|
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
|
Piris A, Garcia-Linacero LM, Ortega-Perez R, Rivas-Garcia S, Martinez-Moya R, Sanmartin M, Zamorano JL. Safety of an Early Discharge Strategy (≤48 h) after ST-Elevation Myocardial Infarction. J Clin Med 2024; 13:3827. [PMID: 38999393 PMCID: PMC11242729 DOI: 10.3390/jcm13133827] [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: 05/23/2024] [Revised: 06/23/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Early discharge following ST-segment-elevation myocardial infarction (STEMI) confers notable advantages for both patients and healthcare systems. However, the adoption of a very early discharge strategy for selected patients remains limited due to safety considerations. We aimed to provide some insight into the safety of a discharge program with a hospital stay lasting <48 h after a primary percutaneous coronary intervention (PCI). Methods: Using a registry of 1105 patients undergoing primary PCI for STEMI in our hospital between January 2015 and October 2023, we enrolled all the patients who had a hospital stay ≤48 h, according to a prespecified institutional protocol. The primary objective was a combined rate of non-fatal stroke, non-fatal acute myocardial infarction, or cardiovascular death within 30 days of discharge. Emergency department visits or hospitalizations due to cardiovascular causes, along with the all-cause mortality, were measured during the same period. Results: A total of 453 (41%) patients were discharged ≤48 h after admission for a STEMI. The mean age was 62.4 (±12.5 years), 24.3% were women, and 17.9% were people with diabetes. Up to 96% of the procedures had been performed through radial artery access, and there were no major vascular complications. Regarding the primary endpoint, there was one event (0.2%; one patient suffered a non-fatal myocardial infarction). There were no cardiovascular deaths or deaths from other causes. Only five patients (1.1%) were re-hospitalized or visited the emergency department due to cardiovascular causes. Conclusions: An early discharge strategy for patients within 48 h of experiencing STEMI and undergoing primary PCI appears feasible and safe.
Collapse
Affiliation(s)
- Antonio Piris
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
| | - Luis Manuel Garcia-Linacero
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
| | - Rodrigo Ortega-Perez
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
| | - Sonia Rivas-Garcia
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
| | - Rafael Martinez-Moya
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
- Unidad Críticos Cardiovasculares, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo 9100, 28034 Madrid, Spain
| | - Marcelo Sanmartin
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
- Unidad Críticos Cardiovasculares, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo 9100, 28034 Madrid, Spain
- Centro de Investigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
| | - Jose Luis Zamorano
- Cardiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain; (A.P.); (L.M.G.-L.); (R.O.-P.); (S.R.-G.); (R.M.-M.); (J.L.Z.)
- Centro de Investigación Biomédica en Red—Enfermedades Cardiovasculares (CIBER-CV), 28029 Madrid, Spain
- Centro de Investigación en Red en Enfermedades Cardiovasculares, Hospital Universitario Ramón y Cajal, Universidad de Alcalá (UAH), 28034 Madrid, Spain
| |
Collapse
|
|
3
|
Kwok CS, Qureshi AI, Lip GYH. The impact of the site of myocardial infarction on in-hospital outcomes for patients with STEMI. Coron Artery Dis 2024; 35:286-291. [PMID: 38251431 DOI: 10.1097/mca.0000000000001334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
BACKGROUND The territory and vessel involved in ST-elevation myocardial infarction (STEMI) is an important and there are limited contemporary studies from the national perspective. METHODS A retrospective cohort study was undertaken of national representative hospital admission in the National Inpatient Sample with a diagnosis of anterior or non-anterior STEMI between 2017 and 2020. Multiple logistic regression and multiple linear regressions were used to determine if there are any differences in in-hospital mortality, length of stay (LOS) and cost for anterior and non-anterior STEMI. RESULTS A total of 655 915 admissions with STEMI were included in the analysis (267 920 anterior STEMI, and 387 995 non-anterior STEMI). Non-anterior STEMI was associated with a significant reduction in mortality (OR 0.91 95% CI 0.89-0.99, P = 0.011) and LOS (coefficient -0.15 95% CI -0.22 to -0.08, P < 0.001) compared to anterior STEMI but there was no significant difference in healthcare costs (-297 95% CI -688 to 74). Analyses considering the infarct-related artery showed that the worse outcomes were associated with left main lesions and left-sided lesions had worse outcomes than right coronary artery lesions. CONCLUSION Non-anterior STEMI is associated with reduced mortality and LOS compared to anterior STEMI. Left-sided coronary lesions had worse outcomes, compared to right coronary lesions. STEMI should be considered in terms of the vessel or territory affected, in relation to outcomes and healthcare costs.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, Missouri, USA
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| |
Collapse
|
|
4
|
Pan J, Li C, Ren Y, Liu Y, Hua C, Wang L. Infarct-related artery only revascularization versus multi-vessel revascularization for patients with Killip I-IV acute myocardial infarction and multivessel disease. Acta Cardiol 2024; 79:464-472. [PMID: 38661286 DOI: 10.1080/00015385.2024.2344331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The optimal revascularization strategy for non-culprit vessels is still up for debate nowadays, particularly when it comes to individuals with different Killip classes. Therefore, the aim of our study was to investigate whether multivessel revascularization, as compared with infarct-related artery (IRA) alone revascularization, improves long-term prognosis in patients who have experienced an acute myocardial infarction (AMI) and have multivessel coronary artery disease (CAD). METHODS A retrospective analysis was conducted on clinical data from 646 patients who presented with AMI and multivessel CAD at Beijing Chaoyang hospital between November 2014 and November 2020. Based on various revascularization strategies, patients were categorised into two groups: IRA-only revascularization (n = 416) and multivessel revascularization (n = 230). The primary endpoint was cardiovascular death. RESULTS In the following 60.6 months (60.6 ± 23.9), the primary endpoint occurred in 3% of the multivessel revascularization group versus 9.6% in the IRA-only revascularization group (HR 0.284, CI 0.120-0.669, p = 0.002). For the Killip I-II patients (n = 533), the primary endpoint occurred in 2.6% of the multivessel revascularization group versus 9.5% in the IRA-only revascularization group (HR 0.236, CI 0.083-0.667, p = 0.003). For Killip III-IV patients (n = 113), there was no significance differences in the primary endpoint. After using the inverse probability weighted method, the benefit of complete revascularization was consistently observed. CONCLUSIONS Multivessel revascularization significantly reduced the incidence of cardiovascular death for patients presenting with AMI and multivessel CAD, particularly for Killip I-II patients. There were no significant differences in the primary outcome across the groups of patients with Killip III-IV.
Collapse
Affiliation(s)
- Jing Pan
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Chuang Li
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuting Ren
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yumeng Liu
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Cuncun Hua
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lefeng Wang
- Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
|
5
|
Kwok CS, Qureshi AI, Will M, Schwarz K, Lip GYH, Borovac JA. Structural Complications Following ST-Elevation Myocardial Infarction: An Analysis of the National Inpatient Sample 2016 to 2020. J Cardiovasc Dev Dis 2024; 11:59. [PMID: 38392273 PMCID: PMC10889581 DOI: 10.3390/jcdd11020059] [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: 12/27/2023] [Revised: 02/07/2024] [Accepted: 02/13/2024] [Indexed: 02/24/2024] Open
Abstract
ST-elevation myocardial infarction (STEMI) is a life-threatening emergency that can result in cardiac structural complications without timely revascularization. A retrospective study from the National Inpatient Sample included all patients with a diagnosis of STEMI between 2016 and 2020. Primary outcomes of interest were in-hospital mortality, length of stay (LoS), and healthcare costs for patients with and without structural complications. There were 994,300 hospital admissions included in the analysis (median age 64 years and 32.2% female). Structural complications occurred in 0.78% of patients. There was a three-fold increase in patients with cardiogenic shock (41.6% vs. 13.6%) and in-hospital mortality (30.6% vs. 10.7%) in the group with structural complications. The median LoS was longer (5 days vs. 3 days), and the median cost was significantly greater (USD 32,436 vs. USD 20,241) for patients with structural complications. After adjustments, in-hospital mortality was significantly greater for patients with structural complications (OR 1.99, 95% CI 1.73-2.30), and both LoS and costs were greater. There was a significant increase in mortality with ruptured cardiac wall (OR 9.16, 95% CI 5.91-14.20), hemopericardium (OR 3.20, 95% CI 1.91-5.35), and ventricular septal rupture (OR 2.57, 95% CI 1.98-3.35) compared with those with no complication. In conclusion, structural complications in STEMI patients are rare but potentially catastrophic events.
Collapse
Affiliation(s)
- Chun Shing Kwok
- Department of Cardiology, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent ST4 6QG, UK
| | - Adnan I Qureshi
- Zeenat Qureshi Stroke Institute and Department of Neurology, University of Missouri, Columbia, MO 65211, USA
| | - Maximillian Will
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3100 Krems, Austria
- Karl Landsteiner Institute for Cardiometabolics, Karl Landsteiner Society, 3100 St. Poelten, Austria
| | - Konstantin Schwarz
- Department of Internal Medicine 3, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, 3100 Krems, Austria
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool John Moores University & Liverpool Heart and Chest Hospital, Liverpool L69 3BX, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, 9220 Aalborg, Denmark
| | - Josip A Borovac
- Division of Interventional Cardiology, Cardiovascular Diseases Department, University Hospital of Split, 21000 Split, Croatia
- Department of Pathophysiology, University of Split School of Medicine, 21000 Split, Croatia
| |
Collapse
|
|
6
|
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]
|
|
7
|
Reindl M, Stiermaier T, Lechner I, Tiller C, Holzknecht M, Fink P, Mayr A, Klug G, Feistritzer HJ, Delewi R, Hirsch A, Carberry J, Carrick D, Bauer A, Metzler B, Nijveldt R, Thiele H, Berry C, Eitel I, Reinstadler SJ. Infarct severity and outcomes in ST-elevation myocardial infarction patients without standard modifiable risk factors - A multicenter cardiac magnetic resonance study. Eur J Intern Med 2024; 119:78-83. [PMID: 37634958 DOI: 10.1016/j.ejim.2023.08.013] [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: 07/02/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Standard modifiable cardiovascular risk factors (SMuRFs) are well-established players in the pathogenesis of ST-elevation myocardial infarction (STEMI). However, in a significant proportion of STEMI patients, no SMuRFs can be identified, and the outcomes of this subgroup are not well described. OBJECTIVES To assess the infarct characteristics at myocardial-tissue level and subsequent clinical outcomes in SMuRF-less STEMIs. METHODS This multicenter, individual patient-data analysis included 2012 STEMI patients enrolled in four cardiac magnetic resonance (CMR) imaging studies conducted in Austria, Germany, Scotland, and the Netherlands. Unstable patients at time of CMR (e.g. cardiogenic shock/after cardiac arrest) were excluded. SMuRF-less was defined as absence of hypertension, smoking, hypercholesterolemia, and diabetes mellitus. All patients underwent CMR 3(interquartile range [IQR]:2-4) days after infarction to assess left ventricular (LV) volumes and ejection fraction, infarct size and microvascular obstruction (MVO). Clinical endpoints were defined as major adverse cardiovascular events (MACE), including all-cause mortality, re-infarction and heart failure. RESULTS No SMuRF was identified in 185 patients (9%). These SMuRF-less patients were older, more often male, had lower TIMI risk score and pre-interventional TIMI flow, and less frequently multivessel-disease. SMuRF-less patients did not show significant differences in CMR markers compared to patients with SMuRFs (all p > 0.10). During a median follow-up of 12 (IQR:12-27) months, 199 patients (10%) experienced a MACE. No significant difference in MACE rates was observed between SMuRF-less patients and patients with SMuRFs (8vs.10%, p = 0.39). CONCLUSIONS In this large individual patient-data pooled analysis of low-risk STEMI patients, infarct characteristics and clinical outcomes were not different according to SMuRF status.
Collapse
Affiliation(s)
- Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Ronak Delewi
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam, the Netherlands
| | - Alexander Hirsch
- Department of Cardiology and Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jaclyn Carberry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Carrick
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, 6020, Innsbruck, Austria.
| |
Collapse
|
|
8
|
Karakayali M, Omar T, Artac I, Ilis D, Arslan A, Altunova M, Cagin Z, Karabag Y, Karakoyun S, Rencuzogullari I. The prognostic value of HALP score in predicting in-hospital mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention. Coron Artery Dis 2023; 34:483-488. [PMID: 37799045 DOI: 10.1097/mca.0000000000001271] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
INTRODUCTION AND OBJECTIVE Despite major advances in reperfusion therapies, morbidity and mortality rates associated with cardiovascular disorders remain high, particularly in patients with ST-segment elevation myocardial infarction (STEMI). Therefore, identifying prognostic variables that can be used to predict morbidity and mortality in STEMI patients is critical for better disease management. The HALP (hemoglobin, albumin, lymphocyte, and platelet) score, a novel index indicating nutritional status and systemic inflammation, provides information about prognosis. In this context, this study was carried out to investigate the relationship between HALP score assessed at admission and in-hospital mortality in STEMI patients. MATERIAL AND METHODS The population of this retrospective study consisted of 1307 consecutive patients diagnosed with STEMI and who underwent primary percutaneous coronary intervention (pPCI). The 1090 patients included in the study sample were divided into two groups based on the median HALP score value of 3.59. In-hospital and all-cause mortality rates during the follow-up were obtained from the registry. RESULTS In-hospital mortality rate was significantly higher in patients with a HALP score of less than 3.59 compared to those with a HALP score of more than 3.59 (7.5% and 0.7%, respectively; P < 0.001). Univariate and multivariate Cox proportional hazard analyses revealed that the HALP score is independently associated with in-hospital mortality. The optimal HALP score cutoff value of <3.72 predicted in-hospital mortality with 95.56% sensitivity and 49.19% specificity. CONCLUSION This study's findings indicate that HALP score may be a significant independent predictor of in-hospital mortality in patients with STEMI treated with pPCI.
Collapse
Affiliation(s)
- Muammer Karakayali
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Timor Omar
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Inanç Artac
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Dogan Ilis
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Ayca Arslan
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Mehmet Altunova
- Department of Cardiology, M.D. Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training Research Hospital, Istanbul
| | - Zihni Cagin
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Yavuz Karabag
- Department of Cardiology, M.D.Kafkas University School of Medicine, Kars
| | - Suleyman Karakoyun
- Department of Cardiology, M.D. Kocaeli Health and Technology University, Kocaeli, Turkey
| | | |
Collapse
|
|
9
|
Anastasiou V, Daios S, Moysidis DV, Zegkos T, Liatsos AC, Stalikas N, Didagelos M, Tsalikakis D, Sarafidis P, Delgado V, Savopoulos C, Ziakas A, Kamperidis V. Right Ventricular Global Longitudinal Strain and Short-Term Prognosis in Patients With First Acute Myocardial Infarction. Am J Cardiol 2023; 205:302-310. [PMID: 37633065 DOI: 10.1016/j.amjcard.2023.08.006] [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: 06/05/2023] [Revised: 07/27/2023] [Accepted: 08/03/2023] [Indexed: 08/28/2023]
Abstract
Right ventricular (RV) dysfunction after acute myocardial infarction (AMI) is a recognized predictor of dismal prognosis. However, the most reliable RV index to predict mortality early after revascularization remains undetermined. This study aimed to explore the ability of RV global longitudinal strain (GLS) to predict inhospital mortality in patients with first AMI. All consecutive patients with first AMI were prospectively enrolled from March 2022 until February 2023. An echocardiogram was performed 24 hours after successful revascularization and RV GLS alongside conventional echocardiographic indexes were measured. Inhospital mortality was recorded. A total of 300 patients (age 61.2 ± 11.8 years, 74% male) were included in the study. RV GLS was the only RV performance index that differed significantly between anterior and inferior ST-segment-elevation patients with AMI (14.5 ± 5.2% vs 17.4 ± 5.1% respectively, p <0.001). After revascularization, 23 patients (7.7%) died in hospital. The model of Global Registry of Acute Coronary Event risk score and left ventricular ejection fraction, built for predicting inhospital mortality, significantly improved its prognostic performance only by the addition of RV GLS (chi-square value increase by 7.485, p = 0.006) compared with the other RV function indexes. RV GLS was independently associated with inhospital mortality (odds ratio 0.83, 95% confidence interval 0.71 to 0.97, p = 0.017) after adjustment for Global Registry of Acute Coronary Event risk score and left ventricular ejection fraction. Echocardiographic RV GLS measured 24 hours after revascularization in patients with first AMI outperformed conventional RV function indexes in predicting inhospital mortality.
Collapse
Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Thomas Zegkos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Alexandros C Liatsos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Stalikas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios Tsalikakis
- Department of Informatics and Telecommunication Engineering, University of Western Macedonia, Kozani, Greece
| | - Pantelis Sarafidis
- First Department of Nephrology, Ippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Triasi Pujol, Barcelona, Spain
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| |
Collapse
|
|
10
|
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: 618] [Impact Index Per Article: 618.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
|
11
|
Lechner I, Reindl M, Tiller C, Holzknecht M, Fink P, Troger F, Angerer G, Angerer S, Henninger B, Mayr A, Klug G, Bauer A, Metzler B, Reinstadler SJ. Temporal Trends in Infarct Severity Outcomes in ST-Segment-Elevation Myocardial Infarction: A Cardiac Magnetic Resonance Imaging Study. J Am Heart Assoc 2023; 12:e028932. [PMID: 37489726 PMCID: PMC10492996 DOI: 10.1161/jaha.122.028932] [Citation(s) in RCA: 3] [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: 11/21/2022] [Accepted: 05/10/2023] [Indexed: 07/26/2023]
Abstract
Background Severity of myocardial tissue injury is a main determinant of morbidity and death related to ST-segment-elevation myocardial infarction (STEMI). Temporal trends of infarct characteristics at the myocardial tissue level have not been described. This study sought to assess temporal trends in infarct characteristics through a comprehensive assessment by cardiac magnetic resonance imaging at a standardized time point early after STEMI. Methods and Results We analyzed patients with STEMI treated with percutaneous coronary intervention at the University Hospital of Innsbruck who underwent cardiac magnetic resonance imaging between 2005 and 2021. The study period was divided into terciles. Myocardial damage characteristics were assessed using a multiparametric cardiac magnetic resonance imaging protocol within the first week after STEMI and compared between groups. A total of 843 patients with STEMI (17% women) with a median age of 57 (interquartile range, 51-66) years were analyzed. While age, sex, and the clinical risk profile expressed as thrombolysis in myocardial infarction risk score were comparable across the study period, there were differences in guideline-recommended therapies. At the same time, there was no significant change in infarct size (P=0.25), microvascular obstruction (P=0.50), and intramyocardial hemorrhage (P=0.34). Left ventricular remodeling indices and left ventricular ejection fraction remained virtually unchanged (all P>0.05). Major adverse cardiovascular events at 4 (interquartile range, 4-5) months were similar between groups (P=0.36). Conclusions In this magnetic resonance imaging study investigating patients with STEMI treated with primary percutaneous coronary intervention over the past 15 years, no change in infarct severity at the myocardial level has been observed. Clinical research on novel therapeutic approaches to reduce myocardial tissue injury should be a priority.
Collapse
Affiliation(s)
- Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Christina Tiller
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Magdalena Holzknecht
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Priscilla Fink
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Felix Troger
- University Clinic of RadiologyMedical University of InnsbruckInnsbruckAustria
| | - Georg Angerer
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Simon Angerer
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Benjamin Henninger
- University Clinic of RadiologyMedical University of InnsbruckInnsbruckAustria
| | - Agnes Mayr
- University Clinic of RadiologyMedical University of InnsbruckInnsbruckAustria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Axel Bauer
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| | - Sebastian J. Reinstadler
- University Clinic of Internal Medicine III, Cardiology and AngiologyMedical University of InnsbruckInnsbruckAustria
| |
Collapse
|
|
12
|
Nabovati E, Farzandipour M, Sadeghi M, Sarrafzadegan N, Noohi F, Sadeqi Jabali M. A Global Overview of Acute Coronary Syndrome Registries: A Systematic Review. Curr Probl Cardiol 2023; 48:101049. [PMID: 34780868 DOI: 10.1016/j.cpcardiol.2021.101049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 12/16/2022]
Abstract
The present study was conducted with the aim of identifying, and summarizing the characteristics of ACS registries at national, multinational and international levels. Literature was searched using keywords in the title and/or abstract without any time limit ending in March, 2021. After excluding duplicates, 2 reviewers independently reviewed the titles and/or abstracts and full text for inclusion. Each reviewer independently extracted the characteristics of the registries from included papers. Finally, the extracted characteristics were confirmed by a second reviewer. Out of the 1309 papers included, 71 ACS registries were identified (including 60 national and 11 multinational and international registries). Most national registries were being used in Europe. Most registries focused on measuring quality. In more than half of the registries, all types of ACS patients were enrolled. The diagnostic and drug classification systems were mentioned in eight and five registries, respectively. The design of 55 registries was hospital-based. The ability of computerized audit checks was made for 34 registries. More than half of the registries had patient consent and had a web-based design. In all the ACS registries, patient characteristics, clinical characteristics and treatment characteristics were recorded and post-discharge follow-up information was recorded in 45 registries. In the current situation and given that a limited number of countries in the world have national ACS registries, reviewing the results of this study and modeling the registries implemented in the leading countries can help countries without a registry to design it.
Collapse
Affiliation(s)
- Ehsan Nabovati
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran
| | - Mehrdad Farzandipour
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Feridoun Noohi
- Iranian Network of Cardiovascular Research, Iran; Cardiovascular Intervention Research Center, Shaheed Rajaie Cardiovascular Medical and Research Center, Tehran, Iran
| | - Monireh Sadeqi Jabali
- Health Information Management Research Center, Department of Health Information Management and Technology, Kashan University of Medical Sciences, Kashan, Iran.
| |
Collapse
|
|
13
|
Silvain J, Cayla G, Ferrari E, Range G, Puymirat E, Delarche N, Collet JP, Dumaine R, Slama M, Payot L, Kasty ME, Aacha K, Vicaut E, Montalescot G. βeta blocker interruption after uncomplicated myocardial infarction: rationale and design of the randomized ABYSS trial. Am Heart J 2023; 258:168-176. [PMID: 36682596 DOI: 10.1016/j.ahj.2023.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 01/10/2023] [Accepted: 01/13/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND The long-term use of β-blocker after myocardial infarction (MI) when global left ventricular ejection fraction (LVEF) is preserved has not been studied in the era of modern myocardial reperfusion and secondary prevention therapies. It is unknown whether β-blockers are useful in stable post-MI patients without reduced LVEF and without heart failure. METHODS The Assessment of β-blocker interruption 1 Year after an uncomplicated myocardial infarction on Safety and Symptomatic cardiac events requiring hospitalization (ABYSS) Trial enrolled in 49 centers in France, 3,700 patients with a prior (>6 months) history of MI and a LVEF >40%, chronically treated with a β-blocker and without any major cardiovascular event (MACE) in the past 6 months. These patients were randomized to interruption or continuation of their β-blocker therapy. The primary objective is to demonstrate the noninferiority of interruption vs continuation of the β-blocker therapy on the primary composite endpoint of all-cause death, stroke, MI, hospitalization for any cardiovascular reason at the end of follow-up (accrual follow-up) with a one-year minimum follow-up for the last randomized patient. Secondary objectives will focus on patient reported outcomes with the evaluation of the quality of life before and after randomization with the EQ5D-5L questionnaire. Enrolment has been completed. CONCLUSION The ABYSS trial evaluates the cardiovascular safety of β-blocker interruption in stabilized post-MI patients without heart failure nor reduced LVEF. ABYSS trial is a reappraisal of β-blockers life-long therapy in stable post-MI patients without reduced LVEF. CLINICAL TRIAL REGISTRATION NCT03498066 (clinicaltrials.gov).
Collapse
Affiliation(s)
- Johanne Silvain
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France.
| | - Guillaume Cayla
- Cardiology department, Nimes university Hospital, Montpellier University, ACTION group, Nimes, France
| | - Emile Ferrari
- Cardiology Department, Pasteur University Hospital, France
| | - Grégoire Range
- Département de Cardiologie, Les Hôpitaux de Chartres, Chartres, France
| | - Etienne Puymirat
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Paris, France; Université de Paris Cité, Paris, France
| | - Nicolas Delarche
- Department of Cardiology, Hopital François Mitterrand, Pau, France
| | - Jean-Philippe Collet
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Raphaelle Dumaine
- Les Grands Prés Cardiac Rehabilitation centre, Villeneuve St Denis, France
| | - Michel Slama
- Cardiology Department Hôpital Bichat, AP-HP, Institut Mutualiste Montsouris, Paris, France
| | - Laurent Payot
- Cardiology Department, General Hospital Yves Le Foll, Saint-Brieuc, France
| | - Mohamad E Kasty
- Département de Cardiologie, Grand Hôpital de l'Est Francilien site Marne-La-Vallée, Jossigny, France
| | - Karim Aacha
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| | - Eric Vicaut
- Unité de Recherche Clinique, ACTION Study Group, Hôpital Fernand Widal (AP-HP), SAMM - Statistique, Analyse et Modélisation Multidisciplinaire EA 4543, Université Paris 1 Panthéon Sorbonne, Paris, France
| | - Gilles Montalescot
- Sorbonne Université, ACTION Study Group, INSERM UMRS1166, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
| |
Collapse
|
|
14
|
Klancik V, Kočka V, Sulzenko J, Widimsky P. The many roles of urgent catheter interventions: from myocardial infarction to acute stroke and pulmonary embolism. Expert Rev Cardiovasc Ther 2023; 21:123-132. [PMID: 36706282 DOI: 10.1080/14779072.2023.2174101] [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] [Indexed: 01/28/2023]
Abstract
INTRODUCTION Cardiovascular diseases (CVDs) are the leading cause of cardiovascular mortality and a major contributor to disability worldwide. The prevalence of CVDs is continuously increasing, and from 1990 to 2019, it has doubled. Global cardiovascular mortality has increased from 12.1 million in 1990 to 18.6 million cases in 2019. The development of therapeutic options for these diseases is at the forefront of interest concerning the extensive socio-economic consequences. Modern endovascular transcatheter therapeutic options contribute to the reduction of cardiovascular morbidity and mortality. AREAS COVERED The article concentrates on the triad of the most common causes of acute cardiovascular mortality and morbidity - myocardial infarction, ischemic stroke, and pulmonary embolism. Current evidence-based indications, specific interventional techniques, and remaining unsolved issues are reviewed and compared. A personal perspective on the possible implications for the future is provided. EXPERT OPINION Primary angioplasty for ST-segment elevation myocardial infarction is a well-established therapeutic option with proven mortality benefits. We suppose that catheter-based interventions for acute stroke will spread quickly from centers of excellence to routine clinical practice. We believe that ongoing research will provide a basis for the expansion of interventional treatment of pulmonary embolism soon.
Collapse
Affiliation(s)
- Viktor Klancik
- Department of Cardiology, Ceske Budejovice Hospital, Inc, Ceske Budejovice, Czech Republic.,Department of Cardiology, Charles University, Czech Republic
| | - Viktor Kočka
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Jakub Sulzenko
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Charles University, Czech Republic.,Department of Cardiology, University Hospital Kralovske Vinohrady, Czech Republic
| |
Collapse
|
|
15
|
Ludman P, Zeymer U, Danchin N, Kala P, Laroche C, Sadeghi M, Caporale R, Shaheen SM, Legutko J, Iakobishvili Z, Alhabib KF, Motovska Z, Studencan M, Mimoso J, Becker D, Alexopoulos D, Kereseselidze Z, Stojkovic S, Zelveian P, Goda A, Mirrakhimov E, Bajraktari G, Farhan HA, Šerpytis P, Raungaard B, Marandi T, Moore AM, Quinn M, Karjalainen PP, Tatu-Chitoiu G, Gale CP, Maggioni AP, Weidinger F. Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2023; 12:22-37. [PMID: 36346109 DOI: 10.1093/ehjacc/zuac143] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/28/2022] [Accepted: 11/04/2022] [Indexed: 11/10/2022]
Abstract
AIMS To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. METHODS AND RESULTS Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. CONCLUSION Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
Collapse
Affiliation(s)
- Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK
| | - Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, Service de Cardiologie Paris, Paris, France
| | - Petr Kala
- Department of Internal Medicine and Cardiology, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roberto Caporale
- Interventional Cardiology Unit, Annunziata Civil Hospital, Cosenza, Italy
| | | | - Jacek Legutko
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland
| | | | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Martin Studencan
- Cardiocentre Presov, Teaching Hospital of J.A. Reiman, Presov, Slovakia
| | - Jorge Mimoso
- Centro Hospitalar e Universitário do Algarve, Faro, Portugal
| | - David Becker
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dimitrios Alexopoulos
- National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Sinisa Stojkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia
| | - Parounak Zelveian
- Scientific Research Institute of Cardiology named after Levon Hovhannisyan, Yerevan, Armenia
| | - Artan Goda
- Cardiology I and Cardiology II, University Hospital Center Mother Theresa, Tirana, Albania
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.,National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan
| | - Gani Bajraktari
- Medical Faculty, University of Prishtina 'Hasan Prishtina', University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Hasan Ali Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology, Baghdad Heart Centre, Medical City, Baghdad, Iraq
| | | | - Bent Raungaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Toomas Marandi
- Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia.,Department of Cardiology, University of Tartu, Tartu, Estonia
| | | | - Martin Quinn
- St Vincent's University Hospital, Dublin 4, Ireland
| | - Pasi Paavo Karjalainen
- Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | | | - Chris P Gale
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.,Department of Cardiology, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.,ANMCO Research Center, Heart Care Foundation, Florence, Italy
| | | | | |
Collapse
|
|
16
|
Yuan M, Ren BC, Wang Y, Ren F, Gao D. Development of a novel tool: a nomogram for predicting in-hospital mortality of patients in intensive care unit after percutaneous coronary intervention. BMC Anesthesiol 2023; 23:5. [PMID: 36609220 PMCID: PMC9817262 DOI: 10.1186/s12871-022-01923-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 11/22/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUNDS Increased risk of in-hospital mortality is critical to guide medical decisions and it played a central role in intensive care unit (ICU) with high risk of in-hospital mortality after primary percutaneous coronary intervention (PCI). At present，most predicting tools for in-hospital mortality after PCI were based on the results of coronary angiography, echocardiography, and laboratory results which are difficult to obtain at admission. The difficulty of using these tools limit their clinical application. This study aimed to develop a clinical prognostic nomogram to predict the in-hospital mortality of patients in ICU after PCI. METHODS We extracted data from a public database named the Medical Information Mart for Intensive Care (MIMIC III). Adult patients with coronary artery stent insertion were included. They were divided into two groups according to the primary outcome (death in hospital or survive). All patients were randomly divided into training set and validation set randomly at a ratio of 6:4. Least absolute shrinkage and selection operator (LASSO) regression was performed in the training set to select optimal variables to predict the in-hospital mortality of patients in ICU after PCI. The multivariate logistical analysis was performed to develop a nomogram. Finally, the predictive efficiency of the nomogram was assessed by area under the receiver operating characteristic curve (AUROC)，integrated discrimination improvement (IDI), and net reclassification improvement (NRI), and clinical net benefit was assessed by Decision curve analysis (DCA). RESULTS A total of 2160 patients were recruited in this study. By using LASSO, 17 variables were finally included. We used multivariate logistic regression to construct a prediction model which was presented in the form of a nomogram. The calibration plot of the nomogram revealed good fit in the training set and validation set. Compared with the sequential organ failure assessment (SOFA) and scale for the assessment of positive symptoms II (SAPS II) scores, the nomogram exhibited better AUROC of 0.907 (95% confidence interval [CI] was 0.880-0.933, p < 0.001) and 0.901 (95% CI was 0.865-0.936, P < 0.001) in the training set and validation set, respectively. In addition, DCA of the nomogram showed that it could achieve good net benefit in the clinic. CONCLUSIONS A new nomogram was constructed, and it presented excellent performance in predicting in-hospital mortality of patients in ICU after PCI.
Collapse
Affiliation(s)
- Miao Yuan
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Bin Cheng Ren
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Yu Wang
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| | - Fuxian Ren
- grid.440747.40000 0001 0473 0092Department of Cardiology, Meishan Brach of the Third Affiliated Hospital, Yanan University School of Medical, Meishan, Sichuan People’s Republic of China
| | - Dengfeng Gao
- grid.43169.390000 0001 0599 1243Cardiology diseases department, Xi’an Jiaotong University Second Affiliated Hospital, NO.157 Xiwu Rd, Xi’an, China
| |
Collapse
|
|
17
|
Han L, Yan F, Zhang Y, Pan Y, Li S, Yang M, Wang Y, Yanru C, Su W, Ma Y. Prevalence and associated factors of mortality after percutaneous coronary intervention for adult patients with ST-elevation myocardial infarction: A systematic review and meta-analysis. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2023; 28:17. [PMID: 37064794 PMCID: PMC10098139 DOI: 10.4103/jrms.jrms_781_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/13/2022] [Accepted: 11/17/2022] [Indexed: 03/18/2023]
Abstract
Background There is a paucity of systematic reviews on the associated factors of mortality among ST-elevation myocardial infarction (STEMI) patients after percutaneous coronary intervention (PCI). This meta-analysis was designed to synthesize available evidence on the prevalence and associated factors of mortality after PCI for adult patients with STEMI. Materials and Methods Databases including the Cochrane Library, PubMed, Web of Science, Embase, Ovid, Scopus, ProQuest, MEDLINE, and CINAHL Complete were searched systematically to identify relevant articles published from January 2008 to March 2020 on factors affecting mortality after PCI in STEMI patients. Meta-analysis was conducted using Stata 12.0 software package. Results Our search yielded 91 cohort studies involving a total of 199, 339 participants. The pooled mortality rate for STEMI patients after PCI was 10%. After controlling for grouping criteria or follow-up time, the following 17 risk factors were significantly associated with mortality for STEMI patients after PCI: advanced age (odds ratio [OR] = 3.89), female (OR = 2.01), out-of-hospital cardiac arrest (OR = 5.55), cardiogenic shock (OR = 4.83), renal dysfunction (OR = 3.50), admission anemia (OR = 3.28), hyperuricemia (OR = 2.71), elevated blood glucose level (OR = 2.00), diabetes mellitus (OR = 1.8), chronic total occlusion (OR = 2.56), Q wave (OR = 2.18), without prodromal angina (OR = 2.12), delay in door-to-balloon time (OR = 1.72), delay in symptom onset-to-balloon time (OR = 1.43), anterior infarction (OR = 1.66), ST-segment resolution (OR = 1.40), and delay in symptom onset-to-door time (OR = 1.29). Conclusion The pooled prevalence of mortality after PCI for STEMI patients was 10%, and 17 risk factors were significantly associated with mortality for STEMI patients after PCI.
Collapse
|
|
18
|
Alves L, Ziegelmann PK, Ribeiro V, Polanczyk C. Hospital Mortality from Myocardial Infarction in Latin America and the Caribbean: Systematic Review and Meta-Analysis. Arq Bras Cardiol 2022; 119:970-978. [PMID: 36541993 PMCID: PMC9814809 DOI: 10.36660/abc.20220194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/01/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most cardiovascular deaths occur in low- and middle-income countries and myocardial infarction is one of the main life-threatening conditions. OBJECTIVE We assessed all-cause in-hospital mortality in patients admitted for myocardial infarction (STEMI and NSTEMI) in Latin America and the Caribbean from 2000 onward. METHODS We systematically searched in electronic bibliographic databases for cohort studies which reported in-hospital mortality due to STEMI and NSTEMI. A meta-analysis was performed and a p-value < 0.05 was considered significant. RESULTS We identified 38 studies (29 STEMI, 3 NSTEMI and 6 both). Pooled STEMI in-hospital mortality was 9.9% (95% CI: 9.1 - 10.7). Heterogeneity was not trivial (I2 = 74% and prediction interval = 6.6 - 14.5). The percentage of reperfusion therapy and decade explain part of the heterogeneity (I2 = 54%). The higher the rate of reperfusion therapy, the lower the in-hospital mortality (coefficient = -0.009, 95% CI: -0.013 to -0.006, p<0.001). This mortality was higher in the first decade as compared with the second (coefficient = -0.14, 95% CI: -0.27 to -0.02, p=0.047). Pooled NSTEMI in-hospital mortality was 6.3% (95% CI: 5.4 - 7.4) and heterogeneity was null. CONCLUSION Pooled STEMI in-hospital mortality in low- and middle-income countries was high in comparison with rates reported in high income countries. To improve these estimates, higher use of reperfusion therapy must be pursued. Pooled NSTEMI in-hospital mortality was similar to the ones found in high-income countries; however, it was based on few studies and most of them were carried out in two countries.
Collapse
Affiliation(s)
- Leonardo Alves
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil,Universidade Federal do Rio GrandeFaculdade de MedicinaRio GrandeRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS – Brasil,Correspondência: Leonardo Alves •, Universidade Federal do Rio Grande – Departamento de Medicina - Gen Osório. CEP 96201-900, Porto Alegre, RS – Brasil. E-mail:
| | - Patrícia K. Ziegelmann
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil
| | - Victor Ribeiro
- Universidade Federal do Rio GrandeFaculdade de MedicinaRio GrandeRSBrasilFaculdade de Medicina, Universidade Federal do Rio Grande, Rio Grande, RS – Brasil
| | - Carisi Polanczyk
- Universidade Federal do Rio Grande do SulPrograma de Pós-Graduação em CardiologiaPorto AlegreRSBrasilPrograma de Pós-Graduação em Cardiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS – Brasil,Hospital de Clínicas de Porto AlegrePorto AlegreRSBrasilHospital de Clínicas de Porto Alegre, Porto Alegre, RS – Brasil
| |
Collapse
|
|
19
|
Frydman S, Freund O, Banai A, Zornitzki L, Banai S, Shacham Y. Relation of Gender to the Occurrence of AKI in STEMI Patients. J Clin Med 2022; 11:jcm11216565. [PMID: 36362793 PMCID: PMC9655780 DOI: 10.3390/jcm11216565] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 10/26/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Patients undergoing percutaneous coronary interventions (PCIs) are prone to a wide range of complications; one complication that is constantly correlated with a worse prognosis is acute kidney injury (AKI). Gender as an independent risk factor for said complications has raised some interest; however, studies have shown conflicting results so far. We aimed to investigate the possible relation of gender to the occurrence of AKI in STEMI patients undergoing PCI. This retrospective observational study cohort included 2967 consecutive patients admitted with STEMI between the years 2008 and 2019. Their renal outcomes were assessed according to KDIGO criteria (AKI serum creatinine ≥ 0.3 mg/dL from baseline within 48 h from admission), and in-hospital complications and mortality were reviewed. Our main results show that female patients were older (69 vs. 60, p < 0.001) and had higher rates of diabetes (29.2% vs. 23%, p < 0.001), hypertension (62.9% vs. 41.3%, p < 0.001), and chronic kidney disease (26.7% vs. 19.3%, p < 0.001). Females also had a higher rate of AKI (12.7% vs. 7.8%, p < 0.001), and among patients with AKI, severe AKI was also more prevalent in females (26.1% vs. 14.5%, p = 0.03). However, in multivariate analyses, after adjusting for the baseline characteristics above, the female gender was a non-significant predictor for AKI (adjusted OR 1.01, 95% CI 0.73−1.4, p = 0.94) or severe AKI (adjusted OR 1.65, 95% CI 0.80−1.65, p = 0.18). In conclusion, while females had higher rates of AKI and severe AKI, gender was not independently associated with AKI after adjusting for other confounding variables. Other comorbidities that are more prevalent in females can account for the difference in AKI between genders.
Collapse
Affiliation(s)
- Shir Frydman
- Correspondence: ; Tel.: +972-3-6973395; Fax: +972-3-6962334
| | | | | | | | | | | |
Collapse
|
|
20
|
Shen M, Wang J, Li D, Zhou X, Guo Y, Zhang W, Guo Y, Wang J, Liu J, Zhao G, Zhao S, Tian J. IntraCoronary Artery Retrograde Thrombolysis vs. Thrombus Aspiration in ST-Segment Elevation Myocardial Infarction: Study Protocol for a Randomized Controlled Trial. Front Cardiovasc Med 2022; 9:928695. [PMID: 36186981 PMCID: PMC9520188 DOI: 10.3389/fcvm.2022.928695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Type 2 diabetes (T2DM) is a major risk factor for myocardial infarction. Thrombus aspiration was considered a good way to deal with coronary thrombus in the treatment of acute myocardial infarction. However, recent studies have found that routine thrombus aspiration is not beneficial. This study is designed to investigate whether intracoronary artery retrograde thrombolysis (ICART) is more effective than thrombus aspiration or percutaneous transluminal coronary angioplasty (PTCA) in improving myocardial perfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods/Design IntraCoronary Artery Retrograde Thrombolysis (ICART) vs. thrombus aspiration or PTCA in STEMI trial is a single-center, prospective, randomized open-label trial with blinded evaluation of endpoints. A total of 286 patients with STEMI undergoing PPCI are randomly assigned to two groups: ICART and thrombus aspiration or PTCA. The primary endpoint is the incidence of >70% ST-segment elevation resolution. Secondary outcomes include distal embolization, myocardial blush grade, thrombolysis in myocardial infarction (TIMI) flow grade, and in-hospital bleeding. Discussion The ICART trial is the first randomized clinical trial (RCT) to date to verify the effect of ICART vs. thrombus aspiration or PTCA on myocardial perfusion in patients with STEMI undergoing PPCI. Clinical Trial Registration [https://www.chictr.org.cn/], identifier [ChiCTR1900023849].
Collapse
Affiliation(s)
- Mingzhi Shen
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Jihang Wang
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
| | - Dongyun Li
- The First Department of Health Care, Second Medical Center, PLA General Hospital, Beijing, China
| | - Xinger Zhou
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuting Guo
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Wei Zhang
- Department of Cardiology, Second Medical Center, PLA General Hospital, Beijing, China
| | - Yi Guo
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
| | - Jian Wang
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
| | - Jie Liu
- Department of Critical Medicine, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Guang Zhao
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shihao Zhao
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
- *Correspondence: Jinwen Tian,
| | - Jinwen Tian
- Department of Cardiology, Hainan Hospital of Chinese People’s Liberation Army (PLA) General Hospital, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Shihao Zhao,
| |
Collapse
|
|
21
|
Gao W, Zhong X, Ma Y, Huang D, Wang R, Zhao S, Yang S, Qian J, Ge J. A randomized multicenter trial to evaluate early invasive strategy for patients with acute ST-segment elevation myocardial infarction presenting 24-48 hours from symptom onset: Protocol of the RESCUE-MI study. Am Heart J 2022; 251:54-60. [PMID: 35525262 DOI: 10.1016/j.ahj.2022.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/26/2022] [Accepted: 05/02/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND For ST-segment elevation myocardial infarction (STEMI) patients presenting 24 to 48 hours from symptom onset, whether early invasive strategy should be performed still remains controversial. METHODS This is a prospective, open-label, multicenter, investigator initiated, randomized controlled trial (NCT04962178) to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset. A total of 366 patients will be included from 10 hospitals in mainland China. They will be randomly (1:1) divided into 2 groups: the early invasive strategy group (primary percutaneous coronary intervention, PPCI) and conservative strategy group (optimal medical therapy with primary PCI not performed). All patients will be followed for 1 month. The primary end point is myocardial infarction size on cardiac magnetic resonance (CMR). The secondary end points are as follows: (1) major adverse cardiovascular events (MACE), which is defined as a composite of cardiac death, recurrent myocardial infarction, ischemic driven target vessel revascularization and stroke; (2) other CMR end points, including microvascular obstruction, intramyocardial hemorrhage, myocardial area at risk, left ventricular ejection fraction, left ventricular end diastolic volume and left ventricular end systolic volume. DISCUSSION This study is designed to evaluate the efficacy of early invasive strategy for STEMI patients within 24 to 48 hours of symptom onset and will add more evidence for clinical practice. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04962178. Registered on July 14, 2021.
Collapse
Affiliation(s)
- Wei Gao
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xin Zhong
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuanji Ma
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Dong Huang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Ruochen Wang
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Shihai Zhao
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Shan Yang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Medical Imaging, Shanghai, China
| | - Juying Qian
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
| |
Collapse
|
|
22
|
Zilio F, Rigoni M, Muraglia S, Borghesi M, Zucchelli F, Todaro D, Dallago M, Braito G, Damaggio F, Nollo G, Bonmassari R. Implementation of a Night Service of Helicopter Transportation to Reduce the Time to Revascularization in STEMI Patients in a Mountainous Region: Impact on Outcomes. J Clin Med 2022; 11:jcm11175089. [PMID: 36079018 PMCID: PMC9457436 DOI: 10.3390/jcm11175089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/25/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Treatment delays are the most easily audited index of quality of care in the setting of ST-segment elevation myocardial infarction; among the components of ischemia time, system delay has been demonstrated to be a predictor of outcomes, and in a mountainous region it relies mostly upon helicopter rescue service. Aim: The aim of the study is to analyze the impact of the activation of helicopter rescue service for the nighttime for urgent transportation of patients on the time to revascularization and on the outcomes of STEMI patients. Methods: Data were prospectively collected in a database and retrospectively split into two different cohorts, based on the presentation date in the 18 months before, or after, the first day of implementation of the new organizational model. The patients were also split into two groups based on the place of STEMI diagnosis, either the chief town territory or the rest of the region, and retrospectively evaluated for vital status at 30 days and 2 years after index event. Results: The number of patients included was 751. For patients coming from outside Trento, an improvement in ST-segment resolution was shown (ST-segment elevation reduction >50% in 54.0% of the patients vs. 36.4%, p < 0.01). Moreover, a reduction in diagnosis-to-reperfusion median time has been demonstrated (from 105 to 97 min, p < 0.01), mainly driven by a reduction during the night shift (from 119 to 100 min, p = 0.02). With regard to 30-day and 2-year mortality, no statistically significant differences were achieved. Discussion: The organizational effort has translated into a significant reduction in the treatment delay for patients coming from outside the chief town. However, although a longer diagnosis to reperfusion time has been related to a higher mortality, a significant reduction in mortality was not demonstrated in our study. However, an improvement in ST-segment elevation resolution was shown for patients coming from outside the city of Trento, a result that could have other potential clinical benefits. Conclusions: Implementation of night flight proved to be effective in reducing the time between the diagnosis and the treatment of patients in the setting of STEMI, improving ST-segment elevation resolution, although no impact was shown on short- and long-term mortality.
Collapse
Affiliation(s)
- Filippo Zilio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
- Correspondence: ; Tel.: +39-0461903121; Fax: +39-0461903122
| | - Marta Rigoni
- BIOtech Lab, Department of Industrial Engineering, University of Trento, 38123 Trento, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
| | - Simone Muraglia
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Marco Borghesi
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | | | - Daniel Todaro
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Michele Dallago
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Giuseppe Braito
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Fabrizio Damaggio
- Department of Cardiology, Santa Chiara Hospital, 38122 Trento, Italy
| | - Giandomenico Nollo
- BIOtech Lab, Department of Industrial Engineering, University of Trento, 38123 Trento, Italy
| | | |
Collapse
|
|
23
|
Castro PPND, Castro MAN, Nascimento GA, Moura I, Pena JLB. Predictors of Hospital Mortality Based on Primary Angioplasty Treatment: A Multicenter Case-Control Study. Arq Bras Cardiol 2022; 119:448-457. [PMID: 35946752 PMCID: PMC9438550 DOI: 10.36660/abc.20210015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Fundamento A estratificação do risco de morte dos pacientes no contexto da angioplastia primária (ATC) é fundamental. Objetivo Identificar os fatores relacionados ao desfecho morte em pacientes submetidos a ATC. Métodos Estudo de caso-controle, utilizando como fonte de dados um registro brasileiro. A associação entre cada variável e o desfecho óbito foi avaliada via modelo de regressão logística binária. Consideramos significativo p<0,05. Resultados Foram analisados 26.990 registros, sendo 18.834 (69,8%) do sexo masculino, com idade mediana de 61 (17) anos. Na análise multivariada, as principais variáveis relacionadas ao desfecho óbito com seus respectivos odds ratio e intervalos de confiança (IC) com nível de significância de 95% foram a idade avançada 70 - 79 anos (2,46; 1,64 - 3,79) e ≥ 80 anos (3,68; 2,38 - 5,81), p<0,001, classificação de Killip II (2,71; 1,92 - 3,83), Killip III (8,14; 5,67 - 11,64), Killip IV (19,83; 14,85 - 26,69), p<0,001, disfunção global acentuada do ventrículo esquerdo (VE) (3,63; 2,39 - 5,68), p<0,001 e ocorrência de infarto após a intervenção (5,01; 2,57- 9,46), p<0,001. O principal fator protetor foi o fluxo TIMI III pós-intervenção (0,18; 0,13 - 0,24), p<0,001, seguido do TIMI II (0,59; 0,41 - 0,86), p=0,005, sexo masculino (0,79; 0,64 - 0,98), p= 0,032, dislipidemia (0,69; 0,59 - 0,85), p<0,001 e número de lesões tratadas (0,86; 0,9 - 0,94), p<0,001. Conclusão Os preditores de mortalidade nos pacientes submetidos a ATC foram: classificação de Killip, reinfarto, idade, disfunção global acentuada do VE, sexo feminino e fluxo TIMI 0/I pós-intervenção.
Collapse
Affiliation(s)
- Pedro Paulo Neves de Castro
- Hospital Marcio Cunha - Hemodinâmica, Ipatinga, MG - Brasil.,Faculdade de Ciências Médicas de Minas Gerais - Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG - Brasil.,Unimed Vale do Aço, Ipatinga, MG - Brasil
| | | | | | - Isabel Moura
- Faculdade de Ciências Médicas de Minas Gerais - Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG - Brasil
| | - José Luiz Barros Pena
- Faculdade de Ciências Médicas de Minas Gerais - Programa de Pós-Graduação stricto sensu em Ciências da Saúde, Belo Horizonte, MG - Brasil.,Hospital Felício Rocho - Ecocardiografia, Belo Horizonte, MG - Brasil
| |
Collapse
|
|
24
|
Shen M, Lu H, Liao Y, Wang J, Guo Y, Zhou X, Nong Y, Fu Z, Wang J, Guo Y, Zhao S, Fan L, Tian J. Intracoronary artery retrograde thrombolysis for ST-segment elevation myocardial infarction with a tortuous coronary artery: A case report and review of the literature. Front Cardiovasc Med 2022; 9:934489. [PMID: 35990969 PMCID: PMC9386044 DOI: 10.3389/fcvm.2022.934489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background How to deal with large thrombus burdens of culprit’s blood vessel remains a great challenge in the treatment of acute myocardial infarction. Case presentation A 32-year-old Chinese man was diagnosed with ST-segment elevation myocardial infarction (STEMI). Coronary angiography revealed that the distal end of a tortuous left circumflex was completely occluded by a large amount of thrombus. Cutted balloon-directed intracoronary artery retrograde thrombolysis (ICART) with urokinase led to the restoration of coronary blood flow. Because there was no obvious plaque rupture or artery stenosis in the coronary artery, it was only dilated, and no stent was implanted. Conclusion Cutted balloon-directed ICART can be performed effectively and safely in some STEMI patients with tortuous coronary vessels and large thrombus. (REST or named ICART ClinicalTrials.gov number, ChiCTR1900023849).
Collapse
Affiliation(s)
- Mingzhi Shen
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Haihui Lu
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yichao Liao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Jian Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yi Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Xinger Zhou
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yingqiao Nong
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Zhenhong Fu
- Department of Cardiology, Sixth Medical Center, PLA General Hospital, Beijing, China
| | - Jihang Wang
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yuting Guo
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Shihao Zhao
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- *Correspondence: Shihao Zhao,
| | - Li Fan
- Department of Cardiology, Second Medical Center, PLA General Hospital, Beijing, China
- Li Fan,
| | - Jinwen Tian
- Department of Cardiology, Hainan Geriatric Disease Clinical Medical Research Center, Hainan Branch of China Geriatric Disease Clinical Research Center, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- Jinwen Tian,
| |
Collapse
|
|
25
|
Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, Rosselló X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras S, Moreno R. Analysis of the management of ST-segment elevation myocardial infarction in Spain. Results from the ACI-SEC Infarction Code Registry. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2022; 75:669-680. [PMID: 35067471 DOI: 10.1016/j.rec.2021.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 10/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) networks should guarantee STEMI care with good clinical results and within the recommended time parameters. There is no contemporary information on the performance of these networks in Spain. The objective of this study was to analyze the clinical characteristics of patients, times to reperfusion, characteristics of the intervention performed, and 30-day mortality. METHODS Prospective, observational, multicenter registry of consecutive patients treated in 17 STEMI networks in Spain (83 centers with the Infarction Code), between April 1 and June 30, 2019. RESULTS A total of 5401 patients were attended (mean age, 64±13 years; 76.9% male), of which 4366 (80.8%) had confirmed STEMI. Of these, 87.5% were treated with primary angioplasty, 4.4% with fibrinolysis, and 8.1% did not receive reperfusion. In patients treated with primary angioplasty, the time between symptom onset and reperfusion was 193 [135-315] minutes and the time between first medical contact and reperfusion was 107 [80-146] minutes. Overall 30-day mortality due to STEMI was 7.9%, while mortality in patients treated with primary angioplasty was 6.8%. CONCLUSIONS Most patients with STEMI were treated with primary angioplasty. In more than half of the patients, the time from first medical contact to reperfusion was <120 minutes. Mortality at 30 days was relatively low.
Collapse
Affiliation(s)
- Oriol Rodríguez-Leor
- Institut del Cor, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Institut de Recerca en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain.
| | - Ana Belén Cid-Álvarez
- Servicio de Cardiología, Hospital Clínico de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | | | - Xavier Rosselló
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Universitari Son Espases, Palma de Mallorca, Balearic Islands, Spain
| | - Soledad Ojeda
- Servicio de Cardiología, Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | - Ana Serrador
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - Ramón López-Palop
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
| | - Javier Martín-Moreiras
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - José Ramón Rumoroso
- Servicio de Cardiología, Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain
| | - Ángel Cequier
- Servicio de Cardiología, Hospital de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Borja Ibáñez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), Madrid, Spain; Servicio de Cardiología, IIS-Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Ignacio Cruz-González
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain
| | - Rafael Romaguera
- Servicio de Cardiología, Hospital de Bellvitge-IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sergio Raposeiras
- Servicio de Cardiología, Hospital Universitario Álvaro Cunqueiro, Instituto de Investigación Sanitaria Galicia Sur, Vigo, Pontevedra, Spain
| | - Raúl Moreno
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Hospital de La Paz, Madrid, Spain
| |
Collapse
|
|
26
|
Batra G, Aktaa S, Wallentin L, Maggioni AP, Ludman P, Erlinge D, Casadei B, Gale CP. Data standards for acute coronary syndrome and percutaneous coronary intervention: the European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart). Eur Heart J 2022; 43:2269-2285. [PMID: 35380662 PMCID: PMC9209007 DOI: 10.1093/eurheartj/ehac133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 02/14/2022] [Accepted: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Standardized data definitions are essential for monitoring and benchmarking the quality of care and patient outcomes in observational studies and randomized controlled trials. There are no contemporary pan-European data standards for the acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). The European Unified Registries for Heart Care Evaluation and Randomised Trials (EuroHeart) project of the European Society of Cardiology (ESC) aimed to develop such data standards for ACS and PCI. Following a systematic review of the literature on ACS and PCI data standards and evaluation of contemporary ACS and PCI registries, we undertook a modified Delphi process involving clinical and registry experts from 11 European countries, as well as representatives from relevant ESC Associations, including the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and Acute CardioVascular Care (ACVC). This resulted in final sets of 68 and 84 'mandatory' variables and several catalogues of optional variables for ACS and PCI, respectively. Data definitions were provided for these variables, which have been programmed as the basis for continuous registration of individual patient data in the online EuroHeart IT platform. By means of a structured process and the interaction with major stakeholders, internationally harmonized data standards for ACS and PCI have been developed. In the context of the EuroHeart project, this will facilitate country-level quality of care improvement, international observational research, registry-based randomized trials, and post-marketing surveillance of devices and pharmacotherapies.
Collapse
Affiliation(s)
- Gorav Batra
- Department of Medical Sciences Cardiology and Uppsala Clinical Research Center Uppsala UniversityUppsalaSweden
| | - Suleman Aktaa
- Leeds Institute of Cardiovascular and Metabolic Medicine University of LeedsLeedsUK
- Leeds Institute for Data Analytics University of LeedsLeedsUK
- Department of Cardiology Leeds Teaching Hospitals NHS TrustLeedsUK
| | - Lars Wallentin
- Department of Medical Sciences Cardiology and Uppsala Clinical Research Center Uppsala UniversityUppsalaSweden
| | - Aldo P Maggioni
- Italian Association of Hospital Cardiologists Research Center (ANMCO)FlorenceItaly
| | - Peter Ludman
- Institute of Cardiovascular Sciences University of BirminghamBirminghamUK
| | - David Erlinge
- Department of Cardiology Skåne University Hospital Lund UniversityLundSweden
| | - Barbara Casadei
- Division of Cardiovascular Medicine NIHR Oxford Biomedical Research Centre University of OxfordOxfordUK
| | - Chris P Gale
- Leeds Institute of Cardiovascular and Metabolic Medicine University of LeedsLeedsUK
- Leeds Institute for Data Analytics University of LeedsLeedsUK
- Department of Cardiology Leeds Teaching Hospitals NHS TrustLeedsUK
| | | |
Collapse
|
|
27
|
Baldi E, Camporotondo R, Gnecchi M, Totaro R, Guida S, Costantino I, Repetto A, Savastano S, Sacchi MC, Bollato C, Giglietta F, Oltrona Visconti L, Leonardi S. Barriers associated with emergency medical service activation in patients with ST-segment elevation acute coronary syndromes. Intern Emerg Med 2022; 17:1165-1174. [PMID: 34826051 PMCID: PMC8616749 DOI: 10.1007/s11739-021-02894-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 11/13/2021] [Indexed: 11/12/2022]
Abstract
Many ST-segment elevation acute coronary syndrome (STEACS) patients fail to activate the Emergency Medical System (EMS), with possible dramatic consequences. Prior studies focusing on barriers to EMS activation included patients with any acute coronary syndrome (ACS) without representation of southern European populations. We aimed to investigate the barriers to EMS call for patients diagnosed for STEACS in Italy. A prospective, single-center, survey administered to all patients treated with primary percutaneous coronary intervention for STEACS in a tertiary hospital in northern Italy from 01/06/2018 to 31/05/2020. The questionnaire was filled out by 293 patients. Of these, 191 (65.2%) activated the EMS after symptoms onset. The main reasons for failing to contact EMS were the perception that the symptoms were unrelated to an important health problem (45.5%) and that a private vehicle is faster than EMS to reach the hospital (34.7%). Patients who called a private doctor after symptoms onset did not call EMS more frequently than those who did not and 30% of the patients who did not call the EMS would still act in the same way if a new episode occurred. Previous history of cardiovascular disease was the only predictor of EMS call. Information campaigns are urgently needed to increase EMS activation in case of suspected STEACS and should be primary focused on patients without cardiovascular history, on the misperception that a private vehicle is faster than EMS activation, and on the fact that cardiac arrest occurs early and may be prevented by EMS activation.
Collapse
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy.
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Rita Camporotondo
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimiliano Gnecchi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Rossana Totaro
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefania Guida
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Ilaria Costantino
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Repetto
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maria Clara Sacchi
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carola Bollato
- Anestesia E Rianimazione II Cardiopolmonare, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giglietta
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
| | | | - Sergio Leonardi
- Department of Molecular Medicine, Section of Cardiology, c/o Fondazione IRCCS Policlinico San Matteo, University of Pavia, Viale Golgi 19, 27100, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
|
28
|
Falco L, Fabris E, Gregorio C, Pezzato A, Milo M, Massa L, Lardieri G, Korcova R, Cominotto F, Vitrella G, Rakar S, Perkan A, Sinagra G. Early prognostic stratification and identification of irreversibly shocked patients despite primary percutaneous coronary intervention. J Cardiovasc Med (Hagerstown) 2022; 23:247-253. [PMID: 34907143 PMCID: PMC10414156 DOI: 10.2459/jcm.0000000000001282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 10/18/2021] [Accepted: 10/31/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite prognostic improvements in ST-elevation myocardial infarction (STEMI), patients presenting with cardiogenic shock (CS) have still high mortality. Which are the relevant early prognostic factors despite revascularization in this high-risk population is poorly investigated. METHODS We analyzed STEMI patients treated with primary percutaneous coronary intervention (PCI) and enrolled at the University Hospital of Trieste between 2012 and 2018. A decision tree based on data available at first medical contact (FMC) was built to stratify patients for 30-day mortality. Multivariate analysis was used to explore independent factors associated with 30-day mortality. RESULTS Among 1222 STEMI patients consecutively enrolled, 7.5% presented with CS. CS compared with no-CS patients had worse 30-day mortality (33% vs 3%, P < 0.01). Considering data available at FMC, CS patients with a combination of age ≥76 years, anterior STEMI and an expected ischemia time > 3 h and 21 min were at the highest mortality risk, with a 30-day mortality of 85.7%. In CS, age (OR 1.246; 95% CI 1.045-1,141; P = 0.003), final TIMI flow 2-3 (OR 0.058; 95% CI 0.004-0.785; P = 0.032) and Ischemia Time (OR = 1.269; 95% CI 1.001-1.609; P = 0.049) were independently associated with 30-day mortality. CONCLUSIONS In a contemporary real-world population presenting with CS due to STEMI, age is a relevant negative factor whereas an early and successful PCI is positively correlated with survival. However, a subgroup of elderly patients had severe prognosis despite revascularization. Whether pPCI may have an impact on survival in a very limited number of irreversibly critically ill patients remains uncertain and the identification of irreversibly shocked patients remains nowadays challenging.
Collapse
Affiliation(s)
| | | | - Caterina Gregorio
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste
| | | | | | | | - Gerardina Lardieri
- Division of Cardiology, Emergency Department, Gorizia–Monfalcone Hospital
| | | | - Franco Cominotto
- Emergency Department, University Hospital of Trieste, Trieste, Italy
| | | | | | | | | |
Collapse
|
|
29
|
Namazi MH, Mazloomi SS, Kalate Aghamohammadi M. Correlation Between TIMI Risk Score and the Number of Vessels Involved in the Angiographic Study; a Cross-sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2022; 10:e16. [PMID: 35402992 PMCID: PMC8986490 DOI: 10.22037/aaem.v10i1.1466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction TIMI (Thrombolysis in Myocardial Infarction) score is a model for predicting the severity of vascular diseases. This study aimed to evaluate the correlation between this score and the number of vessels involved in patients with Unstable Angina (UA) or Non-ST Elevation Myocardial Infarction (NSTEMI). Methods This prospective cross-sectional study was designed to evaluate the correlation between TIMI score, and the number of vessels involved in the angiographic study of NSTEMI and UA patients presenting to emergency department. Results 297 patients with the mean age of 62.16±36.59 years were entered (58.2% male; 193 (65%) UA and 104 (35%) NSTEMI). The Mean TIMI score among patients was 3.21±1.55. Based on the TIMI score, patients were categorized into 3 groups. 105 (35.35%) patients had a TIMI score of 0 to 2, 120 (40.40%) had a score of 3 to 4, and 72 (24.24%) had a score of 5 to 7. Patients with a TIMI score of 5 to 7 had a greater likelihood of three-vessel coronary artery disease compared to patients with a TIMI score of 3 to 4 (OR: 5.34, 95% CI: 2.64 to 10.80; p < 0.0001) or those with a TIMI score of 0 to 2. (OR: 29.45, 95% CI: 12.87 to 67.37; p < 0.0001). Two-vessel coronary artery disease was more likely to be found in patients with a TIMI score of 3 to 4 or those with a score of 5 to 7 compared to patients with a TIMI score of 0 to 2 (OR: 3.69, 95% CI: 1.60 to 8.51; p <0.0001 and OR: 2.67, 95% CI: 1.04 to 6.82; p = 0.04, respectively). Conclusion There is a direct and significant correlation between TIMI score and the number of coronary vessels involved in patients presenting to emergency department following UA or NSTEMI.
Collapse
Affiliation(s)
- Mohammad Hasan Namazi
- Department of Cardiology, Moddares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyede Salimeh Mazloomi
- Department of Cardiology, Moddares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. ,Corresponding Author: Seyede Salimeh Mazloomi; Department of Cardiology, Moddares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: , Tel: +98-9122966448
| | - Mohammad Kalate Aghamohammadi
- Department of Internal Medicine, Shohadaye Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
|
30
|
Oliveira L, Campante Teles R, Machado C, Madeira S, Vale N, Almeida C, Brito J, Leal S, Raposo L, de Araújo Gonçalves P, Pacheco AM, Mesquita Gabriel H, Almeida M, Martins D, Mendes M. Worrisome trends of ST-elevation myocardial infarction during the Covid-19 pandemic: Data from Portuguese centers. Rev Port Cardiol 2022; 41:465-471. [PMID: 35194311 PMCID: PMC8849835 DOI: 10.1016/j.repc.2021.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/10/2021] [Indexed: 01/08/2023] Open
Affiliation(s)
- Luís Oliveira
- Hospital do Divino Espírito Santo, Ponta Delgada, Portugal.
| | | | - Carina Machado
- Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | | | - Nélson Vale
- Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Carla Almeida
- Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | - João Brito
- Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Sílvio Leal
- Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Luís Raposo
- Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | | | | | | | - Manuel Almeida
- Hospital de Santa Cruz, CHLO, Carnaxide, Portugal; CEDOC, Nova Medical School, UNL, Lisboa, Portugal
| | - Dinis Martins
- Hospital do Divino Espírito Santo, Ponta Delgada, Portugal
| | | |
Collapse
|
|
31
|
Skowerski T, Nabrdalik K, Kwiendacz H, Pajak M, Mizia-Stec K, Gasior Z, Gumprecht J. Angiopoietin-2 as a biomarker of non-ST-segment elevation myocardial infarction in patients with or without type 2 diabetes. Arch Med Sci 2022; 18:624-631. [PMID: 35591833 PMCID: PMC9102672 DOI: 10.5114/aoms.2019.89201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/13/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Angiopoietin-2 (Ang-2) is a novel marker of coronary artery disease (CAD) and diabetes (DM). The aim was to evaluate Ang-2 as a potential new biomarker of non-ST elevation myocardial infarction (NSTEMI) in patients with or without type 2 DM (T2DM). MATERIAL AND METHODS This was a multi-center, prospective study that included 138 (males: 91/66%) consecutive patients hospitalized due to NSTEMI, T2DM, or different cardiac disorders. The subjects were divided into four study groups: group A: 28 patients with NSTEMI and T2DM; group B: 47 patients with NSTEMI without T2DM; group C: 31 patients with T2DM, without a history of CAD; group D: 32 patients as a control group. Patients with NSTEMI underwent urgent coronarography. Clinical characteristics including biomarkers (hs-CRP, hsTnT, NT-proBNP, VEGF, HbA1c), SYNTAX SCORE, type of intervention (PCI vs. CABG), and number of implanted stents were taken into account in the analysis. RESULTS Serum Ang-2 concentrations were significantly higher in patients with NSTEMI (group A: 1769 pg/ml; group B: 1757 pg/ml) and patients with T2DM (group C: 1993 pg/ml) as compared to the patients without CAD and without T2DM (group D: 866.8 pg/ml; p < 0.05). The prognostic accuracy of Ang-2 in NSTEMI diagnosis was determined with the area under the ROC curve (area under curve (AUC) = 0.63). CONCLUSIONS Angiopoietin-2 serum concentration is elevated in the presence of NSTEMI in patients with and without T2DM and does not correspond to the degree of myocardial injury and hemodynamic status. Ang-2 remains elevated also in patients with T2DM without a history of CAD.
Collapse
Affiliation(s)
- Tomasz Skowerski
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Katarzyna Nabrdalik
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
| | - Hanna Kwiendacz
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
| | - Maciej Pajak
- Roslin Institute, Midlothian, Edinburgh, United Kingdom of Great Britain & Northern Ireland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Zbigniew Gasior
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Zabrze, Poland
| |
Collapse
|
|
32
|
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
|
|
33
|
Li MF, Wei ZT, Li S, Feng QM, Li JB. Association of Mild Thyroid Dysfunction and Adverse Prognosis Among Chinese Patients With Acute ST Segment Elevation Myocardial Infarction. Front Endocrinol (Lausanne) 2022; 13:879443. [PMID: 35574034 PMCID: PMC9097552 DOI: 10.3389/fendo.2022.879443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Thyroid hormones widely affect the cardiovascular system, but the effects of mild thyroid dysfunction on the clinical prognosis of patients with acute ST segment elevation myocardial infarction (STEMI) remains unclear. Our aims were to analyze the relations between mild thyroid dysfunction at admission and clinical outcomes in Chinese patients with STEMI. METHODS A total of 1,176 STEMI patients with the available data of thyroid function and follow-up were analyzed, including 348 patients with mild thyroid dysfunction [subclinical hypothyroidism (n=81), hyperthyroidism (SHyper) (n=51), and low triiodothyronine syndrome (LT3S) (n=216)] and 828 patients with euthyroid function. During a median 4.4-year follow-up, in-hospital mortality, cardiac and all-cause mortalities were subsequently compared among the four groups. RESULTS Compared with the euthyroid group, STEMI patients in the SHyper and LT3S groups faced obviously increased risks of in-hospital death [odds ratio (OR): 5.007, 95% confidence interval (CI): 1.246-20.124, p = 0.023 and OR: 2.491, 95% CI: 1.054-5.887, p = 0.037, respectively) even after adjustment for various confounding factors. During a median 4.4-year follow-up, STEMI patients with LT3S at baseline had higher cardiovascular mortality [hazard ratio (HR): 1.880, 95% CI: 1.178-2.998, p = 0.008] and all-cause mortality HR: 1.647, 95% CI: 1.072-2.531, p = 0.023] than those with euthyroid at baseline, whereas no significantly increased mortality was found for STEMI patients with SCH and SHyper at baseline. CONCLUSIONS STEMI patients with SHyper at admission had increased risk of in-hospital mortality, and STEMI patients with LT3S at baseline had worse prognosis and higher incidences of in-hospital mortality and cardiovascular and all-cause deaths compared with euthyroid patients.
Collapse
Affiliation(s)
- Mei-Fang Li
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Ze-Tao Wei
- Department of Emergency, Dan Zhou People’s Hospital, Dan Zhou, China
| | - Shuai Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qi-Ming Feng
- Department of Emergency, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Qi-Ming Feng, ; Jing-Bo Li,
| | - Jing-Bo Li
- Department of Cardiology, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- *Correspondence: Qi-Ming Feng, ; Jing-Bo Li,
| |
Collapse
|
|
34
|
Rodríguez-Leor O, Cid-Álvarez AB, Pérez de Prado A, Rosselló X, Ojeda S, Serrador A, López-Palop R, Martín-Moreiras J, Rumoroso JR, Cequier Á, Ibáñez B, Cruz-González I, Romaguera R, Raposeiras S, Moreno R. Análisis de la atención al infarto con elevación del segmento ST en España. Resultados del Registro de Código Infarto de la ACI-SEC. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
|
35
|
Nuevos stents farmacoactivos para mejorar la función endotelial y microvascular coronaria en el IAMCEST. Rev Esp Cardiol (Engl Ed) 2021. [DOI: 10.1016/j.recesp.2021.06.005] [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]
|
|
36
|
Zeymer U, Ludman P, Danchin N, Kala P, Laroche C, Sadeghi M, Caporale R, Shaheen SM, Legutko J, Iakobsishvili Z, Alhabib KF, Motovska Z, Studencan M, Mimoso J, Becker D, Alexopoulos D, Kereseselidze Z, Stojkovic S, Zelveian P, Goda A, Mirrakhimov E, Bajraktari G, Al-Farhan H, Šerpytis P, Raungaard B, Marandi T, Moore AM, Quinn M, Karjalainen PP, Tatu-Chitolu G, Gale CP, Maggioni AP, Weidinger F. Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology. Eur Heart J 2021; 42:4536-4549. [PMID: 34389857 DOI: 10.1093/eurheartj/ehab342] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/18/2021] [Accepted: 06/05/2021] [Indexed: 02/05/2023] Open
Abstract
AIMS The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1-70.1%) for timely reperfusion. CONCLUSIONS The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.
Collapse
Affiliation(s)
- Uwe Zeymer
- Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Bremserstraße 79, 67063 Ludwigshafen am Rhein, Germany
| | - Peter Ludman
- Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston 1, Birmingham, B15 2TT, United Kingdom
| | - Nicolas Danchin
- Hôpital Européen Georges Pompidou, Service de Cardiologie, 20 Rue Leblanc, 75015 Paris, France
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University, Dept of Internal Medicine and Cardiology, Kamenice 5, 625 00 Bohunice, Brno, Czech Republic
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, European Heart House, 2035 Route des Colles, Sophia Antipolis, France
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Shahid Rahmani Alley, Moshtagh Sevom Street, Isfahan, Iran
| | - Roberto Caporale
- Interventional Cardiology Unit, Annunziata Civil Hospital, Via Migliori 1, 87100 Cosenza, Italy
| | | | - Jacek Legutko
- Jagiellonian University Medical College; Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | | | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Zuzana Motovska
- Cardiocenter, Third Faculty of Medicine Charles Univ. and Univ. Hospital Kralovske Ruská 2411, 100 00 Praha 10-Vinohrady, Czech Republic
| | - Martin Studencan
- Teaching Hospital of J.A. Reiman, Cardiocentre Prešov, Jána Hollého 5898/14, 081 81 Prešov, Slovakia
| | - Jorge Mimoso
- Centro Hospitalar e Universitário do Algarve, R. Leao Penedo, 8000-386 Faro, Portugal
| | - David Becker
- Deputy-Director of the Heart and Vascular Center of Semmelweis University, Gaál József út 9, 1122 Budapest, Hungary
| | - Dimitrios Alexopoulos
- National and Kapodistrian University of Athens, Attikon University Hospital, Rimini 1, Chaidari 124 62, Greece
| | - Zviad Kereseselidze
- Chapidze Emergency Cardiology Center, 0159, Didube-Chugureti District, Nino Javakhishvili str., Tbilisi, Georgia
| | - Sinisa Stojkovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia. Department of Cardiology, Clinical Center of Serbia, Pasterova 2, Beograd 11000 Belgrade, Serbia
| | - Parounak Zelveian
- Scientific Research Institute of Cardiology named after Levon Hovhannisyan, 0014, Yerevan, Paruyr Sevaki St., 5 Building (Kanaker-Zeytun adm. district), Yerevan, Armenia
| | - Artan Goda
- Cardiology I & Cardiology II, University Hospital Center Mother Theresa, Rruga e Dibrës 372 Tirana AL, 1000, Albania
| | - Erkin Mirrakhimov
- Kyrgyz State Medical Academy, 92 Akhunbayev St, Bishkek, Kyrgyzstan
- National Center of Cardiology and Internal Medicine, Togolok Moldo Str., 720040, Bishkek, Kyrgyzstan
| | - Gani Bajraktari
- Medical Faculty, University of Prishtina "Hasan Prishtina", University Clinical Centre of Kosova, Pristina 10000, Kosovo
| | - Hasan Al-Farhan
- Iraqi Scientific Council of Cardiology, Baghdad Heart Center, Medical City, Baghdad, Iraq
| | - Pranas Šerpytis
- Vilnius University Faculty of Medicine Hospital Santaros Klinikos, 08406, Santariškių g. 2, Vilnius 08410, Lithuania
| | - Bent Raungaard
- Aalborg University Hospital, Department of Cardiology, Hobrovej 18-22, 9100 Aalborg, Denmark
| | - Toomas Marandi
- North Estonia Medical Centre, J. Sütiste tee 19, 13419 Tallinn, Estonia
| | - Alice May Moore
- Mater Dei Hospital, Triq Dun Karm, L-Imsida, MSD2090 Msida, Malta
| | - Martin Quinn
- St Vincent's University Hospital, Merrion Rd, Dublin 4, D04 N2E0, Ireland
| | | | - Gabriel Tatu-Chitolu
- Spitalul Clinic de Urgenta "Floreasca", Calea Floreasca 8, București 014461, Romania
| | - Chris P Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds School of Medicine, Worsley Building, University of Leeds, LS2 9JT Leeds, UK
| | - Aldo P Maggioni
- EURObservational Research Programme, European Society of Cardiology, European Heart House, 2035 Route des Colles, Sophia Antipolis, France
- Maria Cecilia Hospital, GVM Care & Research, Via Corriera, 1, 48033 Cotignola RA, Italy
| | | | | |
Collapse
|
|
37
|
Aitavaara-Anttila MK, Pernu HH, Rumpunen TK, Similä JPO, Liisanantti JH, Kaakinen TI, Erkinaro TM, Raatiniemi LV. Factors associated with time delay to angiography in acute ST-elevation myocardial infarction - A retrospective cohort study in Northern Finland. Australas Emerg Care 2021; 25:213-218. [PMID: 34782298 DOI: 10.1016/j.auec.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The delay of percutaneous coronary intervention increases the risk of heart failure and mortality in STEMI. The aim of this study was to examine the time intervals of EMS and the factors associated with the time delay to angiography in patients with STEMI. METHODS The present study was conducted in Northern Ostrobothnia, Finland in 2014-2016. All patients transported to the hospital by EMS who were diagnosed with STEMI and underwent a primary angiography within 24 h of arrival were included. Angiography was defined as delayed if it was performed over 120 min of the first medical contact (FMC). RESULTS 310 patients met the inclusion criteria during the study period. Time from the FMC to angiography was less than 120 min in 231 patients (74.5%). In multivariate analysis, the factors associated with delayed angiography were the absence of chest pain (OR 2.46 (1.18-5.13),p = 0.016), dyspnea (OR 3.11 (1.54-6.28),p = 0.002), the treatment protocol violations by EMS (OR 2.41 (0.99-5.80),p = 0.050), treatment initiation at a primary health care center (OR 3.64 (1.39-9.48),p = 0.008), and the distance to hospital of over 100 km (OR 11.87 (6.14-22.93),p < 0.001). CONCLUSION In our study, treatment protocol violations, non-specific symptoms, and the distance to hospital of over 100 km were associated with primary angiography in patients with STEMI transported to the hospital by EMS.
Collapse
Affiliation(s)
- Mia K Aitavaara-Anttila
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Rovaniemi Health Center, Rovaniemi, Finland.
| | | | | | - Jani P O Similä
- Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Janne H Liisanantti
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Tiina M Erkinaro
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Lasse V Raatiniemi
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
|
38
|
Zorkoltseva I, Shadrina A, Belonogova N, Kirichenko A, Tsepilov Y, Axenovich T. In silico genome-wide gene-based association analysis reveals new genes predisposing to coronary artery disease. Clin Genet 2021; 101:78-86. [PMID: 34687547 DOI: 10.1111/cge.14073] [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: 07/19/2021] [Revised: 09/29/2021] [Accepted: 10/13/2021] [Indexed: 11/30/2022]
Abstract
Genome-wide association study (GWAS) have identified more than 300 single nucleotide polymorphisms at 163 independent loci associated with coronary artery disease (CAD). However, there is no full understanding about the causal genes for CAD and the mechanisms of their action. We aimed to perform a post GWAS analysis to identify genes whose polymorphism may influence the risk of CAD. Using the UK Biobank GWAS summary statistics, we performed a gene-based association analysis. We found 63 genes significantly associated with CAD due to their within-gene polymorphisms. Many of these genes are well known. Some known CAD genes such as FURIN and SORT1 did not show the gene-based association because their variants had low GWAS signals or gene-based association was inflated by the strong GWAS signal outside the gene. For several known CAD genes, we demonstrated that their effects could be explained not only or not at all by their own variants but by the variants within the neighboring genes controlling their expression. Using several bioinformatics techniques, we suggested potential mechanisms underlying gene-CAD associations. Three genes, CDK19, NCALD, and ARHGEF12 were not previously associated with CAD. The role of these genes should be clarified in further studies.
Collapse
Affiliation(s)
- Irina Zorkoltseva
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Alexandra Shadrina
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Nadezhda Belonogova
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Anatoly Kirichenko
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia
| | - Yakov Tsepilov
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia.,Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| | - Tatiana Axenovich
- Laboratory of Recombination and Segregation Analysis, Institute of Cytology and Genetics, Novosibirsk, Russia.,Department of Natural Sciences, Novosibirsk State University, Novosibirsk, Russia
| |
Collapse
|
|
39
|
Liu WC, Lin CS, Tsai CS, Tsao TP, Cheng CC, Liou JT, Lin WS, Cheng SM, Lou YS, Lee CC, Lin C. A deep learning algorithm for detecting acute myocardial infarction. EUROINTERVENTION 2021; 17:765-773. [PMID: 33840640 PMCID: PMC9724911 DOI: 10.4244/eij-d-20-01155] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delayed diagnosis or misdiagnosis of acute myocardial infarction (AMI) is not unusual in daily practice. Since a 12-lead electrocardiogram (ECG) is crucial for the detection of AMI, a systematic algorithm to strengthen ECG interpretation may have important implications for improving diagnosis. AIMS We aimed to develop a deep learning model (DLM) as a diagnostic support tool based on a 12-lead electrocardiogram. METHODS This retrospective cohort study included 1,051/697 ECGs from 737/287 coronary angiogram (CAG)-validated STEMI/NSTEMI patients and 140,336 ECGs from 76,775 non-AMI patients at the emergency department. The DLM was trained and validated in 80% and 20% of these ECGs. A human-machine competition was conducted. The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the performance of the DLM. RESULTS The AUC of the DLM for STEMI detection was 0.976 in the human-machine competition, which was significantly better than that of the best physicians. Furthermore, the DLM independently demonstrated sufficient diagnostic capacity for STEMI detection (AUC=0.997; sensitivity, 98.4%; specificity, 96.9%). Regarding NSTEMI detection, the AUC of the combined DLM and conventional cardiac troponin I (cTnI) increased to 0.978, which was better than that of either the DLM (0.877) or cTnI (0.950). CONCLUSIONS The DLM may serve as a timely, objective and precise diagnostic decision support tool to assist emergency medical system-based networks and frontline physicians in detecting AMI and subsequently initiating reperfusion therapy.
Collapse
Affiliation(s)
- Wen-Cheng Liu
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin-Sheng Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chien-Sung Tsai
- Division of Cardiovascular Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Tien-Ping Tsao
- Division of Cardiology, Heart Centre, Cheng Hsin Hospital, Taipei, Taiwan, R.O.C
| | - Cheng-Chung Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Jun-Ting Liou
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Wei-Shiang Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Shu-Meng Cheng
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Yu-Sheng Lou
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chia-Cheng Lee
- Planning and Management Office, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C,Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Chin Lin
- No.161 Min-Chun E. Rd, Sec. 6, Neihu, Taipei 114, Taiwan, R.O.C
| |
Collapse
|
|
40
|
Minucci GS, Reis SMD. Acute Myocardial Infarction and Percutaneous Coronary Intervention: What does the Epidemiological Data of the Last Years Indicate? INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.36660/ijcs.20200256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
|
41
|
Chacón-Díaz M, Hernández-Vásquez A, Vargas-Fernández R, Bendezu-Quispe G. Study protocol of the PEruvian Registry of ST-segment Elevation Myocardial Infarction II (PERSTEMI-II) study. PLoS One 2021; 16:e0257618. [PMID: 34534262 PMCID: PMC8448363 DOI: 10.1371/journal.pone.0257618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Myocardial infarction (MI) is the most prevalent cardiovascular disease globally and is considered a public health problem. In Peru, MI is the second leading cause of death at the national level, with a mortality rate that exceeds 10% in the hospital setting. The study aims to determine the clinical and epidemiological characteristics of ST-segment elevation myocardial infarction (STEMI) in tertiary care facilities belonging to the Peruvian public health system. METHODS AND ANALYSIS This will be a prospective, observational, multicenter study, with baseline and two follow-up assessments: at admission to the health service, and 30 days and 12 months after admission. This multicenter study will be conducted in 27 hospitals located in the main cities of Peru. The patients included in the study will be over 18 years of age, of either sex, and will have been admitted to the health facility with a diagnosis of acute coronary syndrome with ST-segment elevation. The Kaplan-Meier method will be used to estimate the cumulative in-hospital mortality of patients at 30 days and 12 months of follow-up, and the log-rank test will be used to evaluate the differences between the survival curves between reperfused and non-reperfused patients. Subsequently, to evaluate the risk factors for successful reperfusion and cardiovascular adverse events, generalized linear models of the binomial family with log link function will be used to estimate the bivariate and multivariate relative risk (RR) with their respective 95% confidence intervals. This project was approved by the Ethics and Research Committee of the National Cardiovascular Institute (Instituto Nacional Cardiovascular "Carlos Alberto Peschiera Carrillo"-INCOR [in Spanish]; Approval report 21/2019-CEI). DISCUSSION Among the strengths, the observational design will allow the inclusion of a large sample of patients, which will significantly contribute to the knowledge base on STEMI in Peru. It should be noted that this study is the first to examine the clinical-epidemiological characteristics of STEMI in high-resolution hospital centers in Peru with follow-up one year after the event, providing knowledge of these observable characteristics in daily clinical routine. Likewise, the multicenter nature of the study will increase the external validity of the findings. In terms of limitations, the observational design of the study can only describe associations and not causality. Furthermore, since data from medical records will be used, there could be imprecision in the data.
Collapse
Affiliation(s)
| | - Akram Hernández-Vásquez
- Vicerrectorado de Investigación, Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | | | - Guido Bendezu-Quispe
- Centro de Investigación Epidemiológica en Salud Global, Universidad Privada Norbert Wiener, Lima, Peru
| |
Collapse
|
|
42
|
Zhang Y, Tian Y, Dong P, Xu Y, Yu B, Li H, Li J, Ge J, Sun Y, Wang J, Wang L, Chen J, Yan H, Chen Y, Han Y, Huo Y. Treatment delay and reperfusion management of acute ST-segment elevation myocardial infarction: analysis of the China STEMI Care Project Phase 1. QJM 2021; 114:299-305. [PMID: 32569364 DOI: 10.1093/qjmed/hcaa186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The China ST-segment elevation myocardial infarction (STEMI) Care Project (CSCAP) was launched in 2011 to address the problems of insufficient reperfusion and long treatment delay in STEMI care in China. AIM To describe the baseline status of STEMI emergency care in Tertiary PCI Hospitals using Phase 1 (CSCAP-1) data. DESIGN CSCAP-1 is a prospective multi-center STEMI registry. METHODS AND RESULTS A total of 4191 patients with symptom onset within 12 or 12-36 h requiring primary percutaneous coronary intervention (PCI), were enrolled from 53 tertiary PCI hospitals in 14 provinces, municipalities, and autonomous regions of China in CSCAP-1. Among them, 49.0% were self-transported to the hospital, 26.5% were transferred to the hospital by calling the emergency medical services directly, and 24.5% were transferred from other hospitals. In patients with symptom onset within 12 h, 83.2% received primary PCI, 5.9% received thrombolysis and 10.9% received conservative medications. The median door-to-balloon time was 115 (85-170) min and the median door-to-needle time for in-hospital thrombolysis was 80 (50-135) min. The overall in-hospital all-cause mortality was 2.4%, while it was 5.3% in the non-reperfusion group and 2.1% in the reperfusion group (P < 0.001). CONCLUSION Although a long treatment delay and a high proportion of patients transporting themselves to the hospital were observed, trends were positive with greater adoption of primary PCI and lower in-hospital mortality in tertiary hospitals in China. Our results provided important information for further integrated STEMI network construction in China.
Collapse
Affiliation(s)
- Y Zhang
- Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| | - Y Tian
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, 199 Dazhi Street, Nangang District, Harbin 150001, Heilongjiang Province, China
| | - P Dong
- Department of Cardiology, The First Affiliated Hospital of Henan University of Science and Technology, 24 Jinghua Road, Jianxi District, Luoyang 471003, Henan Province, China
| | - Y Xu
- Department of Cardiology, Tenth People's Hospital of Tongji University, 301 Yanchang Middle Road, Jingan District, Shanghai 200072, China
| | - B Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, 246 Xuefu Road, Nangang District, Harbin 150086, Heilongjiang Province, China
| | - H Li
- Department of Cardiology, Daqing Oilfield General Hospital, 9 Zhongkang Street, Sartu District, Daqing 163001, Heilongjiang Province, China
| | - J Li
- Department of Cardiology, Qilu Hospital of Shandong University, 107 Wenhua West Road, Lixia District, Jinan 250012, Shandong Province, China
| | - J Ge
- Department of Cardiology, Zhongshan Hospital Fudan University, 180 Fenglin Road, Xuhui District, Shanghai 200032, China
| | - Y Sun
- Department of Cardiology, Shanxi Datong Coal Group General Hospital, 5999 Herui Street, Hengan New District, Datong 037003, Shanxi Province, China
| | - J Wang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University, 88 Jiefang Road, Shangcheng District, Hangzhou 310009, Zhejiang Province, China
| | - L Wang
- Department of Cardiology, Beijing Chao-yang Hospital, 8 Gongti South Road, Chaoyang District, Beijing 100020, China
| | - J Chen
- Department of Cardiology, Guangdong General Hospital, 106 Zhongshan 2nd Road, Yuexiu District, Guangzhou 510080, Guangdong Province, China
| | - H Yan
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences, 167 Beilishi Road, Xicheng District, Beijing 100037, China
| | - Y Chen
- Department of Cardiology, Chinese PLA General Hospital, 28 Fuxing Road, Haidian District, Beijing 100036, China
| | - Y Han
- Department of Cardiology, General Hospital of Northern Theater Command of People's Liberation Army, 83 Wenhua Road, Shenhe District, Shenyang 110016, Liaoning Province, China
| | - Y Huo
- Department of Cardiology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing 100034, China
| |
Collapse
|
|
43
|
Liu Z, Liu L, Cheng J, Zhang H. Risk Prediction Model Based on Biomarkers of Remodeling in Patients with Acute Anterior ST-Segment Elevation Myocardial Infarction. Med Sci Monit 2021; 27:e927404. [PMID: 34282109 PMCID: PMC8306886 DOI: 10.12659/msm.927404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The aim of the present study was to develop a risk prediction model in patients with acute anterior ST-segment elevation myocardial infarction (STEMI). Material/Methods Clinical data from 333 patients with acute anterior STEMI were retrospectively analyzed. Clinical echocardiographic and angiographic data from patients with left ventricular remodeling (LVR) and those without LVR were compared. Factors that influenced risk were identified using multivariate logistic regression analysis. The area under the curve (AUC) of the receiver operating characteristic curve was used to assess the diagnostic performance of the model. Results After 6-month follow-up, 135 of the patients experienced LVR (LVR group), whereas 198 did not (non-LVR group). Results of multivariate analysis showed that the number of stenosed coronary vessels, left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), transforming growth factor-beta (TGF-β) at admission, and cardiac troponin I 3 days after admission (3-d cTnI) were all factors predictive of LVR in patients with acute anterior STEMI (all P<0.05). The established prediction model was Y=−20.639+0.711×number of stenosed coronary vessels + 0.137×LVEDV-0.129×LVEF+0.026×TGF-β at admission + 0.162×3-d cTnI. The estimated AUC of this model was 0.978 (95% confidence interval [CI] 0.955–0.991), significantly superior to the single-factor numbers for stenosed coronary vessel of 0.650 (95% CI 0.597–0.702), LVEDV of 0.876 (95% CI 0.836–0.910), LVEF of 0.684 (95% CI 0.631–0.734), TGF-β at admission of 0.696 (95% CI 0.644–0.745), cTnI at admission of 0.913 (95% CI 0.877–0.941), and 3-d cTnI of 0.945 (95% CI 0.914–0.967). Conclusions The established model had excellent diagnostic accuracy for predicting LVR in patients with acute anterior STEMI.
Collapse
Affiliation(s)
- Zeyan Liu
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland).,Chest Pain Center, Department of Emergency Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Lijun Liu
- Department of Emergency Medicine, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China (mainland)
| | - Jinglin Cheng
- Chest Pain Center, Department of Emergency Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| | - Hao Zhang
- Chest Pain Center, Department of Emergency Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China (mainland)
| |
Collapse
|
|
44
|
Novel drug-eluting stents to improve coronary endothelial and microvascular function in STEMI patients? ACTA ACUST UNITED AC 2021; 74:1003-1005. [PMID: 34238701 DOI: 10.1016/j.rec.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
|
|
45
|
Ogata S, Marume K, Nakai M, Kaichi R, Ishii M, Ikebe S, Mori T, Komaki S, Kusaka H, Toida R, Kurogi K, Iwanaga Y, Yano T, Yamamoto N, Miyamoto Y. Incidence Rate of Acute Coronary Syndrome Including Acute Myocardial Infarction, Unstable Angina, and Sudden Cardiac Death in Nobeoka City for the Super-Aged Society of Japan. Circ J 2021; 85:1722-1730. [PMID: 34121054 DOI: 10.1253/circj.cj-20-1207] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This study aimed to calculate incidence rates (IR) of acute coronary syndrome (ACS) including acute myocardial infarction (AMI), unstable angina (UAP), and sudden cardiac death (SCD) in Nobeoka city, Japan.Methods and Results:This was an observational study based on a city-wide comprehensive registration between 2015 and 2017 in Nobeoka city, Japan, using 2 databases: all patients with cardiogenic out-of-hospital cardiac arrest in Nobeoka city and hospitalized ACS patients from Miyazaki Prefectural Nobeoka Hospital in which all ACS patients in Nobeoka city were hospitalized except for possible rare cases of patients highly unlikely to be hospitalized elsewhere. The IRs of ACS based on the population size of Nobeoka city (125,000 persons), and their age-adjusted IRs by using the direct method and the 2015 model population of Japan were calculated. There were 260 eligible patients hospitalized with first-onset ACS (age [SD]=71.1 [12.4], 34.2% women) and 107 eligible SCD patients. Crude IRs of hospitalized ACS and SCD patients, and hospitalized AMI and SCD patients, respectively, were 130.2 (183.3 for men, 85.6 for women) and 107.5 (148.4 for men, 73.2 for women) per 100,000. Crude IRs of hospitalized ACS, AMI, and UAP patients, respectively, were 92.3 (132.8 for men, 58.1 for women), 69.6 (97.9 for men, 45.7 for women), and 22.7 (35.0 for men, 12.4 for women) per 100,000. CONCLUSIONS The calculated IRs can be useful in building a health strategy for treating ACS.
Collapse
Affiliation(s)
- Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center
| | - Kyohei Marume
- Miyazaki Prefectural Nobeoka Hospital.,Department of Sport Science, University of Innsbruck
| | - Michikazu Nakai
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Sou Ikebe
- Miyazaki Prefectural Nobeoka Hospital
| | | | | | | | | | | | - Yoshitaka Iwanaga
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| | | | | | - Yoshihiro Miyamoto
- Center for Cerebral and Cardiovascular Disease Information, National Cerebral and Cardiovascular Center
| |
Collapse
|
|
46
|
Dauw J, Martens P, Deferm S, Bertrand P, Nijst P, Hermans L, Van den Bergh M, Housen I, Hijjit A, Warnants M, Cottens D, Ferdinande B, Vrolix M, Dens J, Ameloot K, Dupont M, Mullens W. Left ventricular function recovery after ST-elevation myocardial infarction: correlates and outcomes. Clin Res Cardiol 2021; 110:1504-1515. [PMID: 34091698 DOI: 10.1007/s00392-021-01887-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/31/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Contemporary data on left ventricular function (LVF) recovery in patients with left ventricular dysfunction after ST-elevation myocardial infarction (STEMI) are scarce and to date, no comparison has been made with patients with a baseline normal LVF. This study examined predictors of LVF recovery and its relation to outcomes in STEMI. METHODS Patients presenting with STEMI between January 2010 and December 2016 were categorized in three groups after 3 months according to left ventricular ejection fraction (EF): (i) baseline normal LVF (EF ≥ 50% at baseline); (ii) recovered LVF (EF < 50% at baseline and ≥ 50% after 3 months); and (iii) reduced LVF (EF < 50% at baseline and after 3 months). Heart failure hospitalization, all-cause mortality and cardiovascular mortality were compared between the three groups. RESULTS Of 577 patients, 341 (59%) patients had a baseline normal LVF, 112 (19%) had a recovered LVF and 124 (22%) had a reduced LVF. Independent correlates of LVF recovery were higher baseline EF, lower peak troponin and cardiac arrest. After median 5.8 years, there was no difference in outcomes between patients with LVF recovery and baseline normal LVF. In contrast, even after multivariate adjustment, patients with persistently reduced LVF had a higher risk for heart failure hospitalization (HR 5.00; 95% CI 2.17-11.46) and all-cause mortality (HR 1.87; 95% CI 1.11-3.16). CONCLUSION In contemporary treated STEMI patients, prognosis is significantly worse in those with a persistently reduced LVF after 3 months, compared with patients with a baseline normal LVF and those with LVF recovery.
Collapse
Affiliation(s)
- Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium. .,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium.
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Sébastien Deferm
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Doctoral School for Medicine and Life Sciences, LCRC, UHasselt, Diepenbeek, Belgium
| | - Philippe Bertrand
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Petra Nijst
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Lowie Hermans
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mats Van den Bergh
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Isabel Housen
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Amin Hijjit
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Maarten Warnants
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Daan Cottens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Bert Ferdinande
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Mathias Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Jo Dens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Koen Ameloot
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Matthias Dupont
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600, Genk, Belgium.,Faculty of Medicine and Life Sciences, Biomedical Research Institute, LCRC, UHasselt, Diepenbeek, Belgium
| |
Collapse
|
|
47
|
Porto I, Mattesini A, D'Amario D, Sorini Dini C, Della Bona R, Scicchitano M, Vergallo R, Martellini A, Caporusso S, Trani C, Burzotta F, Bruno P, Di Mario C, Crea F, Valente S, Massetti M. Blood lactate predicts survival after percutaneous implantation of extracorporeal life support for refractory cardiac arrest or cardiogenic shock complicating acute coronary syndrome: insights from the CareGem registry. Intern Emerg Med 2021; 16:463-470. [PMID: 32772282 PMCID: PMC7952335 DOI: 10.1007/s11739-020-02459-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 07/22/2020] [Indexed: 11/29/2022]
Abstract
Refractory cardiogenic shock (RCS) or refractory cardiac arrest (RCA) complicating acute coronary syndrome (ACS) is associated with extremely high mortality rate. Veno-arterial extracorporeal life support (VA-ECLS) represents a valuable therapeutic option to stabilize patients' condition before or at the time of emergency revascularization. We analyzed 29 consecutive patients with RCS or RCA complicating ACS, and implanted with VA-ECLS in two centers who have adopted a similar, structured approach to ECLS implantation. Data were collected from January 2010 to December 2015 and ECLS had to be percutaneously implanted either before (within 48 h) or at the time of attempted percutaneous coronary revascularization (PCI). We investigated in-hospital outcome and factors associated with survival. Twenty-one (72%) were implanted for RCA, whereas 8 (28%) were implanted on ECLS for RCS. All RCA were witnessed and no-flow time was shorter than 5 min in all cases but one. All patients underwent attempted emergency PCI, using radial access in ten cases (34.5%), whereas in three patients a subsequent CABG was performed. Overall, ten patients (34.5%) survived, nine of them with a good neurological outcome. Life threatening complications, including stroke (4 pts), leg ischemia (4 pts), intestinal ischemia (5 pts), and deep vein thrombosis 2 pts), occurred frequently, but were not associated with in-hospital death. Main cause of death was multi-organ failure. PCI variables did not predict survival. Survivors were younger, with shorter low-flow time, and with ECLS mainly implanted for RCS. At multivariate analysis, levels of lactate at ECLS implantation (OR 4.32, 95%CI 1.01-18.51, p = 0.049) emerged as the only variable that independently predicted survival. In patients with RCA or RCS complicating ACS who are percutaneously implanted with ECLS before or at the time of coronary revascularization, in hospital survival rate is higher than 30%. Level of lactate at ECLS implantation appears to be the most important factor to predict survival.
Collapse
Affiliation(s)
- Italo Porto
- Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Italian IRCCS Cardiovascular Network, Genoa, Italy
- Dipartimento di Medicina Interna e Specialità Mediche (DiMI), Università di Genova, Genoa, Italy
| | - Alessio Mattesini
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Domenico D'Amario
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | | | - Roberta Della Bona
- Dipartimento CardioToracoVascolare, IRCCS Ospedale Policlinico San Martino, Genova, Italy, Italian IRCCS Cardiovascular Network, Genoa, Italy
| | | | - Rocco Vergallo
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Antonio Martellini
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | | | - Carlo Trani
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Francesco Burzotta
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Piergiorgio Bruno
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Carlo Di Mario
- Dipartimento del Cuore e dei Vasi, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Filippo Crea
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy
| | - Serafina Valente
- U.O.C. Cardiologia Ospedaliera, A.O.U. Senese Ospedale Santa Maria Alle Scotte, Siena, Italy
| | - Massimo Massetti
- Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy, Italian IRCCS Cardiovascular Network and Università Cattolica del Sacro Cuore, Largo A. Gemelli, 00168, Rome, Italy.
| |
Collapse
|
|
48
|
Willim HA, Harianto JC, Cipta H. Platelet-to-Lymphocyte Ratio at Admission as a Predictor of In-Hospital and Long-Term Outcomes in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis. Cardiol Res 2021; 12:109-116. [PMID: 33738014 PMCID: PMC7935631 DOI: 10.14740/cr1219] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 11/11/2022] Open
Abstract
Background ST-segment elevation myocardial infarction (STEMI) is the most severe form of acute coronary syndrome (ACS) which is associated with significant adverse outcomes. Platelet-to-lymphocyte ratio (PLR) is a novel inflammatory biomarker that has been used as a predictor of various cardiovascular diseases, including ACS. This meta-analysis aimed to investigate the prognostic value of PLR as a predictor of in-hospital and long-term outcomes in patients with STEMI undergoing primary percutaneous coronary intervention (PCI). Methods We performed a comprehensive systematic literature search in the databases of PubMed, ScienceDirect, Cochrane Library, and ProQuest for eligible studies. The primary outcomes were major adverse cardiac events (MACEs) and mortality, both in-hospital and long-term follow-up. The outcomes were compared between patients with high and low admission PLR. The quality assessment was conducted using the Newcastle-Ottawa scale. Review Manager 5.3 was used to perform the meta-analysis. Results Six cohort studies involving 4,289 STEMI patients undergoing primary PCI were included in this meta-analysis. The pooled analysis showed that a high PLR at admission was associated with increased in-hospital MACE (odds ratio (OR) = 1.94, 95% confidence interval (CI) = 1.56 - 2.40, P < 0.00001, I2 = 45%) and in-hospital mortality (OR = 2.07; 95% CI = 1.53 - 2.80; P < 0.00001; I2 = 50%), as well as increased long-term MACE (OR = 1.98; 95% CI = 1.31 - 3.00; P = 0.001; I2 = 72%) and long-term mortality (OR = 2.79; 95% CI = 1.45 - 5.36; P = 0.002; I2 = 83%). Conclusions In patients with STEMI undergoing primary PCI, a high PLR at admission predicts in-hospital MACE and mortality along with long-term MACE and mortality.
Collapse
Affiliation(s)
- Herick Alvenus Willim
- Department of Emergency Medicine, Dr. Agoesdjam Regional Public Hospital, Ketapang, West Kalimantan, Indonesia
| | - Joan Carmen Harianto
- Faculty of Medicine, Tanjungpura University, Pontianak, West Kalimantan, Indonesia
| | - Harie Cipta
- Department of Cardiology and Vascular Medicine, Dr. Agoesdjam Regional Public Hospital, Ketapang, West Kalimantan, Indonesia
| |
Collapse
|
|
49
|
Pereira H, Calé R, Pereira E, Mello S, Vitorino S, Jerónimo de Sousa P, Monteiro S, Pinto FJ, Ramos R, Coelho Dos Santos P, Ferreira J, Silveira J, Morais J. Five years of Stent for Life in Portugal. Rev Port Cardiol 2021; 40:81-90. [PMID: 33608197 DOI: 10.1016/j.repc.2020.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 04/26/2020] [Accepted: 05/05/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To analyze changes in performance indicators five years after Portugal joined the Stent for Life (SFL) initiative. METHODS National surveys were carried out annually over one-month periods designated as study Time Points between 2011 (Time Zero) and 2016 (Time Five). In this study, 1340 consecutive patients with suspected ST-elevation myocardial infarction (STEMI) who underwent coronary angiography, admitted to 18 24/7 primary percutaneous coronary intervention (PCI) centers, were enrolled. RESULTS There was a significant reduction in the proportion of patients who attended primary healthcare centers (20.3% vs. 4.8%, p<0.001) and non-PCI-capable centers (54.5% vs. 42.5%, p=0.013). The proportions of patients who called 112, the national emergency medical services (EMS) number (35.2% vs. 46.6%, p=0.022) and of those transported via the EMS to a PCI-capable center (13.1% vs. 30.5%, p<0.001) increased. The main improvement observed in timings for revascularization was a trend toward a reduction in patient delay (114 min in 2011 vs. 100 min in 2016, p=0.050). System delay and door-to-balloon time remained constant, at a median of 134 and 57 min in 2016, respectively. CONCLUSION During the lifetime of the SFL initiative in Portugal, there was a positive change in patient delay indicators, especially the lower proportion of patients who attended non-PCI centers, along with an increase in those who called 112. System delay did not change significantly over this period. These results should be taken into consideration in the current Stent - Save a Life initiative.
Collapse
Affiliation(s)
- Hélder Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada, CCUL, CAML, University of Lisbon, Portugal.
| | - Rita Calé
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ernesto Pereira
- Cardiology Department, Hospital Garcia de Orta, Almada; Escola Superior de Saude da Cruz Vermelha Portuguesa, Lisboa, Portugal
| | | | - Sílvia Vitorino
- Cardiology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | - Sílvia Monteiro
- Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Fausto J Pinto
- Cardiology Department, CCUL, CAML, University of Lisbon, Portugal
| | - Raquel Ramos
- National Institute of Medical Emergency (INEM), Portugal
| | | | | | - João Silveira
- Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal
| | - João Morais
- Cardiology Department, Santo André Hospital, Leiria, Portugal
| | | |
Collapse
|
|
50
|
|