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Nomograms based on pre-operative parametric for prediction of short-term mortality in acute myocardial infarction patients treated invasively. Aging (Albany NY) 2020; 13:2184-2197. [PMID: 33323557 PMCID: PMC7880403 DOI: 10.18632/aging.202230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 10/20/2020] [Indexed: 12/29/2022]
Abstract
Objective Our aim was to develop and independently validate nomograms to predict short-term mortality in acute myocardial infarction (AMI) patients. Results There were 1229 AMI patients enrolled in this study. In the training cohort (n=534), 69 deaths occurred during a median follow-up period of 375 days. The C-index for 1-year mortality in the training group and the validation cohort was 0.826 (95%CI: 0.780 - 0.872) and 0.775 (95%CI: 0.695 - 0.855), respectively. Integrated Discrimination Improvement (IDI) and net reclassification improvement (NRI) also showed a significant improvement in the accuracy of the new model compared with the Global Registry of Acute Coronary Events (GRACE) risk score. Furthermore, C-index of the prospective cohort (n=309) achieved 0.817 (95%CI: 0.754 - 0.880) for 30-day mortality and 0.790 (95%CI: 0.718 - 0.863) for 1-year mortality. Conclusions Collectively, our simple-to-use nomogram effectively predicts short-term mortality in AMI patients. Methods AMI patients who had undergone invasive intervention between January 2013 and Jan 2018 were enrolled. Cox regression analysis was used on the training cohort to develop nomograms for predicting 30-day and 1-year mortality. Model performance was then evaluated in the validation cohort and another independent prospective cohort.
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A Novel Predictive Model for In-Hospital Mortality Based on a Combination of Multiple Blood Variables in Patients with ST-Segment-Elevation Myocardial Infarction. J Clin Med 2020; 9:jcm9030852. [PMID: 32245024 PMCID: PMC7141500 DOI: 10.3390/jcm9030852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 12/22/2022] Open
Abstract
In emergency clinical settings, it may be beneficial to use rapidly measured objective variables for the risk assessment for patient outcome. This study sought to develop an easy-to-measure and objective risk-score prediction model for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI). A total of 1027 consecutive STEMI patients were recruited and divided into derivation (n = 669) and validation (n = 358) cohorts. A risk-score model was created based on the combination of blood test parameters obtained immediately after admission. In the derivation cohort, multivariate analysis showed that the following 5 variables were significantly associated with in-hospital death: estimated glomerular filtration rate <45 mL/min/1.73 m2, platelet count <15 × 104/μL, albumin ≤3.5 g/dL, high-sensitivity troponin I >1.6 ng/mL, and blood sugar ≥200 mg/dL. The risk score was weighted for those variables according to their odds ratios. An incremental change in the scores was significantly associated with elevated in-hospital mortality (p < 0.001). Receiver operating characteristic curve analysis showed adequate discrimination between patients with and without in-hospital death (derivation cohort: area under the curve (AUC) 0.853; validation cohort: AUC 0.879), and there was no significant difference in the AUC values between the laboratory-based and Global Registry of Acute Coronary Events (GRACE) score (p = 0.721). Thus, our laboratory-based model might be helpful in objectively and accurately predicting in-hospital mortality in STEMI patients.
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Chotechuang Y, Phrommintikul A, Kuanprasert S, Muenpa R, Ruengorn C, Patumanond J, Chaichuen T, Thanachaikun N, Benjanuwatra T, Sukonthasarn A. GRACE score and cardiovascular outcomes prediction among the delayed coronary intervention after post-fibrinolytic STEMI patients in a limited PCI-capable hospital. Open Heart 2020; 7:e001133. [PMID: 32231784 PMCID: PMC7101037 DOI: 10.1136/openhrt-2019-001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 11/21/2019] [Accepted: 02/20/2020] [Indexed: 12/22/2022] Open
Abstract
Background In Thailand, due to limited availability of percutaneous coronary intervention (PCI)-capable hospitals, a number of patients with ST-elevation myocardial infarction (STEMI) after fibrinolytic therapy underwent the delayed coronary intervention (24 hours to 2 weeks). Existing tool such as the Global Registry of Acute Coronary Event (GRACE) to define patients at high risk of cardiovascular outcomes has been used widely, except for patients who had the delayed coronary intervention. We, therefore, evaluated the cardiovascular outcomes of STEMI patients who underwent the delayed coronary intervention. Methods We retrospectively analysed the data from the PCI-capable hospital (Maharaj Nakorn Chiang Mai Hospital) STEMI registry during the period 2007-2012. Patients who received fibrinolytic treatment (SK) and underwent the delayed coronary intervention were included. The outcomes of the study were 30-day and 6-month composite cardiovascular outcomes (including death, re-hospitalised with acute coronary syndrome, re-hospitalised with heart failure and stroke). Results Of all 341 patients included, 229 (67.2%) patients were in the low GRACE score group (<126 points) and 112 (32.8%) patients in the intermediate-high GRACE score group (≥126 points). At 30 days, the composite cardiovascular outcome occurred in 2.2% (n=5) in the low GRACE score group and 11.6% (n=13) in the intermediate-high GRACE score group (p value=0.001). At 6 months, the composite cardiovascular outcomes occurred in 3.9% (n=9) in the low GRACE score group and 13.4% (n=15) in the intermediate-high GRACE score group (p value=0.003). The area under the receiver operating characteristic curve of GRACE score for 6-month composite cardiovascular outcomes was 0.746 (95% CI 0.698 to 0.793). Conclusion Intermediate-high GRACE risk STEMI patients after fibrinolytic therapy in limited PCI-capable hospital who underwent the delayed coronary intervention increased 30-day and 6-month cardiovascular outcomes compared with the low GRACE risk patients. In limited available PCI-capable hospital, GRACE risk score can be helpful in guiding the cardiologists to select a proper time for coronary intervention in post-fibrinolytic STEMI patients.
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Affiliation(s)
- Yotsawee Chotechuang
- Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
- Clinical Epidemiology Program, Clinical Epidemiology and Clinical Statistics Center, Department of Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Srun Kuanprasert
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Chidchanok Ruengorn
- Department of Pharmaceutical Care, Faculty of Pharmacy, Chiangmai University, Chiang Mai, Thailand
- Pharmacoepidemiology and Statistics Research Center (PESRC), Faculty of Pharmacy, Chiangmai University, Chiang Mai, Thailand
| | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
- Department of Clinical Epidemiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tuanchai Chaichuen
- Cardiac Catheterization Laboratory Unit, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Noparat Thanachaikun
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thanawat Benjanuwatra
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Chotechuang Y, Phrommintikul A, Kuanprasert S, Muenpa R, Patumanond J, Chaichuen T, Sukonthasarn A. Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial. HEART ASIA 2019; 11:e011201. [PMID: 31275432 PMCID: PMC6579563 DOI: 10.1136/heartasia-2019-011201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/11/2019] [Accepted: 05/21/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK. METHODS We randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke). RESULTS One hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054). CONCLUSIONS The delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention. TRIAL REGISTRATION NUMBER NCT02131103.
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Affiliation(s)
- Yotsawee Chotechuang
- Clinical Epidemiology Program, Chiang Mai University, Chiang Mai, Thailand
- Department of Internal Medicine, Lampang Hospital, Lampang, Thailand
| | - Arintaya Phrommintikul
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Srun Kuanprasert
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Thammasat University Faculty of Medicine, Pathumthani, Thailand
| | - Tuanchai Chaichuen
- Cardiac Catheterization Laboratory Unit, Chiang Mai University Faculty of Medicine, Chiang Mai, Thailand
| | - Apichard Sukonthasarn
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI). Can J Cardiol 2018; 34:736-743. [DOI: 10.1016/j.cjca.2018.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/20/2022] Open
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Russo JJ, Bagai A, Le May MR, Yan AT. Immediate non-culprit vessel percutaneous coronary intervention (PCI) in patients with acute myocardial infarction and cardiogenic shock: a swinging pendulum. J Thorac Dis 2018; 10:661-666. [PMID: 29608190 DOI: 10.21037/jtd.2018.01.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Juan J Russo
- University of Ottawa Heart Institute, Ottawa, ON, Canada
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | | | - Andrew T Yan
- Terrence Donnelly Heart Centre, St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
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Russo JJ, Goodman SG, Cantor WJ, Ko DT, Bagai A, Tan MK, Di Mario C, Halvorsen S, Le May M, Fernandez-Avilés F, Scheller B, Armstrong PW, Borgia F, Piscione F, Sanchez PL, Yan AT. Does renal function affect the efficacy or safety of a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction? A meta-analysis. Am Heart J 2017; 193:46-54. [PMID: 29129254 DOI: 10.1016/j.ahj.2017.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 07/30/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The efficacy and safety of pharmacoinvasive strategy following fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to renal function have not been established. METHODS Using patient-level data from 4 randomized controlled trials, we examined the efficacy and safety of pharmacoinvasive versus standard treatment after fibrinolysis for STEMI. Patients were stratified based on the estimated glomerular filtration rate (eGFR) on presentation (<60 mL/min/1.73 m2 vs ≥60 mL/min/1.73 m2). The primary outcome was the composite of death or reinfarction at 30 days. RESULTS Of 2,029 patients, 457 (23%) had an eGFR<60 mL/min/1.73 m2. Patients with eGFR<60 mL/min/1.73 m2 were older and had higher Thrombolysis in Myocardial Infarction risk scores. Compared with patients with eGFR≥60 mL/min/1.73 m2, patients with renal dysfunction had higher rates of the primary outcome (5.3% vs 11.8%, respectively; P<.001). There was no significant heterogeneity in the treatment effect of pharmacoinvasive strategy on the primary outcome (P heterogeneity=.73) or the rate of death or reinfarction at 1 year (P heterogeneity=.64) in relation to eGFR. Patients with renal dysfunction had higher rates of in-hospital major bleeding compared with patients with eGFR ≥60 mL/min/1.73 m2 (7.7% vs 4.3%, respectively; P=.004); however, there was no difference in bleeding events between treatment arms in the overall cohort or in relation to eGFR (P heterogeneity=.67). CONCLUSIONS Renal impairment is associated with increased rates of adverse events in STEMI patients treated with fibrinolysis. However, the safety and efficacy of pharmacoinvasive strategy are preserved in patients with renal impairment on presentation.
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Affiliation(s)
- Juan J Russo
- Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario; University of Ottawa Heart Institute, Ottawa, Ontario
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario; Canadian Heart Research Centre, Toronto, Ontario
| | - Warren J Cantor
- University of Toronto, Toronto, Ontario; Southlake Regional Health Centre, Newmarket, Ontario
| | - Dennis T Ko
- Institute for Clinical Evaluative Sciences (ICES), Sunnybrook Research Institute (SRI), Schulich Heart Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario
| | - Akshay Bagai
- Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario
| | - Mary K Tan
- Canadian Heart Research Centre, Toronto, Ontario
| | - Carlo Di Mario
- NHLI Imperial College, London, UK, and University Hospital Careggi, Florence, Italy
| | | | - Michel Le May
- University of Ottawa Heart Institute, Ottawa, Ontario
| | | | - Bruno Scheller
- Innere Medizin III, Universitat des Saarlandes, Homburg, Germany
| | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta
| | | | - Federico Piscione
- Academic Hospital SS. Giovanni e Ruggi, University of Salerno, Salerno, Italy
| | | | - Andrew T Yan
- Terrence Donnelly Heart Centre, Michael's Hospital, Toronto, Ontario; University of Toronto, Toronto, Ontario.
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Pu J, Ding S, Ge H, Han Y, Guo J, Lin R, Su X, Zhang H, Chen L, He B. Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction). Circulation 2017; 136:1462-1473. [PMID: 28844990 DOI: 10.1161/circulationaha.117.030582] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/09/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. METHODS The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay. The primary end point of the study was complete epicardial and myocardial reperfusion after PCI, defined as thrombolysis in myocardial infarction flow grade 3, thrombolysis in myocardial infarction myocardial perfusion grade 3, and ST-segment resolution ≥70%. We also measured infarct size and left ventricular ejection fraction with cardiac magnetic resonance and recorded 30-day clinical and safety outcomes. RESULTS A total of 344 patients from 7 centers were randomized to PhI (n=171) or PPCI (n=173). PhI was noninferior (and even superior) to PPCI for the primary end point (34.2% versus 22.8%, Pnoninferiority<0.05, Psuperiority=0.022), with no significant differences in the frequency of the individual components of the combined end point: thrombolysis in myocardial infarction flow 3 (91.3% versus 89.2%, P=0.580), thrombolysis in myocardial infarction myocardial perfusion grade 3 (65.8% versus 62.9%, P=0.730), and ST-segment resolution ≥70% (50.9% versus 45.5%, P=0.377). Infarct size (23.3%±11.3% versus 25.8%±13.7%, P=0.101) and left ventricular ejection fraction (52.2%±11.0% versus 51.4%±12.0%, P=0.562) were similar in both groups. No significant differences occurred in 30-day rates of total death (0.6% versus 1.2%, P=1.0), reinfarction (0.6% versus 0.6%, P=1.0), heart failure (13.5% versus 16.2%, P=0.545), major bleeding events (0.6% versus 0%, P=0.497), or intracranial hemorrhage (0% versus 0%), but minor bleeding (26.9% versus 11.0%, P<0.001) was observed more often in the PhI group. CONCLUSIONS For patients with STEMI presenting ≤6 hours after symptom onset and with an expected PCI-related delay, a PhI strategy with half-dose alteplase and timely PCI offers more complete epicardial and myocardial reperfusion when compared with PPCI. Adequately powered trials with this reperfusion strategy to assess clinical and safety outcomes are warranted. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01930682.
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Affiliation(s)
- Jun Pu
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Song Ding
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Heng Ge
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Yaling Han
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Jinchen Guo
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Rong Lin
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Xi Su
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Heng Zhang
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Lianglong Chen
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
| | - Ben He
- From Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, China (J.P., S.D., H.G., B.H.); Department of Cardiology, General Hospital of Shenyang Military Region, China (Y.H.); Department of Cardiology, Beijing Luohe Hospital, Capital Medical University, China (J.G.); Department of Cardiology, Fujian Medical University Affiliated the First Quanzhou Hospital, China (R.L.); Department of Cardiology, Wuhan Asia Heart Hospital, China (X.S.); Department of Cardiology, Bengbu Medical University Affiliated the First Hospital, China (H.Z.); and Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, China (L.C.)
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Chotechuang Y, Phrommintikul A, Muenpa R, Patumanond J, Chaichuen T, Kuanprasert S, Thanachikun N, Benjanuwatra T, Sukonthasarn A. The prognostic utility of GRACE risk score in predictive cardiovascular event rate in STEMI patients with successful fibrinolysis and delay intervention in non PCI-capable hospital: a retrospective cohort study. BMC Cardiovasc Disord 2016; 16:212. [PMID: 27821064 PMCID: PMC5100095 DOI: 10.1186/s12872-016-0383-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 10/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Fibrinolytic therapy is the main reperfusion therapy for most STEMI patients in several countries. Current practice guidelines recommended routine early pharmacoinvasive (within 3-24 h after successful fibrinolysis, however it cannot be performed in timely fashion due to limitation of PCI-capable hospitals. This study aimed to evaluate the prognostic utility of the GRACE score in patients receiving delayed intervention after successful fibrinolysis in non PCI-capable hospital. METHODS We retrospectively analysed the data from the Maharaj Nakorn Chiang Mai Hospital acute ST-elevation myocardial infarction (STEMI) registry during the period 2007-2012. The STEMI patients who had successfully fibrionolysis in non PCI-capable hospital and received delayed PCI (during 24 h to 14 days after successful fibrinolytic therapy) at Maharaj Nakorn Chiang Mai hospital were included. The primary end point for this analysis was the composite outcomes, which included all-cause mortality, re-hospitalization with acute coronary syndrome (ACS), re-hospitalization with heart failure (HF) and stroke at 1 and 6-month. RESULTS A total of 152 patients were included. 88 patients and 64 patients were in low GRACE group (GRACE risk score ≤ 125) and intermediate to high GRACE group (GRACE risk score above 126), respectively. The median time from fibrinolysis to coronary intervention in low GRACE group was 8.5 days (interquartile range, 4.6-10.9) and 7.9 days (interquartile range,3.2,12.0) in intermediate to high GRACE group (p = 0.482). At 1 month, the composite cardiovascular outcome at 1 month occurred in 2 patients (2.3 %) in low GRACE group and 10 patients (15.6 %) in intermediate to high GRACE group (P = 0.003). During 6 months, the composite cardiovascular outcomes occurred in 6 patients (6.8 %) in low GRACE group and 12 patients (18.7 %) in intermediate to high GRACE group (P = 0.024). The cumulative of composite cardiovascular outcome was significant higher in intermediate to high GRACE group than in low GRACE group (Hazard ratio: 2.97, 95 % CI 1.11-7.90; p = 0.030). CONCLUSION The long delay pharmacoinvasive strategy in intermediate to high GRACE score after successful fibrinolysis in non PCI-capable facilities were associated with worse cardiovascular outcomes than the patients with low GRACE score at 1 and 6 months. GRACE risk score may be helpful and guided the clinicians in non PCI-capable center in early transferred to early intervention in STEMI patients after fibrinolytic therapy.
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Affiliation(s)
- Yotsawee Chotechuang
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
- Cardiology Division, Internal Medicine Department, Lampang Hospital, Lampang, 52000 Thailand
| | - Arintaya Phrommintikul
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Roungtiva Muenpa
- Pharmaceutical Care Unit, Pharmacy Department, Lampang Hospital, Lampang, 52000 Thailand
| | - Jayanton Patumanond
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University, Bangkok, 12121 Thailand
| | - Tuanchai Chaichuen
- Cardiac catheterization laboratory Unit, Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand 50200
| | - Srun Kuanprasert
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Noparat Thanachikun
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Thanawat Benjanuwatra
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
| | - Apichard Sukonthasarn
- Cardiology Division, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, 50200 Thailand
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Tan NS, Goodman SG, Cantor WJ, Russo JJ, Borgundvaag B, Fitchett D, Džavík V, Tan MK, Elbarouni B, Lavi S, Bagai A, Heffernan M, Ko DT, Yan AT. Efficacy of Early Invasive Management After Fibrinolysis for ST-Segment Elevation Myocardial Infarction in Relation to Initial Troponin Status. Can J Cardiol 2016; 32:1221.e11-1221.e18. [DOI: 10.1016/j.cjca.2016.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 12/30/2015] [Accepted: 01/01/2016] [Indexed: 12/22/2022] Open
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11
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Abdel-Qadir H, Yan AT, Tan M, Borgia F, Piscione F, Di Mario C, Halvorsen S, Cantor WJ, Westerhout CM, Scheller B, Le May MR, Fernandez-Aviles F, Sánchez PL, Lee DS, Goodman SG. Consistency of benefit from an early invasive strategy after fibrinolysis: a patient-level meta-analysis. Heart 2015; 101:1554-61. [DOI: 10.1136/heartjnl-2015-307815] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 06/18/2015] [Indexed: 12/22/2022] Open
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12
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Russo JJ, Goodman SG, Cantor WJ, Tan MK, Borgundvaag B, Fitchett D, Džavík V, Yan RT, Graham JJ, Mehta SR, Yan AT. Efficacy and safety of a routine early invasive strategy in relation to time from symptom onset to fibrinolysis (a subgroup analysis of TRANSFER-AMI). Am J Cardiol 2015; 115:1005-12. [PMID: 25711435 DOI: 10.1016/j.amjcard.2015.01.533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/20/2015] [Accepted: 01/20/2015] [Indexed: 12/22/2022]
Abstract
The aim of this study was to assess the efficacy and safety of an early invasive strategy post-fibrinolysis in relation to time from symptom onset to fibrinolysis in patients with ST-elevation myocardial infarction (STEMI). The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized 1,059 patients receiving fibrinolysis for STEMI to an early invasive strategy versus standard therapy. The primary end point was the composite of death, reinfarction, recurrent ischemia, new or worsening heart failure, or cardiogenic shock at 30 days. In this post hoc subgroup analysis, we examined the effect of an early invasive strategy on efficacy and safety outcomes after stratification by time from symptom onset to fibrinolysis (<2 or ≥2 hours). Of 1,059 patients in TRANSFER-AMI, 557 (53%) received fibrinolysis <2 hours and 502 (47%) ≥2 hours after symptom onset. Compared to patients who received fibrinolysis within 2 hours of symptoms, patients who received fibrinolysis ≥2 hours after symptom onset had higher Global Registry of Acute Coronary Events risk scores (median 127 vs 122, p = 0.004). The effect of an early invasive strategy did not differ between symptom-to-fibrinolysis time strata for the primary efficacy end point (p-heterogeneity = 0.67), 30-day mortality, the composite of death or reinfarction at 30 days, 6 months, or 1 year, or bleeding (all p-heterogeneity >0.40). In conclusion, the efficacy and safety of an early invasive strategy in patients undergoing fibrinolysis for STEMI do not vary in relation to time (<2 or ≥2 hours) from symptom onset to fibrinolysis.
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Elbarouni B, Cantor WJ, Ducas J, Borgundvaag B, Džavík V, Heffernan M, Buller CE, Langer A, Goodman SG, Yan AT. Efficacy of an early invasive strategy after fibrinolysis in ST-elevation myocardial infarction relative to the extent of coronary artery disease. Can J Cardiol 2014; 30:1555-61. [PMID: 25475460 DOI: 10.1016/j.cjca.2014.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 09/02/2014] [Accepted: 09/02/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND A strategy of early transfer for coronary angiography and intervention is superior to a standard approach of delayed coronary angiography after fibrinolysis for ST-elevation myocardial infarction (STEMI). STEMI patients with lesions in noninfarct-related arteries have a worse prognosis compared with patients with single vessel disease. This study aimed to assess whether the benefits of an early invasive strategy differ in patients with single vessel and multivessel disease. METHODS The Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized STEMI patients receiving fibrinolysis to a strategy of early transfer and coronary angiography vs a standard approach. In this post hoc analysis, we stratified 992 patients into 2 groups according to the presence or absence of multivessel disease. We compared the 2 groups in terms of baseline characteristics, in-hospital management, and patient outcomes, and tested for treatment heterogeneity. RESULTS Multivessel disease was present in 369 (37%) patients. Patients with multivessel disease had a greater rate of the primary composite end point of in-hospital death, recurrence of infarction, recurrent ischemia, shock, or heart failure at 30 days (18.2% vs 10.8%; P < 0.001). An early invasive strategy was efficacious in both groups for the primary outcome. In multivariable analysis adjusting for Global Registry of Acute Coronary Events (GRACE) risk score, there was no significant treatment heterogeneity (all P interaction > 0.40) for the primary end point, or death/recurrence of infarction at 6 months and 1 year. CONCLUSIONS Multivessel disease is present in a significant proportion of STEMI patients treated with fibrinolysis and is associated with worse outcomes. A strategy of early transfer and coronary intervention after fibrinolysis was beneficial regardless of the presence or absence of multivessel disease.
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Affiliation(s)
- Basem Elbarouni
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Warren J Cantor
- Southlake Regional Health Centre, Newmarket, University of Toronto, Toronto, Ontario, Canada
| | - John Ducas
- St Boniface General Hospital, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Vladimír Džavík
- Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Christopher E Buller
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Anatoly Langer
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada
| | - Andrew T Yan
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
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Routine invasive management early after fibrinolysis: relationship between baseline risk and treatment effects in a pooled patient-level analysis of 7 randomized controlled trials. Am Heart J 2014; 168:757-65. [PMID: 25440805 DOI: 10.1016/j.ahj.2014.07.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 07/31/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The efficacy of a routine invasive strategy early after fibrinolysis in relation to baseline risk status is unclear. We sought to characterize the interaction between patient risk and treatment with routine invasive strategy early after fibrinolysis for ST-segment elevation myocardial infarction. METHODS We pooled 2,974 patients from 7 randomized trials of fibrinolysis-treated patients with ST-segment elevation myocardial infarction comparing a routine early invasive strategy with a standard approach of percutaneous coronary intervention (PCI) guided by recurrent ischemia or need for rescue. Cox proportional hazards regression was used to examine the interaction between baseline patient risk classified by Thrombolysis in Myocardial Infarction risk score (low/intermediate: ≤ 5 [n = 2,697] vs high: > 5 [n = 277]) and treatment with routine early invasive strategy. RESULTS Time to PCI after fibrinolysis was longer among patients randomized to standard treatment compared with routine early invasive strategy in the low/intermediate-risk strata (median 11.4 vs 3.5 hours), but was only marginally different between the 2 groups in the high-risk strata (median 4.1 vs 3.5 hours). There was a significant interaction between treatment assignment and risk status for the composite of 30-day death or reinfarction (P = .01). Compared with standard treatment, routine early invasive strategy was associated with lower 30-day death/reinfarction in the low/intermediate-risk stratum (7.5% vs 4.0%, P < .001), but not in the high-risk stratum (14.9% vs 19.6%, P = .45). CONCLUSIONS Although clearly beneficial among the larger subgroup of patients at low/intermediate risk, the benefit of a routine early invasive strategy was not evident in the smaller subgroup of higher-risk patients in the context of an increased requirement for urgent PCI in the comparative standard treatment arm.
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Tan NS, Goodman SG, Cantor WJ, Tan MK, Yan RT, Bagnall AJ, Mehta SR, Fitchett D, Strauss BH, Yan AT. Comparison of the efficacy of pharmacoinvasive management for ST-segment elevation myocardial infarction in smokers versus non-smokers (from the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction). Am J Cardiol 2014; 114:955-61. [PMID: 25118119 DOI: 10.1016/j.amjcard.2014.05.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/13/2014] [Accepted: 05/13/2014] [Indexed: 12/22/2022]
Abstract
Compared with non-smokers, cigarette smokers with ST-segment elevation myocardial infarctions derive greater benefit from fibrinolytic therapy. However, it is not known whether the optimal treatment strategy after fibrinolysis differs on the basis of smoking status. The Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized patients with ST-segment elevation myocardial infarctions to a routine early invasive (pharmacoinvasive) versus a standard (early transfer only for rescue percutaneous coronary intervention or delayed angiography) strategy after fibrinolysis. The efficacy of these strategies was compared in 1,051 patients on the basis of their smoking status. Treatment heterogeneity was assessed between smokers and non-smokers, and multivariable analysis was performed to evaluate for an interaction between smoking status and treatment strategy after adjusting for baseline Global Registry of Acute Coronary Events (GRACE) risk score. Smokers (n=448) were younger, had fewer cardiovascular risk factors, and had lower GRACE risk scores. They had a lower rate of the primary composite end point of 30-day mortality, reinfarction, recurrent ischemia, heart failure, or cardiogenic shock and fewer deaths or reinfarctions at 6 months and 1 year. Smoking status was not a significant predictor of either primary or secondary end points in multivariable analysis. Pharmacoinvasive management reduced the primary end point compared with standard therapy in smokers (7.7% vs 13.6%, p=0.04) and non-smokers (13.1% vs 19.7%, p=0.03). Smoking status did not modify treatment effect on any measured outcomes (p>0.10 for all). In conclusion, compared with non-smokers, current smokers receiving either standard or early invasive management of ST-segment elevation myocardial infarction after fibrinolysis have more favorable outcomes, which is likely attributable to their better baseline risk profile. The beneficial treatment effect of a pharmacoinvasive strategy is consistent in smokers and non-smokers.
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Russo JJ, Goodman SG, Cantor WJ, Fitchett D, Heffernan M, Borgundvaag B, Ducas J, Cohen EA, Džavik V, Mehta SR, Buller CE, Yan AT. Efficacy and safety of a routine early invasive strategy after fibrinolysis stratified by glycoprotein IIb/IIIa inhibitor use during percutaneous coronary intervention: a pre-specified subgroup analysis of the TRANSFER-AMI randomised controlled trial. Heart 2014; 100:873-80. [PMID: 24449716 DOI: 10.1136/heartjnl-2013-305231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE We evaluated the efficacy and safety of an early invasive strategy post-fibrinolysis in relation to glycoprotein (GP) IIb/IIIa inhibitor use. METHODS The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomised 1059 ST elevation myocardial infarction patients to an early invasive strategy or standard therapy post-fibrinolysis. The primary end point was the composite of death, reinfarction, recurrent ischaemia, new or worsening heart failure, or cardiogenic shock at 30 days. In this pre-specified analysis, we examined efficacy and safety outcomes of an early invasive strategy after stratification by GPIIb/IIIa inhibitor use, which was permitted during percutaneous coronary intervention (PCI) at the discretion of the treating physician. RESULTS A total of 695 patients (65.6%) received GPIIb/IIIa inhibitors. There was significant heterogeneity (p<0.001) in the efficacy of an early invasive strategy compared to standard therapy, between the strata with GPIIb/IIIa inhibitor use (primary end point 9.6% vs 22.3% respectively, p<0.001) and without GPIIb/IIIa inhibitor use (primary end point 14.8% vs 10.4% respectively, p=0.21). Patients who received GPIIb/IIIa inhibitors had lower Global Registry of Acute Coronary Events (GRACE) risk scores compared to those without GPIIb/IIIa inhibitor use (median 121 vs 130, p<0.001). After adjusting for the interaction between GRACE risk score and treatment assignment, the heterogeneity in the efficacy of an early invasive strategy with respect to GPIIb/IIIa inhibitor use was no longer significant (p interaction=0.08). CONCLUSIONS The apparent difference in the efficacy of an early invasive strategy between GPIIb/IIIa inhibitor strata likely reflects an association between GPIIb/IIIa inhibitor use and baseline risk. GPIIb/IIIa inhibitor use during PCI at the discretion of the treating physician does not appear to modulate the efficacy of an early invasive strategy post-fibrinolysis. CLINICAL TRIAL REGISTRATION http://www.clinicaltrials.gov/ct2/show/NCT00164190, NCT00164190.
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Affiliation(s)
- Juan J Russo
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, , Toronto, Ontario, Canada
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Ketchum ES, Dickstein K, Kjekshus J, Pitt B, Wong MF, Linker DT, Levy WC. The Seattle Post Myocardial Infarction Model (SPIM): prediction of mortality after acute myocardial infarction with left ventricular dysfunction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 3:46-55. [PMID: 24562803 DOI: 10.1177/2048872613502283] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIMS Ischemic heart disease is a leading worldwide cause of death. The Seattle Post Myocardial Infarction Model (SPIM) was developed to predict survival 6 months to 2 years after an acute myocardial infarction with evidence of left ventricular dysfunction. METHODS AND RESULTS A total of 6632 subjects from the EPHESUS trial were used to derive the predictive model, while 5477 subjects from the OPTIMAAL trial were used to validate the model. Cox proportional hazards modeling was used to develop a multivariate risk score predictive of all-cause mortality. The SPIM risk score integrated lab and vital parameters, Killip class, reperfusion or revascularization, the number of cardiac evidence-based medicines (aspirin, statin, β blocker, ACEI/ARB, aldosterone blocker), and the number of cardiac risk factors. The model was predictive of all-cause mortality after myocardial infarction, with an AUC of 0.75 at 6 months and 0.75 at 2 years in the derivation cohort and 0.77 and 0.78 for the same time points in the validation cohort. Model predicted versus Kaplan-Meier observed survival was excellent in the derivation cohort. It remained so in the validation cohort--84.9% versus 85.0% at 2 years. The 10% of subjects with the highest predicted risk had approximately 25 times higher mortality at 2 years than the 10% of subjects with the lowest predicted risk. CONCLUSION The SPIM score was a powerful predictor of outcomes after myocardial infarction with left ventricular dysfunction. Its highly accurate predictions should improve patient and physician understanding of survival and may prove a useful tool in post-infarct risk stratification.
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Wong CK, Leon de la Barra S, Herbison P. Role of routine early angiography post-fibrinolysis for ST elevation myocardial infarction — A meta-regression analysis using angiography rate in the non-routine arm. Int J Cardiol 2013; 167:1888-91. [DOI: 10.1016/j.ijcard.2012.04.151] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/24/2012] [Accepted: 04/28/2012] [Indexed: 11/26/2022]
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WANG ZHONGMING, LIU YABING, JIN QICHEN, WANG XUEQI, DAI MENG, SHAO HUI, ZHAO WENPING, DONG QIULI, WANG SHUPING, ZHANG HAITAO, KONG LICHA, LIU SHAOYUN, WANG DONGYING. The chronergy of recombinant streptokinase thrombolysis in acute myocardial infarction. Exp Ther Med 2013; 5:1363-1366. [PMID: 23737880 PMCID: PMC3671779 DOI: 10.3892/etm.2013.980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/18/2013] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to explore the chronergy of intravenous recombinant streptokinase (r-SK) in patients with acute myocardial infarction (AMI). A total of 114 patients were divided into two groups according to the time of AMI onset: the morning onset (6:01-12:00, n=53) and non-morning onset (12:01-06:00, n=61) groups. The recanalization rate was recorded, as well as anticoagulant and fibrinolytic indices. Statistical analysis was performed to evaluate the recanalization rate following thrombolysis, as well as the anticoagulant and fibrinolytic activities. The recanalization rates following thrombolysis in the morning onset and non-morning onset groups were 60.4 and 82.0%, respectively (P<0.05). The level of plasminogen activator inhibitor-1 (PAI-1) antigen was significantly higher in the morning onset group compared with that in the non-morning onset group (P<0.05). This indicated a resistance to r-SK thrombolysis in the morning at the early stage of AMI, which possibly correlates with increased PAI-1 antigen levels and activity.
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Affiliation(s)
- ZHONG-MING WANG
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - YA-BING LIU
- Department of Internal Medicine, Jingxia Hospital of North China Petroleum Administration, Renqiu, Hebei 062552
| | - QI-CHEN JIN
- Department of Internal Medicine, Jingxia Hospital of North China Petroleum Administration, Renqiu, Hebei 062552
| | - XUE-QI WANG
- Xiangya School of Medicine, Central South University, Changsha, Hunan 410013
| | - MENG DAI
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - HUI SHAO
- Department of Science and Technology, Jingxia Hospital of North China Petroleum Administration, Renqiu, Hebei 062552
| | - WEN-PING ZHAO
- Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, Hebei 071000
| | - QIU-LI DONG
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - SHU-PING WANG
- Department of Radiology, Jingxia Hospital of North China Petroleum Administration, Renqiu, Hebei 062552,
P.R. China
| | - HAI-TAO ZHANG
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - LI-CHA KONG
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - SHAO-YUN LIU
- Second Department of Cardiology, General Hospital of North China Petroleum Administration
| | - DONG-YING WANG
- Second Department of Cardiology, General Hospital of North China Petroleum Administration;,Correspondence to: Professor Dong-Ying Wang, Second Department of Cardiology, General Hospital of North China Petroleum Administration, Renqiu, Hebei 062552, P.R. China E-mail:
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Matthias AT, Ekanayaka R. Precipitant profile of acute heart failure: experience of a tertiary level cardiac centre in Sri Lanka. HEART ASIA 2013; 5:86-91. [PMID: 27326091 DOI: 10.1136/heartasia-2013-010250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/16/2013] [Accepted: 05/05/2013] [Indexed: 11/04/2022]
Abstract
INTRODUCTION AND OBJECTIVES Heart failure (HF) is a common cause of hospitalisation in most countries. Data on acute precipitants of HF and hospitalisation is not available in Sri Lanka. BACKGROUND AND METHODS A prospective study of 100 sequential admissions with HF to the cardiology unit (National Hospital of Sri Lanka) to describe the precipitants and clinical outcome of HF. RESULTS Fifty-eight male and 42 female admissions were studied. Mean age was 60.66 years. Mean hospital stay was 5.5(SD 4.6) days. Sixty had de novo HF and 40 had pre-existing HF. The most common identifiable precipitants were acute ischaemia 37 (37%), anaemia 41 (41%), respiratory tract infection 10 (10%), arrhythmia 11 (11%), worsening renal function 11 (11%) and alcohol 5 (5.7%). Non-adherence to medication 4 (4.6%), smoking 3 (3.9%), exposure to environmental stress 3 (3.4%) and uncontrolled hypertension 1 (1%) were also observed as precipitants. The most common arrhythmia was atrial fibrillation. Out of 34 patients in whom angiotensin-converting enzyme inhibitors or angiotensin-converting enzyme receptor blockers were indicated, 11% were not on the drug. Among 29 patients in whom spironolactone was indicated, seven patients were not on the drug. CONCLUSIONS Most precipitating factors of HF are preventable. Early identification and prevention of anaemia, preventing respiratory tract infection by vaccination, aggressive revascularisation for patients with ischaemia, monitoring of renal functions, and patient education regarding drug and diet compliance, would reduce the number of admissions.
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Affiliation(s)
| | - Ruvan Ekanayaka
- Cardiology Unit , National Hospital of Sri Lanka , Colombo , Sri Lanka
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Influence of 23 coronary artery disease variants on recurrent myocardial infarction or cardiac death: the GRACE Genetics Study. Eur Heart J 2012; 34:993-1001. [DOI: 10.1093/eurheartj/ehs389] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Bhan V, Cantor WJ, Yan RT, Mehta SR, Morrison LJ, Heffernan M, Fitchett D, Džavík V, Ducas J, Borgundvaag B, Cohen EA, Goodman SG, Yan AT. Efficacy of early invasive management post-fibrinolysis in men versus women with ST-elevation myocardial infarction: a subgroup analysis from Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI). Am Heart J 2012; 164:343-50. [PMID: 22980300 DOI: 10.1016/j.ahj.2012.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 05/23/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The TRANSFER-AMI study demonstrated that early routine percutaneous coronary intervention post-fibrinolysis (pharmacoinvasive strategy) is superior to conservative management for ST-elevation myocardial infarction. However, it is not clear whether treatment efficacy differs between men and women. METHODS In this pre-specified subgroup analysis, we compared the efficacy of a pharmacoinvasive strategy in men versus women with acute ST-elevation myocardial infarction who were randomized to a pharmacoinvasive versus standard management following fibrinolysis. The primary end point was a composite of death, recurrent myocardial infarction, recurrent ischemia, heart failure and shock at 30 days. We tested for treatment heterogeneity between men and women using the Breslow-Day test. We also performed multivariable analysis adjusting for GRACE risk score and its interaction with treatment assignment, and evaluated for death/recurrent myocardial reinfarction as a secondary outcome. RESULTS Of the 1059 patients, 843 were men and 216 were women. Compared to men, women were older, had worse Killip class, higher GRACE risk score, and higher rates of death and death/myocardial reinfarction at 30 days. The primary end point did not differ significantly between men and women (13.4% vs 16.7%, P = .22). Compared to standard treatment, a pharmacoinvasive strategy was associated with a lower rate of the primary end point in men (17.5% vs 9.4%, respectively, P < .001), but not in women (16.2% vs 17.1%, P = .86). There was a trend toward an interaction between treatment assignment and sex for the composite primary end point (P = .06). After adjustment for the significant interaction between GRACE risk score and treatment (P < .001), there was no significant interaction between sex and treatment for all the end points (all P > .40). CONCLUSION The borderline heterogeneity in treatment efficacy of a pharmacoinvasive strategy in men versus women was no longer evident after adjustment for the difference in baseline risk. This suggests that sex per se was not an important determinant of the efficacy of a pharmacoinvasive strategy. Owing to the small number of women in this trial, further study in this area is needed.
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Diego A, de Prado AP, Cuellas C, de Miguel A, Samaniego B, Alonso-Rodríguez D, Bangueses R, Vega B, Martín J, Fernandez-Vazquez F. P2Y12 platelet reactivity after thrombolytic therapy for ST-segment elevation myocardial infarction. Thromb Res 2012; 130:e31-6. [DOI: 10.1016/j.thromres.2012.05.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 04/28/2012] [Accepted: 05/25/2012] [Indexed: 01/09/2023]
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Diamond GA, Kaul S. By desperate appliance relieved? On the clinical relevance of risk stratification to therapeutic decision-making. Am J Cardiol 2012; 109:919-23. [PMID: 22196779 DOI: 10.1016/j.amjcard.2011.10.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Revised: 10/31/2011] [Accepted: 10/31/2011] [Indexed: 11/17/2022]
Abstract
Risk stratification is a mainstay of current cardiovascular care. Its practical relevance to therapeutic decision making depends, however, on the often unverified assumption that higher risk patients experience greater treatment benefit. The truth of this assumption depends, in turn, on the particular set of variables in the putative risk prediction model, the pathophysiology of the underlying disease, and the associated goal(s) of therapy. If the operative set of risk predictors is incomplete (ignoring variables affected by treatment) or inconsistent (including variables unaffected by treatment), this will influence the relation between pretreatment risk and post-treatment benefit in complex ways having material clinical consequences. In conclusion, the clinical appropriateness of risk stratification must not be assumed. Instead, risk stratification guidelines specific to a particular disease and a particular treatment should be founded on prospective empiric validation.
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Huber K. Optimizing reperfusion therapy in acute ST-elevation myocardial infarction by a pharmaco-invasive treatment approach in a well-organized network. Eur Heart J 2011; 33:1184-6. [PMID: 22120752 DOI: 10.1093/eurheartj/ehr427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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