1
|
Craciun LM, Buleu F, Pah AM, Badalica-Petrescu M, Bodea O, Man DE, Cosor OC, Iurciuc S, Dragan S, Rada M. The Benefits of a Comprehensive Cardiac Rehabilitation Program for Patients with Acute Coronary Syndrome: A Follow-Up Study. J Pers Med 2023; 13:1516. [PMID: 37888127 PMCID: PMC10608079 DOI: 10.3390/jpm13101516] [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: 09/18/2023] [Revised: 10/16/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Secondary prevention after acute coronary syndrome (ACS) is essential to reduce cardiovascular mortality and hospital readmission, ensuring patients return to normal with an improved quality of life. Thus, we investigate the benefits of a comprehensive cardiac rehabilitation (CR) program on lifestyle, risk factors and adherence to guideline-directed medical therapy (GDMT) in patients after ACS and myocardial revascularization through coronary artery by-pass grafting (CABG) or percutaneous coronary intervention (PCI). METHODS This is a prospective, longitudinal study in consecutive post-CABG or PCI patients after ACS that participated or not in a comprehensive CR. Cardiovascular risk factors, quality of life and adherence to GDMT were analyzed in terms of assessing the benefit of 12 months of comprehensive CR on reaching guidelines secondary prevention targets. RESULTS At the inclusion in comprehensive CR of all patients (n = 480), 85% had hypertension; 86% had elevated total cholesterol values; 69% were characterized by metabolic syndrome; 43% were obese; 31% were active smokers and 29% had type 2 diabetes mellitus. Only 26.66% (n = 128) followed the entire program for 12 months. No statistically significant differences in the prescription of GDMT at hospital discharge after myocardial revascularization between the CR (+) group (n = 128) versus CR (-) group (n = 352) (p > 0.05) were observed. After 12 moths, a significant adherence to GDMT in the CR (+) group vs. CR (-) group was recorded, as follows: antiplatelet agents (100% versus 96%, p = 0.001), beta-blockers (99% versus 92%, p = 0.02), ACE inhibitors/ARAB (89% versus 79%, p = 0.04), lipid-lowering drugs (100% versus 89%, p = 0.001). In total, 82% of the CR (+) patients had a significantly higher adherence at GDMT (82% versus 64%, p = 0.001). At 12 moths, the CR (+) group was characterized by significantly lower values than at the inclusion but some values still increased: systolic blood pressure (139.25 + 19.20 mmHg (p < 0.03)), total cholesterol (171.07 + 48.59 mg/dL (p = 0.0001)) and LDL-cholesterol (102.83 + 41.30 mg/dL (p = 0.009)). At the same time, the analysis of psychosocial factors using the HAD questionnaire revealed a statistically significant improvement in anxiety and depression scores: HAD-A score (9.1 ± 3.7 at T0 vs. 7.1 ± 4.2 at T1, p = 0.001) and HAD-D score (7.7 ± 3.19 at T0 vs. 6.4 ± 4.3 at T1, p = 0.003). A multivariable analysis, following GDMT, showed the actual value or information and training of patients regarding optimal cardiovascular risk factor control was independently associated with lower values of systolic blood pressure (R2 = 0.48), diastolic (R2 = 0.38), serum glucose (R2 = 0.48), glycated hemoglobin (R2 = 0.50), total cholesterol (R2 = 0.31), LDL-cholesterol (R2 = 0.30), HDL-cholesterol (R2 = 0.19) and serum triglycerides (R2 = 0.20). CONCLUSION The twelve-month participation of post-ACS patients in comprehensive CR resulted in excellent post-revascularization management, as well as good adherence to guideline-directed medical therapy, provided further confirmation of the benefit of secondary prevention. Despite high adherence to drug treatments, targets for blood pressure, total cholesterol and LDL-cholesterol are inadequately achieved. Therefore, in the era of personalized medicine, patients with ACS should benefit from specific, comprehensive cardiovascular recovery programs that contain physiotherapists, psychologists, nutritionists and an experienced cardiologist in cardiovascular rehabilitation.
Collapse
Affiliation(s)
- Laura Maria Craciun
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Florina Buleu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Ana Maria Pah
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Marius Badalica-Petrescu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Olivia Bodea
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Dana Emilia Man
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
- Research Center of the Timisoara Institute of Cardiovascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Oana Catalina Cosor
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Stela Iurciuc
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| | - Simona Dragan
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
- Research Center of the Timisoara Institute of Cardiovascular Diseases, “Victor Babes” University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria Rada
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square no. 2, 300041 Timisoara, Romania; (L.M.C.); (A.M.P.); (M.B.-P.); (O.B.); (D.E.M.); (O.C.C.); (S.I.); (S.D.); (M.R.)
| |
Collapse
|
2
|
Manfrini O, Amaduzzi PL, Cenko E, Bugiardini R. Prognostic implications of peripheral artery disease in coronary artery disease. Curr Opin Pharmacol 2019; 39:121-128. [PMID: 29705248 DOI: 10.1016/j.coph.2018.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/07/2018] [Accepted: 04/05/2018] [Indexed: 12/24/2022]
Abstract
Prevalence of peripheral arterial disease in patients with coronary artery disease is considerably higher than in the general population. A graded increase in the risk of major cardiovascular events in a variety of clinical settings is associated with the number of arterial beds affected by peripheral arterial disease. This is not surprising, considering that both coronary artery disease and peripheral arterial disease are linked to a higher prevalence of cardiovascular risk factors and a greater incidence of atherosclerotic burden. Aggressive lipid lowering therapy is associated with less coronary and peripheral arterial disease progression and greater regression. On the contrary, blood pressure therapy should be carefully managed, considering the association of both high and low values of pressure with adverse outcomes.
Collapse
Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Peter Louis Amaduzzi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| |
Collapse
|
3
|
Dinesch V, Dinesch M, Sirbu IV, Macarie C, Buruian M. Risk Factors Associated with Acute Coronary Syndrome after Successful Percutaneous Coronary Intervention. ACTA MEDICA MARISIENSIS 2017. [DOI: 10.1515/amma-2017-0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objective: Admission for acute coronary syndrome after successful percutaneous coronary intervention is a delicate situation for the patient and doctor. Predictors of these cases are poorly described.
Methods: We retrospectively analysed the files of post-percutaneous coronary intervention patients admitted to the Department of Cardiology of the Institute for Cardiovascular Disease and Heart Transplant in Tirgu Mures between January 2012 and December 2015. Analyses using the t-test, chi-square test, and Fisher test were performed to compare demographics, clinical and angiographic characteristics of patients with acute coronary syndrome, patients with stable angina, and those without symptoms.
Results: One hundred eighty post-percutaneous coronary intervention patients were readmitted; 46 patients (25.55%) were readmitted for acute coronary syndrome. Histories of arterial hypertension and renal dysfunction at hospital admission were associated with acute coronary syndrome. Bare metal stent in-stent restenosis and localisation of bare metal stent in-stent restenosis of the left descendent coronary artery were angiographic predictors of acute coronary syndrome.
Conclusion: Several clinical and angiographic factors identify patients at high risk for acute coronary syndrome after successful percutaneous coronary intervention. Recognition and treatment of these factors may prevent readmission for such a dangerous condition and may improve outcomes.
Collapse
Affiliation(s)
| | - Mihail Dinesch
- Department of Cardiology , Institute for Cardiovascular Disease and Heart Transplant , Tîrgu Mures , Romania
| | - Ileana Voichita Sirbu
- Department of Internal Medicine M3 , University of Medicine and Pharmacy , Tîrgu Mures , Romania
| | - Cosmin Macarie
- Department of Internal Medicine M3 , University of Medicine and Pharmacy , Tîrgu Mures , Romania
| | - Mircea Buruian
- Department of Morphologic Sciences M1 , University of Medicine and Pharmacy Tîrgu Mures , Romania
| |
Collapse
|
4
|
Cenko E, Ricci B, Kedev S, Kalpak O, Câlmâc L, Vasiljevic Z, Knežević B, Dilic M, Miličić D, Manfrini O, Koller A, Dorobantu M, Badimon L, Bugiardini R. The no-reflow phenomenon in the young and in the elderly. Int J Cardiol 2016; 222:1122-1128. [DOI: 10.1016/j.ijcard.2016.07.209] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
|
5
|
Câlmâc L, Bătăilă V, Ricci B, Vasiljevic Z, Kedev S, Gustiene O, Trininic D, Knežević B, Miličić D, Dilic M, Manfrini O, Cenko E, Badimon L, Bugiardini R, Scafa-Udriște A, Tăutu O, Dorobanțu M. Factors associated with use of percutaneous coronary intervention among elderly patients presenting with ST segment elevation acute myocardial infarction (STEMI): Results from the ISACS-TC registry. Int J Cardiol 2016; 217 Suppl:S21-6. [DOI: 10.1016/j.ijcard.2016.06.227] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/25/2016] [Indexed: 12/14/2022]
|
6
|
Cenko E, Ricci B, Kedev S, Vasiljevic Z, Dorobantu M, Gustiene O, Knežević B, Miličić D, Dilic M, Manfrini O, Koller A, Badimon L, Bugiardini R. Invasive versus conservative strategy in acute coronary syndromes: The paradox in women's outcomes. Int J Cardiol 2016; 222:1110-1115. [PMID: 27514628 DOI: 10.1016/j.ijcard.2016.07.211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 12/22/2022]
Abstract
BACKGROUND We explored benefits and risks of an early invasive compared with a conservative strategy in women versus men after non-ST elevation acute coronary syndromes (NSTE-ACS) using the ISACS-TC database. METHODS From October 2010 to May 2014, 4145 patients were diagnosed as having a NSTE-ACS. We excluded 258 patients managed with coronary bypass surgery. Of the remaining 3887 patients, 1737 underwent PCI (26% women). The primary endpoint was the composite of 30-day mortality and severe left ventricular dysfunction defined as an ejection fraction <40% at discharge. RESULTS Women were older and more likely to exhibit more risk factors and Killip Class ≥2 at admission as compared with men. In patients who underwent PCI, peri-procedural myocardial injury was not different among sexes (3.1% vs. 3.2%). Women undergoing PCI experienced higher rates of the composite endpoint (8.9% vs. 4.9%, p=0.002) and 30-day mortality (4.4% vs. 2.0%, p=0.008) compared with men, whereas those who managed with only routine medical therapy (RMT) did not show any sex difference in outcomes. In multivariable analysis, female sex was associated with favorable outcomes (adjusted HR for the composite endpoint: 0.72, 95% CI: 0.58-0.91) in patients managed with RMT, but not in those undergoing PCI (adjusted HR: 0.96, 95% CI: 0.61-1.52). CONCLUSIONS We observed a more favorable outcome in women than men when patients were managed with RMT. Women and men undergoing PCI have similar outcomes. These data suggest caution in extrapolating the results from men to women in an overall population of patients in the context of different therapeutic strategies.
Collapse
Affiliation(s)
- Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia
| | - Maria Dorobantu
- University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania; Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania
| | - Olivija Gustiene
- Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Božidarka Knežević
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Davor Miličić
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia
| | - Mirza Dilic
- Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest H-1123, Hungary; Department of Physiology, New York Medical College, Valhalla, NY 10595, USA
| | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy.
| |
Collapse
|
7
|
Knežević B, Musić L, Batrićević G, Bošković A, Bulatović N, Nenezić A, Vujović J, Kalezić M. Optimizing prevention and guideline-concordant care in Montenegro. Int J Cardiol 2016; 217 Suppl:S32-6. [PMID: 27381861 DOI: 10.1016/j.ijcard.2016.06.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 06/25/2016] [Indexed: 01/13/2023]
Abstract
BACKGROUND Guidelines recommend use of evidence-based medications in patients discharged after an acute coronary syndrome (ACS). Yet the current rates of adherence in many eastern European countries are unknown. OBJECTIVE To determine whether 6month outpatient follow-up after ACS is associated with recommended rates of medication adherence in Montenegro. METHODS A prospective analysis was conducted in 585 ACS patients confirmed to be alive after ACS at 6month follow-up. The study was undertaken between 2012 and 2015, from 9 International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC) hospitals in the Montenegro. The primary outcome was guideline-concordant care, defined as 100% compliance with 5 medications: aspirin, clopidogrel, beta-blockers, and statins in ACS patients, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers [ACEI/ARB] for the subset of patients with left ventricular systolic dysfunction, as assessed by an ejection fraction less than 40% at discharge. In addition to the composite end point, the achievement of each single treatment measure was analyzed. Multivariate predictors of long-term medication adherence were also identified. RESULTS Guideline-concordant care (GCC) at discharge increased from 2012 to 2015 (adjusted OR for increase 1.51; CI 0.88-2.52). GCC over 6months was adhered in 73% of patients. In patients who did not achieve GCC, adherence was persistently high with 92.3% for aspirin, 91.3% for statins and 72% for ACE-inhibitors or angiotensin-receptor blockers (ARBs). Adherence was lower for clopidogrel (57.7%) and beta-blockers (64.4%). After adjusting for demographic and clinical differences, in-hospital referral to PCI and ST segment elevation myocardial infarction (STEMI) were associated with greater medication adherence at 6month follow-up. CONCLUSIONS In Montenegro, long-term adherence to evidence-based medication after ACS is high. Adherence to guideline-recommended therapies increased over time with participation to the ISACS-TC. The lower achievement of GCC in patients treated medically and in those with non-ST-segment elevation ACS needs particular attention.
Collapse
Affiliation(s)
- Božidarka Knežević
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro.
| | - Ljilja Musić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Goran Batrićević
- Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Aneta Bošković
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Nebojša Bulatović
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Ana Nenezić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Jelena Vujović
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| | - Milovan Kalezić
- Center of Cardiology, Clinical Center of Montenegro, Ljubljanska bb., 81000 Podgorica, Montenegro
| |
Collapse
|
8
|
Manfrini O, Ricci B, Cenko E, Dorobantu M, Kalpak O, Kedev S, Kneževic B, Koller A, Milicic D, Vasiljevic Z, Badimon L, Bugiardini R. Association between comorbidities and absence of chest pain in acute coronary syndrome with in-hospital outcome. Int J Cardiol 2016; 217 Suppl:S37-43. [PMID: 27381858 DOI: 10.1016/j.ijcard.2016.06.221] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 06/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND To evaluate the impact of comorbidities on the management and outcomes of acute coronary syndrome (ACS) patients without chest pain/discomfort (i.e. ACS without typical presentation). METHODS Of the 11,458 ACS patients, enrolled by the International Survey of Acute Coronary Syndrome in Transitional Countries (ISACS-TC; ClinicalTrials.gov: NCT01218776), 8.7% did not have typical presentation at the initial evaluation, and 40.2% had comorbidities. The odds of atypical presentation increased proportionally with the number of comorbidities (odds ratio [OR]: 1, no-comorbid; OR: 1.64, 1 comorbidity; OR: 2.52, 2 comorbidities; OR: 4.57, ≥3 comorbidities). RESULTS Stratifying the study population by the presence/absence of comorbidities and typical presentation, we found a decreasing trend for use of medications and percutaneous intervention (OR: 1, typical presentation and no-comorbidities; OR: 0.70, typical presentation and comorbidities; OR: 0.23, atypical presentation and no-comorbidities; OR: 0.18, atypical presentation and comorbidities). On the opposite, compared with patients with typical presentation and no-comorbidities (OR: 1, referent), there was an increasing trend (p<0.001) in the risk of death (OR: 2.00, OR: 2.52 and OR: 4.83) in the above subgroups. However, after adjusting for comorbidities, medications and invasive procedures, atypical presentation was not a predictor of in-hospital death. Independent predictors of poor outcome were history of stroke (OR: 2.04), chronic kidney disease (OR: 1.57), diabetes mellitus (OR: 1.49) and underuse of invasive procedures. CONCLUSIONS In the ISACS-TC, atypical ACS presentation was often associated with comorbidities. Atypical presentation and comorbidities influenced underuse of in-hospital treatments. The latter and comorbidities are related with poor in-hospital outcome, but not atypical presentation, per se.
Collapse
Affiliation(s)
- Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Maria Dorobantu
- Clinical Emergency Hospital Bucharest, Cardiology Department, Bucharest, Romania
| | - Oliver Kalpak
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Božidarka Kneževic
- Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro
| | - Akos Koller
- Institute of Natural Sciences, University of Physical Education, Budapest, Hungary; Department of Physiology, New York Medical College, Valhalla, NY, USA
| | - Davor Milicic
- Department for Cardiovascular Diseases, University of Zagreb, Zagreb, Croatia
| | | | - Lina Badimon
- Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Institute Carlos III, Autonomous University of Barcelona, Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
| | | |
Collapse
|
9
|
Ma W, Liang Y, Zhu J, Yang Y, Tan H, Yu L, Gao X, Feng G, Li J. Impact of Admission Systolic Blood Pressure and Antecedent Hypertension on Short-Term Outcomes After ST-Segment Elevation Myocardial Infarction: Strobe-Compliant Article. Medicine (Baltimore) 2015; 94:e1446. [PMID: 26313807 PMCID: PMC4602932 DOI: 10.1097/md.0000000000001446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We evaluated the combined effect of admission systolic blood pressure (SBP) and antecedent hypertension on short-term outcomes in patients with ST-segment elevation myocardial infarction (STEMI). Data were derived from a multicenter survey of 7303 consecutive patients with STEMI. Patients were divided into 4 groups according to different blood pressure status: high SBP without hypertension, high SBP with hypertension, low SBP without hypertension, and low SBP with hypertension. The primary endpoints were 7 and 30-day all-cause mortality. The prevalence of hypertension was 40.7%, and the best cutoff of admission SBP for predicting 30-day mortality was 108 mmHg by receiver-operating characteristic curve. Patients with hypertension were older, more often female, also had longer onset-to-admission time, more comorbidities, and higher Killip class. Patients with both low SBP (≤108 mmHg) and hypertension group had significantly higher 7 and 30-day mortality than those in other groups (all P < 0.001). After multivariate adjustment, low SBP with hypertension group was still an independent risk factor for predicting 7-day mortality (hazard ratios [HR] 1.86, 95% confidence interval [CI] 1.41-2.46; P < 0.001) and 30-day mortality (HR 1.88, 95% CI 1.46-2.43; P < 0.001). In patients with SBP > 108 mmHg, a history of hypertension could increase the risk of 30-day mortality by 27% (HR 1.00 vs 1.27, P = 0.012), while in patients with SBP ≤ 108 mmHg, this increased risk reached to 37% (HR 1.51 vs 1.88, P < 0.001). In conclusion, low admission SBP was the relatively dominant contributor for predicting 7 and 30-day all-cause mortality, and a concurrent antecedent hypertension increased the corresponding risk of mortality.
Collapse
Affiliation(s)
- Wenfang Ma
- From the State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | | | | | | | | | | | | | | | | |
Collapse
|