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Cisneros-Barroso E, Rossello X. Sodium-glucose cotransporter 2 inhibitors in acute and chronic coronary syndrome with and without heart failure. Eur J Heart Fail 2024. [PMID: 38808622 DOI: 10.1002/ejhf.3321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024] Open
Affiliation(s)
- Eugenia Cisneros-Barroso
- Internal Medicine Department, Hospital Universitari Son Llàtzer, Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Xavier Rossello
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Nishihira K, Nakai M, Kuriyama N, Kadooka K, Honda Y, Emori H, Yamamoto K, Nishino S, Kudo T, Ogata K, Kimura T, Kaikita K, Shibata Y. Guideline-Directed Medical Therapy for Elderly Patients With Acute Myocardial Infarction Who Undergo Percutaneous Coronary Intervention - Insights From a Retrospective Observational Study. Circ J 2024; 88:931-937. [PMID: 38233147 DOI: 10.1253/circj.cj-23-0837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
BACKGROUND The efficacy of guideline-directed medical therapy (GDMT) in the elderly remains unclear. This study evaluated the impact of GDMT (aspirin or a P2Y12inhibitor, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, β-blocker, and statin) at discharge on long-term mortality in elderly patients with acute myocardial infarction (AMI) who had undergone percutaneous coronary intervention (PCI).Methods and Results: Of 2,547 consecutive patients with AMI undergoing PCI in 2009-2020, we retrospectively analyzed 573 patients aged ≥80 years. The median follow-up period was 1,140 days. GDMT was prescribed to 192 (33.5%) patients at discharge. Compared with patients without GDMT, those with GDMT were younger and had higher rates of ST-segment elevation myocardial infarction and left anterior descending artery culprit lesion, higher peak creatine phosphokinase concentration, and lower left ventricular ejection fraction (LVEF). After adjusting for confounders, GDMT was independently associated with a lower cardiovascular death rate (hazard ratio [HR] 0.35; 95% confidence interval [CI] 0.16-0.81), but not with all-cause mortality (HR 0.77; 95% CI 0.50-1.18). In the subgroup analysis, the favorable impact of GDMT on cardiovascular death was significant in patients aged 80-89 years, with LVEF <50%, or with an estimated glomerular filtration rate ≥30 mL/min/1.73 m2. CONCLUSIONS GDMT in patients with AMI aged ≥80 years undergoing PCI was associated with a lower cardiovascular death rate but not all-cause mortality.
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Affiliation(s)
| | - Michikazu Nakai
- Clinical Research Support Center, University of Miyazaki Hospital
| | - Nehiro Kuriyama
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Kosuke Kadooka
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Yasuhiro Honda
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Hiroki Emori
- Department of Cardiology, Miyazaki Medical Association Hospital
| | | | - Shun Nishino
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Takeaki Kudo
- Department of Cardiology, Miyazaki Medical Association Hospital
| | - Kenji Ogata
- Department of Cardiology, Miyazaki Medical Association Hospital
| | | | - Koichi Kaikita
- Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki
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Fayol A, Schiele F, Ferrières J, Puymirat E, Bataille V, Tea V, Chamandi C, Albert F, Lemesle G, Cayla G, Weizman O, Simon T, Danchin N. Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults. Circ Cardiovasc Qual Outcomes 2024; 17:e010685. [PMID: 38682335 DOI: 10.1161/circoutcomes.123.010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed. METHODS The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences. RESULTS Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]). CONCLUSIONS In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
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Affiliation(s)
- Antoine Fayol
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - François Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France (F.S.)
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Victoria Tea
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Chekrallah Chamandi
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Franck Albert
- Department of Cardiology, Hospital of Chartres, France (F.A.)
| | - Gilles Lemesle
- Department of Cardiology, Heart and Lung Institute, University Hospital of Lille, France (G.L.)
- University of Lille, France (G.L.)
- Institut Pasteur de Lille, France (G.L.)
- FACT (French Alliance for Cardiovascular Trials), Paris (G.L.)
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, University of Montpellier, France (G.C.)
| | - Orianne Weizman
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Platform of East of Paris (Unité de Recherche Clinique des hopitaux EST parisiens, Comité de Recherche Clinique des hopitaux EST parisiens, Centre de Ressources Biologiques), Hôpital St Antoine, Sorbonne University, and FACT (T.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- Hôpital Paris St Joseph, and FACT (N.D.)
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Gonzalez-Del-Hoyo M, Mas-Llado C, Blaya-Peña L, Siquier-Padilla J, Coughlan JJ, Peral V, Rossello X. Type of evidence supporting ACC/AHA and ESC clinical practice guidelines for acute coronary syndrome. Clin Res Cardiol 2024; 113:546-560. [PMID: 37436514 DOI: 10.1007/s00392-023-02262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
AIM The aim of clinical practice guidelines for ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS) is to assist healthcare professionals in clinical decision-making. We evaluated the type of studies supporting these guidelines and their recommendations. METHODS All references and recommendations in the 2013 and 2014 ACC/AHA and 2017 and 2020 (ESC clinical guidelines for STEMI and NSTE-ACS were reviewed. References were classified into meta-analyses, randomised, non-randomised, and other types (e.g., position papers, reviews). Recommendations were classified according to class and their level of evidence (LOE). RESULTS We retrieved 2128 non-duplicated references: 8.4% were meta-analyses, 26.2% randomised studies, 44.7% non-randomised studies, and 20.7% 'other' papers. Meta-analyses were based on randomised data in 78% of cases and used individual-patient data in 20.2%. Compared to non-randomised studies, randomised studies were more frequently multicentre (85.5% vs. 65.5%) and international (58.2% vs. 28.5%). The type of studies supporting recommendations varied as per the LOE of the recommendation. For LOE-A recommendations, the breakdown of supporting recommendations was: 18.5% meta-analyses, 56.6% randomised studies, 16.6% non-randomised studies and 8.3% 'other' papers; for LOE-B this breakdown was 9%, 39.8%, 38.2%, and 12.9%; and for LOE-C; 4.6%, 19.3%, 30.3%, and 45.9%. CONCLUSIONS The references supporting the ACC/AHA and ESC guidelines on STEMI and NSTE-ACS consisted of non-randomised studies in ~ 45% of cases, with less than a third of the references consisting of meta-analyses and randomised studies. The type of studies supporting guideline recommendations varied widely by the LOE of the recommendation.
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Affiliation(s)
- Maribel Gonzalez-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Caterina Mas-Llado
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital de Manacor, Manacor, Spain
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Laura Blaya-Peña
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
| | | | - J J Coughlan
- Deutsches Herzzentrum München und Technische Universität München, Munich, Germany
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain.
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma, Spain.
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.
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Earle NJ, Doughty RN, Devlin G, White H, Riddell C, Choi Y, Kerr AJ, Poppe KK. Sex differences in outcomes after acute coronary syndrome vary with age: a New Zealand national study. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:284-292. [PMID: 38085048 PMCID: PMC10927026 DOI: 10.1093/ehjacc/zuad151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 03/13/2024]
Abstract
AIMS This study investigated age-specific sex differences in short- and long-term clinical outcomes following hospitalization for a first-time acute coronary syndrome (ACS) in New Zealand (NZ). METHODS AND RESULTS Using linked national health datasets, people admitted to hospital for a first-time ACS between January 2010 and December 2016 were included. Analyses were stratified by sex and 10-year age groups. Logistic and Cox regression were used to assess in-hospital death and from discharge the primary outcome of time to first cardiovascular (CV) readmission or death and other secondary outcomes at 30 days and 2 years. Among 63 245 people (mean age 69 years, 40% women), women were older than men at the time of the ACS admission (mean age 73 vs. 66 years), with a higher comorbidity burden. Overall compared with men, women experienced higher rates of unadjusted in-hospital death (10% vs. 7%), 30-day (16% vs. 12%) and 2-year (44% vs. 34%) death, or CV readmission (all P < 0.001). Age group-specific analyses showed sex differences in outcomes varied with age, with younger women (<65 years) at higher risk than men and older women (≥85 years) at lower risk than men: unadjusted hazard ratio of 2-year death or CV readmission for women aged 18-44 years = 1.51 [95% confidence interval (CI) 1.21-1.84] and aged ≥85 years = 0.88 (95% CI 0.83-0.93). The increased risk for younger women was no longer significant after multivariable adjustment whereas the increased risk for older men remained. CONCLUSION Men and women admitted with first-time ACS have differing age and comorbidity profiles, resulting in contrasting age-specific sex differences in the risk of adverse outcomes between the youngest and oldest age groups.
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Affiliation(s)
- Nikki J Earle
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Gerry Devlin
- Cardiology, Gisborne Hospital, Gisborne, New Zealand
| | - Harvey White
- Cardiology, Te Toka Tumai Auckland Hospital, Auckland, New Zealand
| | - Craig Riddell
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
| | - Yeunhyang Choi
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Andrew J Kerr
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
- Section of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
- Middlemore Hospital, Counties Manukau District Health Board, Auckland, New Zealand
| | - Katrina K Poppe
- Department of Medicine, University of Auckland, Park Avenue, Graton, Auckland 1023, New Zealand
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Gonzalez-Del-Hoyo M, Mas-Llado C, Siquier-Padilla J, Blaya-Peña L, Coughlan JJ, Peral V, Rossello X. A systematic assessment of the characteristics of randomized controlled trials cited by acute coronary syndrome clinical practice guidelines. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:176-188. [PMID: 37296213 DOI: 10.1093/ehjqcco/qcad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 06/12/2023]
Abstract
AIMS The aim of this study was to describe the methodological features of the randomized controlled trials (RCTs) cited in American and European clinical practice guidelines (CPGs) for ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS Out of 2128 non-duplicated references cited in the 2013 and 2014 American College of Cardiology/American Heart Association and 2017 and 2020 European Society of Cardiology CPGs for STEMI and NSTE-ACS, we extracted data for 407 RCTs (19.1% of total references). The majority were multicenter studies (81.8%), evaluated pharmacological interventions (63.1%), had a 2-arm (82.6%), and superiority (90.4%) design. Most RCTs (60.2%) had an active comparator, and 46.2% were funded by industry. The median observed sample size was 1001 patients (84.2% of RCTs achieved ≥80% of the intended sample size). Most RCTs had a single primary outcome (90.9%), which was a composite in just over half (51.9%). Among the RCTs testing for superiority, 44.0% reported a P-value of ≥0.05 for the primary outcome and 61.9% observed a risk reduction of >15%. The observed treatment effect was lower-than-expected in 67.6% of RCTs, with 34.4% having at least a 20% lower-than-expected treatment effect. The calculated post hoc statistical power was ≥80% for 33.9% of cited RCTs. CONCLUSIONS This analysis demonstrates that RCTs cited by CPGs can still have significant methodological issues and limitations, highlighting that a better understanding of the methodological aspects of RCTs is crucial in order to formulate recommendations relevant to clinical practice.
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Affiliation(s)
- Maribel Gonzalez-Del-Hoyo
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Caterina Mas-Llado
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital de Manacor, Carretera Manacor-Alcudia, 07500 Manacor, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Joan Siquier-Padilla
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Laura Blaya-Peña
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - J J Coughlan
- Cardiovascular Research Institute, Universtiy of Medicine and Health Sciences, Mater Private Network, D07 KWR1 Dublin, Ireland
| | - Vicente Peral
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Carretera de Valldemossa, 79, 07120 Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Carretera de Valldemossa, 79, 07120 Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almagro, 3, 28029 Madrid, Spain
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:55-161. [PMID: 37740496 DOI: 10.1093/ehjacc/zuad107] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
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Coughlan JJ, Rossello X. Anaemia in patients with cardiogenic shock complicating acute myocardial infarction: Surrogate marker of poor outcome or therapeutic target? Eur J Heart Fail 2024; 26:458-459. [PMID: 38247170 DOI: 10.1002/ejhf.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Affiliation(s)
- J J Coughlan
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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Mas-Llado C, Rossello X, González-Del-Hoyo M, Pocock S, de Werf FV, Chin CT, Danchin N, Lee SWL, Medina J, Huo Y, Bueno H. Secondary Prevention Therapies in Real-World Patients with Myocardial Infarction: Eligibility Based on Randomized Trials Supporting European and American Guidelines. Am J Med 2024; 137:137-146.e10. [PMID: 37838236 DOI: 10.1016/j.amjmed.2023.09.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE We aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries. METHODS Recommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients. RESULTS There were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers). CONCLUSION Most real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.
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Affiliation(s)
- Caterina Mas-Llado
- Cardiology Department, Hospital de Manacor, Spain; Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain
| | - Xavier Rossello
- Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain; Cardiology Department, Health Research Institute of the Balearic Islands, Hospital Universitari Son Espases, Palma, Spain; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
| | | | | | - Frans Van de Werf
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | | | - Nicolas Danchin
- Hôpital Européen Georges Pompidou & René Descartes University, France
| | | | | | - Yong Huo
- Beijing University First Hospital, China
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain; Cardiology Department, Hospital Universitario 12 de Octubre, and Instituto de Investigación i+12, Madrid, Spain; Facultad de Medicina, Universidad Complutense de Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain.
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10
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Schou M, Claggett B, Miao ZM, Fernandez A, Filippatos G, Granger C, Jering K, Maggioni AP, McCausland F, Villota JN, Rouleau JL, Mody FV, van der Meer P, Vinereanu D, McGrath M, Zhou Y, Mann DL, Solomon SD, Steg PG, Braunwald E, McMurray JJV, Pfeffer MA, Køber L. Sacubitril/valsartan compared to ramipril in high-risk post-myocardial infarction patients stratified according to use of mineralocorticoid receptor antagonists: Insight from the PARADISE MI trial. Eur J Heart Fail 2024; 26:130-139. [PMID: 37933184 DOI: 10.1002/ejhf.3079] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 10/25/2023] [Accepted: 10/31/2023] [Indexed: 11/08/2023] Open
Abstract
AIM It is unknown whether safety and clinical endpoints by use of sacubitril/valsartan (an angiotensin receptor-neprilysin inhibitor [ARNI]) are affected by mineralocorticoid receptor antagonists (MRA) in high-risk myocardial infarction (MI) patients. The aim of this study was to examine whether MRA modifies safety and clinical endpoints by use of sacubitril/valsartan in patients with a MI and left ventricular systolic dysfunction (LVSD) and/or pulmonary congestion. METHODS AND RESULTS Patients (n = 5661) included in the PARADISE MI trial (Prospective ARNI vs. ACE Inhibitor Trial to Determine Superiority in Reducing Heart Failure Events After MI) were stratified according to MRA. Primary outcomes in this substudy were worsening heart failure or cardiovascular death. Safety was defined as symptomatic hypotension, hyperkalaemia >5.5 mmol/L, or permanent drug discontinuation. A total of 2338 patients (41%) were treated with MRA. Safety of ARNI compared to ramipril was not altered significantly by ± MRA, and both groups had similar increase in symptomatic hypotension with ARNI. In patients taking MRA, the risk of hyperkalaemia or permanent drug discontinuation was not significantly altered by ARNI (p > 0.05 for all comparisons). The effect of ARNI compared with ramipril was similar in those who were and were not taking MRA (hazard ratio [HR]MRA 0.96, 95% confidence interval [CI] 0.77-1.19 and HRMRA- 0.87, 95% CI 0.71-1.05, for the primary endpoint; p = 0.51 for interaction [Clinical Endpoint Committee adjudicated]); similar findings were observed if investigator-reported endpoints were evaluated (p = 0.61 for interaction). CONCLUSIONS Use of a MRA did not modify safety or clinical endpoints related to initiation of ARNI compared to ramipril in the post-MI setting in patients with LVSD and/or congestion.
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Affiliation(s)
- Morten Schou
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Brian Claggett
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Zi Michael Miao
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, Department of Cardiology, Attikon University Hospital, Athens, Greece
| | | | - Karola Jering
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | | | - Finnian McCausland
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | | | - Freny Vaghaiwalla Mody
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of Cardiology, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peter van der Meer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Dragos Vinereanu
- University of Medicine and Pharmacy Carol Davila, University and Emergency Hospital, Bucharest, Romania
| | - Martina McGrath
- Renal Division, Department of Medicine (F.R.M.), Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Yinong Zhou
- Novartis Pharmaceutical Corporation, East Hanover, NJ, USA
| | - Douglas L Mann
- Washington University School of Medicine, St Louis, MO, USA
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Philippe Gabriel Steg
- Université de Paris, AP-HP (Assistance Publique-Hôpitaux de Paris), FACT (French Alliance for Cardiovascular Trials) and INSERM U-1148, Paris, France
| | - Eugene Braunwald
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - John J V McMurray
- British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland
| | - Marc A Pfeffer
- Cardiovascular Division, Brigham and Women's Hospital, and Harvard Medical School Boston, Boston, MA, USA
| | - Lars Køber
- Rigshospitalet, Blegdamsvej, University of Copenhagen, Copenhagen, Denmark
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11
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Nishihira K, Honda S, Takegami M, Kojima S, Takahashi J, Itoh T, Watanabe T, Yamashita J, Saji M, Tsujita K, Takayama M, Sumiyoshi T, Kimura K, Yasuda S. Percutaneous coronary intervention for ST-elevation myocardial infarction complicated by cardiogenic shock in a super-aging society. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:847-855. [PMID: 37724765 DOI: 10.1093/ehjacc/zuad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/07/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023]
Abstract
AIMS ST-segment elevation myocardial infarction complicated by cardiogenic shock (STEMICS) is associated with substantial mortality. As life expectancy increases, percutaneous coronary intervention (PCI) is being performed more frequently, even in elderly patients with acute myocardial infarction (AMI). This study sought to investigate the characteristics and impact of PCI on in-hospital mortality in patients with STEMICS. METHODS AND RESULTS The Japan AMI Registry (JAMIR) is a retrospective, nationwide, real-world database. Among 46 242 patients with AMI hospitalized in 2011-2016, 2760 patients with STEMICS (median age, 72 years) were studied. We compared 2396 (86.8%) patients who underwent PCI with 364 (13.2%) patients who did not. The percentage of mechanical circulatory support use in patients with STEMICS was 69.3% and in-hospital mortality was 34.6%. Compared with patients who did not undergo PCI, patients undergoing PCI were younger and had a higher rate of intra-aortic balloon pump use. A higher proportion was male or current smokers. In-hospital mortality was significantly lower in the PCI group than in the no-PCI group (31.3% vs. 56.0%, P < 0.001). Percutaneous coronary intervention was independently associated with lower in-hospital mortality [adjusted odds ratio (OR), 0.508; 95% confidence interval (CI), 0.347-0.744]. In 789 (28.6%) patients aged ≥80 years, PCI was associated with fewer in-hospital cardiac deaths (adjusted OR, 0.524; 95% CI, 0.281-0.975), but was not associated with in-hospital mortality (adjusted OR, 0.564; 95% CI, 0.300-1.050). CONCLUSION In Japan, PCI was effective in reducing in-hospital cardiac death in elderly patients with STEMICS. Age alone should not preclude potentially beneficial invasive therapy.
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Affiliation(s)
- Kensaku Nishihira
- Department of Cardiology, Miyazaki Medical Association Hospital, 1173 Arita, Miyazaki 880-2102, Japan
| | - Satoshi Honda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Misa Takegami
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Public Health and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sunao Kojima
- Department of Cardiology, Sakura-jyuji Yatsushiro Rehabilitation Hospital, Kumamoto, Japan
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tomonori Itoh
- Division of Community Medicine, Department of Medical Education/Division of Cardiology, Department of Medicine, Iwate Medical University, Morioka, Japan
| | - Tetsu Watanabe
- Department of Cardiology, Pulmonology, and Nephrology, Yamagata University School of Medicine, Yamagata, Japan
| | - Jun Yamashita
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Mike Saji
- Department of Cardiology, Sakakibara Heart Institute, Fuchu, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
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12
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Rossello X, Rubini Gimenez M. The dapagliflozin in patients with myocardial infarction (DAPA-MI) trial in perspective. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:862-863. [PMID: 37979161 DOI: 10.1093/ehjacc/zuad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Affiliation(s)
- Xavier Rossello
- Cardiology Department, Institut D'investigació Sanitària Illes Balears (Idisba), Hospital Universitari Son Espases,Carretera de Valldemossa 79, 07120 Palma, Spain
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), C. de Melchor Fernández Almagro 3, 28029 Madrid, Spain
- Faculty of Medicine, Universitat De Les Illes Balears (UIB), Carretera de Valldemossa, Km 7.5, 07122 Palma, Spain
| | - Maria Rubini Gimenez
- Cardiology and Internal Medicine Department, Leipzig University Heart Center, 04289 Leipzig, Germany
- Cardiology Department, IMED Hospitales, 46100 Valencia, Spain
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13
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Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, Claeys MJ, Dan GA, Dweck MR, Galbraith M, Gilard M, Hinterbuchner L, Jankowska EA, Jüni P, Kimura T, Kunadian V, Leosdottir M, Lorusso R, Pedretti RFE, Rigopoulos AG, Rubini Gimenez M, Thiele H, Vranckx P, Wassmann S, Wenger NK, Ibanez B. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023; 44:3720-3826. [PMID: 37622654 DOI: 10.1093/eurheartj/ehad191] [Citation(s) in RCA: 498] [Impact Index Per Article: 498.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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14
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Patel KV, Budoff MJ, Valero-Elizondo J, Lahan S, Ali SS, Taha MB, Blaha MJ, Blankstein R, Shapiro MD, Pandey A, Arias L, Feldman T, Cury RC, Cainzos-Achirica M, Shah SH, Ziffer JA, Fialkow J, Nasir K. Coronary Atherosclerosis Across the Glycemic Spectrum Among Asymptomatic Adults: The Miami Heart Study at Baptist Health South Florida. Circ Cardiovasc Imaging 2023; 16:e015314. [PMID: 37772409 PMCID: PMC10695004 DOI: 10.1161/circimaging.123.015314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/01/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The contemporary burden and characteristics of coronary atherosclerosis, assessed using coronary computed tomography angiography (CCTA), is unknown among asymptomatic adults with diabetes and prediabetes in the United States. The pooled cohort equations and coronary artery calcium (CAC) score stratify atherosclerotic cardiovascular disease risk, but their association with CCTA findings across glycemic categories is not well established. METHODS Asymptomatic adults without atherosclerotic cardiovascular disease enrolled in the Miami Heart Study were included. Participants underwent CAC and CCTA testing and were classified into glycemic categories. Prevalence of coronary atherosclerosis (any plaque, noncalcified plaque, plaque with ≥1 high-risk feature, maximal stenosis ≥50%) assessed by CCTA was described across glycemic categories and further stratified by pooled cohort equations-estimated atherosclerotic cardiovascular disease risk and CAC score. Adjusted logistic regression was used to evaluate the associations between glycemic categories and coronary outcomes. RESULTS Among 2352 participants (49.5% women), the prevalence of euglycemia, prediabetes, and diabetes was 63%, 30%, and 7%, respectively. Coronary plaque was more commonly present across worsening glycemic categories (euglycemia, 43%; prediabetes, 58%; diabetes, 69%), and similar pattern was observed for other coronary outcomes. In adjusted analyses, compared with euglycemia, prediabetes and diabetes were each associated with higher odds of any coronary plaque (OR, 1.30 [95% CI, 1.05-1.60] and 1.75 [1.17-2.61], respectively), noncalcified plaque (OR, 1.47 [1.19-1.81] and 1.99 [1.38-2.87], respectively), and plaque with ≥1 high-risk feature (OR, 1.65 [1.14-2.39] and 2.53 [1.48-4.33], respectively). Diabetes was associated with stenosis ≥50% (OR, 3.01 [1.79-5.08]; reference=euglycemia). Among participants with diabetes and estimated atherosclerotic cardiovascular disease risk <5%, 46% had coronary plaque and 10% had stenosis ≥50%. Among participants with diabetes and CAC=0, 30% had coronary plaque and 3% had stenosis ≥50%. CONCLUSIONS Among asymptomatic adults, worse glycemic status is associated with higher prevalence and extent of coronary atherosclerosis, high-risk plaque, and stenosis. In diabetes, CAC was more closely associated with CCTA findings and informative in a larger population than the pooled cohort equations.
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Affiliation(s)
- Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Matthew J Budoff
- Harbor-UCLA Medical Center, Torrance, CA (M.J.B.)
- David Geffen School of Medicine, University of California, Los Angeles (M.J.B.)
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
| | - Shubham Lahan
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Shozab S Ali
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
| | - Ron Blankstein
- Brigham and Women's Hospital Heart and Vascular Center, and Harvard Medical School, Boston, MA (R.B.)
| | - Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.)
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (A.P.)
| | - Lara Arias
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Theodore Feldman
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Ricardo C Cury
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
- Herbert Wertheim College of Medicine, Florida International University, Miami (S.S.A., T.F., R.C.C.)
| | - Miguel Cainzos-Achirica
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
- Department of Cardiology, Hospital del Mar and Hospital del Mar Research Institute, Barcelona, Spain (M.C.-A.)
| | - Svati H Shah
- Duke Clinical Research Institute, Durham, NC (S.H.S.)
| | - Jack A Ziffer
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Jonathan Fialkow
- Miami Cardiac and Vascular Institute, Baptist Health South Florida (S.S.A., L.A., T.F., R.C.C., J.A.Z., J.F.)
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, TX (K.V.P., J.V.-E., S.L., M.B.T., K.N.)
- Center for Outcomes Research, Houston Methodist (J.V.-E., K.N.)
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins University School of Medicine, Baltimore (M.J.B., M.C.-A., K.N.)
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15
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Tindale A, Cretu I, Meng H, Panoulas V. Complete revascularization is associated with higher mortality in patients with ST-elevation myocardial infarction, multi-vessel disease and shock defined by hyperlactataemia: results from the Harefield Shock Registry incorporating explainable machine learning. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:615-623. [PMID: 37309061 PMCID: PMC10519804 DOI: 10.1093/ehjacc/zuad062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/22/2023] [Accepted: 06/07/2023] [Indexed: 06/14/2023]
Abstract
AIMS Revascularization strategy for patients with ST-elevation myocardial infarction (STEMI) and multi-vessel disease varies according to the patient's cardiogenic shock status, but assessing shock acutely can be difficult. This article examines the link between cardiogenic shock defined solely by a lactate of ≥2 mmol/L and mortality from complete vs. culprit-only revascularization in this cohort. METHODS AND RESULTS Patients presenting with STEMI, multi-vessel disease without severe left main stem stenosis and a lactate ≥2 mmol/L between 2011 and 2021 were included. The primary endpoint was mortality at 30 days by revascularization strategy for shocked patients. Secondary endpoints were mortality at 1 year and over a median follow-up of 30 months. Four hundred and eight patients presented in shock. Mortality in the shock cohort was 27.5% at 30 days. Complete revascularization (CR) was associated with higher mortality at 30 days [odds ratio (OR) 2.1 (1.02-4.2), P = 0.043], 1 year [OR 2.4 (1.2-4.9), P = 0.01], and over 30 months follow-up [hazard ratio (HR) 2.2 (1.4-3.4), P < 0.001] compared with culprit lesion-only percutaneous coronary intervention (CLOP). Mortality was again higher in the CR group after propensity matching (P = 0.018) and inverse probability treatment weighting [HR 2.0 (1.3-3.0), P = 0.001]. Furthermore, explainable machine learning demonstrated that CR was behind only blood gas parameters and creatinine levels in importance for predicting 30-day mortality. CONCLUSION In patients presenting with STEMI and multi-vessel disease in shock defined solely by a lactate of ≥2 mmol/L, CR is associated with higher mortality than CLOP.
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Affiliation(s)
- Alexander Tindale
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, UB9 6JH, UK
- National Heart and Lung Institute, Imperial College London, Harefield Hospital, Hill End Road, UB9 6JH, London, UK
| | - Ioana Cretu
- College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Hongying Meng
- College of Engineering, Design and Physical Sciences, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, UK
| | - Vasileios Panoulas
- Department of Cardiology, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, Hill End Road, Harefield, UB9 6JH, UK
- National Heart and Lung Institute, Imperial College London, Harefield Hospital, Hill End Road, UB9 6JH, London, UK
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16
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Rossello X, Vranckx P. MULTi-vessel Immediate vs. STAged RevaScularization in Acute Myocardial Infarction: the MULTISTARS AMI trial. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:629-630. [PMID: 37675657 DOI: 10.1093/ehjacc/zuad104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Xavier Rossello
- Cardiology Department, Institut D'investigació Sanitària Illes Balears ( IdISBa), Hospital Universitari Son Espases, Carretera de Valldemossa 79, Palma 07120, Spain
- Clinical Research Department, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Calle Melchor Fernández Almadro 3, Madrid 28029, Spain
- Faculty of Medicine, Universitat de les Illes Balears (UIB), Palma 07122, Spain
| | - Pascal Vranckx
- Department of Cardiology and Critical Care Medicine, Hartcentrum Hasselt, Jessa Ziekenhuis, Hasselt 3500, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt 3500, Belgium
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17
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Rossello X. Globalization does not lead to homogenization in randomized controlled trials: Impact on sample size estimation. Eur J Heart Fail 2023; 25:1243-1245. [PMID: 37323085 DOI: 10.1002/ejhf.2934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023] Open
Affiliation(s)
- Xavier Rossello
- Cardiology Department, Hospital Universitari Son Espases, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Facultad de Medicina, Universitat de les Illes Balears (UIB), Palma, Spain
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
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