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The outcomes of acute myocardial infarction patients comorbidity with hypertension and hyperhomocysteinemia. Sci Rep 2021; 11:22936. [PMID: 34824345 PMCID: PMC8617252 DOI: 10.1038/s41598-021-02340-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 11/09/2021] [Indexed: 11/30/2022] Open
Abstract
This study investigated the outcomes and major adverse cardiovascular events (MACEs) incurred by acute myocardial infarction (AMI) patients comorbiding with hypertension and hyperhomocysteinemia (HHcy) during hospitalization and 1-year follow-up. 648 consecutive AMI patients were divided into four categories: (1) hypertension with Hcy ≥ 15 µmol/L; (2) hypertension with Hcy < 15 µmol/L; (3) no-hypertension with Hcy ≥ 15 µmol/L; (4) no-hypertension with Hcy < 15 µmol/L. Information taken from these case files included gender, past medical history, vital signs, laboratory examination, electrocardiogram, coronary angiography, cardiac ultrasound, and medicine treatment. The primary endpoints were duration of coronary care units (CCU) stay, duration of in-hospital stay, and MACEs during follow-up. Our data show that hypertension and HHcy have a synergistic effect in AMI patients, AMI comorbiding with hypertension and HHcy patients had more severe multi-coronary artery disease and more frequent non-culprit coronary lesions complete clogging, had a higher prevalence of pro-brain natriuretic peptide, and significant decreases in the left ventricular ejection fraction. These patients had significant increases in the duration of CCU stay and in-hospital stay, had significant increase in the rate of MACEs, had significant decreases in the survival rate during follow-up.
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Sivapathan S, Jeyaprakash P, Zaman SJ, Burgess SN. Management of Multivessel Disease and Physiology Testing in ST Elevation Myocardial Infarction. Interv Cardiol Clin 2021; 10:333-343. [PMID: 34053620 DOI: 10.1016/j.iccl.2021.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
For decades, advances in ST elevation myocardial infarction (STEMI) care have been driven by timely reperfusion of the occluded culprit vessel. More recently, however, the focus has shifted to revascularization of nonculprit vessels in STEMI patients. Five landmark randomized trials, all published in the past 7 years, have highlighted the importance of complete revascularization in STEMI treatment. This review focuses on evidence-based management of STEMI in the setting of multivessel disease, highlighting contemporary data that investigate the impact of complete revascularization.
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Affiliation(s)
- Shanthosh Sivapathan
- Department of Cardiology, University of Sydney and Nepean Hospital, Derby Street, Kingswood, New South Wales 2747, Australia. https://twitter.com/drsonyaburgess
| | - Prajith Jeyaprakash
- Department of Cardiology, University of Sydney and Nepean Hospital, Derby Street, Kingswood, New South Wales 2747, Australia
| | - Sarah J Zaman
- Department of Cardiology, University of Sydney, Monash University and Westmead Hospital, Corner of Darcy Road, Westmead 2145, Australia
| | - Sonya N Burgess
- University of New South Wales, University of Sydney, and Department of Cardiology, Nepean Hospital, Derby Street, Sydney, New South Wales 2747, Australia.
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Burgess SN, French JK, Nguyen TL, Leung M, Richards DAB, Thomas L, Mussap C, Lo S, Juergens CP. The impact of incomplete revascularization on early and late outcomes in ST-elevation myocardial infarction. Am Heart J 2018; 205:31-41. [PMID: 30153623 DOI: 10.1016/j.ahj.2018.07.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 07/24/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND In ST-elevation myocardial infarction (STEMI) in patients with multivessel disease, there is a lack of consensus regarding the importance of complete revascularization and the timing of treatment of nonculprit stenoses. Our objective was to investigate the impact of incomplete revascularization in STEMI patients using the residual Synergy Between PCI with TAXUS and Cardiac Surgery score (rSS) to define completeness of revascularization. METHODS This study examined associations between incomplete revascularization, determined by the rSS, and the combined outcome of cardiac death and myocardial infarction (MI). Patients were divided into groups: rSS = 0 (complete revascularization), rSS = 1-8 (incomplete revascularization with a low burden of residual disease), or rSS >8 (incomplete revascularization with a high burden of residual disease). RESULTS The rSS score was calculated in 589 consecutive patients; 25% had an rSS of 0, 42% rSS 1-8, and 33% rSS >8. At median follow-up of 3.5 years, cardiac death and MI occurred in 5% of rSS = 0 patients, 15% rSS = 1-8, and 26% with rSS >8 (P < .001). The rSS was powerful independent predictor of cardiac death and MI (hazard ratio 5.05, CI 2.89-12.00, rSS >8 vs rSS 0, P < .001 and hazard ratio 2.96, CI 1.31-6.69, rSS = 1-8 vs rSS = 0, P = .009), respectively, and an independent predictor of mortality, MI, unplanned revascularization, and major adverse cardiovascular events. CONCLUSIONS In patients with STEMI, the rSS independently predicts cardiac death and MI. Patients with an rSS >8 had substantially higher rates of cardiac death or MI. The rSS can be used to define incomplete revascularization in STEMI and predict adverse outcomes.
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Affiliation(s)
- Sonya N Burgess
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology, Nepean Hospital, Sydney, New South Wales, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia.
| | - Tuan L Nguyen
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
| | - Melissa Leung
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
| | - David A B Richards
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
| | - Liza Thomas
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia; Department of Cardiology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Christian Mussap
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
| | - Sidney Lo
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
| | - Craig P Juergens
- Department of Cardiology, Liverpool Hospital, Sydney, New South Wales, Australia; The University of New South Wales, Sydney, New South Wales, Australia
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Gerber Y, Weston SA, Enriquez-Sarano M, Manemann SM, Chamberlain AM, Jiang R, Roger VL. Atherosclerotic Burden and Heart Failure After Myocardial Infarction. JAMA Cardiol 2018; 1:156-62. [PMID: 27437886 DOI: 10.1001/jamacardio.2016.0074] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
IMPORTANCE Whether the extent of coronary artery disease (CAD) is associated with the occurrence of heart failure (HF) after myocardial infarction (MI) is not known. Furthermore, whether this association might differ by HF type according to preserved or reduced ejection fraction (EF) has yet to be determined. OBJECTIVES To evaluate in a community cohort of patients with incident (first-ever) MI the association of angiographic CAD with subsequent HF and to examine the prognostic role of CAD according to HF subtypes: HF with reduced EF and HF with preserved EF. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort study was conducted in 1922 residents of Olmsted County, Minnesota, with incident MI diagnosed between January 1, 1990, and December 31, 2010, and no prior HF; study participants were followed up through March 31, 2013. The extent of angiographic CAD was determined at baseline and categorized according to the number of major epicardial coronary arteries with 50% or more lumen diameter obstruction. MAIN OUTCOMES AND MEASURES The primary end point was time to incident HF. The primary exposure variable was the extent of CAD as expressed by the number of major coronary arteries with significant obstruction (0-, 1-, 2-, or 3-vessel disease) obtained from coronary angiograms performed no more than 1 day after the MI. Heart failure was ascertained by the Framingham criteria and classified by type according to EF (50% cutoff). RESULTS Of the 1922 participants, 1258 (65.4%) were men (mean [SD] age, 64 [13] years). During a mean follow-up period of 6.7 (5.9) years, 588 patients (30.6%) developed HF. With death and recurrent MI modeled as competing risks, the cumulative incidence rates of post-MI HF among patients with 0 or 1, 2, and 3 diseased vessels were 10.7%, 14.6%, and 23.0% at 30 days; and 14.7%, 20.6%, and 29.8% at 5 years, respectively (P < .001 for trend). After adjustment for clinical characteristics in a Cox proportional hazards regression model, the hazard ratios (95% CIs) for HF were 1.25 (0.99-1.59) and 1.75 (1.40-2.20) in patients with 2 and 3 vessels vs 0 or 1 occluded vessel, respectively (P < .001 for trend). The increased risk with a greater number of occluded vessels was independent of the occurrence of a recurrent MI and did not differ appreciably by HF type. CONCLUSIONS AND RELEVANCE The extent of angiographic CAD is an indicator of post-MI HF regardless of HF type and independent of recurrent MI. These data underscore the need to further investigate the processes taking place in the transition from myocardial injury to HF.
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Affiliation(s)
- Yariv Gerber
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota2Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Susan A Weston
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Maurice Enriquez-Sarano
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sheila M Manemann
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Alanna M Chamberlain
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ruoxiang Jiang
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Véronique L Roger
- Division of Cardiovascular Diseases, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
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Andries G, Khera S, Timmermans RJ, Aronow WS. Complete versus culprit only revascularization in ST-elevation myocardial infarction-a perspective on recent trials and recommendations. J Thorac Dis 2017; 9:2159-2167. [PMID: 28840017 DOI: 10.21037/jtd.2017.06.95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The presence of multivessel coronary artery disease (CAD) is strongly associated with higher 30-day mortality, reduced myocardial reperfusion success, reinfarction, and occurrence of major adverse cardiac events (MACE) at 1 year compared with single-vessel CAD. Despite higher morbidity and mortality in patients with ST-elevation myocardial infarction (STEMI) and coexistent multivessel CAD, major guidelines recommended against percutaneous coronary intervention (PCI) on non-culprit lesions at the time of primary PCI in patients with STEMI who are hemodynamically stable. The presence of multivessel CAD often poses a therapeutic dilemma for interventional cardiologists. A few larger scale randomized controlled trials (RCTs) and meta-analyses have been conducted. The conclusions regarding multivessel PCI generally trend towards lower risk of MACE, repeat revascularization, with similar risks of recurrent myocardial infarction (MI) and mortality. However, none of the RCTs were adequately powered for hard outcomes of death and MI.
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Affiliation(s)
- Gabriela Andries
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Sahil Khera
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA.,Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Robert J Timmermans
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
| | - Wilbert S Aronow
- Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla, New York, USA
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Han TW, Zhou SS, Li JT, Tian F, Mu Y, Jing J, Han YF, Chen YD. Homocysteine is associated with the progression of non-culprit coronary lesions in elderly acute coronary syndrome patients after percutaneous coronary intervention. J Geriatr Cardiol 2016; 13:299-305. [PMID: 27403138 PMCID: PMC4921541 DOI: 10.11909/j.issn.1671-5411.2016.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 02/26/2016] [Accepted: 02/27/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The influence of homocysteine (Hcy) on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit coronary lesions (NCCLs) is controversial. This study aims to evaluate whether the plasma level of Hcy is related to the progression of NCCLs after percutaneous coronary stent implantation in elderly patients with acute coronary syndrome (ACS). METHODS A total of 223 elderly patients (≥ 65 years old) with ACS undergoing stent implantation and follow-up coronary angiography were enrolled. Laboratory determination comprised of blood sample evaluation for Hcy was carried out before baseline coronary intervention. The patients were classified into two groups according to the blood Hcy tertiles (≥ 15 mmol/L or < 15 mmol/L). Patients were followed up for 12.2 months. NCCL progression was assessed by three-dimensional quantitative coronary angiography. RESULTS A significantly higher ratio of NCCL progression was observed in the group with baseline Hcy concentrations above 15 mmol/L compared to the group with concentrations below 15 mmol/L (41/127, 32.3% vs. 14/96, 14.6%, P = 0.002). Multivariate Cox regression analysis showed that Hcy and diabetes mellitus were independent risk factors for NCCL progression. The crude hazard ratio (HR) of NCCL progression for Hcy level was 1.056 (95% CI: 1.01-1.104, P = 0.015). The adjusted HR of NCCL progression for Hcy level was 1.024 (95% CI: 1.007-1.042, P = 0.007). The adjusted HR of NCCL progression for diabetes mellitus was 1.992 (95% CI: 1.15-3.44, P = 0.013). CONCLUSIONS Hcy is an independent risk factor for NCCL progression after 12 months of follow-up in elderly patients with ACS who has undergone percutaneous coronary stenting.
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Affiliation(s)
- Tian-Wen Han
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Shan-Shan Zhou
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jian-Tao Li
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Feng Tian
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yang Mu
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Jing Jing
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yun-Feng Han
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Yun-Dai Chen
- Department of Cardiology, Chinese PLA General Hospital, Beijing, China
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Ahmed N, Layland J, Carrick D, Petrie MC, McEntegart M, Eteiba H, Hood S, Lindsay M, Watkins S, Davie A, Mahrous A, Carberry J, Teng V, McConnachie A, Curzen N, Oldroyd KG, Berry C. Safety of guidewire-based measurement of fractional flow reserve and the index of microvascular resistance using intravenous adenosine in patients with acute or recent myocardial infarction. Int J Cardiol 2016; 202:305-10. [PMID: 26418191 PMCID: PMC4669307 DOI: 10.1016/j.ijcard.2015.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 07/27/2015] [Accepted: 09/14/2015] [Indexed: 12/19/2022]
Abstract
AIMS Coronary guidewire-based diagnostic assessments with hyperemia may cause iatrogenic complications. We assessed the safety of guidewire-based measurement of coronary physiology, using intravenous adenosine, in patients with an acute coronary syndrome. METHODS We prospectively enrolled invasively managed STEMI and NSTEMI patients in two simultaneously conducted studies in 6 centers (NCT01764334; NCT02072850). All of the participants underwent a diagnostic coronary guidewire study using intravenous adenosine (140 μg/kg/min) infusion for 1-2 min. The patients were prospectively assessed for the occurrence of serious adverse events (SAEs) and symptoms and invasively measured hemodynamics were also recorded. RESULTS 648 patients (n=298 STEMI patients in 1 hospital; mean time to reperfusion 253 min; n=350 NSTEMI in 6 hospitals; median time to angiography from index chest pain episode 3 (2, 5) days) were included between March 2011 and May 2013. Two NSTEMI patients (0.3% overall) experienced a coronary dissection related to the guidewire. No guidewire dissections occurred in the STEMI patients. Chest symptoms were reported in the majority (86%) of patient's symptoms during the adenosine infusion. No serious adverse events occurred during infusion of adenosine and all of the symptoms resolved after the infusion ceased. CONCLUSIONS In this multicenter analysis, guidewire-based measurement of FFR and IMR using intravenous adenosine was safe in patients following STEMI or NSTEMI. Self-limiting symptoms were common but not associated with serious adverse events. Finally, coronary dissection in STEMI and NSTEMI patients was noted to be a rare phenomenon.
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Affiliation(s)
- Nadeem Ahmed
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Jamie Layland
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - David Carrick
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Mark C Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Margaret McEntegart
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Hany Eteiba
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Stuart Hood
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Mitchell Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Stuart Watkins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Andrew Davie
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Ahmed Mahrous
- Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Jaclyn Carberry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
| | - Vannesa Teng
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Nick Curzen
- University Hospital Southampton Foundation Trust, Southampton, UK; Faculty of Medicine, University of Southampton, Southampton, UK
| | - Keith G Oldroyd
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK
| | - Colin Berry
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, Scotland, UK; Department of Cardiology, Golden Jubilee National Hospital, Glasgow G81 4DY, Scotland, UK.
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Kowalewski M, Schulze V, Berti S, Waksman R, Kubica J, Kołodziejczak M, Buffon A, Suryapranata H, Gurbel PA, Kelm M, Pawliszak W, Anisimowicz L, Navarese EP. Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials. Heart 2015; 101:1309-17. [DOI: 10.1136/heartjnl-2014-307293] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 05/08/2015] [Indexed: 01/08/2023] Open
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