF during long-term follow-up. LVEF recovery can be predicted by baseline characteristics.
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Affiliation(s)
- Chuanfen Liu
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
- Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China
| | - Meng Guo
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
- Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China
| | - Yuxia Cui
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
- Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China
| | - Manyan Wu
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
- Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China
| | - Hong Chen
- Department of Cardiology, Peking University People’s Hospital, Beijing, China
- Center for Cardiovascular Translational Research, Peking University People’s Hospital, Beijing, China
- Beijing Key Laboratory of Early Prediction and Intervention of Acute Myocardial Infarction, Peking University People’s Hospital, Beijing, China
- Correspondence: Hong Chen
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Preoperative Comorbidities Associated With Early Mortality in Hip Fracture Patients: A Multicenter Study. J Am Acad Orthop Surg 2023; 31:81-86. [PMID: 36580049 DOI: 10.5435/jaaos-d-21-01055] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 08/05/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Multiple comorbidities in hip fracture patients are associated with increased mortality and complications. The goal of this study was to characterize the relationship between specific patient factors including comorbidities and outcomes in geriatric hip fractures, including length of stay, unplanned ICU admission, discharge disposition, complications, and mortality. METHODS This is a retrospective review of a trauma database from five Level 1 and Level 2 trauma centers of patients with hip fractures of the femoral neck and intertrochanteric region who underwent treatment using hip pinning, hemiarthroplasty, total hip arthroplasty, cephalomedullary nailing, or dynamic hip screw fixation. Mortality was the primary outcome variable (including in-hospital mortality, 30-day mortality, 60-day mortality, and 90-day mortality). Secondary outcome variables included in-hospital adverse events, unplanned transfer to the ICU, postoperative length of stay, and discharge disposition. Regression analyses were used for evaluation of relationships between comorbidities as independent variables and primary and secondary outcomes as dependent variables. RESULTS Two thousand three hundred patients were included. The mortality was 1.8%, 7.0%, 10.9%, and 14.1% for in-hospital, 30-day, 60-day, and 90-day mortality, respectively. Diabetes and cognitive impairment present on admission were associated with mortality at all-time intervals. COPD was the only comorbidity that signaled in-hospital adverse event with an odds ratio of 1.67 (P = 0.012). No patient factors, time to surgery, or comorbidities signaled unplanned ICU transfer. Patients with renal failure and COPD had longer hospital stays after surgery. CONCLUSION Geriatric hip fractures continue to have high short-term morbidity and mortality. Identifying patients with increased odds of early mortality and adverse events can help teams optimize care and outcomes. Patients with diabetes, cognitive impairment, renal failure, and COPD may benefit from continued and improved medical optimization during the perioperative period as well as being more closely managed by a medicine team without delaying time to the operating room.
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Zahler D, Rozenfeld KL, Pasternak Y, Itach T, Lupu L, Banai S, Shacham Y. Relation of Pain-to-Balloon Time and Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Am J Cardiol 2022; 163:38-42. [PMID: 34763825 DOI: 10.1016/j.amjcard.2021.09.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022]
Abstract
Limited and inconsistent data are present regarding the importance of the time delay between symptom onset and balloon inflation in ST-segment elevation myocardial infarction (STEMI) patients. We aimed to investigate the possible influence of prolonging pain-to-balloon times (PBT) on in-hospital outcomes and mortality in a large cohort of patients with STEMI undergoing primary percutaneous coronary intervention. We retrospectively studied 2,345 STEMI patients (age 61 ± 13 years, 82% men) who underwent primary percutaneous coronary intervention. Patients were stratified according to PBT into 3 groups: ≤120 minutes, 121 to 360 minutes, and >360 minutes. Patients' records were assessed for the occurrence of in-hospital complications, 30-day, and 1-year mortality. Of the 2,345 study patients, 36% had PBT time ≤120 minutes, 40% had PBT of 121 to 360 minutes and 24% had PBT time >360 minutes. The major part of the total PBT (average 358 minutes) was caused by the time interval from symptom onset to hospital arrival, namely, pain-to-door time (average 312 minutes) in all 3 groups. Longer PBT was associated with a lower left ventricular ejection fraction, higher incidence of in-hospital complications, and higher 30-day mortality. In 2 multivariate cox regression models, a per-hour increase in PBT (hazard ratio 1.03 [95% confidence interval 1.00 to 1.06], p = 0.039) as well as PBT >360 minutes (hazard ratio 1.6 [95% confidence interval 1.1 to 2.5], p = 0.04) were both independently associated with an increased risk for 1-year mortality. In conclusion, PBT may be an accurate and independent marker for adverse events, pointing to the importance of coronary reperfusion as early as possible based on the onset of pain.
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Alıcı G, Barman HA, Atıcı A, Tuğrul S, Genç Ö, Şahin İ. The Impact of Lesion Complexity and the CHA 2DS 2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction. Int J Clin Pract 2022; 2022:8066780. [PMID: 35685511 PMCID: PMC9159176 DOI: 10.1155/2022/8066780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/29/2021] [Accepted: 01/04/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). OBJECTIVE The present study aimed to determine the impact of lesion complexity and the CHA2DS2-VASc score on SR in patients with STEMI. METHODS A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(-) (n = 1402), according to their initial angiography and SR status. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. RESULTS The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(-) (mean CHA2DS2-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA2DS2-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(-) (0% vs. 6.7%, p < 0.001). CONCLUSION Our study demonstrated that lesion complexity and the CHA2DS2-VASc score are independently associated with spontaneous reperfusion.
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Affiliation(s)
- Gökhan Alıcı
- Okmeydani Training and Research Hospital, Department of Cardiology, Darulaceze Street No:25, Okmeydanı 34384, İstanbul, Turkey
| | - Hasan Ali Barman
- İstanbul University–Cerrahpasa, Institute of Cardiology, İstanbul, Turkey
| | - Adem Atıcı
- İstanbul Medeniyet University, Göztepe Training and Research Hospital, Department of Cardiology, İstanbul 34722, Turkey
| | - Sevil Tuğrul
- Bağcılar Training and Research Hospital, Department of Cardiology, Bağcılar Center, Mimar Sinan Street, Bağcılar, İstanbul 34100, Turkey
| | - Ömer Genç
- Ağrı Training and Research Hospital, Department of Cardiology, Ağrı Center, Ağrı 04200, Turkey
| | - İrfan Şahin
- Bağcılar Training and Research Hospital, Department of Cardiology, Bağcılar Center, Mimar Sinan Street, Bağcılar, İstanbul 34100, Turkey
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Chen X, Guo W, Zhao L, Huang W, Wang L, Sun A, Li L, Mo F. Acute Myocardial Infarction Detection Using Deep Learning-Enabled Electrocardiograms. Front Cardiovasc Med 2021; 8:654515. [PMID: 34262951 PMCID: PMC8273385 DOI: 10.3389/fcvm.2021.654515] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/24/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Acute myocardial infarction (AMI) is associated with a poor prognosis. Therefore, accurate diagnosis and early intervention of the culprit lesion are of extreme importance. Therefore, we developed a neural network algorithm in this study to automatically diagnose AMI from 12-lead electrocardiograms (ECGs). Methods: We used the open-source PTB-XL database as the training and validation sets, with a 7:3 sample size ratio. Twenty-One thousand, eight hundred thirty-seven clinical 12-lead ECGs from the PTB-XL dataset were available for training and validation (15,285 were used in the training set and 6,552 in the validation set). Additionally, we randomly selected 205 ECGs from a dataset built by Chapman University, CA, USA and Shaoxing People's Hospital, China, as the testing set. We used a residual network for training and validation. The model performance was experimentally verified in terms of area under the curve (AUC), precision, sensitivity, specificity, and F1 score. Results: The AUC of the training, validation, and testing sets were 0.964 [95% confidence interval (CI): 0.961-0.966], 0.944 (95% CI: 0.939-0.949), and 0.977 (95% CI: 0.961-0.991), respectively. The precision, sensitivity, specificity, and F1 score of the deep learning model for AMI diagnosis from ECGs were 0.827, 0.824, 0.950, and 0.825, respectively, in the training set, 0.789, 0.818, 0.913, and 0.803, respectively, in the validation set, and 0.830, 0.951, 0.951, and 0.886, respectively, in the testing set. The AUC for automatic AMI location diagnosis of LMI, IMI, ASMI, AMI, ALMI were 0.969 (95% CI: 0.959-0.979), 0.973 (95% CI: 0.962-0.978), 0.987 (95% CI: 0.963-0.989), 0.961 (95% CI: 0.956-0.989), and 0.996 (95% CI: 0.957-0.997), respectively. Conclusions: The residual network-based algorithm can effectively automatically diagnose AMI and MI location from 12-lead ECGs.
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Affiliation(s)
- Xiehui Chen
- Shenzhen Longhua District Central Hospital, Shenzhen, China
| | - Wenqin Guo
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Lingyue Zhao
- Department of Ambulatory Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Weichao Huang
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Lili Wang
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Aimei Sun
- Department of Cardiology, Fuwai Hospital Chinese Academy of Medical Sciences, Shenzhen, Shenzhen, China
| | - Lang Li
- Department of Cardiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Fanrui Mo
- Department of Cardiology, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
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Torre E, Colombo GL, Di Matteo S, Martinotti C, Valentino MC, Rebora A, Cecoli F, Monti E, Galimberti M, Di Bartolo P, Gaggioli G, Bruno GM. Economic Impact of COVID-19 Lockdown on Italian NHS: Focus on Diabetes Mellitus. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:503-518. [PMID: 34163191 PMCID: PMC8213950 DOI: 10.2147/ceor.s313577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/19/2021] [Indexed: 01/14/2023] Open
Abstract
Background In Italy, the adoption of a total lockdown has generated almost total suspension of outpatient visits except for emergencies. Even after lockdown, the pandemic fear created additional barriers to access the health services. The aim of our study is to evaluate the economic impact of the lockdown for COVID-19 on public health in Italy, focusing on its effects on diabetic population. Materials and Methods We analyzed the impact of the lockdown on excess mortality and morbidity in the Italian diabetic population during 2020. The analysis was divided into several steps: a quantification of specialist visit reduction, the calculation of excess mortality in the diabetic population, the economic evaluation of the slowdown in the use of innovative diabetic therapies. Furthermore, the impact of the lockdown on the reduction of procedures and follow-up visits in diabetic population was evaluated. The overall impact of the pandemic and lockdown effects on costs and quality of life was then calculated. Results During 2020, a drop of 28% in patient access has been observed. Diabetic patients recorded a twice higher mortality value compared to general population (20.4% vs 10.2%). The analysis of market data revealed a slowdown in consumption of new antidiabetic therapies (−14%, 27% vs 41%). We estimated an expense of €26.6 million for NHS and a loss of 257 utilities in diabetic population due to the missed benefits related to slowdown in innovative antidiabetic drugs use and non-optimal follow-up and control of diabetes complications. In simulation scenarios, we also estimated an overall expenditure ranging from €38.7 to 94.0 million and a loss of 294–836 utilities. Conclusion Diabetic population paid a high tribute to pandemic and lockdown, both in terms of number of deaths and burden of diabetic complications, together with an overall deterioration of quality of life.
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Affiliation(s)
- Enrico Torre
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Sergio Di Matteo
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Chiara Martinotti
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Maria Chiara Valentino
- S.A.V.E. Studi Analisi Valutazioni Economiche S.r.l., Health Economics & Outcomes Research, Milan, Italy
| | - Alberto Rebora
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Francesca Cecoli
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | - Eleonora Monti
- Endocrinology Diabetology and Metabolic Diseases Unit - ASL3, Genoa, Italy
| | | | - Paolo Di Bartolo
- Diabetes Center of Ravenna, Romagna Diabetes Clinical Network, Romagna Local Health Authority, Ravenna, Italy
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Percutaneous Versus Surgical Revascularization for Acute Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 31:50-54. [PMID: 33339773 DOI: 10.1016/j.carrev.2020.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Acute myocardial infarction (AMI) is a common medical condition in our clinical practice that should be treated with appropriate revascularization in a timely manner. Percutaneous revascularization (PR) has been the first-line treatment option when feasible. Limited data is available comparing PR to surgical revascularization (SR) in the AMI setting. METHODS Study population was extracted from the 2016 Nationwide Readmissions Data using International Classification of Diseases, tenth edition, clinical modifications/procedure coding system codes for AMI, PR, SR, and procedural complications. Study endpoints included in-hospital all-cause mortality, length of index hospital stay (LOS), stroke, acute kidney injury, bleeding, need for blood transfusion, acute respiratory failure, and total hospital charges. RESULTS The study identified 45,539 discharges with a principal admission diagnosis of AMI (38.7% ST elevation and 61.3% non-ST elevation) who had either PR or SR as a principal procedure (79.1% PR versus 20.9% SR). Single vessel revascularization was performed in 67.8% (93.1% had PR versus 6.9% had SR, p < 0.01). Multivessel revascularization was performed in 32.2% (64.8% had PR versus 35.2% had SR, p < 0.01). 83% of SR was in the setting of non-ST elevation AMI (NSTEMI). In comparison to SR, PR was associated with higher in-hospital all-cause mortality (3.7% versus 2.2%, p < 0.01), shorter LOS (4.3 versus 11.6 days, p < 0.01), and lower incidence of post-procedural stroke (1.0% versus 1.8%, p < 0.01), acute kidney injury (14.9% versus 24.8%, p < 0.01), bleeding (4.3% versus 47.1%, p < 0.01), need for blood transfusion (2.9% versus 18.5%, p < 0.01), acute respiratory failure (10.7% versus 19.8%, p < 0.01), and total hospital charges (120,590$ versus 229,917$, p < 0.01). These results persist after adjustment for baseline characteristics. In a subgroup analysis, SR mortality benefit persisted in patients who had multivessel revascularization (in both ST and non-ST elevation AMI), but not in single vessel revascularization. CONCLUSIONS In patients presented with AMI, PR was associated with higher in-hospital all-cause mortality but lower morbidity, shorter LOS, and lower total hospital charges than SR. However, the mortality benefit of SR was seen in multivessel revascularization only, and not in single vessel revascularization.
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Zughaib M, Ters P, Singh R, Zughaib M. Urban vs Suburban: Is the Door-to-Balloon Time Affected by Geographic, Socioeconomic, or Racial Differences? A Tale of Two Campuses. Cardiol Res Pract 2020; 2020:8367123. [PMID: 32963825 PMCID: PMC7495227 DOI: 10.1155/2020/8367123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 09/02/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In 2004, the ACC/AHA released guidelines in the treatment of ST-segment elevation myocardial infarction (STEMI) within a time window from the time a patient physically enters the hospital to the time of percutaneous coronary intervention (PCI). This time window is defined as the door-to-balloon time (DTB) and is recommended to be under 90 minutes to improve patient mortality. To add another layer of complexity, patients with varying socioeconomic status and racial differences experience large disparities in health. Our institution provides care for patients in two locations separated by approximately 30 miles within the Detroit metropolitan area. We aimed this study to investigate any differences between DTB times of our two campuses (urban versus suburban population) as well as any differences in the components that comprise DTB times. METHODS We retrospectively collected data on all patients who presented to either Campus 1 or Campus 2 with a STEMI from 2016 to 17. DTB times, demographical, temporal, and anatomical data were collected and analyzed. Our search included 169 patients who met the full inclusion criteria. RESULTS The combined average of the overall DTB time for both campuses was 81 minutes, 15 seconds (95% CI: 78:05, 84:25). The average DTB time in Campus 1 was 78 minutes and 41 seconds (95% CI: 73:05, 84:18) versus 82 minutes and 46 seconds (95% CI: 78:55, 86:38) for Campus 2 (p=0.24). There were no statistically significant differences between either campuses within the separate metrics that comprise DTB times. CONCLUSIONS Our study demonstrated that we have been able to provide high-quality care to all of our patients presenting with STEMI at either campus, regardless of socioeconomic differences in the populations they serve. Additionally, each campus has demonstrated DTB well below the nationally recommended guidelines.
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Affiliation(s)
- Marc Zughaib
- Providence Hospital, Michigan State University, Southfield, MI, USA
| | - Patrick Ters
- Providence Hospital, Michigan State University, Southfield, MI, USA
| | - Robby Singh
- Providence Hospital, Michigan State University, Southfield, MI, USA
| | - Marcel Zughaib
- Providence Hospital, Michigan State University, Southfield, MI, USA
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Park J, Choi KH, Lee JM, Kim HK, Hwang D, Rhee TM, Kim J, Park TK, Yang JH, Song YB, Choi JH, Hahn JY, Choi SH, Koo BK, Chae SC, Cho MC, Kim CJ, Kim JH, Jeong MH, Gwon HC, Kim HS. Prognostic Implications of Door-to-Balloon Time and Onset-to-Door Time on Mortality in Patients With ST -Segment-Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Heart Assoc 2020; 8:e012188. [PMID: 31041869 PMCID: PMC6512115 DOI: 10.1161/jaha.119.012188] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background In patients with ST-segment-elevation myocardial infarction, timely reperfusion therapy with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset-to-door (O2D) time or D2B time would enhance survival of patients with ST-segment-elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST-segment-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Methods and Results We analyzed 5243 patients with ST-segment-elevation myocardial infarction were treated at 20 tertiary hospitals capable of primary percutaneous coronary intervention in Korea. The association between O2D or D2B time with all-cause mortality at 1 year was evaluated. The median O2D time was 2.0 hours, and the median D2B time was 59 minutes. A total of 92.2% of the total population showed D2B time ≤90 minutes. In univariable analysis, 1-hour delay of D2B time was associated with a 55% increased 1-year mortality, whereas 1-hour delay of O2D time was associated with a 4% increased 1-year mortality. In multivariable analysis, D2B time showed an independent association with mortality (adjusted hazard ratio, 1.90; 95% CI , 1.51-2.39; P<0.001). Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19-0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.
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Affiliation(s)
- Jonghanne Park
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,2 Department of Internal Medicine Naju National Hospital Jeollanam-do Korea
| | - Ki Hong Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo Myung Lee
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyun Kuk Kim
- 4 Department of Internal Medicine and Cardiovascular Center Chosun University Hospital University of Chosun College of Medicine Gwangju Korea
| | - Doyeon Hwang
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | - Tae-Min Rhee
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.,5 National Maritime Medical Center Changwon Korea
| | - Jihoon Kim
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Taek Kyu Park
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jeong Hoon Yang
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Young Bin Song
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Jin-Ho Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Joo-Yong Hahn
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Seung-Hyuk Choi
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Bon-Kwon Koo
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
| | | | - Myeong Chan Cho
- 7 Cardiology Division Department of Internal Medicine Chungbuk National University Hospital Cheongju Korea
| | - Chong Jin Kim
- 8 Department of Internal Medicine Kyunghee University College of Medicine Seoul Korea
| | - Ju Han Kim
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Myung Ho Jeong
- 9 Department of Internal Medicine and Heart Center Chonnam National University Hospital Gwangju Korea
| | - Hyeon-Cheol Gwon
- 3 Division of Cardiology Department of Internal Medicine Heart Vascular Stroke Institute Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Hyo-Soo Kim
- 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea
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Cloutier JM, Hayes C, Ducas J, Allen DW. Reducing Delay to Treatment of ST-Elevation Myocardial Infarction With Software Electrocardiographic Interpretation and Transmission (SCINET). CJC Open 2020; 2:111-117. [PMID: 32462124 PMCID: PMC7242508 DOI: 10.1016/j.cjco.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/11/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) has resulted in improved outcomes. However, many patients still walk in to the emergency department (ED) with STEMI, experiencing delays and worse outcomes. Software electrocardiogram (ECG) diagnosis of STEMI and electronic transmission to a cardiologist may result in improved door-to-device (D2D) times. METHODS We retrospectively identified all patients presenting with STEMI from January 2015 to September 2016. Components of delay in D2D, ED variables, and the patients' ECGs were extracted from our regional database. All ECGs performed for suspected myocardial infarction in the region were extracted over the study period. We assessed the accuracy of the software 12SL in diagnosing STEMI, ED contributors to delays in D2D, and the potential reduction in D2D if software diagnosis of STEMI resulted in activation of the cardiac catheterization laboratory. RESULTS A total of 379 patients presented to an ED in our region and received primary percutaneous coronary intervention over the study period. In the 143,574 ECGs performed over the study period for suspected STEMI, the overall sensitivity and specificity of 12SL were 90.5% and 99.98%, respectively. We estimated a potential 17-minute reduction in D2D in the 90.5% of patients correctly identified as having STEMI, with a false activation rate of 4%. Female patients and older patients experienced an even larger potential benefit, with 24- and 25-minute reductions in D2D, respectively. CONCLUSIONS Patients who walk in to an ED with STEMI experience significant system-related delays in recognition and treatment. Automated software diagnosis of STEMI is accurate and could result in significant improvements in D2D times.
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Affiliation(s)
- Justin M. Cloutier
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Christopher Hayes
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - John Ducas
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David W. Allen
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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11
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Mohamed MO, Rashid M, Farooq S, Siddiqui N, Parwani P, Shiers D, Thamman R, Gulati M, Shoaib A, Chew-Graham C, Mamas MA. Acute Myocardial Infarction in Severe Mental Illness: Prevalence, Clinical Outcomes, and Process of Care in U.S. Hospitalizations. Can J Cardiol 2019; 35:821-830. [PMID: 31292080 DOI: 10.1016/j.cjca.2019.04.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Severe mental illness (SMI) is associated with increased cardiovascular mortality. We sought to examine the prevalence, clinical outcomes, and management strategy of patients with SMI presenting with acute myocardial infarction (AMI). METHODS All AMI hospitalizations from the National Inpatient Sample were included, stratified by mental health status into 5 groups: no SMI, schizophrenia, other non-organic psychoses (ONOP), bipolar disorder, and major depression. Regression analyses were performed to assess the association (adjusted odds ratios [ORs], P ≤ 0.001 for all outcomes) between SMI subtypes and clinical outcomes. RESULTS Of 6,968,777 AMI hospitalizations between 2004 and 2014, 439,544 patients (6.5%) had an SMI diagnosis. Although patients with schizophrenia and ONOP experienced higher crude rates of in-hospital mortality and stroke compared with those without SMI, only schizophrenic patients were at increased odds of mortality (OR, 1.10; 95% confidence interval [CI], 1.04-1.16), whereas ONOP was the only group at increased odds of stroke (OR, 1.53; 95% CI, 1.42-1.65) after multivariate adjustment. Patients with ONOP were the only group associated with increased odds of in-hospital bleeding compared with those without SMI (OR, 1.11; 95% CI, 1.04-1.17). All those with SMI subtypes were less likely to receive coronary angiography and percutaneous coronary intervention, with the schizophrenia group being at least odds of either procedure (OR, 0.46; 95% CI, 0.45-0.48 and OR, 0.57; 95% CI, 0.55-0.59, respectively). CONCLUSION Schizophrenia and ONOP are the only SMI subtypes associated with adverse clinical outcomes after AMI. However, all patients with SMI were less likely to receive invasive management for AMI, with female gender and schizophrenia diagnosis being the strongest predictors of conservative management. A multidisciplinary approach between psychiatrists and cardiologists could improve the outcomes of this high-risk population.
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Affiliation(s)
- Mohamed Osama Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Saeed Farooq
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Nishat Siddiqui
- Nevill Hall Hospital, Aneurin Bevan University Health Board, Wales, United Kingdom
| | - Purvi Parwani
- Division of Cardiology, Department of Medicine, Loma Linda University Health, Loma Linda, California, USA
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ritu Thamman
- Department of Cardiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Martha Gulati
- Division of Cardiology, University of Arizona, Phoenix, Arizona, USA
| | - Ahmad Shoaib
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Keele University, Keele, United Kingdom; Midlands Partnership NHS Foundation Trust, Staffordshire, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Applied Clinical Science and Primary Care and Health Sciences, Keele University, Keele, United Kingdom.
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12
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Huang B, Huang LF, Zhao L, Zeng Z, Wang X, Cao D, Yang L, Ye Z, Chen X, Liu B, He TC, Wang X. Microvesicles (MIVs) secreted from adipose-derived stem cells (ADSCs) contain multiple microRNAs and promote the migration and invasion of endothelial cells. Genes Dis 2019; 7:225-234. [PMID: 32215292 PMCID: PMC7083715 DOI: 10.1016/j.gendis.2019.04.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022] Open
Abstract
Extracellular vesicles (EVs) such as microvesicles (MIVs) play an important role in intercellular communications. MIVs are small membrane vesicles sized 100–1000 nm in diameter that are released by many types of cells, such as mesenchymal stem cells (MSCs), tumor cells and adipose-derived stem cells (ADSC). As EVs can carry out autocrine and paracrine functions by controlling multiple cell processes, it is conceivable that EVs can be used as delivery vehicles for treating several clinical conditions, such as to improve cardiac angiogenesis after myocardial infarction (MI). Here, we seek to investigate whether ADSC-derived MIVs contain microRNAs that regulate angiogenesis and affect cell migration of endothelial cells. We first characterized the ADSC-derived MIVs and found that the MIVs had a size range of 100–300 nm, and expressed the MIV marker protein Alix. We then analyzed the microRNAs in ADSCs and ADSC-derived MIVs and demonstrated that ADSC-derived MIVs selectively released a panel of microRNAs, several of which were related to angiogenesis, including two members of the let-7 family. Furthermore, we demonstrated that ADSC-derived MIVs promoted the cell migration and invasion of the HUVEC endothelial cells. The PKH26-labeled ADSC-derived MIVs were effectively uptaken into the cytoplasm of HUVEC cells. Collectively, our results demonstrate that the ADSC-derived MIVs can promote migration and invasion abilities of endothelial cells, suggesting pro-angiogenetic potential. Future studies should focus on investigating the roles and mechanisms through which ADSC-derived MIVs regulate angiogenesis.
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Affiliation(s)
- Bo Huang
- Ministry of Education Key Laboratory of Diagnostic Medicine and School of Laboratory Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.,Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Lin-Feng Huang
- Department of Clinical Laboratory Medicine, Jiangxi Maternal and Child Health Hospital, Nanchang, 330006, China
| | - Ling Zhao
- Ministry of Education Key Laboratory of Diagnostic Medicine and School of Laboratory Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.,Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Zongyue Zeng
- Ministry of Education Key Laboratory of Diagnostic Medicine and School of Laboratory Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.,Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Xi Wang
- Ministry of Education Key Laboratory of Diagnostic Medicine and School of Laboratory Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.,Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Daigui Cao
- Ministry of Education Key Laboratory of Diagnostic Medicine and School of Laboratory Medicine, and The Affiliated Hospitals of Chongqing Medical University, Chongqing Medical University, Chongqing, 400016, China.,Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of Orthopaedic Surgery, Chongqing General Hospital Affiliated with the University of Chinese Academy of Sciences, Chongqing, 400013, China
| | - Lijuan Yang
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of Obstetrics and Gynecology, The First Hospital of Lanzhou University, Lanzhou, 730030, China
| | - Zhenyu Ye
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of General Surgery, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China
| | - Xian Chen
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of Clinical Laboratory Medicine, The Affiliated Hospital of Qingdao University, Qingdao, 266061, China
| | - Bin Liu
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA.,Department of Biology, School of Life Sciences, Southwest University, Chongqing, 400715, China
| | - Tong-Chuan He
- Molecular Oncology Laboratory, Department of Orthopaedic Surgery and Rehabilitation Medicine, The University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Xiaozhong Wang
- Department of Clinical Laboratory Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
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13
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Gebhard CE, Gebhard C, Maafi F, Bertrand MJ, Stähli BE, Maredziak M, Bengs S, Haider A, Zhang ZW, Smith DC, Ly HQ. Impact of summer season on pre-hospital time delays in women and men undergoing primary percutaneous coronary intervention. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 656:322-330. [PMID: 30513423 DOI: 10.1016/j.scitotenv.2018.11.363] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pre-hospital delays have been associated with poor outcomes in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It is currently unknown how environmental variables affect treatment delays in these patients. METHODS AND RESULTS The association between environmental variables, time to treatment including transportation times and adverse in-hospital events was assessed in 1828 consecutive patients with STEMI undergoing primary PCI between 2010 and 2014 in the Montreal metropolitan area. Median[Q1;Q3] total ischemia time was significantly longer during summer season (April-September) as compared to winter season (October-March, 201[140;305] min vs 187[126;266] min, p = 0.022). This difference between seasons was due to a significant increase in median decision time to seek treatment for symptoms during summer (90[46;185] min vs 78[40;156], p = 0.004). The former peaked during July and August and was most pronounced in men. Hence, outside temperature and summer season were identified as strong predictors of prolonged decision time in patients with STEMI (p < 0.001 and p = 0.002, respectively). Transportation times slightly increased during winter season and snow fall, this difference, however, was not significant (p = 0.46). A significant increase in in-hospital adverse outcomes following primary PCI was observed during summer season as compared to winter season (7.2% vs 4.8%, p = 0.032). Accordingly, multivariate logistic regression models adjusted for baseline variables identified summer season as a strong predictor of periprocedural adverse events (OR 1.83, 95% CI 1.2-3.11, p = 0.037). CONCLUSION Contrary to our initial hypothesis, pre-hospital delays in patients with STEMI are considerably longer and associated with adverse in-hospital outcomes during summer season. Considering the consequences of global warming, it is imperative that educational efforts targeting patients' perception are implemented to counter treatment delays.
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Affiliation(s)
- Caroline E Gebhard
- Montreal Heart Institute, Montreal, Canada; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Catherine Gebhard
- Montreal Heart Institute, Montreal, Canada; Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland.
| | | | | | | | - Monika Maredziak
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Susan Bengs
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Ahmed Haider
- Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | | | - Hung Q Ly
- Montreal Heart Institute, Montreal, Canada; Department of Medicine, Université de Montréal, Montreal, Canada
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14
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Garber L, McAndrew TC, Chung ES, Stancak B, Svendsen JH, Monteiro J, Fischer TM, Kueffer F, Ryan T, Bax J, Leon AR, Stone GW. Predictors of Left Ventricular Remodeling After Myocardial Infarction in Patients With a Patent Infarct Related Coronary Artery After Percutaneous Coronary Intervention (from the Post-Myocardial Infarction Remodeling Prevention Therapy [PRomPT] Trial). Am J Cardiol 2018; 121:1293-1298. [PMID: 29580631 DOI: 10.1016/j.amjcard.2018.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/29/2018] [Accepted: 02/06/2018] [Indexed: 11/29/2022]
Abstract
Left ventricular (LV) remodeling after myocardial infarction (MI) is a strong predictor of heart failure and mortality. The predictors of long-term remodeling after MI have been incompletely studied. We therefore examined the correlates of LV remodeling in patients with large ST-segment elevation myocardial infarction and a patent infarct artery after percutaneous 2coronary intervention (PCI) from the randomized Post-Myocardial Infarction Remodeling Prevention Therapy trial. Peri-infarct pacing had a neutral effect on long-term remodeling in patients with large first MI. The present analysis includes 109 patients in whom an open artery was restored after PCI, and in whom LV end-diastolic volume (LVEDV) at baseline and 18 months was assessed by transthoracic echocardiography. Multivariable models were fit to identify the independent predictors of LVEDV at baseline and 18 months. By multivariable analysis, male sex (p = 0.004) and anterior MI location (p = 0.03) were independently associated with baseline LVEDV. The following variables were independent predictors of increased LVEDV at 18 months: younger age (p = 0.01), male sex (p = 0.03), peak creatine phosphokinase (p = 0.03), shorter time from MI to baseline transthoracic echocardiography (p = 0.04), baseline LVEDV (p < 0.0001), and lack of statin use (p = 0.03). In conclusion, patients with large MI and an open infarct artery after PCI, anterior MI location, and male sex were associated with greater baseline LVEDV, but MI location was not associated with 18-month LVEDV. In contrast, younger age, peak creatine phosphokinase, male sex, baseline LVEDV, and lack of statin use were associated with long-term LV remodeling.
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Affiliation(s)
- Leonid Garber
- New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | - Thomas C McAndrew
- New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
| | | | - Branislav Stancak
- Eastern Slovakia Institute for Cardiac and Vascular Diseases, Kosice, Slovakia
| | - Jesper H Svendsen
- Rigshospitalet and the University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Jeroen Bax
- Leiden University Medical Center, Leiden, The Netherlands
| | - Angel R Leon
- Emory University School of Medicine, Atlanta, Georgia
| | - Gregg W Stone
- New York-Presbyterian Hospital, Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York.
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15
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Masuda J, Kishi M, Kumagai N, Yamazaki T, Sakata K, Higuma T, Ogimoto A, Dohi K, Tanigawa T, Hanada H, Nakamura M, Sokejima S, Takayama M, Higaki J, Yamagishi M, Okumura K, Ito M. Rural-Urban Disparity in Emergency Care for Acute Myocardial Infarction in Japan. Circ J 2018; 82:1666-1674. [PMID: 29593169 DOI: 10.1253/circj.cj-17-1275] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.Methods and Results:In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001). CONCLUSIONS AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.
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Affiliation(s)
- Jun Masuda
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | | | - Toru Yamazaki
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Takumi Higuma
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine
| | - Akiyoshi Ogimoto
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hiroyuki Hanada
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Shigeru Sokejima
- Department of Public Health and Occupational Medicine, Mie University Graduate School of Medicine
| | | | - Jitsuo Higaki
- Department of Integrated Medicine and Informatics, Ehime University Graduate School of Medicine
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine, Kanazawa University Graduate School of Medicine
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
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16
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Cole J, Beare R, Phan TG, Srikanth V, MacIsaac A, Tan C, Tong D, Yee S, Ho J, Layland J. Staff Recall Travel Time for ST Elevation Myocardial Infarction Impacted by Traffic Congestion and Distance: A Digitally Integrated Map Software Study. Front Cardiovasc Med 2018; 4:89. [PMID: 29359134 PMCID: PMC5766675 DOI: 10.3389/fcvm.2017.00089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/15/2017] [Indexed: 11/16/2022] Open
Abstract
Background Recent evidence suggests hospitals fail to meet guideline specified time to percutaneous coronary intervention (PCI) for a proportion of ST elevation myocardial infarction (STEMI) presentations. Implicit in achieving this time is the rapid assembly of crucial catheter laboratory staff. As a proof-of-concept, we set out to create regional maps that graphically show the impact of traffic congestion and distance to destination on staff recall travel times for STEMI, thereby producing a resource that could be used by staff to improve reperfusion time for STEMI. Methods Travel times for staff recalled to one inner and one outer metropolitan hospital at midnight, 6 p.m., and 7 a.m. were estimated using Google Maps Application Programming Interface. Computer modeling predictions were overlaid on metropolitan maps showing color coded staff recall travel times for STEMI, occurring within non-peak and peak hour traffic congestion times. Results Inner metropolitan hospital staff recall travel times were more affected by traffic congestion compared with outer metropolitan times, and the latter was more affected by distance. The estimated mean travel times to hospital during peak hour were greater than midnight travel times by 13.4 min to the inner and 6.0 min to the outer metropolitan hospital at 6 p.m. (p < 0.001). At 7 a.m., the mean difference was 9.5 min to the inner and 3.6 min to the outer metropolitan hospital (p < 0.001). Only 45% of inner metropolitan staff were predicted to arrive within 30 min at 6 p.m. compared with 100% at midnight (p < 0.001), and 56% of outer metropolitan staff at 6 p.m. (p = 0.021). Conclusion Our results show that integration of map software with traffic congestion data, distance to destination and travel time can predict optimal residence of staff when on-call for PCI.
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Affiliation(s)
- Justin Cole
- Peninsula Health Heart Service, Frankston, VIC, Australia.,Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Richard Beare
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia.,Developmental Imaging, Murdoch Children's Research Institute, Parkville, VIC, Australia
| | - Thanh G Phan
- School of Clinical Sciences, Monash Health, Monash University, Melbourne, VIC, Australia
| | - Velandai Srikanth
- Peninsula Clinical School, Monash University, Melbourne, VIC, Australia
| | - Andrew MacIsaac
- Department of Cardiology, St Vincent's Hospital, Melbourne, VIC, Australia
| | | | - David Tong
- Peninsula Health Heart Service, Frankston, VIC, Australia
| | - Susan Yee
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jesslyn Ho
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Jamie Layland
- Peninsula Health Heart Service, Frankston, VIC, Australia.,Peninsula Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Cardiology, St Vincent's Hospital, Melbourne, VIC, Australia
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17
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Koh JQ, Tong DC, Sriamareswaran R, Yeap A, Yip B, Wu S, Perera P, Menon S, Noaman SA, Layland J. In-hospital ‘CODE STEMI’ improves door-to-balloon time in patients undergoing primary percutaneous coronary intervention. Emerg Med Australas 2017; 30:222-227. [DOI: 10.1111/1742-6723.12855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/14/2017] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ji Quan Koh
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
| | - David C Tong
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | | | - Allysha Yeap
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Bryan Yip
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Sam Wu
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Padeepa Perera
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
| | - Shyaman Menon
- Department of Emergency; Peninsula Health; Melbourne Victoria Australia
| | - Saad Al Noaman
- Department of Emergency; Peninsula Health; Melbourne Victoria Australia
| | - Jamie Layland
- Department of Cardiology; Peninsula Health; Melbourne Victoria Australia
- Department of Medicine; Monash University; Melbourne Victoria Australia
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18
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Almawiri A, Jan V, Ziad A, Martin J, Josef S. Mortality benefit of primary transportation to a PCI-capable center persists through an eight-year follow-up in patients with ST-segment elevation myocardial infarction. J Interv Cardiol 2017; 30:522-526. [DOI: 10.1111/joic.12419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 07/11/2017] [Accepted: 07/18/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Abdulwasya Almawiri
- Department of Cardiovascular Medicine; University Hospital in Hradec Kralove; Charles University; Hradec Kralove Czech Republic
| | - Vojacek Jan
- Department of Cardiovascular Medicine; University Hospital in Hradec Kralove; Charles University; Hradec Kralove Czech Republic
| | - Albahri Ziad
- Department of Pediatrics; University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
| | - Jakl Martin
- Department of Emergency Medicine; University Hospital in Hradec Kralove; Hradec Kralove Czech Republic
- Department of Internal Medicine; University of Defense; Faculty of Military Health Sciences; Hradec Kralove Czech Republic
| | - Stasek Josef
- Department of Cardiovascular Medicine; University Hospital in Hradec Kralove; Charles University; Hradec Kralove Czech Republic
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19
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Askandar S, Bob-Manuel T, Singh P, Khouzam RN. Shorter Door-To-Balloon ST-Elevation Myocardial Infarction Time: Should There Be a Minimum Limit? Curr Probl Cardiol 2017; 42:175-187. [DOI: 10.1016/j.cpcardiol.2017.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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20
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Savonitto S, De Luca G, Goldstein P, van T' Hof A, Zeymer U, Morici N, Thiele H, Montalescot G, Bolognese L. Antithrombotic therapy before, during and after emergency angioplasty for ST elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:173-190. [PMID: 26124456 DOI: 10.1177/2048872615590148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The first three hours after symptom onset hold the maximum potential for myocardial reperfusion and salvage in ST-elevation myocardial infarction (STEMI) patients. During this period timely primary percutaneous coronary intervention (PPCI) or, when PPCI is not promptly feasible, pre-hospital administration of fibrinolyis or a glycoprotein IIb/IIIa-inhibitor (GPI) have been shown to restore coronary patency and reperfusion and even result in myocardial infarction (MI) abortion. On the other hand, oral antiplatelet therapy may not yet guarantee sufficient platelet inhibition. Patients presenting after this golden time have less, if any, benefit from an aggressive antithrombotic treatment prior to PPCI. Antithrombotic treatment during primary angioplasty should be tailored on the basis of the coronary thrombotic burden, vascular approach and the patient's risk of bleeding complications. A GPI-based approach may be favourable in patients presenting early with large MI and high thrombus burden, whereas a bivalirudin-based approach without GPI may be preferred in patients with higher bleeding risk. There are no data to support the use of GPI in bailout conditions. The powerful oral P2Y12 inhibitors, prasugrel and ticagrelor, have been clearly shown to prevent stent thrombosis and recurrent ischaemic events after emergency percutaneous coronary intervention in STEMI patients. Open issues remaining are the treatment of patients with high bleeding risk, such as the elderly and those requiring anticoagulation, as well as the duration of dual antiplatelet therapy after STEMI.
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Affiliation(s)
| | | | | | | | - Uwe Zeymer
- 5 Klinikum Ludwigshafen, Ludwigshafen, Germany
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Bajka B, Orzan M, Jakó B, Kovács I. Distance-related Differences in Critical Times, Protocol Activation and Mortality in a Regional STEMI Network. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2016. [DOI: 10.1515/jce-2016-0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Introduction: The aim of the study was to assess the differences in critical network times and mortality in STEMI patients presenting to hospitals in the same STEMI network, but located at different distances from the pPCI center.
Methods: Four-hundreed sixteen patients with STEMI were studied. Group 1: 101 patients presenting to any of the six regional hospitals in the network located at less than 70 km from the pPCI center, with a maximum transport time of 30 minutes. Group 2: 81 patients presenting to any of the three territorial hospitals in the network located at 70–150 km from the pPCI center, with a transport time between 30 and 70 minutes. Group 3: 93 patients presenting to any of the four territorial hospitals in the network located at 150–250 km from the pPCI center, with a transport time between 70 and 150 minutes. Group 4: 141 patients presenting directly to the emergency room of the pPCI center. The following time intervals were recorded: presentation time (PT), from the onset of symptoms to arrival at the pPCI center; protocol initiation time (PIT), from arrival at the pPCI center to STEMI protocol initiation; ischemic time (IT), from the onset of symptoms to repermeabilisation; door to balloon time (DTB), from arrival in the pPCI center to balloon.
Results: PT showed no significant difference between the groups – 183.08 ± 25.2 minutes vs. 199.1 ± 32.4 minutes vs. 166.7 ± 42.5 minutes vs. 161.91 ± 36.8 minutes, respectively (p=0.4). PIT was significantly lower in Group 3 (61.66 ± 15.4 minutes in Group 3 vs. 92 ± 11.5 minutes in Group 2 vs. 107.4 ± 12.5 minutes in Group 1, p = 0.002). DTB time was significantly longer for patients presenting directly to the pPCI center compared to those arriving from Zone 1, 2 or 3 hospitals, 86.96 ± 11.6 minutes vs. 52.27 ± 11.2 minutes vs. 39.94 ± 10.3 minutes vs. 43.9 ± 5.3 minutes, p <0.001). Despite the differences in distance to the pPCI center, there was no significant difference in total IT between the groups (Group 1, 344.6 ± 53.4 minutes; Group 2, 369.3 ± 42.6 minutes; Group 3, 366.65 ± 36.4 minutes; and 340.2 ± 26.9 minutes in the pPCIcenter, p = 0.2), and this was reflected in similar rates of mortality (Group 1, 3.9%; Group 2, 3.7%; Group 3, 3.2%; and 3.5% in the pPCI center).
Conclusion: A well organized STEMI network can shorten protocol initiation and DTB times, achieving similar ischemic times and resulting in similar mortality rates with the centers located closer to the pPCI center. Early activation of the STEMI protocol could lead to superior results even in areas situated at longer distances from the pPCI center.
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Affiliation(s)
- Balázs Bajka
- Department of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
| | - Marius Orzan
- Department of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
| | - Beáta Jakó
- Department of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
| | - István Kovács
- Department of Cardiology, County Emergency Clinical Hospital, Tîrgu Mureş, Romania
- University of Medicine and Pharmacy, Tîrgu Mureș, Romania
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“Time Is Muscle” Only in Experienced Hands and High-Volume Centers. J Intensive Care Med 2016. [DOI: 10.1177/0885066602017004008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Left ventricular systolic dysfunction is associated with adverse outcomes in acute right ventricular infarction. Coron Artery Dis 2016; 27:277-86. [DOI: 10.1097/mca.0000000000000358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mawri S, Michaels A, Gibbs J, Shah S, Rao S, Kugelmass A, Lingam N, Arida M, Jacobsen G, Rowlandson I, Iyer K, Khandelwal A, McCord J. The Comparison of Physician to Computer Interpreted Electrocardiograms on ST-elevation Myocardial Infarction Door-to-balloon Times. Crit Pathw Cardiol 2016; 15:22-25. [PMID: 26881816 DOI: 10.1097/hpc.0000000000000067] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The purpose of the project was to study the impact that immediate physician electrocardiogram (ECG) interpretation would have on door-to-balloon times in ST-elevation myocardial infarction (STEMI) as compared with computer-interpreted ECGs. METHODS This was a retrospective cohort study of 340 consecutive patients from September 2003 to December 2009 with STEMI who underwent emergent cardiac catheterization and percutaneous coronary intervention. Patients were stratified into 2 groups based on the computer-interpreted ECG interpretation: those with acute myocardial infarction identified by the computer interpretation and those not identified as acute myocardial infarction. Patients (n = 173) from September 2003 to June 2006 had their initial ECG reviewed by the triage nurse, while patients from July 2006 to December 2009 (n = 167) had their ECG reviewed by the emergency department physician within 10 minutes. Times for catheterization laboratory activation and percutaneous coronary intervention were recorded in all patients. RESULTS Of the 340 patients with confirmed STEMI, 102 (30%) patients were not identified by computer interpretation. Comparing the prior protocol of computer ECG to physician interpretation, the latter resulted in significant improvements in median catheterization laboratory activation time {19 minutes [interquartile range (IQR): 10-37] vs. 16 minutes [IQR: 8-29]; P < 0.029} and in median door-to-balloon time [113 minutes (IQR: 86-143) vs. 85 minutes (IQR: 62-106); P < 0.001]. CONCLUSION The computer-interpreted ECG failed to identify a significant number of patients with STEMI. The immediate review of ECGs by an emergency physician led to faster activation of the catheterization laboratory, and door-to-balloon times in patients with STEMI.
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Affiliation(s)
- Sagger Mawri
- From the *Department of Medicine, †Heart & Vascular Institute, ‡Department of Public Health Sciences, Henry Ford Hospital, Detroit, MI; and §GE Healthcare, Milwaukee, WI
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Fanari Z, Abraham N, Kolm P, Doorey J, Herman A, Hoban A, Reddy V, Hammami S, Leonovich J, Rahman E, Weintraub WS, Doorey AJ. Aggressive Measures to Decrease "Door to Balloon" Time and Incidence of Unnecessary Cardiac Catheterization: Potential Risks and Role of Quality Improvement. Mayo Clin Proc 2015; 90:1614-22. [PMID: 26549506 PMCID: PMC4679675 DOI: 10.1016/j.mayocp.2015.08.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/28/2015] [Accepted: 08/13/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the impact of an aggressive protocol to decrease the time from hospital arrival to onset of reperfusion therapy ("door to balloon [DTB] time") on the incidence of false-positive (FP) diagnosis of ST-segment elevation myocardial infarction (STEMI) and in-hospital mortality. PATIENTS AND METHODS The study population included 1031 consecutive patients with presumed STEMI and confirmed ST-segment elevation who underwent emergent catheterization between July 1, 2008, and December 1, 2012, On July 1, 2009, we instituted an aggressive protocol to reduce DTB time. A quality improvement (QI) initiative was introduced on January 1, 2011, to maintain short DTB while improving outcomes. Outcomes were compared before and after the initiation of the DTB time protocol and similarly before and after the QI initiative. Outcomes were DTB time, the incidence of FP-STEMI, and in-hospital mortality. A review of the emergency catheterization database for the 10-year period from January 1, 2001, through December 31, 2010, was performed for historical comparison. RESULTS Of the 1031 consecutive patients with presumed STEMI who were assessed, 170 were considered to have FP-STEMI. The median DTB time decreased significantly from 76 to 61 minutes with the aggressive DTB time protocol (P=.001), accompanied by an increase of FP-STEMI (7.7% vs 16.5%; P=.02). Although a nonsignificant reduction of in-hospital mortality occurred in patients with true-positive STEMI (P=.60), a significant increase in in-hospital mortality was seen in patients with FP-STEMI (P=.03). After the QI initiative, a shorter DTB time (59 minutes) was maintained while decreasing FP-STEMI in-hospital mortality. CONCLUSION Aggressive measures to reduce DTB time were associated with an increased incidence of FP-STEMI and FP-STEMI in-hospital mortality. Efforts to reduce DTB time should be monitored systematically to avoid unnecessary procedures that may delay other appropriate therapies in critically ill patients.
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Affiliation(s)
- Zaher Fanari
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE.
| | - Niksad Abraham
- Heart Health Services, North Oaks Medical Center, Hammond, LA
| | - Paul Kolm
- Value Institute, Christiana Care Health System, Newark, DE
| | - Jennifer Doorey
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Angela Herman
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - Angela Hoban
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - Vivek Reddy
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - Sumaya Hammami
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - Jennifer Leonovich
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - Ehsanur Rahman
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
| | - William S Weintraub
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE; Value Institute, Christiana Care Health System, Newark, DE
| | - Andrew J Doorey
- Center for Heart and Vascular Health, Christiana Care Health System, Newark, DE
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de-Miguel-Balsa E, Latour-Pérez J, Baeza-Román A, Llamas-Álvarez A, Ruiz-Ruiz J, Fuset-Cabanes MP. Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality. J Womens Health (Larchmt) 2015; 24:882-8. [DOI: 10.1089/jwh.2014.5011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Eva de-Miguel-Balsa
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Jaime Latour-Pérez
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Anna Baeza-Román
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Ana Llamas-Álvarez
- Intensive Care and Coronary Unit, Hospital General Universitario de Elche, Elche, Alicante, Spain
| | - Javier Ruiz-Ruiz
- Intensive Care and Coronary Unit, Hospital General de Castelló, Castelló, Castelló, Spain
| | - M Paz Fuset-Cabanes
- Intensive Care and Coronary Unit, Hospital Universitario y Politécnico la Fe, Valencia, Spain
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Polańska-Skrzypczyk M, Karcz M, Bekta P, Kępka C, Sielatycki P, Rużyłło W, Witkowski A. Total ischaemic time and 9-year outcomes in STEMI patients treated with pPCI. Int J Cardiol 2015; 184:184-189. [PMID: 25705011 DOI: 10.1016/j.ijcard.2015.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 12/12/2014] [Accepted: 02/07/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Prolonged total ischaemic time (TIT) has been shown to independently predict poor myocardial perfusion in STEMI patients and affect in-hospital mortality. We aim to evaluate the influence of TIT on long-term follow-up (F/U) and identify the factors associated with TIT in patients with STEMI treated with pPCI at a high volume centre. METHODS In a prospective "all-comer" registry, clinical, angiographic and procedural characteristics, TIT and 9-year mortality were determined in consecutive STEMI patients treated with pPCI. Patients were divided according to TIT into three groups: A) <3, B) 3-6 and C) >6h. RESULTS Among 1064 patients, TIT was known in 1002 patients, 5 patients were lost to F/U. For censored observations F/U was 7.2-8.8 years. There were 350, 461, and 186 patients in groups A, B, and C, respectively. Patients in group A compared to B and C were younger, more often males and smokers, less frequently had history of CAD, and more frequently had occluded infarct related artery. However, final TIMI3 was obtained more frequently. Overall 30-day mortality was 4%, one-year mortality 7% and nine-year mortality 27%. Multivariable logistic regression models indicated that longer TIT was associated with a higher risk of 9-year mortality (A-21%, B-28%, C-37%, p<0.0005). TIT>6h was independently associated with advanced age, diabetes mellitus, history of CAD and higher rate of initial TIMI grade flow 3. CONCLUSIONS TIT is strongly related with mortality in STEMI patients even after nine years of F/U. This finding reinforces the necessity of shortening the TIT in all STEMI patients.
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Affiliation(s)
- M Polańska-Skrzypczyk
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland.
| | - M Karcz
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - P Bekta
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
| | - C Kępka
- Institute of Cardiology, Department of Coronary and Structural Heart Diseases, Warsaw, Poland
| | | | - W Rużyłło
- Institute of Cardiology, Department of Coronary and Structural Heart Diseases, Warsaw, Poland
| | - A Witkowski
- Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland
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Grover S, Bell G, Lincoff M, Jeorg L, Madsen PL, Huang S, Leow S, Figtree G, Chakrabarty A, Leong DP, Woodman RJ, Selvanayagam JB. Utility of CMR Markers of Myocardial Injury in Predicting LV Functional Recovery: Results from PROTECTION AMI CMR Sub-study. Heart Lung Circ 2015; 24:891-7. [PMID: 25846255 DOI: 10.1016/j.hlc.2015.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 03/02/2015] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adverse left ventricular (LV) remodelling following acute ST-segment elevation myocardial infarction (STEMI) has prognostic importance. We aimed to predict 90-day left ventricular (LV) function following acute STEMI using variables from clinical presentation, biomarkers, and cardiovascular magnetic resonance imaging (CMR). METHODS Consecutive patients undergoing primary percutaneous coronary intervention for anterior STEMI as part of the Selective Inhibition of Delta-protein Kinase C for the Reduction of Infarct Size in Acute Myocardial Infarction (PROTECTION-AMI) trial were enrolled into the CMR sub-study at selected sites. CMR was performed at baseline (days 3 to 5) and 90 days and used to evaluate infarct size, myocardial salvage index, infarct heterogeneity, microvascular obstruction and global LV function. Biochemical markers including creatinine kinase area under the curve (CK AUC), peak CK, peak CK-myocardial band (CK-MB) and AUC, and troponin I were collected at specific time-points. RESULTS Ninety-six patients were enrolled in the CMR sub study and 85 completed the 90-day follow-up, across 24 centres worldwide. LV ejection fraction (EF) was 56% (46-63%) at baseline and 60% (49-67%) at 90 days (p<0.001). Infarct size had moderate inverse correlation with 90-day EF (Spearman's rho=-0.7, p < 0.001) and had the strongest correlation when compared to myocardial salvage index (Spearman's rho=0.5, p=0.001), infarct heterogeneity (Spearman's rho=-0.4, p=0.02 or microvascular obstruction (Spearman's rho=-0.4, p<0.001). All biochemical markers had similar moderate relationship to LVEF at 90 days (Spearman's rho -0.6 to -0.8, p=0.001). In a multivariable model, only baseline LVEF, CMR infarct size and infarct heterogeneity independently predicted 90-day LVEF. CONCLUSION This study reports findings of a combined CMR protocol (including myocardial oedema imaging) in a multi-centre, multi-vendor setting. We found infarct size, infarct heterogeneity and myocardial salvage index correlated favourably with 90-day LVEF, however only the former two were independently predictive.
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Affiliation(s)
- Suchi Grover
- Flinders University, Adelaide, SA, Australia; Cardiology Department, Flinders Medical Centre, Adelaide, SA Austrlaia; Cardiac Imaging Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia.
| | - Gregory Bell
- KAI Pharmaceuticals Inc, San Francisco, CAL, USA
| | - Michael Lincoff
- Cleveland Clinic, Coordinating Center for Clinical Research (C5 Research), Cleveland, OH, USA
| | - Lucas Jeorg
- Flinders University, Adelaide, SA, Australia
| | | | - Saling Huang
- KAI Pharmaceuticals Inc, San Francisco, CAL, USA
| | - Sean Leow
- Flinders University, Adelaide, SA, Australia; Cardiac Imaging Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Gemma Figtree
- Cardiology Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Adhiraj Chakrabarty
- Flinders University, Adelaide, SA, Australia; Cardiac Imaging Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Darryl P Leong
- Flinders University, Adelaide, SA, Australia; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada
| | - Richard J Woodman
- Flinders Centre for Epidemiology and Biostatistics, Flinders University, Adelaide, SA, Australia
| | - Joseph B Selvanayagam
- Flinders University, Adelaide, SA, Australia; Cardiology Department, Flinders Medical Centre, Adelaide, SA Austrlaia; Cardiac Imaging Research Centre, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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Nallamothu BK, Normand SLT, Wang Y, Hofer TP, Brush JE, Messenger JC, Bradley EH, Rumsfeld JS, Krumholz HM. Relation between door-to-balloon times and mortality after primary percutaneous coronary intervention over time: a retrospective study. Lancet 2015; 385:1114-22. [PMID: 25467573 PMCID: PMC4409657 DOI: 10.1016/s0140-6736(14)61932-2] [Citation(s) in RCA: 252] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent reductions in average door-to-balloon (D2B) times have not been associated with decreases in mortality at the population level. We investigated this seemingly paradoxical finding by assessing components of this association at the individual and population levels simultaneously. We postulated that the changing population of patients undergoing primary percutaneous coronary intervention (pPCI) contributed to secular trends toward an increasing mortality risk, despite consistently decreased mortality in individual patients with shorter D2B times. METHODS This was a retrospective study of ST-elevation myocardial infarction (STEMI) patients who underwent pPCI between Jan 1, 2005, and Dec 31, 2011, in the National Cardiovascular Data Registry (NCDR) CathPCI Registry. We looked for catheterisation laboratory visits associated with STEMI. We excluded patients not undergoing pPCI, transfer patients for pPCI, patients with D2B times less than 15 min or more than 3 h, and patients at hospitals that did not consistently report data across the study period. We assessed in-hospital mortality in the entire cohort and 6-month mortality in elderly patients aged 65 years or older matched to data from the Centers for Medicare and Medicaid Services. We built multilevel models to assess the relation between D2B time and in-hospital and 6-month mortality, including both individual and population-level components of this association after adjusting for patient and procedural factors. FINDINGS 423 hospitals reported data on 150,116 procedures with a 55% increase in the number of patients undergoing pPCI at these facilities over time, as well as many changes in patient and procedural factors. Annual D2B times decreased significantly from a median of 86 min (IQR 65-109) in 2005 to 63 min (IQR 47-80) in 2011 (p<0·0001) with a concurrent rise in risk-adjusted in-hospital mortality (from 4·7% to 5·3%; p=0·06) and risk-adjusted 6-month mortality (from 12·9% to 14·4%; p=0·001). In multilevel models, shorter patient-specific D2B times were consistently associated at the individual level with lower in-hospital mortality (adjusted OR for each 10 min decrease 0·92; 95% CI 0·91-0·93; p<0·0001) and 6-month mortality (adjusted OR for each 10 min decrease, 0·94; 95% CI 0·93-0·95; p<0·0001). By contrast, risk-adjusted in-hospital and 6-month mortality at the population level, independent of patient-specific D2B times, rose in the growing and changing population of patients undergoing pPCI during the study period. INTERPRETATION Shorter patient-specific D2B times were consistently associated with lower mortality over time, whereas secular trends suggest increased mortality risk in the growing and changing pPCI population. The absence of association of annual D2B time and changes in mortality at the population level should not be interpreted as an indication of its individual-level relation in patients with STEMI undergoing primary PCI. FUNDING National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Brahmajee K Nallamothu
- Center for Clinical Management Research, Ann Arbor VA Medical Center, and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | | | - Yongfei Wang
- Department of Internal Medicine, Yale University School of Medicine, and Center for Outcome Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
| | - Timothy P Hofer
- Center for Clinical Management Research, Ann Arbor VA Medical Center, and Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - John E Brush
- Cardiology Division, Eastern Virginia Medical School, and Sentara Cardiovascular Research Institute, Norfolk, VA, USA
| | - John C Messenger
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth H Bradley
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA
| | - John S Rumsfeld
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Harlan M Krumholz
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, USA; Section of Cardiovascular Medicine and the Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, USA
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De Luca G, van't Hof AW, Gibson CM, Cutlip D, Zeymer U, Noc M, Maioli M, Zorman S, Gabriel HM, Emre A, Rakowski T, Gyongyosi M, Huber K, Bellandi F, Dudek D. Impact of time from symptom onset to drug administration on outcome in patients undergoing glycoprotein IIb-IIIa facilitated primary angioplasty (from the EGYPT cooperation). Am J Cardiol 2015; 115:711-5. [PMID: 25655867 DOI: 10.1016/j.amjcard.2014.12.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 10/24/2022]
Abstract
Contrasting data have been so far reported on facilitation with glycoprotein IIb-IIIa inhibitors (GpIIbIIIa) in patients who underwent primary percutaneous coronary intervention. However, it has been demonstrated a time-dependent composition of coronary thrombus in ST-segment elevation myocardial infarction, with more platelets in the first hours. Subsequently, the benefits of early administration of GpIIbIIIa may be affected by the time from symptoms onset to GpIIbIIIa, that therefore is the aim of this study. Our population is represented by 814 patients who underwent GpIIbIIIa facilitated primary angioplasty included in the Early glycoprotein IIb-IIIa inhibitors in primary angioplasty database. Patients were divided according to quartiles of time from symptom onset to GpIIbIIIa administration (≤65 minutes; 65 to 100 minutes; 101 to 178 minutes; and >178 minutes). Myocardial perfusion was evaluated by myocardial blush grade and ST-segment resolution. Time from symptoms onset to GpIIbIIIa was linearly associated with hypertension, diabetes, hypercholesterolemia, and previous myocardial infarction but inversely associated with smoking. Abciximab was more often administrated later from symptoms onset. Time from symptoms onset to GpIIbIIIa was significantly associated with the rate of preprocedural recanalization (thrombolysis in myocardial infarction [TIMI] 2 to 3; p <0.001), postprocedural TIMI 3 flow (p <0.001), the rate of complete ST-segment resolution (p <0.001), and the rate of myocardial blush grade 2 to 3 (p <0.001) and inversely associated with the occurrence of distal embolization (p <0.001). Follow-up data were collected at a median (twenty-fifth to seventy-fifth) of 360 (30 to 1,095) days. A total of 52 patients had died. Time to GpIIbIIIa had a significant impact on mortality (hazard ratio [95% confidence interval] 1.46 [1.11 to 1.92], p = 0.007) that was confirmed after correction for baseline confounding factors (adjusted hazard ratio [95% confidence interval] 1.41 [1.02 to 2.21], p = 0.042). In conclusion, this study showed that in patients who underwent primary angioplasty with upstream GpIIbIIIa, time from symptoms onset to GpIIbIIIa strongly impacts on preprocedural recanalization, distal embolization, myocardial perfusion, and long-term survival.
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McHugh M, Kang R, Cohen AB, Restuccia JD, Periyanayagam U, Hasnain-Wynia R. Use of quality improvement interventions and the link to performance on percutaneous intervention for acute myocardial infarction. J Emerg Med 2015; 48:744-50. [PMID: 25766427 DOI: 10.1016/j.jemermed.2014.12.049] [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: 08/11/2014] [Revised: 11/04/2014] [Accepted: 12/21/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Despite numerous calls for hospitals to employ quality improvement (QI) interventions to improve emergency department (ED) performance, their impact has not been explored in multi-site investigations. OBJECTIVE We investigated the association between use of QI interventions (patient flow strategies, ED electronic dashboards, and five-level triage systems) and hospital performance on receipt of percutaneous intervention (PCI) within 90 min for acute myocardial infarction patients, a publicly available quality measure. METHODS This was an exploratory, cross-sectional analysis of secondary data from 292 hospitals. Data were drawn from the Quality Improvement Activities Survey, the American Hospital Association's Annual Survey, and Hospital Compare. Linear regression models were used to detect differences in PCI performance scores based on whether hospitals employed one or more QI interventions. RESULTS Fifty-three percent of hospitals reported widespread use of patient flow strategies, 62% reported using a dashboard, and 74% reported using a five-level triage system. Time to PCI performance scores were 3.5 percentage points higher (i.e., better) for hospitals that used patient flow strategies and 6.2 percentage points higher for hospitals that used a five-level triage system. Scores were 10.4 percentage points higher at hospitals that employed two quality improvement interventions and 12.8 percentage points higher at hospitals that employed three. CONCLUSION Employing QI interventions was associated with better PCI scores. More research is needed to explore the direction of this relationship, but results suggest that hospitals should consider adopting patient flow strategies, electronic dashboards, and five-level triage systems to improve PCI scores.
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Affiliation(s)
- Megan McHugh
- Center for Healthcare Studies, Chicago, Illinois; Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Raymond Kang
- Center for Healthcare Studies, Chicago, Illinois
| | - Alan B Cohen
- School of Management, Boston University, Boston, Massachusetts
| | | | - Usha Periyanayagam
- Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Harvard Medical School, Boston, Massachusetts
| | - Romana Hasnain-Wynia
- Center for Healthcare Studies, Chicago, Illinois; Patient-Centered Outcomes Research Institute (Current Appointment), Washington, DC
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Ryu DR, Choi JW, Lee BK, Cho BR. Effects of critical pathway on the management of patients with ST-elevation acute myocardial infarction in an emergency department. Crit Pathw Cardiol 2015; 14:31-35. [PMID: 25679085 DOI: 10.1097/hpc.0000000000000035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AIMS Critical pathways (CP) are clinical management plans that provide the sequence and timing of actions of medical staff. The main goal of a CP is to provide optimal patient care and to improve time-effectiveness. Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time of <90 minutes for patients undergoing primary percutaneous coronary intervention (PCI). The aim of this study was to identify the effects of CP on the management of patients with STEMI in an emergency department. METHODS The study population consisted of 175 patients undergoing primary PCI for STEMI who presented to the emergency department of Kangwon National University Hospital (Chuncheon, South Korea) with chest pain from July 1, 2005 to November 30, 2010. We retrospectively analyzed medication use, symptom onset-to-door times, door-to-balloon times, total ischemic times, and the reperfusion rate within 90 minutes. We also measured the 30-day and 1-year total mortality rates pre- and post-CP implementation. RESULTS The effects of CP implementation on the medication use outcomes in patients with acute myocardial infarction were increased between the pre- and post-CP patients groups. The median door-to-balloon time declined significantly from 85 to 64 minutes after CP implementation (P = 0.001), and the primary PCI rate within 90 minutes was significantly increased (57% vs. 79%, P = 0.01). However, the symptom to door time was not changed between the pre- and post-CP groups (150 minutes vs. 149 minutes; P = 0.841). Although the total ischemic time was decreased after CP implementation, it was not statistically insignificant (352.5 minutes vs. 281 minutes; P = 0.397). Moreover, the 30-day and 1-year total mortality rates of the 2 groups did not change (12.0% vs. 12.0%, P > 0.999; 13.0% vs. 17.3%, P = 0.425, respectively). However, the 1-year mortality rates of 2 groups based on a total ischemic time of 240 minutes, which was median value, decreased significantly from 19.0% to 9.0%. (P = 0. 018) CONCLUSION:: Implementation of a CP resulted in greater use of recommended medications and reductions in the median door-to-balloon time. However, it did not reduce the symptom onset-to-door time, total ischemic time, or the 30-day and 1-year mortality rates. Therefore, additional strategies are needed to reduce mortality in patients with acute myocardial infarction undergoing primary PCI.
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Affiliation(s)
- Dong Ryeol Ryu
- From the *Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University; and †Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
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Nguyen B, Fennessy M, Leya F, Nowak W, Ryan M, Freeberg S, Gill J, Dieter RS, Steen L, Lewis B, Cichon M, Probst B, Jarotkiewicz M, Wilber D, Lopez JJ. Comparison of primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction during and prior to availability of an in-house STEMI system: early experience and intermediate outcomes of the HARRT program for achieving routine D2B times <60 minutes. Catheter Cardiovasc Interv 2015; 86:186-96. [PMID: 25504976 DOI: 10.1002/ccd.25769] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 12/06/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Over the last decade, significant advances in ST-elevation myocardial infarction (STEMI) workflow have resulted in most hospitals reporting door-to-balloon (D2B) times within the 90 min standard. Few programs have been enacted to systematically attempt to achieve routine D2B within 60 min. We sought to determine whether 24-hr in-house catheterization laboratory coverage via an In-House Interventional Team Program (IHIT) could achieve D2B times below 60 min for STEMI and to compare the results to the standard primary percutaneous coronary intervention (PCI) approach. METHODS An IHIT program was established consisting of an attending interventional cardiologist, and a catheterization laboratory team present in-hospital 24 hr/day. For all consecutive STEMI patients, we compared the standard primary PCI approach during the two years prior to the program (group A) to the initial 20 months of the IHIT program (group B), and repeated this analysis for only CMS-reportable patients. The D2B process was analyzed by calculating workflow intervals. The primary endpoint was D2B process times, and secondary endpoints included in-hospital and 6-month cardiovascular outcomes and resource utilization. RESULTS An IHIT program for STEMI resulted in significant reductions across all treatment intervals with an overall 57% reduction in D2B time, and an absolute reduction in mean D2B time of 71 min. There were no differences pre- and post-program implementation in regard to individual or composite components of in-hospital cardiovascular outcomes; however at 6 months, there was a reduction in cardiovascular rehospitalization after program implementation (30 vs. 5%, P < 0.01). The IHIT program resulted in a significant reduction in length-of-stay (LOS) (90 ± 102 vs. 197 ± 303 hr, P = 0.02), and critical care time (54 ± 97 vs. 149 ± 299 hr, P = 0.02). CONCLUSIONS Availability of an in-house 24-hr STEMI team significantly decreased reperfusion time and led to improved clinical outcomes and a shorter LOS for PCI-treated STEMI patients.
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Affiliation(s)
- Bryant Nguyen
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Michelle Fennessy
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Ferdinand Leya
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Wojciech Nowak
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Michael Ryan
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Sheldon Freeberg
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Jasrai Gill
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Robert S Dieter
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Lowell Steen
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Bruce Lewis
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Mark Cichon
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Beatrice Probst
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - Michael Jarotkiewicz
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - David Wilber
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
| | - John J Lopez
- Division of Cardiology, Department of Medicine, Loyola University Medical Center, Stritch School of Medicine, Maywood, Illinois
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De Luca G, Parodi G, Sciagrà R, Venditti F, Bellandi B, Vergara R, Migliorini A, Valenti R, Antoniucci D. Preprocedural TIMI flow and infarct size in STEMI undergoing primary angioplasty. J Thromb Thrombolysis 2015; 38:81-6. [PMID: 23928869 DOI: 10.1007/s11239-013-0977-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite optimal epicardial recanalization, primary angioplasty for STEMI is still associated with suboptimal reperfusion in a relatively large proportion of patients. The aim the current study was to evaluate the impact of preprocedural TIMI flow on myocardial scintigraphic infarct size among STEMI undergoing primary angioplasty. Our population is represented by 793 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Poor preprocedural TIMI flow (TIMI 0-1) was observed in 645 patients (81.3%). Poor preprocedural TIMI flow was associated with more hypercholesterolemia (p = 0.012), and a trend in lower prevalence of diabetes (p = 0.081). Preprocedural TIMI flow significantly affected scintigraphic and enzymatic infarct size. Similar findings were observed in the analysis restricted to patients with postprocedural TIMI 3 flow. The impact of preprocedural TIMI flow on scintigraphic infarct size was confirmed when the analysis was performed according to the percentage of patients above the median (p < 0.001) and after adjustment for baseline confounding factors (Hypercholesterolemia and diabetes) [adjusted OR (95% CI) for pre preprocedural TIMI 3 flow = 0.59 (0.46-0.75), p < 0.001]. This study shows that among patients with STEMI undergoing primary angioplasty, poor preprocedural TIMI flow is independently associated with larger infarct size.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, "Maggiore della Carità" Hospital, Eastern Piedmont University, Novara, Italy,
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Clinical Outcomes of Early Repatriation for Patients With ST-Segment Elevation Myocardial Infarction: A Propensity-Matched Analysis. Can J Cardiol 2015; 31:1225-31. [PMID: 26081691 DOI: 10.1016/j.cjca.2015.01.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/30/2015] [Accepted: 01/30/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Because of limitations on hospital resources, patients with ST-elevation myocardial infarction (STEMI) who undergo successful primary percutaneous coronary intervention (PCI) are often repatriated to non-PCI centres. However, the safety of this practice is not clear. Our objective was to evaluate the safety of early repatriation of STEMI patients after PCI to a non-PCI centre, compared with ongoing treatment at the PCI centre. METHODS Consecutive STEMI patients, who received primary PCI at 1 of 4 PCI hospitals in Toronto, Canada between 2010 and 2012 were identified. Patients with shock or who died within 24 hours of presentation were excluded. Outcomes of interest were all-cause mortality and readmission for recurrent myocardial infarction (MI) at 1 year. To account for confounding because of the observational nature of our data, propensity score-matched pairs of patients who were repatriated vs nonrepatriated were identified. RESULTS Using the propensity score, 430 well matched pairs were identified, representing our cohort. There was no significant difference between repatriated and nonrepatriated groups in 1-year mortality (repatriated: 6.7%, nonrepatriated: 5.6%, hazard ratio, 1.18; 95% confidence interval, 0.69-2.03; P = 0.545). The 1-year readmission rates for MI were significantly greater for the repatriated group compared with the nonrepatriated group (repatriated: 12.1%; nonrepatriated: 5.8%; hazard ratio, 2.09; 95% confidence interval, 1.30-3.36; P = 0.002). CONCLUSIONS A strategy of early repatriation of STEMI patients was associated with a greater rate of readmission for MI. Our study raises questions regarding the safety of an early repatriation strategy that merit further research.
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Kanazawa H, Tseliou E, Malliaras K, Yee K, Dawkins JF, De Couto G, Smith RR, Kreke M, Seinfeld J, Middleton RC, Gallet R, Cheng K, Luthringer D, Valle I, Chowdhury S, Fukuda K, Makkar RR, Marbán L, Marbán E. Cellular postconditioning: allogeneic cardiosphere-derived cells reduce infarct size and attenuate microvascular obstruction when administered after reperfusion in pigs with acute myocardial infarction. Circ Heart Fail 2015; 8:322-32. [PMID: 25587096 DOI: 10.1161/circheartfailure.114.001484] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Intracoronary delivery of cardiosphere-derived cells (CDCs) has been demonstrated to be safe and effective in porcine and human chronic myocardial infarction. However, intracoronary delivery of CDCs after reperfusion in acute myocardial infarction has never been assessed in a clinically-relevant large animal model. We tested CDCs as adjunctive therapy to reperfusion in a porcine model of myocardial infarction. METHODS AND RESULTS First, escalating doses (5, 7.5, and 10 million cells) of allogeneic CDCs were administered intracoronary 30 minutes after reperfusion. Forty-eight hours later, left ventriculography was performed and animals euthanized to measure area at risk, infarct size (IS), and microvascular obstruction. Second, identical end points were measured in a pivotal study of minipigs (n=14) that received 8.5 to 9 million allogeneic CDCs, placebo solution, or sham. Multiple indicators of cardioprotection were observed with 7.5 and 10 million allogeneic CDCs, but not 5 million CDCs, relative to control. In the pivotal study, IS, microvascular obstruction, cardiomyocyte apoptosis, and adverse left ventricular remodeling were all smaller in the CDC group than in sham or placebo groups. In addition, serum troponin I level at 24 hours was lower after CDC infusion than that in the placebo or sham groups, consistent with the histologically-demonstrated reduction in IS. CONCLUSIONS Intracoronary delivery of allogeneic CDCs is safe, feasible, and effective in cardioprotection, reducing IS, preventing microvascular obstruction, and attenuating adverse acute remodeling. This novel cardioprotective effect, which we call cellular postconditioning, differs from previous strategies to reduce IS in that it works even when initiated with significant delay after reflow.
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Affiliation(s)
- Hideaki Kanazawa
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Eleni Tseliou
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Konstantinos Malliaras
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Kristine Yee
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - James F Dawkins
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Geoffrey De Couto
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Rachel R Smith
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Michelle Kreke
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Jeffrey Seinfeld
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Ryan C Middleton
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Romain Gallet
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Ke Cheng
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Daniel Luthringer
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Ileana Valle
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Supurna Chowdhury
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Keiichi Fukuda
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Raj R Makkar
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Linda Marbán
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.)
| | - Eduardo Marbán
- From the Cedars-Sinai Heart Institute, Los Angeles, CA (H.K., E.T., K.M., K.Y., J.F.D., G.D.C., R.R.S., J.S., R.C.M., R.G., D.L., S.C., R.R.M., L.M., E.M.); Capricor Inc, Los Angeles, CA (R.R.S., M.K., I.V., L.M.); Department of Cardiology, Keio University School of Medicine, Tokyo, Japan (H.K., K.F.); Department of Molecular Biomedical Sciences and Center for Comparative Medicine and Translational Research, College of Veterinary Medicine, North Carolina State University, Raleigh (K.C.); and Joint Department of Biomedical Engineering, University of North Carolina at Chapel Hill and North Carolina State University, Raleigh (K.C.).
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Deutsch SB, Krivitsky EL. Decreased Door to Balloon Time: Better Outcome for the Patient? ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wjcd.2015.53007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Age adjusted nationwide trends in the incidence of all cause and ST elevation myocardial infarction associated cardiogenic shock based on gender and race in the United States. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2015; 16:2-5. [DOI: 10.1016/j.carrev.2014.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 11/17/2022]
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Imori Y, Akasaka T, Shishido K, Ochiai T, Tobita K, Yamanaka F, Mizuno S, Saito S. Prehospital Transfer Pathway and Mortality in Patients Undergoing Primary Percutaneous Coronary Intervention. Circ J 2015; 79:2000-8. [DOI: 10.1253/circj.cj-14-0678] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yoichi Imori
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Takeshi Akasaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Koki Shishido
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Tomoki Ochiai
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Kazuki Tobita
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Shingo Mizuno
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital
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Park JS, Cha KS, Shin D, Lee DS, Lee HW, Oh JH, Choi JH, Lee HC, Hong TJ, Jeong MH, Ahn Y, Chae SC, Kim YJ. Impact of non-chest pain complaint as a presenting symptom on door-to-balloon time and clinical outcomes in patients with acute ST-elevation myocardial infarction. Am J Cardiol 2014; 114:1801-9. [PMID: 25438905 DOI: 10.1016/j.amjcard.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/14/2014] [Accepted: 09/14/2014] [Indexed: 11/18/2022]
Abstract
Many patients with ST-elevation myocardial infarctions (STEMIs) have non-chest pain complaints and are given low priority during triage. This prospective, multicenter, observational, registry-based study investigated the impact of non-chest pain complaints on door-to-balloon (DTB) time and clinical outcomes. Patients with STEMI who had undergone primary percutaneous coronary intervention were compared with respect to the presence of chest pain or non-chest pain complaints as presenting symptoms. To eliminate biased estimates, a propensity score model was built, and 2 cohorts of 1:1 matched patients were obtained. Propensity matching identified 2 cohorts of 976 patients each. After comparing patients with chest pain and those with non-chest pain complaints, significant delays in the median DTB time were noted (74 vs 84 minutes, respectively; p <0.001). Non-chest pain complaints were independent predictors of DTB time in the multivariate linear regression models. In-hospital mortality (adjusted hazard ratio [HR] 1.402, 95% confidence interval [CI] 0.727 to 2.705, p = 0.313), all-cause mortality (adjusted HR 1.175, 95% CI 0.453 to 3.853, p = 0.642), and major adverse cardiac events at follow-up (adjusted HR 0.139, 95% CI 0.876 to 1.48, p = 0.331) did not differ between the 2 groups of patients. In conclusion, short- and long-term clinical outcomes in patients with STEMI with non-chest pain complaints do not differ from those of patients with chest pain as the presenting symptom, despite having delayed diagnosis and reperfusion.
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Affiliation(s)
- Jin Sup Park
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea; Medical Research Institute, Pusan National University Hospital, Busan, South Korea.
| | - Donghun Shin
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Dae Sung Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Hye Won Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jun-Hyok Oh
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Jung Hyun Choi
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Han Cheol Lee
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Taek Jong Hong
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Shung Chull Chae
- Department of Cardiology, Kyungpook National University Hospital, Daegu, South Korea
| | - Young Jo Kim
- Department of Cardiology, Yeungnam University Hospital, Daegu, South Korea
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Cvjeticanin B, Prutki M, Dumic-Cule I, Veir Z, Grgurevic L, Vukicevic S. Possible target for preventing fibrotic scar formation following acute myocardial infarction. Med Hypotheses 2014; 83:656-8. [PMID: 25441837 DOI: 10.1016/j.mehy.2014.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 09/10/2014] [Indexed: 01/26/2023]
Abstract
Bone morphogenetic protein 1 (BMP1) was originally isolated from bone with other BMPs due to its affinity for heparin. While all other BMPs are members of the Transforming Growth Factor β (TGFβ) superfamily of growth factors, BMP1 is not an authentic member of the BMP protein family. Together with mammalian Tolloid Like protein 1 (mTLL-1) and mTLL-2, BMP1 comprise a small group of zinc- and calcium-dependent proteinases. Acute myocardial infarction (AMI) is the leading cause of death in developed countries which accounts for 13% of deaths worldwide. It was recently shown that inhibition of BMP1-3 reduces progression of fibrosis in chronic kidney disease and suggested that BMP1-3 is an important molecule for fibrogenesis. We hypothesize that inhibition of BMP1-3 represents future of therapeutic interventions in the heart tissue fibrosis following AMI. This novel approach aims to acquire the first candidate specific treatment for recuperating the heart function in patients with AMI.
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Affiliation(s)
- Bruno Cvjeticanin
- Department of Surgery, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
| | - Maja Prutki
- Department of Radiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ivo Dumic-Cule
- Department of Surgery, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Zoran Veir
- Department of Surgery, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Lovorka Grgurevic
- Laboratory for Mineralized Tissue, Department of Anatomy, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Slobodan Vukicevic
- Laboratory for Mineralized Tissue, Department of Anatomy, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia
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Kannan VD, Veazie PJ. Who avoids going to the doctor and why? Audience segmentation analysis for application of message development. HEALTH COMMUNICATION 2014; 30:635-645. [PMID: 25062466 DOI: 10.1080/10410236.2013.878967] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This exploratory study examines the prevalent and detrimental health care phenomenon of patient delay in order to inform formative research leading to the design of communication strategies. Delayed medical care diminishes optimal treatment choices, negatively impacts prognosis, and increases medical costs. Various communication strategies have been employed to combat patient delay, with limited success. This study fills a gap in research informing those interventions by focusing on the portion of patient delay occurring after symptoms have been assessed as a sign of illness and the need for medical care has been determined. We used CHAID segmentation analysis to produce homogeneous segments from the sample according to the propensity to avoid medical care. CHAID is a criterion-based predictive cluster analysis technique. CHAID examines a variety of characteristics to find the one most strongly associated with avoiding doctor visits through a chi-squared test and assessment of statistical significance. The characteristics identified then define the segments. Fourteen segments were produced. Age was the first delineating characteristic, with younger age groups comprising a greater proportion of avoiders. Other segments containing a comparatively larger percent of avoiders were characterized by lower income, lower education, being uninsured, and being male. Each segment was assessed for psychographic properties associated with avoiding care, reasons for avoiding care, and trust in health information sources. While the segments display distinct profiles, having had positive provider experiences, having high health self-efficacy, and having an internal rather than external or chance locus of control were associated with low avoidance among several segments. Several segments were either more or less likely to cite time or money as the reason for avoiding care. And several older aged segments were less likely than the remaining sample to trust the government as a source for health information. Implications for future research are discussed.
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Park JK, Kim SH, Shin JH, Shin J, Kim KS, Lim YH. Early text page alarms sent to cardiologists reduce door-to-balloon times in ST-elevation myocardial infarction. J Telemed Telecare 2014; 20:242-249. [PMID: 24829257 DOI: 10.1177/1357633x14536350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We assessed an early notification system using smartphones to reduce door-to-balloon times (DTBT) in ST-elevation myocardial infarction (STEMI). Text page alarms were sent to cardiologists for all patients presenting with chest pain or an equivalent in the emergency department before acquisition of an electrocardiogram (ECG). A total of 210 patients (with mean age of 59 years) were investigated (109 in the intervention group and 101 in a control group from the previous two-year period). The primary outcome, the DTBT, was significantly lower in the intervention group compared to the control group (55.0 and 92.5 min, respectively, P < 0.001). In a secondary analysis, the length of hospital stay was also significantly less. However, there was no significant improvement in all-cause one-year mortality. Early text page alarms using smartphones were effective in reducing the DTBT, but had a limited effect on clinical outcome.
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Affiliation(s)
- Jin-Kyu Park
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Seok Hwan Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Jeong Hun Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Jinho Shin
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Kyung-Soo Kim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Young-Hyo Lim
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Hanyang University Medical Center, Seoul, Korea
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Coventry LL, Bremner AP, Williams TA, Jacobs IG, Finn J. Symptoms of Myocardial Infarction: Concordance between Paramedic and Hospital Records. PREHOSP EMERG CARE 2014; 18:393-401. [DOI: 10.3109/10903127.2014.891064] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Austin D, Yan AT, Spratt JC, Kunadian V, Edwards RJ, Egred M, Bagnall AJ. Patient characteristics associated with self-presentation, treatment delay and survival following primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:214-22. [DOI: 10.1177/2048872614527011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Austin
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Andrew T Yan
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Canada
| | - James C Spratt
- Department of Cardiology, Forth Valley Hospital, Larbert, UK
| | - Vijay Kunadian
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Richard J Edwards
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Bagnall
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Yang X, Pinto DS, Chakrabarti AK. Optimizing reperfusion in patients with STEMI: a critical evaluation of pharmacologic and non-pharmacologic strategies. Am J Cardiovasc Drugs 2013; 13:399-406. [PMID: 24043331 DOI: 10.1007/s40256-013-0045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Among patients with ST-elevation myocardial infarction (STEMI), rapidly re-establishing normal coronary blood flow is of paramount importance. More than 25 % of hospitals in the USA do not have access to timely primary percutaneous coronary intervention, highlighting the need for clinicians to understand both pharmacologic and non-pharmacologic strategies for STEMI. This manuscript reviews the current state of the art in STEMI care, describing both pharmacologic and non-pharmacologic strategies for reperfusion.
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De Luca G, Gibson MC, Hof AWV, Cutlip D, Zeymer U, Noc M, Maioli M, Zorman S, Gabriel MH, Secco GG, Emre A, Dudek D, Rakowski T, Gyongyosi M, Huber K, Bellandi F. Impact of time-to-treatment on myocardial perfusion after primary percutaneous coronary intervention with Gp IIb–IIIa inhibitors. J Cardiovasc Med (Hagerstown) 2013; 14:815-20. [DOI: 10.2459/jcm.0b013e32835fcb38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Menees DS, Peterson ED, Wang Y, Curtis JP, Messenger JC, Rumsfeld JS, Gurm HS. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013; 369:901-9. [PMID: 24004117 DOI: 10.1056/nejmoa1208200] [Citation(s) in RCA: 511] [Impact Index Per Article: 46.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention (PCI). Door-to-balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives. However, it is not known whether national improvements in door-to-balloon times have been accompanied by a decline in mortality. METHODS We analyzed annual trends in door-to-balloon times and in-hospital mortality using data from 96,738 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2005 through June 2009 at 515 hospitals participating in the CathPCI Registry. In a subgroup analysis using a linked Medicare data set, we assessed 30-day mortality. RESULTS Median door-to-balloon times declined significantly, from 83 minutes in the 12 months from July 2005 through June 2006 to 67 minutes in the 12 months from July 2008 through June 2009 (P<0.001). Similarly, the percentage of patients for whom the door-to-balloon time was 90 minutes or less increased from 59.7% in the first year to 83.1% in the last year (P<0.001). Despite improvements in door-to-balloon times, there was no significant overall change in unadjusted in-hospital mortality (4.8% in 2005-2006 and 4.7% in 2008-2009, P=0.43 for trend) or in risk-adjusted in-hospital mortality (5.0% in 2005-2006 and 4.7% in 2008-2009, P=0.34), nor was a significant difference observed in unadjusted 30-day mortality (P=0.64). CONCLUSIONS Although national door-to-balloon times have improved significantly for patients undergoing primary PCI for ST-segment elevation myocardial infarction, in-hospital mortality has remained virtually unchanged. These data suggest that additional strategies are needed to reduce in-hospital mortality in this population. (Funded by the National Cardiovascular Data Registry of the American College of Cardiology Foundation.).
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Affiliation(s)
- Daniel S Menees
- University of Michigan, Department of Internal Medicine, Division of Cardiovascular Medicine, Ann Arbor, MI 48109, USA.
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Myers SR, Salhi RA, Lerner EB, Gilson R, Kraus A, Kelly JJ, Hargarten S, Carr BG. A pilot study describing access to emergency care in two states using a model emergency care categorization system. Acad Emerg Med 2013; 20:894-903. [PMID: 24050795 DOI: 10.1111/acem.12208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The Institute of Medicine (IOM)'s "Future of Emergency Care" report recommended the categorization and regionalization of emergency care, but no uniform system to categorize hospital emergency care capabilities has been developed. The absence of such a system limits the ability to benchmark outcomes, to develop regional systems of care, and of patients to make informed decisions when seeking emergency care. The authors sought to pilot the deployment of an emergency care categorization system in two states. METHODS A five-tiered emergency department (ED) categorization system was designed, and a survey of all Pennsylvania and Wisconsin EDs was conducted. This 46-item survey described hospital staffing, characteristics, resources, and practice patterns. Based on responses, EDs were categorized as limited, basic, advanced, comprehensive, and pediatric critical care capable. Prehospital transport times were then used to determine population access to each level of care. RESULTS A total of 247 surveys were received from the two states (247 of 297, 83%). Of the facilities surveyed, roughly one-quarter of hospitals provided advanced care, 10.5% provided comprehensive care, and 1.6% provided pediatric critical care. Overall, 75.1% of the general population could reach an advanced or comprehensive ED within 60 minutes by ground transportation. Among the pediatric population (age 14 years and younger), 56.2% could reach a pediatric critical care or comprehensive ED, with another 19.5% being able to access an advanced ED within 60 minutes. CONCLUSIONS Using this categorization system, fewer than half of all EDs provide advanced or comprehensive emergency care. While the majority of the population has access to advanced or comprehensive care within an hour, a significant portion (25%) does not. This article describes how an ED categorization scheme could be developed and deployed across the United States. There are implications for prehospital planning, patient decision-making, outcomes measurement, interfacility transfer coordination, and development of regional emergency care systems.
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Affiliation(s)
- Sage R. Myers
- Division of Pediatric Emergency Medicine; Children's Hospital of Philadelphia; Philadelphia PA
| | - Rama A. Salhi
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
| | - E. Brooke Lerner
- Department of Emergency Medicine; Milwaukee WI
- Medical College of Wisconsin; Milwaukee WI
| | - Rebecca Gilson
- Department of Emergency Medicine; Beth Israel Deaconess Hospital; Boston MA
| | | | - John J. Kelly
- Department of Emergency Medicine; Albert Einstein Health System; Philadelphia PA
| | - Stephen Hargarten
- Department of Emergency Medicine; Milwaukee WI
- Medical College of Wisconsin; Milwaukee WI
| | - Brendan G. Carr
- Perelman School of Medicine; University of Pennsylvania; Philadelphia PA
- Departments of Emergency Medicine & Epidemiology; University of Pennsylvania; Philadelphia PA
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