|
1
|
Bajraktari G, Elezi S, Bytyci I, Ibrahimi P, Abdyli G, Pllana-Pruthi E, Karahoda R, Batalli A, Poniku A, Shatri M, Gashi D, Bajraktari A, Shatri F, Henein MY. The Rationale and Design of the KOSovan Acute Coronary Syndrome (KOS-ACS) Registry. Diagnostics (Basel) 2024; 14:1486. [PMID: 39061623 PMCID: PMC11276365 DOI: 10.3390/diagnostics14141486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/23/2024] [Indexed: 07/28/2024] Open
Abstract
The KOSovan Acute Coronary Syndrome (KOS-ACS) Registry is established as a prospective, continuous, nationwide, web-based registry that is operated online. The KOS-ACS registry is designed with the following objectives: (1) to obtain data on the demographic, clinical, and laboratory characteristics of ACS patients treated in Kosovo; (2) to create a national database with information on health care in ACS patients treated in Kosovo; (3) to identify the national features of associations between ACS characteristics and clinical outcomes, including mortality, complications, the length of hospital stay, and the quality of clinical care; and (4) to propose a practical guide for improving the quality and efficiency of ACS treatment in Kosovo. The Kosovo Society of Cardiology and University of Prishtina will be responsible for the development of the KOS-ACS registry and centralized data analysis at the national level. The KOS-ACS Registry will enroll all patients admitted, at any of the registered clinical centers, with the diagnosis of ACS and who will be clinically managed at any of the Kosovo hospitals. Data on patient demographics, clinical characteristics, previous and hospital drug treatment, and reperfusion therapy will be collected. The type of ACS (unstable angina, NSTEMI, or STEMI) will also be clearly defined. The time from first medical contact to balloon inflation (FMC-to-balloon) and door-to-ballon time will be registered. In-hospital death and complications will be registered. Data on the post-hospital primary outcome (MACE: cardiac death, all-cause mortality, hospitalization, stroke, need for coronary revascularization) of patients, at 30 days and 1 year, will be included in the registry.
Collapse
Affiliation(s)
- Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Ibadete Bytyci
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Pranvera Ibrahimi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Genc Abdyli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Edita Pllana-Pruthi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Rona Karahoda
- Research Unit, Heimerer College, 10000 Prishtina, Kosovo;
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Afrim Poniku
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
- Medical Faculty, University of Prishtina, 10000 Prishtina, Kosovo
| | - Mentor Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Drilon Gashi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Artan Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Faik Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (S.E.); (I.B.); (P.I.); (G.A.); (E.P.-P.); (A.B.); (A.P.); (M.S.); (D.G.); (A.B.); (F.S.)
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| |
Collapse
|
|
2
|
Cenko E, Manfrini O, Fabin N, Dorobantu M, Kedev S, Milicic D, Vasiljevic Z, Bugiardini R. Clinical determinants of ischemic heart disease in Eastern Europe. THE LANCET REGIONAL HEALTH. EUROPE 2023; 33:100698. [PMID: 37954000 PMCID: PMC10636265 DOI: 10.1016/j.lanepe.2023.100698] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 07/02/2023] [Accepted: 07/07/2023] [Indexed: 11/14/2023]
Abstract
Cardiovascular inequalities remain pervasive in the European countries. Disparities in disease burden is apparent among population groups based on sex, ethnicity, economic status or geography. To address this challenge, The Lancet Regional Health - Europe convened experts from a broad range of countries to assess the current state of knowledge of cardiovascular disease inequalities across Europe. This report presents the main challenges in Eastern Europe. There were pronounced variations in cardiovascular disease mortality rates across Eastern European countries with a remarkably high disease burden in the North-Eastern Europe. There were also significant differences in access and delivery to healthcare and unmet healthcare needs. Addressing the cardiovascular determinants of health and reducing health disparities in its many dimensions has long been a priority of the European Parliament's work through resolutions and by financing pilot projects. Yet, despite these efforts, few large-scale studies have been conducted to examine the feasibility of reducing cardiovascular disparities in Eastern Europe. There is an urgent need for improved data, measurements, reporting, and comparisons; and for dedicated, collaborative research. There is also a need for a broader understanding of the typology of actions needed to tackle cardiovascular inequalities and a clear political will.
Collapse
Affiliation(s)
- Edina Cenko
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Olivia Manfrini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- IRCCS Azienda Ospedaliero-Universitaria di Bologna Sant’Orsola Hospital, Bologna, Italy
| | - Natalia Fabin
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Maria Dorobantu
- University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania
| | - Sasko Kedev
- University Clinic for Cardiology, 1000 Skopje, Republic of North Macedonia
- Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, 1000 Skopje, Republic of North Macedonia
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | | | - Raffaele Bugiardini
- Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| |
Collapse
|
|
3
|
Bergami M, Cenko E, Yoon J, Mendieta G, Kedev S, Zdravkovic M, Vasiljevic Z, Miličić D, Manfrini O, van der Schaar M, Gale CP, Badimon L, Bugiardini R. Statins for primary prevention among elderly men and women. Cardiovasc Res 2022; 118:3000-3009. [PMID: 34864917 PMCID: PMC9648819 DOI: 10.1093/cvr/cvab348] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 11/24/2021] [Indexed: 11/14/2022] Open
Abstract
AIMS We undertook a propensity match-weighted cohort study to investigate whether statin treatment recommendations for statins translate into improved cardiovascular (CV) outcomes in the current routine clinical care of the elderly. METHODS AND RESULTS We included in our analysis (ISACS Archives -NCT04008173) a total of 5619 Caucasian patients with no known prior history of CV disease who presented to hospital with a first manifestation of CV disease with age of 65 years or older. The risk of ST-segment elevation myocardial infarction (STEMI) was much lower in statin users than in non-users in both patients aged 65-75 years [14.7% absolute risk reduction; relative risk (RR): 0.55, 95% CI 0.45-0.66] and those aged 76 years and older (13.3% absolute risk reduction; RR: 0.58, 95% CI 0.46-0.72). Estimates were similar in patients with and without history of hypercholesterolaemia (interaction test; P-values = 0.24 and 0.35). Proportional reductions in STEMI diminished with female sex in the old (P for interaction = 0.002), but not in the very old age (P for interaction = 0.26). We also observed a remarkable reduction in the risk of 30 day mortality from STEMI with statin therapy in both age groups (10.2% absolute risk reduction; RR: 0.39; 95% CI 0.23-0.68 for patients aged 76 or over and 3.8% absolute risk reduction; RR 0.37; 95% CI 0.17-0.82 for patients aged 65-75 years old; interaction test, P-value = 0.46). CONCLUSIONS Preventive statin therapy in the elderly reduces the risk of STEMI with benefits in mortality from STEMI, irrespective of the presence of a history of hypercholesterolaemia. This effect persists after the age of 76 years. Benefits are less pronounced in women. Randomized clinical trials may contribute to more definitively determine the role of statin therapy in the elderly.
Collapse
Affiliation(s)
- Maria Bergami
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | | | - Guiomar Mendieta
- Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), C. de Melchor Fernández Almagro, 3, 28029, Madrid, Spain
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University ‘Ss. Cyril and Methodius’, Skopje 1000, Macedonia
| | - Marija Zdravkovic
- Department of Cardiology, University Clinical Hospital Center Bezanijska Kosa are two separate words, Belgrade 11080, Serbia
| | - Zorana Vasiljevic
- School of Medicine, University of Belgrade, Dr Subotica 8, 11000, Belgrade, Serbia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Kispaticeva 12, HR-10000, Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California 56-125B Engineering IV Building 420 Westwood Plaza, Los Angeles, CA 90095-1594USA
- Cambridge Centre for Artificial Intelligence in Medicine, Department of Applied Mathematics and Theoretical Physics and Department of Population Health, University of Cambridge, Trinity Ln, Cambridge CB2 1TN, UK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Woodhouse, Leeds LS2 9JT, UK
| | - Lina Badimon
- Cardiovascular Program (ICCC), IR-IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, C/ Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico Sant’Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy
| |
Collapse
|
|
4
|
The use of reperfusion therapy in transition countries without fully applicable pharmacoinvasive strategy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp190118090k] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. The pharmacoinvasive (PI) therapy is a recommended strategy in patients (pts) with ST elevation myocardial infarction (STEMI) unable to undergo timely primary percutaneous coronary intervention (p-PCI). The aim of the study was to find out the cohorts of pts who are not treated by any reperfusion therapy (RT) as well to determine the outcome of the pts treated with RT in a transition country without fully applicable PI therapy. Methods. The study analyzed data from the Hospital National Registry for Acute Coronary Syndrome of Serbia (HORACS). Results. The significant predictors of the withdrawing of the application of any RT in the model [c 75.6%, SE 0.004, 95% CI 0.748?0.761)] were a ge ( ? 6 5 years), heart failure (Killip II-IV), diabetes mellitus, and the time to first medical contact (FMC) (> 360 min). In patients without RT, mortality was 15.7%, in pts treated with fibrinolytic therapy (FT) was 10.5%, and in pts treated with pPCI, it was 6.2% (p < 0.000). Within 3 hours to FMC, higher in-hospital mortality was in FT pts (FT 8.7% vs p-PCI 4.3%). FT treated patients were older, had more comorbidities and heart failure (HF). However, after propensity score matching, in order to ad-just the differences among the pts, the mortality rate remained higher in FT pts but not statistically significantly higher than in p-PCI pts (FT 8.8% vs p-PCI 6.4%). Conclusion. The balance of the best cost-benefit strategies for better use of RT is difficult to achieve in transition countries. The possibility for timely p-PCI and PI therapy is especially not applicable in high-risk patients, older pts, pts with HF, and those with diabetes mellitus.
Collapse
|
|
5
|
de Barros e Silva PGM, Macedo TA, Lopes RD, Okada MY, Frigini T, Roveri PO, Balada R, de Macedo LS, Furlan V. Chest Pain Network with Support of Telemedicine: Impact on Reperfusion Therapy and Clinical Outcomes After 8 Years of Experience. TELEMEDICINE REPORTS 2021; 2:284-292. [PMID: 35720760 PMCID: PMC8812289 DOI: 10.1089/tmr.2021.0033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/20/2021] [Indexed: 06/15/2023]
Abstract
Background: Different approaches of evaluation by cardiologists using telemedicine have the potential of improving care of patients with ST elevation myocardial infarction (STEMI). Objective: To compare the use of pharmacoinvasive strategy and associated clinical outcomes (heart failure [HF] and mortality) among patients with STEMI before and after a program of telemedicine and also according to the level of support by telemedicine. Methods: A chest pain network with the support of a cardiologist through telemedicine was implemented in 2012 in 22 emergency departments without a local cardiac catheterization laboratory. Initially (phase 1 of telemedicine), the decision to discuss the case with the cardiologist was based on the judgment of the emergency physician. At the end of 2018, the use of telemedicine was modified and a dedicated cardiologist was available continuously to discuss systematically all suspected cases (phase 2 of telemedicine). The use of fibrinolytics and the rates of HF and in-hospital mortality were compared among three different periods: pretelemedicine (2011), and phase 1 and phase 2 of the telemedicine program. Results: We evaluated 1034 STEMI patients and after comparing the three phases, we did not find significant differences regarding age, gender, and comorbidities. The use of fibrinolytics before transferring STEMI patients to a percutaneous coronary intervention center (pharmacoinvasive strategy) increased after telemedicine implementation (38% vs. 65.2%; p < 0.01), which was associated with a lower rate of HF (23.9% vs. 14.4%; p = 0.01) and death (7.9% vs. 4.0%; p = 0.05). The in-hospital mortality was lower in phase 2 with systematic evaluation by telemedicine compared with pretelemedicine (7.9% vs. 3.3%; p = 0.04). Conclusion: The implementation of a systematic and organized chest pain protocol, including telemedicine support, was associated with a significant increase in the use of pharmacoinvasive strategy and better clinical patient outcomes in patients with STEMI. Our findings provide important insights on how to improve the management of this high-risk population, reducing the gap between evidence and clinical practice.
Collapse
Affiliation(s)
| | - Thiago Andrade Macedo
- Hospital Samaritano Paulista, São Paulo, Brazil
- Centro Universitário São Camilo, São Paulo, Brazil
| | - Renato D. Lopes
- Hospital Samaritano Paulista, São Paulo, Brazil
- Americas Serviços Medicos, São Paulo, Brazil
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | | | | | | | | | | | - Valter Furlan
- Hospital Samaritano Paulista, São Paulo, Brazil
- Americas Serviços Medicos, São Paulo, Brazil
| |
Collapse
|
|
6
|
Barzdins J, Luguzis A, Valeinis J, Lepiksone J, Skrule J, Pildava S, Konstante R. Towards evidence-based management: A nationwide administrative data-based audit of acute myocardial infarction in Latvia. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2021. [DOI: 10.1080/20479700.2019.1693710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Juris Barzdins
- Centre for Health Management and Informatics, Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Artis Luguzis
- Laboratory for Statistical Research and Data Analysis at the Faculty of Physics, Mathematics and Optometry, University of Latvia, Latvia
| | - Janis Valeinis
- Laboratory for Statistical Research and Data Analysis at the Faculty of Physics, Mathematics and Optometry, University of Latvia, Latvia
| | - Jana Lepiksone
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Latvia
| | - Jolanta Skrule
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Latvia
| | - Santa Pildava
- Research and Health Statistics Department, Centre for Disease Prevention and Control, Latvia
| | | |
Collapse
|
|
7
|
Schiele F, Aktaa S, Rossello X, Ahrens I, Claeys MJ, Collet JP, Fox KAA, Gale CP, Huber K, Iakobishvili Z, Keys A, Lambrinou E, Leonardi S, Lettino M, Masoudi FA, Price S, Quinn T, Swahn E, Thiele H, Timmis A, Tubaro M, Vrints CJM, Walker D, Bueno H, Halvorsen S, Jernberg T, Jortveit J, Blöndal M, Ibanez B, Hassager C. 2020 Update of the quality indicators for acute myocardial infarction: a position paper of the Association for Acute Cardiovascular Care: the study group for quality indicators from the ACVC and the NSTE-ACS guideline group. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:224-233. [PMID: 33550362 DOI: 10.1093/ehjacc/zuaa037] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 12/10/2020] [Indexed: 12/18/2022]
Abstract
AIMS Quality indicators (QIs) are tools to improve the delivery of evidence-base medicine. In 2017, the European Society of Cardiology (ESC) Association for Acute Cardiovascular Care (ACVC) developed a set of QIs for acute myocardial infarction (AMI), which have been evaluated at national and international levels and across different populations. However, an update of these QIs is needed in light of the accumulated experience and the changes in the supporting evidence. METHODS AND RESULTS The ESC methodology for the QI development was used to update the 2017 ACVC QIs. We identified key domains of AMI care, conducted a literature review, developed a list of candidate QIs, and used a modified Delphi method to select the final set of indicators. The same seven domains of AMI care identified by the 2017 Study Group were retained for this update. For each domain, main and secondary QIs were developed reflecting the essential and complementary aspects of care, respectively. Overall, 26 QIs are proposed in this document, compared to 20 in the 2017 set. New QIs are proposed in this document (e.g. the centre use of high-sensitivity troponin), some were retained or modified (e.g. the in-hospital risk assessment), and others were retired in accordance with the changes in evidence [e.g. the proportion of patients with non-ST segment elevation myocardial infarction (NSTEMI) treated with fondaparinux] and the feasibility assessments (e.g. the proportion of patients with NSTEMI whom risk assessment is performed using the GRACE and CRUSADE risk scores). CONCLUSION Updated QIs for the management of AMI were developed according to contemporary knowledge and accumulated experience. These QIs may be applied to evaluate and improve the quality of AMI care.
Collapse
Affiliation(s)
- François Schiele
- University Hospital Besancon, Boulevard Fleming, 25000 Besancon, France
| | | | - Xavier Rossello
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospital Universitari Son Espases & Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain.,CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain
| | - Ingo Ahrens
- Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Cologne, Germany
| | | | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, Paris, France.,INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Keith A A Fox
- University and Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Sigmund Freud University, Medical Faculty, Vienna, Austria
| | - Zaza Iakobishvili
- Department of Community Cardiology, Clalit Health Services, Jaffa District, Tel Aviv, Israel
| | | | - Ekaterini Lambrinou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sergio Leonardi
- University of Pavia and Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy
| | - Maddalena Lettino
- Cardio-Thoracic-Vascular Department, San Gerardo Hospital, Monza, Italy
| | | | - Susanna Price
- Royal Brompton & Harefield NHS Foundation Trust, Imperial College, London, UK
| | - Tom Quinn
- Kingston University & St. George's, University of London, London, UK
| | - Eva Swahn
- Linkoping University, Linkoping, Sweden
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Adam Timmis
- Barts Heart Centre and Queen Mary University London, London, UK
| | | | - Christiaan J M Vrints
- Antwerp University Hospital, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | | | - Hector Bueno
- CIBER de enfermedades CardioVasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario 12 de Octubre and Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.,Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway
| | - Tomas Jernberg
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Jarle Jortveit
- Department of Cardiology, Sørlandet Hospital Arendal, Arendal, Norway
| | - Mai Blöndal
- Department of Cardiology, Tartu University, Estonia
| | - Borja Ibanez
- Department of Cardiology, Hospital Fundación Jiménez Díaz, Madrid, Spain
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
|
8
|
Manfrini O, Cenko E, Bugiardini R. Gender Differences in Residual Risk Factors for Major Adverse Cardiovascular Events Following ACS and How to Bridge the Gap. Curr Atheroscler Rep 2020; 22:65. [PMID: 32880760 DOI: 10.1007/s11883-020-00882-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW The review aims to describe the differences between men and women in those factors that can influence a worse prognosis in women after an acute cardiovascular event. RECENT FINDINGS Women adequately treated with current evidence-based medications for acute myocardial infarction and for conventional cardiovascular risk factors, such as hypertension, diabetes, smoking, and dyslipidemia, still have an extra risk of death compared with men. Additional factors that increase the risk of poor prognosis for the index event have been identified. The residual risk can be due to factors affecting the prognosis of the women from outside (they are external to the patient's body) and also to factors that, on the contrary, belong to the female body (female being/female sex). The review will give an update on those residual risk factors, including young age, vulnerability for de novo heart failure, time from symptom onset to treatment, heath care delivered during the weekend, and depression, which generally negatively influence the outcome of women with an acute myocardial infarction.
Collapse
Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40128, Bologna, Italy.
| |
Collapse
|
|
9
|
Izadpanah P, Falahati F, Mokhtari AM, Hosseinpour F, Faham B, Sheidaee R, Jalali S, Zare H, Hassanipour S. The survival rate of patients with ST-Segment elevation myocardial infarction treated with primary percutaneous coronary intervention and thrombolysis. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
|
10
|
Cardiovascular Healthcare in 2020 – Alarming Realities in Romania. JOURNAL OF INTERDISCIPLINARY MEDICINE 2020. [DOI: 10.2478/jim-2020-0014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
|
11
|
Cenko E, van der Schaar M, Yoon J, Manfrini O, Vasiljevic Z, Vavlukis M, Kedev S, Miličić D, Badimon L, Bugiardini R. Sex-Related Differences in Heart Failure After ST-Segment Elevation Myocardial Infarction. J Am Coll Cardiol 2020; 74:2379-2389. [PMID: 31699278 DOI: 10.1016/j.jacc.2019.08.1047] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/13/2019] [Accepted: 08/18/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND ST-segment elevation myocardial infarction (STEMI) complicated by symptoms of acute de novo heart failure is associated with excess mortality. Whether development of heart failure and its outcomes differ by sex is unknown. OBJECTIVES This study sought to examine the relationships among sex, acute heart failure, and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS Patients were recruited from a network of hospitals in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776). Main outcome measures were incidence of Killip class ≥II at hospital presentation and risk-adjusted 30-day mortality rates were estimated using inverse probability of weighting and logistic regression models. RESULTS This study included 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation, the incidence of de novo heart failure at hospital presentation was significantly higher for women than for men (25.1% vs. 20.0%, odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.21 to 1.48). Women with de novo heart failure had higher 30-day mortality than did their male counterparts (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05 to 1.58). The sex-related difference in mortality rates was still apparent in patients with de novo heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07 to 1.96). CONCLUSIONS Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than do their male counterparts. Therefore, de novo heart failure is a key feature to explain mortality gap after STEMI among women and men.
Collapse
Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy. https://twitter.com/EdinaCenko
| | | | - Jinsung Yoon
- Department of Electrical and Computer Engineering, University of California, Los Angeles, Los Angeles, California
| | - Olivia Manfrini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | | | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lina Badimon
- Cardiovascular Program (ICCC), IR-Hospital de la Santa Creu i Sant Pau, CiberCV-Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy.
| |
Collapse
|
|
12
|
Ghaemian A, Yazdani J, Farsavian AA, Golshani S, Nabati M, Dabirian M, Jalalian R, Abedi SM, Mirjani B. Fractional Flow Reserve as a Standard of Reference for Ischemia Early After ST Elevation Myocardial Infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 21:1411-1416. [PMID: 31176706 DOI: 10.1016/j.carrev.2019.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/04/2019] [Accepted: 04/17/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of the present study was to assess the value of the fractional flow reserve (FFR) of the infarct-related artery (IRA) early after ST elevation myocardial infarction (STEMI) in detecting reversible ischemia. METHODS Single photon emission computed tomography (SPECT) at rest and after dipyridamole stress, and within 24 hour FFR of the IRA was performed on 69 patients 3 to 7 days after STEMI. FFR was 0.80 or less in 61 (88.4%) of them. In these patients, percutaneous coronary intervention (PCI) was performed, and a second SPECT study was repeated within 14 days. RESULTS SPECT showed reversible ischemia in 36 (59%) of these 61 patients, and converted to negative in 29 of them. Thus, the SPECT results of these 29 patients were defined as true positive before angioplasty and true negative after angioplasty. Considering the true-positive and true-negative SPECT results as the gold standard, the sensitivity, specificity, and positive and negative predictive values of the FFR of 0.80 or less compared to this gold standard were 96.7%, 100%, 100%, and 96.6%, respectively (ĸ = 0.97, P < 0.001). CONCLUSIONS In the early phase after STEMI, the reliability of FFR to determine residual ischemia in the IRA is very high in those patients with true-positive SPECT before and true-negative SPECT after PCI.
Collapse
Affiliation(s)
- Ali Ghaemian
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran.
| | - Jamshid Yazdani
- Faculty of Health, Mazandaran University of Medical Sciences, Iran
| | - Ali Asghar Farsavian
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| | - Samad Golshani
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| | - Maryam Nabati
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| | - Mozhdeh Dabirian
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| | - Rozita Jalalian
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| | - Seyed Mohamad Abedi
- Department of Nuclear Medicine, Mazandaran University of Medical Sciences, Iran
| | - Bahareh Mirjani
- Mazandaran Cardiovascular Research Center, Mazandaran University of Medical Sciences, Iran
| |
Collapse
|
|
13
|
Cenko E, Yoon J, Kedev S, Stankovic G, Vasiljevic Z, Krljanac G, Kalpak O, Ricci B, Milicic D, Manfrini O, van der Schaar M, Badimon L, Bugiardini R. Sex Differences in Outcomes After STEMI: Effect Modification by Treatment Strategy and Age. JAMA Intern Med 2018; 178:632-639. [PMID: 29630703 PMCID: PMC6145795 DOI: 10.1001/jamainternmed.2018.0514] [Citation(s) in RCA: 185] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
IMPORTANCE Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI). OBJECTIVE To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk. DESIGN, SETTING, AND PARTICIPANTS From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776). EXPOSURES Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI. MAIN OUTCOMES AND MEASURES Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models. RESULTS There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTW adjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively). CONCLUSIONS AND RELEVANCE Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.
Collapse
Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Jinsung Yoon
- Department of Electrical and Computer Engineering, University of California, Los Angeles
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Goran Stankovic
- Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | | | - Gordana Krljanac
- Clinical Center of Serbia, Department of Cardiology, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Oliver Kalpak
- University Clinic of Cardiology, Medical Faculty, University Ss. Cyril and Methodius, Skopje, Macedonia
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Mihaela van der Schaar
- Department of Electrical and Computer Engineering, University of California, Los Angeles
| | - Lina Badimon
- Cardiovascular Research Institute (ICCC), CiberCV-Institute Carlos III, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| |
Collapse
|
|
14
|
Aeyels D, Sinnaeve PR, Claeys MJ, Gevaert S, Schoors D, Sermeus W, Panella M, Coeckelberghs E, Bruyneel L, Vanhaecht K. Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey. Acta Cardiol 2017; 73:1-10. [PMID: 29237337 DOI: 10.1080/00015385.2017.1411664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 05/25/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. METHODS AND RESULTS A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. CONCLUSIONS A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.
Collapse
Affiliation(s)
- Daan Aeyels
- a Leuven Institute for Healthcare Policy , Katholieke Universiteit Leuven , Leuven , Belgium
| | - Peter R Sinnaeve
- b Department of Cardiology , University Hospitals Leuven , Leuven , Belgium
| | - Marc J Claeys
- c Department of Cardiology , Antwerp University Hospital , Edegem , Belgium
| | - Sofie Gevaert
- d Department of Cardiology , Ghent University Hospital , Ghent , Belgium
| | - Danny Schoors
- e Department of Cardiology , University Hospitals Brussels , Brussels , Belgium
| | - Walter Sermeus
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Massimiliano Panella
- g Department of Clinical and Experimental Medicine , Amedeo Avogadro University of Eastern Piedmont , Vercelli , Italy
| | | | - Luk Bruyneel
- f Institute for Healthcare Policy , University of Leuven , Leuven , Belgium
| | - Kris Vanhaecht
- h Department of Quality Management , University Hospitals Leuven , Leuven , Belgium
| |
Collapse
|
|
15
|
Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, Wilkins E, Wright L, Vos R, Bax J, Blum M, Pinto F, Vardas P. European Society of Cardiology: Cardiovascular Disease Statistics 2017. Eur Heart J 2017; 39:508-579. [PMID: 29190377 DOI: 10.1093/eurheartj/ehx628] [Citation(s) in RCA: 513] [Impact Index Per Article: 73.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/26/2022] Open
Abstract
Aims The European Society of Cardiology (ESC) Atlas has been compiled by the European Heart Agency to document cardiovascular disease (CVD) statistics of the 56 ESC member countries. A major aim of this 2017 data presentation has been to compare high-income and middle-income ESC member countries to identify inequalities in disease burden, outcomes, and service provision. Methods and results The Atlas utilizes a variety of data sources, including the World Health Organization, the Institute for Health Metrics and Evaluation, and the World Bank to document risk factors, prevalence, and mortality of cardiovascular disease and national economic indicators. It also includes novel ESC-sponsored survey data of health infrastructure and cardiovascular service provision provided by the national societies of the ESC member countries. Data presentation is descriptive with no attempt to attach statistical significance to differences observed in stratified analyses. Important differences were identified between the high-income and middle-income member countries of the ESC with regard to CVD risk factors, disease incidence, and mortality. For both women and men, the age-standardized prevalence of hypertension was lower in high-income countries (18% and 27%) compared with middle-income countries (24% and 30%). Smoking prevalence in men (not women) was also lower (26% vs. 41%) and together these inequalities are likely to have contributed to the higher CVD mortality in middle-income countries. Declines in CVD mortality have seen cancer becoming a more common cause of death in a number of high-income member countries, but in middle-income countries declines in CVD mortality have been less consistent where CVD remains the leading cause of death. Inequalities in CVD mortality are emphasized by the smaller contribution they make to potential years of life lost in high-income countries compared with middle-income countries both for women (13% vs. 23%) and men (20% vs. 27%). The downward mortality trends for CVD may, however, be threatened by the emerging obesity epidemic that is seeing rates of diabetes increasing across all the ESC member countries. Survey data from the National Cardiac Societies showed that rates of cardiac catheterization and coronary artery bypass surgery, as well as the number of specialist centres required to deliver them, were greatest in the high-income member countries of the ESC. The Atlas confirmed that these ESC member countries, where the facilities for the contemporary treatment of coronary disease were best developed, were often those in which declines in coronary mortality have been most pronounced. Economic resources were not the only driver for delivery of equitable cardiovascular health care, as some middle-income ESC member countries reported rates for interventional procedures and device implantations that matched or exceeded the rates in wealthier member countries. Conclusion In documenting national CVD statistics, the Atlas provides valuable insights into the inequalities in risk factors, health care delivery, and outcomes of CVD across the ESC member countries. The availability of these data will underpin the ESC's ambitious mission 'to reduce the burden of cardiovascular disease' not only in its member countries but also in nation states around the world.
Collapse
Affiliation(s)
- Adam Timmis
- Department of Cardiology, Barts Heart Centre, Queen Mary University, West Smithfield, London, UK
| | - Nick Townsend
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Chris Gale
- Division of Epidemiology, Medical Research Council Bioinformatics Centre, Leeds Institute of Cardiovascular and Metabolic Medicine, Worsley Building, Level 11, Clarendon Way, University of Leeds, Leeds, UK
| | - Rick Grobbee
- Department of Clinical Epidemiology, University Medical Center, Heidelberglaan 100, CX Utrecht, Netherlands
| | - Nikos Maniadakis
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | - Marcus Flather
- Department of Medicine and Health Sciences, Norwich Medical School, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Elizabeth Wilkins
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Lucy Wright
- Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, UK
| | - Rimke Vos
- Department of Clinical Epidemiology, University Medical Center, Heidelberglaan 100, CX Utrecht, Netherlands
| | - Jeroen Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, Netherlands
| | - Maxim Blum
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | - Fausto Pinto
- Department of Cardiology, University Hospital Santa Maria, University of Lisbon, Avenida Professor Egas Moniz, Lisbon, Portugal
| | - Panos Vardas
- European Society of Cardiology Health Policy Unit, European Heart Health Institute, 29 Square de Meeus, 4th Floor, Brussels, Belgium
| | | |
Collapse
|
|
16
|
Timmis A, Gale CP, Flather M, Maniadakis N, Vardas P. Cardiovascular disease statistics from the European atlas: inequalities between high- and middle-income member countries of the ESC. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2017; 4:1-3. [DOI: 10.1093/ehjqcco/qcx045] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
|
17
|
Bugiardini R, Ricci B, Cenko E, Vasiljevic Z, Kedev S, Davidovic G, Zdravkovic M, Miličić D, Dilic M, Manfrini O, Koller A, Badimon L. Delayed Care and Mortality Among Women and Men With Myocardial Infarction. J Am Heart Assoc 2017; 6:e005968. [PMID: 28862963 PMCID: PMC5586439 DOI: 10.1161/jaha.117.005968] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 07/07/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Women with ST-segment-elevation myocardial infarction (STEMI) have higher mortality rates than men. We investigated whether sex-related differences in timely access to care among STEMI patients may be a factor associated with excess risk of early mortality in women. METHODS AND RESULTS We identified 6022 STEMI patients who had information on time of symptom onset to time of hospital presentation at 41 hospitals participating in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776) from October 2010 through April 2016. Patients were stratified into time-delay cohorts. We estimated the 30-day risk of all-cause mortality in each cohort. Despite similar delays in seeking care, the overall time from symptom onset to hospital presentation was longer for women than men (median: 270 minutes [range: 130-776] versus 240 minutes [range: 120-600]). After adjustment for baseline variables, female sex was independently associated with greater risk of 30-day mortality (odds ratio: 1.58; 95% confidence interval, 1.27-1.97). Sex differences in mortality following STEMI were no longer observed for patients having delays from symptom onset to hospital presentation of ≤1 hour (odds ratio: 0.77; 95% confidence interval, 0.29-2.02). CONCLUSIONS Sex difference in mortality following STEMI persists and appears to be driven by prehospital delays in hospital presentation. Women appear to be more vulnerable to prolonged untreated ischemia. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01218776.
Collapse
Affiliation(s)
- Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Serbia
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Goran Davidovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac, Serbia
- Faculty of Medical Sciences, University in Kragujevac, Serbia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Serbia
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia
| | - Mirza Dilic
- Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary
- Department of Physiology, New York Medical College, Valhalla, NY
| | - Lina Badimon
- Cardiovascular Research Institute (ICCC), CiberCV-Institute Carlos III, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau Autonomous University of Barcelona, Spain
| |
Collapse
|
|
18
|
Cenko E, Ricci B, Kedev S, Kalpak O, Câlmâc L, Vasiljevic Z, Knežević B, Dilic M, Miličić D, Manfrini O, Koller A, Dorobantu M, Badimon L, Bugiardini R. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol 2016; 222:1122-1128. [DOI: 10.1016/j.ijcard.2016.07.209] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
|
|
19
|
Ricci B, Manfrini O, Cenko E, Vasiljevic Z, Dorobantu M, Kedev S, Davidovic G, Zdravkovic M, Gustiene O, Knežević B, Miličić D, Badimon L, Bugiardini R. Primary percutaneous coronary intervention in octogenarians. Int J Cardiol 2016; 222:1129-1135. [PMID: 27506888 DOI: 10.1016/j.ijcard.2016.07.204] [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: 07/25/2016] [Accepted: 07/28/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Limited data are available on the outcome of primary percutaneous coronary intervention (PCI) in octogenarian patients, as the elderly are under-represented in randomized trials. This study aims to provide insights on clinical characteristics, management and outcome of the elderly and very elderly presenting with STEMI. METHODS 2225 STEMI patients ≥70years old (mean age 76.8±5.1years and 53.8% men) were admitted into the network of the ISACS-TC registry. Of these patients, 72.8% were ≥70 to 79years old (elderly) and 27.2% were ≥80years old (very-elderly). The primary end-point was 30-day mortality. RESULTS Thirty-day mortality rates were 13.4% in the elderly and 23.9% in the very-elderly. Primary PCI decreased the unadjusted risk of death both in the elderly (OR: 0.32, 95% CI: 0.24-0.43) and very-elderly patients (OR: 0.45, 95% CI 0.30-0.68), without significant difference between groups. In the very-elderly hypertension and Killip class ≥2 were the only independent factors associated with mortality; whereas in the elderly female gender, prior stroke, chronic kidney disease and Killip class ≥2 were all factors independently associated with mortality. Factors associated with the lack of use of reperfusion were female gender and atypical chest pain in the very-elderly and in the elderly; in the elderly, however, there were some more factors, namely: history of diabetes, current smoking, prior stroke, Killip class ≥2 and history chronic kidney disease. CONCLUSIONS Age is relevant in the prognosis of STEMI, but its importance should not be considered secondary to other major clinical factors. Primary PCI appears to have beneficial effects in the octogenarian STEMI patients.
Collapse
Affiliation(s)
- Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Maria Dorobantu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Goran Davidovic
- Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac Faculty of Medical Sciences, University in Kragujevac, Kragujevac, Serbia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olivija Gustiene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Božidarka Knežević
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| |
Collapse
|
|
20
|
Contemporary roles of registries in clinical cardiology: Insights from Western and Eastern European countries. Int J Cardiol 2016; 217 Suppl:S13-5. [DOI: 10.1016/j.ijcard.2016.06.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/25/2016] [Indexed: 11/22/2022]
|
|
21
|
Bugiardini R, Badimon L. The International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC): 2010–2015. Int J Cardiol 2016; 217 Suppl:S1-6. [DOI: 10.1016/j.ijcard.2016.06.219] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 01/10/2023]
|
|
22
|
Cenko E, Ricci B, Kedev S, Vasiljevic Z, Dorobantu M, Gustiene O, Knežević B, Miličić D, Dilic M, Manfrini O, Koller A, Badimon L, Bugiardini R. Invasive versus conservative strategy in acute coronary syndromes: The paradox in women's outcomes. Int J Cardiol 2016; 222:1110-1115. [PMID: 27514628 DOI: 10.1016/j.ijcard.2016.07.211] [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: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We explored benefits and risks of an early invasive compared with a conservative strategy in women versus men after non-ST elevation acute coronary syndromes (NSTE-ACS) using the ISACS-TC database. METHODS From October 2010 to May 2014, 4145 patients were diagnosed as having a NSTE-ACS. We excluded 258 patients managed with coronary bypass surgery. Of the remaining 3887 patients, 1737 underwent PCI (26% women). The primary endpoint was the composite of 30-day mortality and severe left ventricular dysfunction defined as an ejection fraction <40% at discharge. RESULTS Women were older and more likely to exhibit more risk factors and Killip Class ≥2 at admission as compared with men. In patients who underwent PCI, peri-procedural myocardial injury was not different among sexes (3.1% vs. 3.2%). Women undergoing PCI experienced higher rates of the composite endpoint (8.9% vs. 4.9%, p=0.002) and 30-day mortality (4.4% vs. 2.0%, p=0.008) compared with men, whereas those who managed with only routine medical therapy (RMT) did not show any sex difference in outcomes. In multivariable analysis, female sex was associated with favorable outcomes (adjusted HR for the composite endpoint: 0.72, 95% CI: 0.58-0.91) in patients managed with RMT, but not in those undergoing PCI (adjusted HR: 0.96, 95% CI: 0.61-1.52). CONCLUSIONS We observed a more favorable outcome in women than men when patients were managed with RMT. Women and men undergoing PCI have similar outcomes. These data suggest caution in extrapolating the results from men to women in an overall population of patients in the context of different therapeutic strategies.
Collapse
Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Maria Dorobantu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania
| | - Olivija Gustiene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Božidarka Knežević
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Mirza Dilic
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, USA
| | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
| |
Collapse
|
|
23
|
Dilić M, Terzić I, Kulić M. Primary percutaneous coronary intervention network in Bosnia and Herzegovina: Where are we now and how to improve PCI network. Int J Cardiol 2016; 217 Suppl:S49-51. [PMID: 27381862 DOI: 10.1016/j.ijcard.2016.06.320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 06/28/2016] [Indexed: 11/29/2022]
Abstract
Reperfusion is the most effective therapy for patients with ST segment elevation myocardial infarction (STEMI). Time from symptom onset to reperfusion is the most important factor influencing short and long-term mortality. There are several modes of reperfusion therapy. Fibrinolysis (either in pre-hospital or in-hospital setting), and primary percutaneous coronary intervention (p-PCI) or a combination of both are the most relevant treatment options. Primary p-PCI is the preferred option in centers with experienced teams and a high volume of reperfusion procedures. Cardiovascular mortality rate in Bosnia and Herzegovina (B&H) is among the highest in Europe, 545/100,000, and the rate of acute myocardial infarction is approximately 7000 per year. Despite recent improvement in reperfusion therapy in the last 5years, mortality of STEMI still patients remains high. The goal of this perspective article is to describe the current situation of p-PCI network in B&H. Establishing networks of reperfusion at regional and national level, implies a broad spectrum and close collaboration between all the actors involved in reperfusion therapy, namely hospitals, cardiology units emergency medical services, and primary care physicians.
Collapse
Affiliation(s)
- M Dilić
- Clinical Center University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| | - I Terzić
- BH Heart Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina.
| | - M Kulić
- Clinical Center University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
|
24
|
Fazlibegović E, Terzić I, Hadziomerovic M. Current uses of ISACS-TC registry in Mostar. Int J Cardiol 2016; 217 Suppl:S44-6. [PMID: 27372740 DOI: 10.1016/j.ijcard.2016.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 06/25/2016] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease (CVD) contributes greatly to inequalities in health in Europe. The acute myocardial infarction (MI) in hospital death rate in Bosnia and Herzegovina is three fold higher than in European Union countries before the enlargement in 2004. There is also a striking difference in mortality between Bosnia and Herzegovina and Central and East European countries that joined the EU in 2004. Rapid development of high technology treatment procedures, which followed the economic recovery of the European Union countries, still have only limited influence on the overall control of MI death rate. Large potential to control MI death rate lies in developing PCI capable network with target to rapid reperfusion therapy in MI patients. The hypothesis that social factors may contribute to explain high MI death rate is attractive, but still is an assumption. However, if confirmed, transforming such knowledge into a practical health policy would be a great challenge. A resource-saving balanced assessment approach to health technology development is warrant in Bosnia and Herzegovina. An international help is needed.
Collapse
Affiliation(s)
- Emir Fazlibegović
- Division of Cardiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina.
| | | | - Mustafa Hadziomerovic
- Division of Cardiology, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| |
Collapse
|
|
25
|
Knežević B, Musić L, Batrićević G, Bošković A, Bulatović N, Nenezić A, Vujović J, Kalezić M. Optimizing prevention and guideline-concordant care in Montenegro. Int J Cardiol 2016; 217 Suppl:S32-6. [PMID: 27381861 DOI: 10.1016/j.ijcard.2016.06.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/25/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Guidelines recommend use of evidence-based medications in patients discharged after an acute coronary syndrome (ACS). Yet the current rates of adherence in many eastern European countries are unknown. OBJECTIVE To determine whether 6month outpatient follow-up after ACS is associated with recommended rates of medication adherence in Montenegro. METHODS A prospective analysis was conducted in 585 ACS patients confirmed to be alive after ACS at 6month follow-up. The study was undertaken between 2012 and 2015, from 9 International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) hospitals in the Montenegro. The primary outcome was guideline-concordant care, defined as 100% compliance with 5 medications: aspirin, clopidogrel, beta-blockers, and statins in ACS patients, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB] for the subset of patients with left ventricular systolic dysfunction, as assessed by an ejection fraction less than 40% at discharge. In addition to the composite end point, the achievement of each single treatment measure was analyzed. Multivariate predictors of long-term medication adherence were also identified. RESULTS Guideline-concordant care (GCC) at discharge increased from 2012 to 2015 (adjusted OR for increase 1.51; CI 0.88-2.52). GCC over 6months was adhered in 73% of patients. In patients who did not achieve GCC, adherence was persistently high with 92.3% for aspirin, 91.3% for statins and 72% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Adherence was lower for clopidogrel (57.7%) and beta-blockers (64.4%). After adjusting for demographic and clinical differences, in-hospital referral to PCI and ST segment elevation myocardial infarction (STEMI) were associated with greater medication adherence at 6month follow-up. CONCLUSIONS In Montenegro, long-term adherence to evidence-based medication after ACS is high. Adherence to guideline-recommended therapies increased over time with participation to the ISACS-TC. The lower achievement of GCC in patients treated medically and in those with non-ST-segment elevation ACS needs particular attention.
Collapse
Affiliation(s)
- Božidarka Knežević
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
| | - Ljilja Musić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Goran Batrićević
- Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Aneta Bošković
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Nebojša Bulatović
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Ana Nenezić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Jelena Vujović
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Milovan Kalezić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| |
Collapse
|
|
26
|
Manfrini O, Ricci B, Cenko E, Dorobantu M, Kalpak O, Kedev S, Kneževic B, Koller A, Milicic D, Vasiljevic Z, Badimon L, Bugiardini R. Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome. Int J Cardiol 2016; 217 Suppl:S37-43. [PMID: 27381858 DOI: 10.1016/j.ijcard.2016.06.221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1.64, 1 comorbidity; OR: 2.52, 2 comorbidities; OR: 4.57, ≥3 comorbidities). RESULTS Stratifying the study population by the presence/absence of comorbidities and typical presentation, we found a decreasing trend for use of medications and percutaneous intervention (OR: 1, typical presentation and no-comorbidities; OR: 0.70, typical presentation and comorbidities; OR: 0.23, atypical presentation and no-comorbidities; OR: 0.18, atypical presentation and comorbidities). On the opposite, compared with patients with typical presentation and no-comorbidities (OR: 1, referent), there was an increasing trend (p<0.001) in the risk of death (OR: 2.00, OR: 2.52 and OR: 4.83) in the above subgroups. However, after adjusting for comorbidities, medications and invasive procedures, atypical presentation was not a predictor of in-hospital death. Independent predictors of poor outcome were history of stroke (OR: 2.04), chronic kidney disease (OR: 1.57), diabetes mellitus (OR: 1.49) and underuse of invasive procedures. CONCLUSIONS In the ISACS-TC, atypical ACS presentation was often associated with comorbidities. Atypical presentation and comorbidities influenced underuse of in-hospital treatments. The latter and comorbidities are related with poor in-hospital outcome, but not atypical presentation, per se.
Collapse
Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Maria Dorobantu
- Clinical Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - Oliver Kalpak
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Božidarka Kneževic
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Davor Milicic
- Department for Cardiovascular Diseases, University of Zagreb, Zagreb, Croatia
| | | | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | | |
Collapse
|
|
27
|
Halmosi R, Deres L, Gal R, Eros K, Sumegi B, Toth K. PARP inhibition and postinfarction myocardial remodeling. Int J Cardiol 2016; 217 Suppl:S52-9. [PMID: 27392900 DOI: 10.1016/j.ijcard.2016.06.223] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/25/2016] [Indexed: 11/19/2022]
Abstract
Coronary artery disease accounts for the greatest proportion of cardiovascular diseases therefore it is the major cause of death worldwide. Its therapeutic importance is indicated by still high mortality of myocardial infarction, which is one of the most severe forms of CVDs. Moreover, the risk of developing heart failure is very high among survivors. Heart failure is accompanied by high morbidity and mortality rate, therefore this topic is in the focus of researchers' interest. After a myocardial infarct, at first ventricular hypertrophy develops as a compensatory mechanism to decrease wall stress but finally leads to left ventricular dilation. This phenomenon is termed as myocardial remodeling. The main characteristics of underlying mechanisms involve cardiomyocyte growth, vessel changes and increased collagen production, in all of which several mechanical stress induced neurohumoral agents, oxidative stress and signal transduction pathways are involved. The long term activation of these processes ultimately leads to left ventricular dilation and heart failure with decreased systolic function. Oxidative stress causes DNA breaks producing the activation of nuclear poly(ADP-ribose) polymerase-1 (PARP-1) enzyme that leads to energy depletion and unfavorable modulation of different kinase cascades (Akt-1/GSK-3β, MAPKs, various PKC isoforms) and thus it promotes the development of heart failure. Therefore inhibition of PARP enzyme could offer a promising new therapeutical approach to prevent the onset of heart failure among postinfarction patients. The purpose of this review is to give a comprehensive summary about the most significant experimental results and mechanisms in postinfarction remodeling.
Collapse
Affiliation(s)
- Robert Halmosi
- 1st Department of Medicine, Division of Cardiology, University of Pecs, Pecs, Hungary; Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Laszlo Deres
- 1st Department of Medicine, Division of Cardiology, University of Pecs, Pecs, Hungary; Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Roland Gal
- 1st Department of Medicine, Division of Cardiology, University of Pecs, Pecs, Hungary
| | - Krisztian Eros
- 1st Department of Medicine, Division of Cardiology, University of Pecs, Pecs, Hungary; Department of Biochemistry and Medical Chemistry, University of Pecs, Pecs, Hungary; Szentagothai Research Center, University of Pecs, Pecs, Hungary
| | - Balazs Sumegi
- Department of Biochemistry and Medical Chemistry, University of Pecs, Pecs, Hungary; Szentagothai Research Center, University of Pecs, Pecs, Hungary; MTA-PTE, Nuclear and Mitochondrial Interactions Research Group, Pecs, Hungary
| | - Kalman Toth
- 1st Department of Medicine, Division of Cardiology, University of Pecs, Pecs, Hungary; Szentagothai Research Center, University of Pecs, Pecs, Hungary; MTA-PTE, Nuclear and Mitochondrial Interactions Research Group, Pecs, Hungary.
| |
Collapse
|
|
28
|
Vasiljevic-Pokrajcic Z, Mickovski N, Davidovic G, Asanin M, Stefanovic B, Krljanac G, Radosavljevic-Radovanovic M, Radovanovic N, Lasica R, Milanović S, Bjekić J, Majstorovic-Stakic M, Trifunovic D, Karadzic A, Rajic D, Milosevic A, Zdravkovic M, Saric J, Bugiardini R. Sex and age differences and outcomes in acute coronary syndromes. Int J Cardiol 2016; 217 Suppl:S27-31. [PMID: 27395070 DOI: 10.1016/j.ijcard.2016.06.217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 06/25/2016] [Indexed: 01/07/2023]
Abstract
BACKGROUND There is conflicting information about sex differences in presentation, treatment, and outcome after acute coronary syndromes (ACS) in the era of reperfusion therapy and percutaneous coronary intervention. The aim of this study was to examine presentation, acute therapy, and outcomes of men and women with ACS with special emphasis on their relationship with younger age (≤65years). METHODS From January 2010 to June 2015, we enrolled 5140 patients from 3 primary PCI capable hospitals. Patients were registered according to the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) registry protocol (ClinicalTrials.gov: NCT01218776). The primary outcome was the incidence of in-hospital mortality. RESULTS The study population was constituted by 2876 patients younger than 65years and 2294 patients older. Women were older than men in both the young (56.2±6.6 vs. 54.1±7.4) and old (74.9±6.4 vs. 73.6±6.0) age groups. There were 3421 (66.2%) patients with ST elevation ACS (STE-ACS) and 1719 (33.8%) patients without ST elevation ACS (NSTE-ACS). In STE-ACS, the percentage of patients who failed to receive reperfusion was higher in women than in men either in the young (21.7% vs. 15.8%) than in the elderly (35.2% vs. 29.6%). There was a significant higher mortality in women in the younger age group (age-adjusted OR 1.52, 95% CI: 1.01-2.29), but there was no sex difference in the older group (age-adjusted OR 1.10, 95% CI: 0.87-1.41). Significantly sex differences in mortality were not seen in NSTE-ACS patients. CONCLUSIONS In-hospital mortality from ACS is not different between older men and women. A higher short-term mortality can be seen only in women with STEMI and age of 65 or less.
Collapse
Affiliation(s)
| | - Natasa Mickovski
- Department for Prevention and Control of Non-Communicable Disease, Center for Prevention and Control of Diseases, Institute of Public Health of Serbia "Dr Milan Jovanović Batut", Belgrade, Serbia
| | - Goran Davidovic
- Clinical Centre Kragujevac, University Clinic, Medical Faculty Kragujevac, Serbia
| | - Milika Asanin
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Branislav Stefanovic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Gordana Krljanac
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | | | - Nebojsa Radovanovic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Ratko Lasica
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Sladjan Milanović
- University of Belgrade, Institute for Medical Research, Department of Neurophysiology, Belgrade, Serbia
| | - Jovana Bjekić
- University of Belgrade, Institute for Medical Research, Department of Neurophysiology, Belgrade, Serbia
| | | | - Danijela Trifunovic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Ana Karadzic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Dubravka Rajic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Aleksandra Milosevic
- Clinical Center of Serbia, University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Marija Zdravkovic
- Clinical Centre, "Bezanijska Kosa", University of Belgrade, Medical Faculty, Belgrade, Serbia
| | - Jelena Saric
- Clinical Centre, "BezanijskaKosa", Belgrade, Serbia
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostics and Specialty Medicine, University of Bologna, Italy
| |
Collapse
|
|
29
|
Gale CP. Inequalities in reperfusion therapy for STEMI. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:4-5. [DOI: 10.1093/ehjqcco/qcv031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|