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Wohlfahrt P, Jenča D, Melenovský V, Šramko M, Kotrč M, Želízko M, Mrázková J, Adámková V, Pitha J, Kautzner J. Trajectories and determinants of left ventricular ejection fraction after the first myocardial infarction in the current era of primary coronary interventions. Front Cardiovasc Med 2022; 9:1051995. [PMID: 36451922 PMCID: PMC9702523 DOI: 10.3389/fcvm.2022.1051995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 10/27/2022] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Left ventricular ejection fraction (EF) is an independent predictor of adverse outcomes after myocardial infarction (MI). However, current data on trajectories and determinants of EF are scarce. The present study aimed to describe the epidemiology of EF after MI. METHODS Data from a single-center prospectively-designed registry of consecutive patients hospitalized at a large tertiary cardiology center were utilized. RESULTS Out of 1,593 patients in the registry, 1,065 were hospitalized for MI type I (65.4% STEMI) and had no previous history of heart failure or MI. At discharge, EF < 40% was present in 238 (22.3%), EF 40-50% in 326 (30.6%) and EF > 50% in 501 (47.0%). Patients with EF < 40% were often those who suffered subacute and anterior STEMI, had higher heart rate at admission and higher maximal troponin level, and had more often HF signs requiring intravenous diuretics. Among subjects with EF < 40%, the follow-up EF was available in 166 (80% of eligible). Systolic function recovered to EF > 50% in 39 (23.1%), slightly improved to EF 40-50% in 44 (26.0%) and remained below 40% in 86 (50.9%). Systolic function improvement to EF > 40% was predicted by lower severity of coronary atherosclerosis, lower leukocyte count, and the absence of atrial fibrillation. CONCLUSIONS Despite recent improvements in in-hospital MI care, one in five patients has systolic dysfunction at hospital discharge. Out of these, EF improves in 51%, and full recovery is observed in 23%. The severity of coronary atherosclerosis, inflammatory response to MI, and atrial fibrillation may affect EF recovery.
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Affiliation(s)
- Peter Wohlfahrt
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- First Medical School, Charles University, Prague, Czechia
| | - Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Third Medical School, Charles University, Prague, Czechia
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Marek Šramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Martin Kotrč
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Michael Želízko
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Jolana Mrázková
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Jan Pitha
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), Prague, Czechia
- Medical and Dentistry School, Palacký University, Olomouc, Czechia
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Fabiszak T, Kasprzak M, Koziński M, Kubica J. Assessment of Selected Baseline and Post-PCI Electrocardiographic Parameters as Predictors of Left Ventricular Systolic Dysfunction after a First ST-Segment Elevation Myocardial Infarction. J Clin Med 2021; 10:5445. [PMID: 34830726 PMCID: PMC8619668 DOI: 10.3390/jcm10225445] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the performance of ten electrocardiographic (ECG) parameters regarding the prediction of left ventricular systolic dysfunction (LVSD) after a first ST-segment-elevation myocardial infarction (STEMI). METHODS We analyzed 249 patients (74.7% males) treated with primary percutaneous coronary intervention (PCI) included into a single-center cohort study. We sought associations between baseline and post-PCI ECG parameters and the presence of LVSD (defined as left ventricular ejection fraction [LVEF] ≤ 40% on echocardiography) 6 months after STEMI. RESULTS Patients presenting with LVSD (n = 52) had significantly higher values of heart rate, number of leads with ST-segment elevation and pathological Q-waves, as well as total and maximal ST-segment elevation at baseline and directly after PCI compared with patients without LVSD. They also showed a significantly higher prevalence of anterior STEMI and considerably wider QRS complex after PCI, while QRS duration measurement at baseline showed no significant difference. Additionally, patients presenting with LVSD after 6 months showed markedly more severe ischemia on admission, as assessed with the Sclarovsky-Birnbaum ischemia score, smaller reciprocal ST-segment depression at baseline and less profound ST-segment resolution post PCI. In multivariate regression analysis adjusted for demographic, clinical, biochemical and angiographic variables, anterior location of STEMI (OR 17.78; 95% CI 6.45-48.96; p < 0.001), post-PCI QRS duration (OR 1.56; 95% CI 1.22-2.00; p < 0.001) expressed per increments of 10 ms and impaired post-PCI flow in the infarct-related artery (IRA; TIMI 3 vs. <3; OR 0.14; 95% CI 0.04-0.46; p = 0.001) were identified as independent predictors of LVSD (Nagelkerke's pseudo R2 for the logistic regression model = 0.462). Similarly, in multiple regression analysis, anterior location of STEMI, wider post-PCI QRS, higher baseline number of pathological Q-waves and a higher baseline Sclarovsky-Birnbaum ischemia score, together with impaired post-PCI flow in the IRA, higher values of body mass index and glucose concentration on admission were independently associated with lower values of LVEF at 6 months (corrected R2 = 0.448; p < 0.00001). CONCLUSIONS According to our study, baseline and post-PCI ECG parameters are of modest value for the prediction of LVSD occurrence 6 months after a first STEMI.
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Affiliation(s)
- Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
| | - Marek Koziński
- Department of Cardiology and Internal Medicine, Medical University of Gdańsk, ul. Powstania Styczniowego 9B, 81-519 Gdynia, Poland;
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, ul. Skłodowskiej-Curie 9, 85-094 Bydgoszcz, Poland; (M.K.); (J.K.)
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Determinantes e impacto pronóstico de la insuficiencia cardiaca y la fracción de eyección del ventrículo izquierdo en el síndrome coronario agudo. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.10.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Agra Bermejo R, Cordero A, García-Acuña JM, Gómez Otero I, Varela Román A, Martínez Á, Álvarez Rodríguez L, Abou-Jokh C, Rodríguez-Mañero M, Cid Álvarez B, López-Palop R, Carrillo P, González-Juanatey JR. Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome Settings. ACTA ACUST UNITED AC 2017; 71:820-828. [PMID: 29249471 DOI: 10.1016/j.rec.2017.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/19/2017] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES Contemporary data on the incidence and prognosis of heart failure (HF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scant. The aim of this study was to examine the relationship between LVEF and HF with long-term prognosis in a cohort of patients with ACS. METHODS This is a retrospective observational study of 6208 patients consecutively admitted for ACS to 2 different Spanish hospitals. Baseline characteristics were examined and a follow-up period was established for registration of death and HF rehospitalization as the primary endpoint. RESULTS Among the study participants, 5064 had ACS without HF during hospitalization: 290 (5.8%) had LVEF<40%, 540 (10.6%) LVEF 40% to 49%, and 4234 (83.6%) LVEF ≥ 50%. The remaining 1144 patients developed HF in the acute phase: 395 (34.6%) had LVEF<40%, 251 (21.9%) LVEF 40% to 49%, and 498 (43.5%) LVEF ≥ 50%. Patients with LVEF 40% to 49% had a demographic and clinical profile with intermediate features between the LVEF <40% and LVEF ≥ 50% groups. Kaplan-Meier curves showed that mortality and HF readmissions were statistically different depending on LVEF in the non-HF group but not in the HF group. Left ventricular ejection fraction ≥ 50% was an independent prognostic factor in the non-HF group only. CONCLUSIONS In ACS, long-term prognosis is considerably worse in patients who develop HF during hospitalization than in patients without HF, irrespective of LVEF. This parameter is a strong prognostic predictor only in patients without HF.
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Affiliation(s)
- Rosa Agra Bermejo
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain.
| | - Alberto Cordero
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - José M García-Acuña
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Inés Gómez Otero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Alfonso Varela Román
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Álvaro Martínez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Leyre Álvarez Rodríguez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Charigan Abou-Jokh
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Moisés Rodríguez-Mañero
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Belén Cid Álvarez
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - Pilar Carrillo
- Servicio de Cardiología, Hospital Universitario San Juan, San Juan de Alicante, Alicante, Spain
| | - José R González-Juanatey
- Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain
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Kwok CS, Bachmann MO, Mamas MA, Stirling S, Shepstone L, Myint PK, Zaman MJ. Effect of age on the prognostic value of left ventricular function in patients with acute coronary syndrome: A prospective registry study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:191-198. [PMID: 26676673 DOI: 10.1177/2048872615623038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study aims to study the prognostic impact of left ventricular function on mortality and examine the effect of age on the prognostic value of left ventricular function. METHODS We examined the myocardial ischaemia national audit project registry (2006-2010) data with a mean follow-up of 2.1 years. Left ventricular function was categorised into good (ejection fraction ⩾50%), moderate (ejection fraction 30-49%) and poor (ejection fraction <30%) categories. Cox proportional hazards models were constructed to examine the prognostic significance of left ventricular function in different age groups (<65, 65-74, 75-84 and ⩾85 years) on all-cause mortality adjusting for baseline variables. RESULTS Out of 424,848 patients, left ventricular function data were available for 123,609. Multiple imputations were used to impute missing values of left ventricular function and the final sample for analyses was drawn from 414,305. After controlling for confounders, 339,887 participants were included in the regression models. For any age group, mortality was higher with a worsening degree of left ventricular impairment. Increased age reduced the adverse prognosis associated with reduced left ventricular function (hazard ratios of death comparing poor left ventricular function to good left ventricular function were 2.11, 95% confidence interval 1.88-2.37 for age <65 years and 1.28, 95% confidence interval 1.20-1.36 for age ⩾85 years). Older patients had a high mortality risk even in those with good left ventricular function. Hazard ratios of mortality for ⩾85 compared to <65 years (hazard ratio = 1.00) within good, moderate and poor ejection fraction groups were 5.89, 4.86 and 3.43, respectively. CONCLUSIONS In patients with acute coronary syndrome, clinicians should interpret the prognostic value of left ventricular function taking into account the patient's age.
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Affiliation(s)
- Chun Shing Kwok
- 1 Cardiovascular Research Group, Keele University, UK.,2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK
| | | | - Mamas A Mamas
- 1 Cardiovascular Research Group, Keele University, UK
| | | | - Lee Shepstone
- 3 Norwich Medical School, University of East Anglia, UK
| | - Phyo Kyaw Myint
- 2 Aberdeen Gerontological and Epidemiological Interdisciplinary Research Group (AGEING), University of Aberdeen, UK
| | - M Justin Zaman
- 3 Norwich Medical School, University of East Anglia, UK.,4 Department of Medicine, James Paget University Hospital, UK
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Im MS, Kim HL, Kim SH, Lim WH, Seo JB, Chung WY, Zo JH, Kim MA, Park KW, Koo BK, Kim HS, Chae IH, Cho DJ, Ahn Y, Jeong MH. Different prognostic factors according to left ventricular systolic function in patients with acute myocardial infarction. Int J Cardiol 2016; 221:90-6. [PMID: 27400303 DOI: 10.1016/j.ijcard.2016.06.100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 05/24/2016] [Accepted: 06/21/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND Initial left ventricular (LV) systolic function is a main determinant of clinical outcomes in patients with acute myocardial infarction (AMI). This study was performed to investigate whether AMI patients have different prognostic factors according to their baseline LV systolic function. METHODS A total of 12,988 patients with AMI from a nationwide database were analyzed. Major adverse cardiovascular events (MACEs) within 12months of AMI, including death, nonfatal myocardial infarction (MI), and revascularization, were assessed. RESULTS Patients were stratified into two groups according to LV ejection fraction (LVEF): those with LVEF<40% and those with LVEF≥40%. Patients with LVEF<40% (n=1962, 15.1%) were older and had more unfavorable cardiovascular risk factors than those with LVEF≥40% (n=11,026, 84.9%). The rate of MACE was higher in patients with LVEF<40% than in those with LVEF≥40% (26.8% vs 11.4%, p<0.001). Independent predictors of 12-month MACEs in patients with LVEF≥40% were history of MI, high Killip stage, three-vessel disease, and lower renal function, which are already known as risk factors. However, diabetes mellitus (hazard ratio [HR], 1.68; 95% confidence interval [CI], 1.17-2.40; p=0.008), and the use of rennin-angiotensin system (RAS) blockers (HR, 0.63; 95% CI, 0.41-0.95; p=0.029) were independent factors for 12-month MACE in patients with LVEF <40%. CONCLUSIONS Prognostic factors determining 12-month MACE after AMI are different according to LVEF. Management following AMI should be tailored according to their LV systolic function.
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Affiliation(s)
- Moon-Sun Im
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Hack-Lyoung Kim
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sang-Hyun Kim
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea.
| | - Woo-Hyun Lim
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jae-Bin Seo
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Young Chung
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Joo-Hee Zo
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Myung-A Kim
- Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyung-Woo Park
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Bon-Kwon Koo
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, Republic of Korea
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Dong-Ju Cho
- Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Youngkeun Ahn
- Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Chonnam National University Hospital, Gwangju, Republic of Korea
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Swiatkiewicz I, Kozinski M, Magielski P, Gierach J, Fabiszak T, Kubica A, Sukiennik A, Navarese EP, Odrowaz-Sypniewska G, Kubica J. Usefulness of C-reactive protein as a marker of early post-infarct left ventricular systolic dysfunction. Inflamm Res 2012; 61:725-34. [PMID: 22446726 PMCID: PMC3375005 DOI: 10.1007/s00011-012-0466-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 02/28/2012] [Accepted: 03/08/2012] [Indexed: 01/20/2023] Open
Abstract
Objective To assess the usefulness of in-hospital measurement of C-reactive protein (CRP) concentration in comparison to well-established risk factors as a marker of post-infarct left ventricular systolic dysfunction (LVSD) at discharge. Materials and methods Two hundred and four consecutive patients with ST-segment-elevation myocardial infarction (STEMI) were prospectively enrolled into the study. CRP plasma concentrations were measured before reperfusion, 24 h after admission and at discharge with an ultra-sensitive latex immunoassay. Results CRP concentration increased significantly during the first 24 h of hospitalization (2.4 ± 1.9 vs. 15.7 ± 17.0 mg/L; p < 0.001) and persisted elevated at discharge (14.7 ± 14.7 mg/L), mainly in 57 patients with LVSD (2.4 ± 1.8 vs. 25.0 ± 23.4 mg/L; p < 0.001; CRP at discharge 21.9 ± 18.6 mg/L). The prevalence of LVSD was significantly increased across increasing tertiles of CRP concentration both at 24 h after admission (13.2 vs. 19.1 vs. 51.5 %; p < 0.0001) and at discharge (14.7 vs. 23.5 vs. 45.6 %; p < 0.0001). Multivariate analysis demonstrated CRP concentration at discharge to be an independent marker of early LVSD (odds ratio of 1.38 for a 10 mg/L increase, 95 % confidence interval 1.01–1.87; p < 0.04). Conclusion Measurement of CRP plasma concentration at discharge may be useful as a marker of early LVSD in patients after a first STEMI.
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Affiliation(s)
- Iwona Swiatkiewicz
- Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland.
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Beyer J, Halbritter K, Weise M, Schellong S. Influence of antithrombin and argatroban on disseminated intravascular coagulation parameters in a patient with septic shock. Thromb Res 2008; 124:383-6. [PMID: 19062078 DOI: 10.1016/j.thromres.2008.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 10/12/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
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Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failur. Eur J Heart Fail 2008; 10:1215-23. [DOI: 10.1016/j.ejheart.2008.09.009] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/27/2008] [Accepted: 09/25/2008] [Indexed: 11/19/2022] Open
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Abstract
Patients who have had a myocardial infarction (MI) are at high risk for developing left ventricular dysfunction (LVD), which predisposes them to heart failure and is associated with an increased mortality risk. Early coronary revascularization, either with percutaneous coronary intervention or coronary artery bypass graft surgery, plays an important role in the preservation and restoration of left ventricular function after MI. This article discusses the effects of primary and nonemergent percutaneous coronary revascularization procedures on survival, left ventricular function, and the occurrence of complications, such as recurrent MI and stroke, compared with the effects of thrombolytic therapy. In addition, this article describes rescue revascularization procedures for patients who failed thrombolysis and those presenting relatively late or with negative electrocardiographic findings. Advanced interventional techniques, such as percutaneous ventricular assist devices and bioabsorbable stents, are very promising and may potentially help improve the outcomes of post-MI patients with LVD; however, the use of these techniques requires further validation.
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Konstantino Y, Chen E, Hasdai D, Boyko V, Battler A, Behar S, Haim M. Gender differences in mortality after acute myocardial infarction with mild to moderate heart failure. ACTA ACUST UNITED AC 2007; 9:43-7. [PMID: 17453538 DOI: 10.1080/17482940601100819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Heart failure (HF) is associated with poor outcome after acute myocardial infarction (AMI). Women have higher mortality rate than men after AMI, however, it is unknown whether women with HF after AMI have different prognosis than men. AIM To compare the prognosis of men and women with AMI and mild-moderate HF. METHODS We analyzed data of 3456 consecutive patients with AMI hospitalized in all cardiac care units in Israel during two nationwide surveys. RESULTS Among patients with AMI and HF on admission: women were older, had more risk factors, and were less likely to undergo percutaneous coronary angiography/intervention. Women with HF had higher (7-days, 30-days, and 1-year) crude mortality rates than men. However, adjusted mortality rates were not significantly different between genders. CONCLUSIONS Women with AMI complicated by HF had higher crude mortality rate than men that was eliminated after multivariate analysis, suggesting that the higher mortality rate may be attributed to increased prevalence of risk factors and lower rate of revascularization and medical therapies among women. Women with AMI and HF should be considered as a high-risk subgroup with adverse outcome. It remains to be determined whether more intensive management will improve their prognosis.
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Affiliation(s)
- Yuval Konstantino
- Cardiology Department, Rabin Medical Center, Beilinmson Campus, Jabotinsky St., Petah-Tikva 49100, Israel.
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Weir RAP, McMurray JJV. Epidemiology of heart failure and left ventricular dysfunction after acute myocardial infarction. Curr Heart Fail Rep 2007; 3:175-80. [PMID: 17129511 DOI: 10.1007/s11897-006-0019-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The development of heart failure and/or left ventricular systolic dysfunction has long been regarded as an ominous complication, significantly increasing the morbidity and short- and long-term mortality of survivors of acute myocardial infarction. Although the incidence of heart failure after myocardial infarction has fallen over the last few decades, it remains common, complicating up to 45% of infarcts. Moreover, up to 60% of myocardial infarcts will result in left ventricular systolic dysfunction, depending on the exact definition used. Those at greatest risk of developing heart failure are the elderly, females, and those with prior myocardial infarction. Advances in the management of acute myocardial infarction have led to reduced in-hospital mortality (even when complicated by heart failure), but longer-term mortality remains high in these patients.
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Affiliation(s)
- Robin A P Weir
- Department of Cardiology, Western Infirmary, Glasgow, G11 6NT, United Kingdom
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Lipinski MJ, Vetrovec GW. Medical treatment of patients with heart failure or left ventricular dysfunction undergoing percutaneous coronary intervention. Am J Cardiovasc Drugs 2006; 6:313-25. [PMID: 17083266 DOI: 10.2165/00129784-200606050-00004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Management of ischemic patients with pre-existing or new-onset left ventricular (LV) dysfunction poses a special challenge in terms of the timing of percutaneous coronary intervention (PCI) and appropriate adjunctive medications to optimize outcome while minimizing risk. In a systematic fashion, this review attempts to provide a management scheme for patients with heart failure or LV dysfunction that present with stable angina, ST-segment elevation myocardial infarction, or unstable angina/non-ST-segment elevation myocardial infarction. By addressing therapeutic approaches to acute or decompensated heart failure and timing of coronary angiography based on severity of ischemia, we provide evidence-based recommendations for medications to initiate before, during, and following PCI.
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Affiliation(s)
- Michael J Lipinski
- Division of Cardiology, Medical College of Virginia Campus of Virginia Commonwealth University, Richmond, Virginia, USA
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Whalley GA, Gamble GD, Doughty RN. Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies. Heart 2006; 92:1588-94. [PMID: 16740920 PMCID: PMC1861228 DOI: 10.1136/hrt.2005.083055] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine, through a systematic review and meta-analysis, the magnitude of the survival deficit associated with a restrictive filling pattern after acute myocardial infarction (AMI). METHODS Online databases were searched for prospective echocardiography outcome studies of patients after AMI. All authors were contacted to seek confirmation of their data. Restrictive filling was compared with all non-restrictive filling patterns. Review Manager Version 4.2.7 software was used for analysis. RESULTS 3855 patients in 16 studies were identified. Follow up varied from two weeks to five years (> 1 year, 10 studies; and > 4 years, four studies). 776 (20%) of patients had a restrictive filling pattern at baseline. 580 patients died (247 in the restrictive group), and the overall odds ratio for death (restrictive filling worse) was 4.10 (95% confidence interval 3.38 to 4.99). CONCLUSIONS Mortality is about four times higher in patients with a restrictive filling pattern than in those with non-restrictive filling patterns after AMI. Echocardiographic assessment of diastolic filling pattern is an important part of the echocardiographic assessment of patients after myocardial infarction and provides important prognostic information about such patients.
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Affiliation(s)
- G A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
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15
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Weir RAP, McMurray JJV, Velazquez EJ. Epidemiology of heart failure and left ventricular systolic dysfunction after acute myocardial infarction: prevalence, clinical characteristics, and prognostic importance. Am J Cardiol 2006; 97:13F-25F. [PMID: 16698331 DOI: 10.1016/j.amjcard.2006.03.005] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The development of heart failure and/or left ventricular systolic dysfunction (LVSD) in the setting of acute myocardial infarction (AMI) results in significant risk far above that of AMI independently. In patients admitted to the hospital for AMI, concomitant heart failure and/or LVSD on hospital admission or development of either or both of these conditions during admission are among the strongest predictors of inhospital death and are associated with significant increases in inhospital, 30-day, and long-term mortality and rehospitalization rates. Given the high risks in this population, aggressive treatment, comprising early initiation and sustained use of evidence-based treatments, is essential for improving prognosis.
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Affiliation(s)
- Robin A P Weir
- Department of Cardiology, Western Infirmary, Glasgow, United Kingdom, and Department of Medicine, Duke University Medical Center, Durham, NC, USA
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16
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Lipinski MJ, Martin RE, Cowley MJ, Goudreau E, Malloy WN, Vetrovec GW. Improved survival for stenting vs. balloon angioplasty for the treatment of coronary artery disease in patients with ischemic left ventricular dysfunction. Catheter Cardiovasc Interv 2005; 66:547-53. [PMID: 16216018 DOI: 10.1002/ccd.20455] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While earlier studies of balloon angioplasty (BA) in patients with left ventricular (LV) dysfunction suggested high late mortality, a study directly comparing coronary stenting and BA has not been performed. Since stenting provides a more durable revascularization, we sought to compare long-term survival in patients undergoing stenting vs BA in patients with decreased left ventricular ejection fractions (LVEF). We evaluated consecutive patient procedures performed in our institution from 1996 through 1999. Patients were considered part of the stent group if they received at least one stent. To be included, patients had to have a technically adequate angiographic LV gram with a calculated LVEF<or=50%. Patients with prior CABG were excluded. Mortality data was retrieved using the United States Social Security Death Index. Follow-up ranged from 3.5 to 6.5 years. Statistical analysis was performed and tests were significant with a P-value<0.05. A total of 238 patients fulfilled our criteria. Mean age was 57.5+/-12 years, mean LVEF was 39+/-10%, 67% were males, 71.5% received stents, 62% had a recent MI, and 19% died during follow-up. Overall 5-year survival was 84% for stenting and 77% for BA (P=NS). Patients with an LVEF<or=40% (n=110) had better survival at 5 years if they received a stent compared with BA alone (76% for stents vs. 53% for BA; P<0.05). Stenting was found to be significant predictor of late survival on Cox Hazard Regression analysis in patients with an LVEF<or=50% and LVEF<or=40%. This study demonstrates improved 5-year survival for patients undergoing stenting compared with balloon angioplasty in patients with LVEF<or=40%.
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Affiliation(s)
- Michael J Lipinski
- Division of Cardiology, Virginia Commonwealth University Medical Center, Richmond, Virginia
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17
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Gurm HS, Bhatt DL. Thrombin, an ideal target for pharmacological inhibition: a review of direct thrombin inhibitors. Am Heart J 2005; 149:S43-53. [PMID: 15644793 DOI: 10.1016/j.ahj.2004.10.022] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Hitinder S Gurm
- Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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18
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Haim M, Battler A, Behar S, Fioretti PM, Boyko V, Simoons ML, Hasdai D. Acute coronary syndromes complicated by symptomatic and asymptomatic heart failure: does current treatment comply with guidelines? Am Heart J 2004; 147:859-64. [PMID: 15131543 DOI: 10.1016/j.ahj.2003.11.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Patients with acute coronary syndromes (ACS) complicated by heart failure (HF) are at increased risk of death. Treatment with angiotensin-converting enzyme inhibitors (ACEI), beta-blockers, and early invasive risk stratification are recommended for these patients. AIM The purpose of the current study was to assess adherence to treatment guidelines of patients with ACS complicated by HF in Europe and the Mediterranean region. METHODS AND RESULTS Of the 10,484 patients who participated in Euro-Heart ACS survey, 9587 had known HF status and were without cardiogenic shock; 7058 (74%) did not have symptomatic HF and 2529 (26%) presented with or developed symptomatic HF during hospitalization. HF patients were older and had more cardiovascular risk factors. ACEI were more commonly used in HF patients (75% vs 56%, P < .01), whereas beta-blockers were less frequently used (75% vs 82%, P < .01). Coronary angiography and in hospital revascularization rates were lower among HF patients (42% vs 57% for coronary angiography, P < .01, and 32% vs 42% for revascularization, P < .01). Similar trends were noticed among patients with left ventricular dysfunction (symptomatic and asymptomatic).Adjusted in-hospital mortality risk was higher among patients with ACS complicated by symptomatic HF regardless of electrocardiographic type of ACS: (ST-elevation ACS, OR 2.5, 95% CI 1.6-3.9; non-ST-elevation ACS, OR 8.9,95% CI 4.5-17.7; undetermined-ECG ACS, OR 9.3, 95% CI 2.5-34). CONCLUSIONS Patients with ACS complicated by HF were at increased risk of dying. A relatively high percentage of HF patients were treated with ACEI and beta-blockers in accordance with current recommendations. Rates of coronary angiography and revascularization were significantly lower in ACS patients with HF versus those without HF, which potentially contributed to their worse mortality [corrected]
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Affiliation(s)
- Moti Haim
- Cardiology Department, Rabin Medical Center, Petah-Tikva, Israel
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19
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Freimark D, Matetzky S, Leor J, Boyko V, Barbash IM, Behar S, Hod H. Timing of aspirin administration as a determinant of survival of patients with acute myocardial infarction treated with thrombolysis. Am J Cardiol 2002; 89:381-5. [PMID: 11835915 DOI: 10.1016/s0002-9149(01)02256-1] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Unlike thrombolytic agents, there are conflicting data regarding the time-dependent effect of aspirin treatment on outcome in acute myocardial infarction (AMI). We sought to evaluate the impact of timing of aspirin administration (before vs after thrombolysis) on mortality of patients with AMI. Our study included 1,200 patients with ST elevation AMI treated with thrombolysis. Early (n = 364) versus late (n = 836) users were defined as those receiving emergency aspirin before versus after initiation of thrombolysis, respectively. Time (median) from symptom onset to initiation of aspirin treatment was significantly shorter in early versus late users (1.6 vs 3.5 hours; p <0.001). There were no significant differences between the 2 groups with respect to baseline clinical characteristics. Early aspirin users were more likely to develop reischemia, to be treated with beta blockers, to be referred to coronary angiography, percutaneous transluminal coronary angioplasty, or coronary artery bypass graft surgery. Early users experienced lower mortality at 7 days (2.5% vs 6.0%, p = 0.01), 30 days (3.3% vs 7.3%, p = 0.008), and 1 year (5.0% vs 10.6%, p = 0.002) than late users. This survival benefit persisted for patients with and without previous aspirin therapy or revascularization and after adjustment for baseline characteristics and therapies at 7 days (odds ratio 0.36, 95% confidence interval 0.15 to 0.79), at 30 days (odds ratio 0.39, 95% confidence interval 0.17 to 0.82), and at 1 year (odds ratio 0.41, 95% confidence interval 0.21 to 0.74). Our study proposes a time-dependent benefit from aspirin in patients with AMI treated with thrombolysis.
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Affiliation(s)
- Dov Freimark
- The Heart Institute, Sheba Medical Center, Tel-Aviv University, Tel-Hashomer, Israel
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