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Yaliqin N, Aimaier S, Adi D, Ma YT, Yu ZX. Impact of Duration of Diabetes Mellitus on Long-Term Outcome in Type 2 Diabetic Patients with Primary Percutaneous Coronary Intervention after the First Myocardial Infarction. Cardiology 2024; 149:297-313. [PMID: 38763137 DOI: 10.1159/000538032] [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: 10/20/2023] [Accepted: 02/21/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) increases the risk of mortality in patients with acute myocardial infarction (AMI). The impact of the diabetes duration on the long-term outcome of those with percutaneous coronary intervention (PCI) after the first AMI is unclear. In this study, we evaluated the predictive value of diabetes duration in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs). METHODS A total of 394 type 2 DM patients with PCI after the first AMI were enrolled and were divided into two groups by the diabetes duration: a short-DM group with diabetes duration of <5 years and a long-DM group with a duration of ≥5 years. The clinical endpoint was MACCEs. RESULTS Multivariate Cox regression analysis found that the diabetes duration was independently associated with increased occurrence of MACCEs (HR: 1.512, 95% CI: 1.033, 2.215, p = 0.034), along with hypertension, Killip class III or IV, creatinine, multivessel disease, and continuous hypoglycemic therapy. After adjusting for the confounding variables, a nested Cox model showed that diabetes duration was still an independent risk factor of MACCEs (HR: 1.963, 95% CI: 1.376, 2.801, p < 0.001). The Kaplan-Meier survival curve illustrated a significantly high risk of MACCEs (HR: 2.045, p < 0.0001) in long-duration DM patients. After propensity score matching, a longer diabetes duration was associated with an increased risk of MACCE occurrence. CONCLUSION Long-duration diabetes was independently associated with poor clinical outcomes after PCI in patients with their first myocardial infarction. Despite the diabetes duration, continuous hypoglycemic therapy significantly improved long-term clinical outcomes.
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Affiliation(s)
- Nazila Yaliqin
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China,
| | - Salamaiti Aimaier
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Dilare Adi
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Yi-Tong Ma
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Zi-Xiang Yu
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
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Yi HJ, Shin DS, Kim BT. Dynamic changes of systemic inflammation response index and systemic immune-inflammation index are associated with delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage. J Stroke Cerebrovasc Dis 2024; 33:107626. [PMID: 38325674 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107626] [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: 11/13/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVES Delayed cerebral ischemia (DCI) is a factor contributing to poor outcome of aneurysmal subarachnoid hemorrhage (aSAH). Serial inflammatory response is known to affect the occurrence of DCI. The aim of this study was to evaluate associations of dynamic changes of various inflammatory markers with occurrence of DCI after aSAH. METHODS A total of 279 patients with interventional treatment for aSAH were enrolled, and dichotomized according to the occurrence of DCI. Various inflammatory markers, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and their dynamic changes were analyzed at four different time points. Receiver operating characteristic (ROC) curve analysis with area under the curve (AUC) and univariate, multivariate Cox regression analyses with hazard ratio (HR) and 95 % confidence interval (CI) were performed to identify predictors for DCI. RESULTS Differences of SII and SIRI values between DCI (+) and DCI (-) group were significantly higher at 5-7 days than at other time points (P < 0.001 and P < 0.001, respectively). SII and SIRI had higher predicting values for DCI occurrence than other inflammatory markers (AUC: 0.862, 95 % CI: 0.786-0.928; P < 0.001 and AUC: 0.851, 95 % CI: 0.769-0.913; P < 0.001, respectively). SII at 5-7 days (HR: 1.74, 95 % CI: 1.38-3.22, P = 0.020) and SIRI at 5-7 days (HR: 1.62, 95 % CI: 1.28-2.84, P = 0.035) were associated with occurrence of DCI. CONCLUSIONS Dynamic changes of SII and SII might be predictors of DCI occurrence in patients with aSAH.
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Affiliation(s)
- Ho Jun Yi
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea; Department of Neurosurgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea; Department of Neurosurgery, Hangang Sacred Heart Hospital, Hallym University, Seoul, South Korea
| | - Dong-Seong Shin
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
| | - Bum-Tae Kim
- Department of Neurosurgery, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea
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Liu Y, Liu J, Liu L, Cao S, Jin T, Chen L, Wu G, Zong G. Association of Systemic Inflammatory Response Index and Pan-Immune-Inflammation-Value with Long-Term Adverse Cardiovascular Events in ST-Segment Elevation Myocardial Infarction Patients After Primary Percutaneous Coronary Intervention. J Inflamm Res 2023; 16:3437-3454. [PMID: 37600225 PMCID: PMC10438435 DOI: 10.2147/jir.s421491] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 08/01/2023] [Indexed: 08/22/2023] Open
Abstract
Aim Reducing the high morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) and improving patient prognosis remains a major global challenge. This study aimed to explore whether dynamic fluctuations in biomarkers are valuable predictors of prognosis in patients with STEMI. Methods This study included 216 patients with STEMI. Blood routine tests were performed on admission, 12 h after percutaneous coronary intervention (PCI), and at discharge. Systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation-value (PIV) serum immune-inflammatory markers were calculated. The Cox proportional hazard model was used to assess the factors independently associated with the prognosis of STEMI. The optimal cutoff values for the inflammatory markers were calculated. Results Eighty-five (39.35%) of the 216 patients had major adverse cardiovascular events (MACEs) during the 1-year follow-up. Most were male (81.18%) with a median age of 64 years (interquartile, 55-69.5). Killip class ≥ II on admission (hazard ratio [HR], 1.859; 95% CI, 1.169-2.957; P = 0.009), total stent length (HR, 1.016; 95% CI, 1.003-1.029; P = 0.019), values of SIRI at 12 h after PCI (HR, 1.079; 95% CI, 1.050-1.108; P < 0.001), and the Gensini score (HR, 1.014; 95% CI, 1.007-1.022; P < 0.001) were independently associated with an increased risk of MACEs. Compared with SII, SIRI and PIV calculated at various time points and dynamically fluctuating changes, SIRI (cutoff value, 4.15; 95% CI, 0.701-0.819; P < 0.001) and PIV (cutoff value, 622.71; 95% CI, 0.674-0.796; P < 0.001) at 12 h after PCI showed the best efficacy for the prognosis of STEMI. Conclusion Our study provides relevant evidence to the notion that SIRI or PIV at 12 h after PCI may be more accurate and economical predictors of long-term adverse prognosis in patients with STEMI.
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Affiliation(s)
- Yehong Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
| | - Jie Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
| | - Longqun Liu
- Department of Respirology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
| | - Shaoqing Cao
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, People’s Republic of China
| | - Tianhui Jin
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
| | - Liang Chen
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, People’s Republic of China
| | - Gangyong Wu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, People’s Republic of China
| | - Gangjun Zong
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, People’s Republic of China
- Department of Cardiology, Wuxi Clinical College of Anhui Medical University, Wuxi, Jiangsu, People’s Republic of China
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Sathvik M, Kalva ECSS, Suma G. A Study on Acute Myocardial Infarction and Its Prognostic Predictors. Cureus 2023; 15:e34775. [PMID: 36909023 PMCID: PMC10005819 DOI: 10.7759/cureus.34775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/10/2023] Open
Abstract
Introduction Acute Myocardial Infarction (AMI) is a serious cardiac event characterized by the sudden death of heart muscle tissue due to the obstruction of blood flow to the heart. It is a leading cause of death and disability worldwide. The relationship between AMI and serum uric acid levels is an area of ongoing research. Serum uric acid is a byproduct of purine metabolism and is typically present in the blood at low levels. Elevated levels of uric acid have been linked to several cardiovascular risk factors, including hypertension, diabetes, and hyperlipidemia. This has led to the investigation of the relationship between uric acid levels and AMI. Materials and Methods In this study, 100 individuals who were presented with acute myocardial infarction were included. All patients were categorized into four Killip's classes based on history, clinical examination, and lab investigation. Subsequently, the four Killip's classes were co-related with the serum uric acid of the patient. Results Serum uric acid levels were high in males compared to females. serum uric acid levels were high in Killip's class III (7.24) and IV (7.57) compared to class I (4.48) and II (5.26). There was no significant correlation between serum uric acid and the co-morbidities like diabetes and hypertension, with a p-value of 0.48. Conclusion An increase in Killip Class is positively correlated with an increase in blood uric acid levels. Uric acid can therefore be utilized as a prognostic indicator in individuals who present with myocardial infarction.
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Affiliation(s)
- Manduri Sathvik
- Department of Internal Medicine, NRI Medical College and General Hospital, Guntur, IND
| | | | - Gonji Suma
- Department of Community Medicine, Katuri Medical College and Hospital, Guntur, IND
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Oh S, Kim JH, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH. Association between baseline smoking status and clinical outcomes following myocardial infarction. Front Cardiovasc Med 2022; 9:918033. [PMID: 35935630 PMCID: PMC9354586 DOI: 10.3389/fcvm.2022.918033] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 06/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Whether the effect of smoking on clinical outcomes following an acute myocardial infarction (AMI) is beneficial or detrimental remains inconclusive. We invesetigated the effect of smoking on the clinical outcomes in patients following an AMI. Methods Among 13,104 patients between November 2011 and June 2015 from a nationwide Korean AMI registry, a total of 10,193 participants were extracted then classified into two groups according to their smoking habit: (1) smoking group (n = 6,261) and (2) non-smoking group (n = 3,932). The participants who smoked were further subclassified according to their smoking intensity quantified by pack years (PYs): (1) <20 PYs (n = 1,695); (2) 20–40 PYs (n = 3,018); and (3) ≥40 PYs (n = 2,048). Each group was compared to each other according to treatment outcomes. The primary outcome was the incidence of major adverse cardiac and cerebrovascular events (MACCEs), which is a composite of all-cause mortality, non-fatal MI (NFMI), any revascularization, cerebrovascular accident, rehospitalization, and stent thrombosis. Secondary outcomes included the individual components of MACCEs. The Cox proportional hazard regression method was used to evaluate associations between baseline smoking and clinical outcomes following an AMI. Two propensity score weighting methods were performed to adjust for confounders, including propensity score matching and inverse probability of treatment weighting. Results While the incidence of all clinical outcomes, except for stent thrombosis, was lower in the smoking group than in the non-smoking group in the unadjusted data, the covariates-adjusted data showed statistical attenuation of these differences but a higher all-cause mortality in the smoking group. For smokers, the incidence of MACCEs, all-cause mortality, cardiac and non-cardiac death, and rehospitalization was significantly different between the groups, with the highest rates of MACCE, all-cause mortality, non-cardiac death, and rehospitalization in the group with the highest smoking intensity. These differences were statistically attenuated in the covariates-adjusted data, except for MACCEs, all-cause mortality, and non-cardiac death, which had the highest incidence in the group with ≥40 PYs. Conclusion Smoking had no beneficial effect on the clinical outcomes following an AMI. Moreover, for those who smoked, clinical outcomes tended to deteriorate as smoking intensity increased.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
- *Correspondence: Ju Han Kim,
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, South Korea
- Department of Cardiology, Chonnam National University Medical School, Hwasun, South Korea
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Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Association between total ischemic time and in-hospital mortality after emergency PCI in patients with acute ST-segment elevation myocardial infarction: a retrospective study. BMC Cardiovasc Disord 2022; 22:80. [PMID: 35246059 PMCID: PMC8896149 DOI: 10.1186/s12872-022-02526-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom-to-balloon time (SBT) represents the total ischemic time in ST-elevated myocardial infarction (STEMI) and is associated with poor long-term outcomes. The study aimed to explore the association between SBT and in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods This retrospective, multicenter, observational study included patients admitted to the Hebei General Hospital, Baoding No. 1 Central Hospital, and Cangzhou Central Hospital from January 2016 to December 2018. The outcome was all-cause mortality during the hospital stay. Logistic regression models were established to explore the association between SBT and all-cause mortality during the hospital stay. Results This study included 1169 patients: 876 males of 59.6 ± 11.4 years of age, and 293 females 66.3 ± 13.3 years of age. A first analysis showed EF had an interaction with SBT (P = 0.01). In patients with EF ≥ 50%, SBT was not an independent risk factor for postoperative all-cause mortality in the hospital (all P > 0.05). In patients with EF < 50%, SBT was an independent risk factor for postoperative all-cause mortality in the hospital [model 3: 1.51 (1.17, 1.54), P for trend = 0.01]. Conclusions SBT was independently associated with all-cause mortality in the hospital after PCI in patients with acute STEMI and EF < 50%. Specifically, the risk of in-hospital mortality for those with SBT ≥ 361 min is increased by 51% compared with those with SBT ≤ 120 min.
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Affiliation(s)
- Nan Gao
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China.,Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Xiaoyong Qi
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China. .,Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Gang Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
| | - Xiao Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Ning Zhu
- Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
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Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Establishment and validation of a risk model for prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary PCI. BMC Cardiovasc Disord 2020; 20:513. [PMID: 33297955 PMCID: PMC7727168 DOI: 10.1186/s12872-020-01804-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background Currently, how to accurately determine the patient prognosis after a percutaneous coronary intervention (PCI) remains unclear and may vary among populations, hospitals, and datasets. The aim of this study was to establish a prediction model of in-hospital mortality risk after primary PCI in patients with acute ST-elevated myocardial infarction (STEMI). Methods This was a multicenter, observational study of patients with acute STEMI who underwent primary PCI. The outcome was in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method was used to select the features that were the most significantly associated with the outcome. A regression model was built using the selected variables to select the significant predictors of mortality. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results Totally, 1169 and 316 patients were enrolled in the training and validation sets, respectively. Fourteen predictors were identified by the LASSO analysis: sex, Killip classification, left main coronary artery disease (LMCAD), grading of thrombus, TIMI classification, slow flow, application of IABP, administration of β-blocker, ACEI/ARB, symptom-to-door time (SDT), symptom-to-balloon time (SBT), syntax score, left ventricular ejection fraction (LVEF), and CK-MB peak. The mortality risk prediction nomogram achieved good discrimination for in-hospital mortality (training set: C-statistic = 0.987; model calibration: P = 0.722; validation set: C-statistic = 0.984, model calibration: P = 0.669). Area under the curve (AUC) values for the training and validation sets are 0.987 (95% CI: 0.981–0.994, P = 0.003) and 0.990 (95% CI: 0.987–0.998, P = 0.007), respectively. DCA shows that the nomogram can achieve good net benefit. Conclusions A novel nomogram was developed and is a simple and accurate tool for predicting the risk of in-hospital mortality in patients with acute STEMI who underwent primary PCI.
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Affiliation(s)
- Nan Gao
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Gang Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xiao Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ning Zhu
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei, China
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Ahmed OE, Abohamr SI, Alharbi SA, Aldrewesh DA, Allihimy AS, Alkuraydis SA, Alhammad IM, Elsheikh E, Azazy AS, Mohammed AA, Dar MA, Abazid RM. In-hospital mortality of acute coronary syndrome in elderly patients. Saudi Med J 2019; 40:1003-1007. [PMID: 31588478 PMCID: PMC6887884 DOI: 10.15537/smj.2019.10.24583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 09/17/2019] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To analyze predictors of death in elderly patients diagnosed with acute coronary syndrome (ACS). Methods: A record-based study carried out between January 2016 and January 2018 at The central province in Saudi Arabia. All elderly patients (greater than 75 years) with definite diagnosis of ACS were retrospectively included. Demographic data, echocardiographic, and angiographic parameters were reported. Results: A total of 179 patients were enrolled, 129 (72%) were male. The mean age was 79±4.7 years. Approximately 102 (57%) patients were diagnosed with ST-segment elevation myocardial infarction (STEMI). Of all 125 (70%) underwent invasive coronary angiography, we found that 43 (24%) had significant single vessel disease (1VD), 29 (16.2%) had 2 vessel disease (2VD), and 41 (22.9%) had 3 vessel disease (3VD) or left main stenosis. During hospitalization 21 (11.7%) patients died, t-test analysis showed patients who died were significantly older (82±6.7 versus [vs.] 79±4.2 years, p=0.003). In addition we found that ejection fraction was lower in death group (30.2%±10.7) vs. (36.5%±1.1) in survivors, p=0.017); STEMI was more common in death group (90.5%) vs. (52.5%) in survivors, p=0.001); similarly, the prevalence of 3VD was higher in death group (38.1%) vs. (20.9%) in survivors, p=0.018). Importantly, PCI was not significantly different between death and survival groups (40% vs. 53.8%, p=0.177). A multivariate regression analysis demonstrated that predictors of death were: age (hazard ratio [HR], 1.214; 95% confidence interval [CI], 1.122-1.384; p less than 0.0001), intubation (HR, 10.106; 95% CI, 9.844-10.792; p less than 0.0001), and raised creatinine kinase-MB (CK-MB) (HR, 1.005; 95% CI, 1.002-1.013; p=0.04) predicted in hospital death. Conclusion: Older age, mechanical ventilation and raised CK-MB can significantly predict death in elderly patients (greater than 75-year-old) diagnosed with ACS; nevertheless, PCI showed no survival benefits.
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Affiliation(s)
- Omima E Ahmed
- Department of Cardiology, Prince Sultan Cardiac Center Qassim, Qassim, Buraydah, Kingdom of Saudi Arabia.
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Ali M, Lange SA, Wittlinger T, Lehnert G, Behrend S, Ziadeh B, Ali K, Sakellaropoulos S, Ganchev G, Rigopoulos AG, Noutsias M. RETRACTED ARTICLE: Direct transfer of STEMI patients to cardiac catheterization laboratory : Prognostic relevance for in-hospital mortality. Herz 2019; 44:460. [PMID: 29350253 DOI: 10.1007/s00059-017-4673-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Affiliation(s)
- M Ali
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany.
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany.
| | - S A Lange
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Centre Lübeck, Lübeck, Germany
| | - T Wittlinger
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany
| | - G Lehnert
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany
| | - S Behrend
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany
| | - B Ziadeh
- Department of Cardiology, AsklepiosHarzklinik Goslar, KöslinerStraße 12, 38642, Goslar, Germany
| | - K Ali
- Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
| | - S Sakellaropoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - G Ganchev
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - A G Rigopoulos
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
| | - M Noutsias
- Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, 06120, Halle (Saale), Germany
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Efficacy and Safety of Ticagrelor Compared with Clopidogrel in Patients with End-Stage Renal Disease with Acute Myocardial Infarction. Am J Cardiovasc Drugs 2019; 19:325-334. [PMID: 30746615 DOI: 10.1007/s40256-018-00318-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study investigated the efficacy and safety of ticagrelor compared with clopidogrel in patients with end-stage renal disease (ESRD) and acute myocardial infarction (AMI). METHODS We retrospectively enrolled patients who had received regular dialysis and had undergone percutaneous coronary intervention (PCI) for AMI at our hospital between January 2013 and December 2016. Outcomes analyzed included cardiovascular death, death from any cause, MI, stroke, and bleeding events. RESULT Patients were allocated to the ticagrelor group (N = 74) or the clopidogrel group (N = 116) according to the treatment they had received. No statistically significant differences were found between the groups in terms of in-hospital primary endpoint (composite of cardiovascular death, MI, and stroke: 12.2% and 15.5% for ticagrelor and clopidogrel, respectively; p = 0.518), secondary endpoint, or any bleeding events (39.2 vs. 34.5%; p = 0.511). No statistically significant differences were found for the 1-year primary endpoint (p = 0.424), secondary endpoint, and any bleeding events (p = 0.663). Risk factors for in-hospital cardiovascular death were shock and cardiopulmonary resuscitation at initial AMI presentation, lack of beta-blocker use, and in-hospital gastrointestinal bleeding. Risk factors for 1-year cardiovascular death were shock at initial AMI presentation and lack of beta-blocker use. Only respiratory failure was a risk factor for in-hospital and 1-year gastrointestinal bleeding. CONCLUSION In patients with ESRD and AMI, ticagrelor resulted in numerically fewer but statistically nonsignificant rates of in-hospital and 1-year cardiovascular events with no significant increase in bleeding events compared with clopidogrel.
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In-hospital mortality after acute STEMI in patients undergoing primary PCI. Herz 2017; 43:741-745. [PMID: 28993843 DOI: 10.1007/s00059-017-4621-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 08/28/2017] [Accepted: 08/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Acute myocardial infarction (AMI) is the main cause of global and in-hospital mortality in patients with cardiovascular diseases. We aimed to examine the association between the coronary artery involved and the in-hospital mortality in patients who underwent primary percutaneous coronary intervention (pPCI) after ST segment elevation myocardial infarction (STEMI). METHODS The in-hospital mortality of STEMI patients who underwent pPCI was assessed at the Department of Cardiology, Harzklinik Goslar, Germany, which has no access to immediate mechanical circulatory support (MCS), between 2013 and 2017. RESULTS We enrolled 312 STEMI patients, with a mean age of 67.1 ± 13.4 years, of whom 211 (68%) were male. In-hospital mortality was documented in 31 patients (10%). In-hospital mortality was associated with pre-hospital cardiopulmonary resuscitation (CPR; n = 39/12.5%), older age, lower systolic blood pressure, Killip class > 1, triple-vessel disease (each p < 0.0001), female gender (p = 0.0158), and with the localization of the treated culprit lesion in the left main coronary artery (LMCA; p = 0.0083) and in the ramus circumflexus (RCX; p = 0.0141). CONCLUSION In this monocentric cohort, all-cause in-hospital mortality of STEMI patients after pPCI was significantly higher in those patients with culprit lesions in the LMCA and in the RCX, which may prove to be a substantial novel risk factor for STEMI-related mortality. Increasing age and female gender may be interdependent risk factors for mortality in this patient population. Furthermore, our data highlight the importance of the availability of MCS options in pPCI centers for patients after CPR.
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Fang YN, Tong MS, Sung PH, Chen YL, Chen CH, Tsai NW, Huang CJ, Chang YT, Chen SF, Chang WN, Lu CH, Yip HK. Higher neutrophil counts and neutrophil-to-lymphocyte ratio predict prognostic outcomes in patients after non-atrial fibrillation-caused ischemic stroke. Biomed J 2017; 40:154-162. [PMID: 28651737 PMCID: PMC6136280 DOI: 10.1016/j.bj.2017.03.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 02/21/2017] [Accepted: 03/02/2017] [Indexed: 12/21/2022] Open
Abstract
Background We aimed to determine whether higher neutrophil counts (NC) and neutrophil-to-lymphocyte ratio (NLR) were independently predictive of worse in-hospital outcome in patients after acute ischemic stroke (IS). Methods A retrospective observational study with prospective manner of IS registration. Between April 2012 and August 2014, a total number of 1731 patients with post-IS were consecutively enrolled in the study. Blood samples were drawn upon admission. Primary endpoint was in-hospital mortality. Secondary endpoint was severe stroke (≥16 NIHSS). Results The NC progressively increased from mild (NIHSS ≤ 5) to moderate (NIHSS ≥ 6 < 16) and severe (NIHSS ≥ 16) stroke (p = 0.006). NLR was independently associated with in-hospital mortality (p = 0.002). Multiple stepwise linear regression analysis showed that NC (p = 0.001) and NLR (p = 0.002) were independently predictive of higher NIHSS. Multiple stepwise logistic regression analysis showed that NC was independently associated with severe stroke (p < 0.0001). The best discriminating factor for in-hospital mortality with respect to NLR was ≥3.20 (sensitivity 62.7%, specificity 60.3%, likelihood ratio: 12.2). Patients with NLR ≥3.20 had a 2.55-fold increased risk for in-hospital mortality (OR = 1.49–4.37) compared to patients with NLR <3.20. The best discriminating factor for severe stroke (≥16 NIHSS) with respect to NC was ≥74% (sensitivity 47.1%, specificity 74.0%, likelihood ratio: 29.0). Patients with NC >74% had a 2.54-fold increased risk of severe stroke (OR = 1.82–3.54) compared to patients with NC <74%. Conclusion NLR was independently associated with in-hospital mortality and higher NC was independently predictive of severe stroke.
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Affiliation(s)
- Yen-Nan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Meng-Shen Tong
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Chen
- Division of General Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Nei-Wen Tsai
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Jen Huang
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ya-Ting Chang
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Fang Chen
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; Department of Nursing, Asia University, Taichung, Taiwan.
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13
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Metkus TS, Albaeni A, Chandra-Strobos N, Eid SM. Incidence and Prognostic Impact of Respiratory Support in Patients With ST-Segment Elevation Myocardial Infarction. Am J Cardiol 2017; 119:171-177. [PMID: 27956004 DOI: 10.1016/j.amjcard.2016.09.037] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
Data addressing the use of respiratory support in acute coronary syndromes are lacking. To address this evidence gap, we characterized prognostic impact and trends in utilization of invasive mechanical ventilation (IMV) and noninvasive ventilation (NIV) in patients hospitalized with ST-segment elevation myocardial infarction (STEMI) from 2002 through 2013 using the National Inpatient Sample. Multivariate logistic regression was performed to identify patient, hospital, and clinical characteristics associated with requiring IMV or NIV within 24 hours of hospitalization. Multivariate Cox proportional hazards regression was used to quantify the magnitude of in-hospital mortality associated with IMV and NIV use. From 2002 to 2013, we identified 1,867,114 patients with STEMI. Age, gender, higher co-morbidity burden, and chronic pulmonary disease were significantly associated with need for respiratory support. The use of IMV and NIV increased at average annual rates of 6.6% and 14.3%, respectively (ptrend <0.001). Age- and gender-adjusted mortality rates are high but declined for patients with STEMI requiring IMV (44.7% in 2002 to 37.6% in 2013, ptrend = 0.002) and NIV (11.6% in 2002 to 6.8% in 2013, ptrend <0.001). Compared to patients with STEMI with no ventilation need, a requirement for IMV or NIV was associated with increased adjusted in-hospital mortality (hazard ratio 2.5, p <0.001 and 1.7, p <0.001, respectively). In conclusion, approximately 1 in 23 patients hospitalized with STEMI will require respiratory support in the form of IMV or NIV. Patients with STEMI who require respiratory support have a high risk of death, although rates of in-hospital mortality have decreased over time.
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Affiliation(s)
- Thomas S Metkus
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Aiham Albaeni
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nisha Chandra-Strobos
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shaker M Eid
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Pesaro AEP, Katz M, Katz JN, Barbas CSV, Makdisse MR, Correa AG, Franken M, Pereira C, Serrano CV, Lopes RD. Mechanical Ventilation and Clinical Outcomes in Patients with Acute Myocardial Infarction: A Retrospective Observational Study. PLoS One 2016; 11:e0151302. [PMID: 26977804 PMCID: PMC4792462 DOI: 10.1371/journal.pone.0151302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 02/25/2016] [Indexed: 11/21/2022] Open
Abstract
Purpose Patients with acute myocardial infarction (AMI) and respiratory impairment may be treated with either invasive or non-invasive mechanical ventilation (MV). However, there has been little testing of non-invasive MV in the setting of AMI. Our objective was to evaluate the incidence and associated clinical outcomes of patients with AMI who were treated with non-invasive or invasive MV. Methods This was a retrospective observational study in which consecutive patients with AMI (n = 1610) were enrolled. The association between exclusively non-invasive MV, invasive MV and outcomes was assessed by multivariable models. Results Mechanical ventilation was used in 293 patients (54% invasive and 46% exclusively non-invasive). In-hospital mortality rates for patients without MV, with exclusively non-invasive MV, and with invasive MV were 4.0%, 8.8%, and 39.5%, respectively (P<0.001). The median lengths of hospital stay were 6 (5.8–6.2), 13 (11.2–4.7), and 28 (18.0–37.9) days, respectively (P<0.001). Exclusively non-invasive MV was not associated with in-hospital death (adjusted HR = 0.90, 95% CI 0.40–1.99, P = 0.79). Invasive MV was strongly associated with a higher risk of in-hospital death (adjusted HR = 3.07, 95% CI 1.79–5.26, P<0.001). Conclusions In AMI setting, 18% of the patients required MV. Almost half of these patients were treated with exclusively non-invasive strategies with a favorable prognosis, while patients who needed to be treated invasively had a three-fold increase in the risk of death. Future prospective randomized trials are needed to compare the effectiveness of invasive and non-invasive MV for the initial approach of respiratory failure in AMI patients.
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Affiliation(s)
| | - Marcelo Katz
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Jason N. Katz
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Carmen Sílvia Valente Barbas
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Pulmonary Department, Heart Institute (INCOR), University of São Paulo Medical School, São Paulo, SP, Brazil
| | | | | | | | | | - Carlos V. Serrano
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Heart Institute (INCOR), University of Sao Paulo Medical School, São Paulo, SP, Brazil
| | - Renato D. Lopes
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina, United States of America
- Federal University of São Paulo, Paulista School of Medicine, São Paulo, SP, Brazil
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15
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Chen HC, Lee WC, Chen YL, Fang HY, Chen CJ, Yang CH, Hang CL, Fang CY, Yip HK, Wu CJ. The impacts of prolonged emergency department length of stay on clinical outcomes of patients with ST-segment elevation myocardial infarction after reperfusion. Intern Emerg Med 2016; 11:107-14. [PMID: 26498658 DOI: 10.1007/s11739-015-1330-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Emergency department and hospital crowding have become an increasing problem. The clinical outcomes of prolonged emergency department (ED) length of stay in acute ST-segment elevation myocardial infarction (STEMI) patients after reperfusion are still unknown. Between January 2008 and December 2011, 432 consecutive patients with STEMI undergoing primary PCI were recruited. Patients were divided into two groups: the immediate admission group (length of ED stay <8 h; IA group) and the prolonged ED stay group (length of ED stay ≧8 h; PS group). The median lengths of ED stay of the patients in both groups were 29.97 h in the PS group (n = 145, 33.6%) and 1.78 h in the IA group (n = 287, 66.4%), respectively. The age, gender, risk factors of coronary artery disease, characteristic of coronary angiography, and TIMI risk score did not differ between the two groups. During nearly 4-year clinical follow-up, the short-term and long-term clinical outcomes were similar between the two groups. B-blocker and statins were used infrequently in the ED. In addition, patients with high TIMI risk score in the PS group had higher incidence of 1-year re-MI (6.8 vs. 1.8%; p = 0.045). In the era of primary PCI for STEMI patients after reperfusion, prolonged ED length of stay may not influence clinical outcomes. Patients with high TIMI risk score in the PS group still had a trend toward worse clinical outcome after long ED stays.
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Affiliation(s)
- Huang-Chung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Hsiu-Yu Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Chih-Yuan Fang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC.
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No. 123, Ta Pei Road, Niao Sung District, Kaohsiung, 83301, Taiwan, ROC.
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16
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Effect of weekend admission for acute myocardial infarction on in-hospital mortality: a retrospective cohort study. Int J Cardiol 2014; 179:315-20. [PMID: 25464474 DOI: 10.1016/j.ijcard.2014.11.070] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/08/2014] [Accepted: 11/05/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND No previous nationwide study has examined whether there is a 'weekend effect' of higher mortality after admission for acute myocardial infarction (AMI) when percutaneous coronary intervention (PCI) is easily accessible. METHODS Using the Diagnosis Procedure Combination inpatient database in Japan, we identified AMI patients aged ≥20 years who were admitted to acute care hospitals between July 1, 2010 and March 31, 2013. Multivariable regression models fitted with generalized estimating equations were used to determine the association between weekend admission and in-hospital mortality. Eligible patients were also classified into subgroups according to Killip class at admission. RESULTS Of 111,200 eligible patients, 30,847 patients were admitted on weekends and 80,353 patients on weekdays. Overall, the in-hospital mortality was significantly higher for weekend admission than for weekday admission (13.6% versus 11.4%; P<0.001; unadjusted odds ratio [OR] 1.222; 95% confidence interval [CI] 1.172 to 1.274), despite the higher rate of PCI performed on the day of admission (68.9% versus 64.8%; P<0.001). The association remained significant after adjusting for baseline characteristics, invasive procedures, and medications (adjusted OR 1.144, 95% CI 1.079 to 1.214). In subgroup analyses, the effect of weekend admission remained significant in the Killip II to IV subgroups, but became insignificant in the Killip I subgroup (adjusted OR 1.002, 95% CI 0.828 to 1.213). CONCLUSIONS This study showed that weekend admission for AMI was significantly associated with higher in-hospital mortality even in a setting where PCI was highly available.
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Lee WC, Tsai TH, Chen YL, Yang CH, Chen SM, Chen CJ, Lin CJ, Cheng CI, Hang CL, Wu CJ, Yip HK. Safety and feasibility of coronary stenting in unprotected left main coronary artery disease in the real world clinical practice--a single center experience. PLoS One 2014; 9:e109281. [PMID: 25329166 PMCID: PMC4203693 DOI: 10.1371/journal.pone.0109281] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 09/10/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study evaluated the feasibility, safety, and prognostic outcome in patients with significant unprotected left main coronary artery (ULMCA) disease undergoing stenting. METHOD AND RESULTS Between January 2010 and December 2012, totally 309 patients, including those with stable angina [13.9% (43/309)], unstable angina [59.2% (183/309)], acute non-ST-segment elevation myocardial infarction (NSTEMI) [24.3% (75/309)], and post-STEMI angina (i.e., onset of STEMI<7 days) [2.6% (8/309)] with significant ULMCA disease (>50%) undergoing stenting using transradial arterial approach, were consecutively enrolled. The patients' mean age was 68.9±10.8 yrs. Incidences of advance congestive heart failure (CHF) (defined as ≥ NYHA Fc 3) and multi-vessel disease were 16.5% (51/309) and 80.6% (249/309), respectively. Mechanical supports, including IABP for critical patients (defined as LVEF <35%, advanced CHF, or hemodynamically unstable) and extra-corporeal membrane oxygenator (ECMO) for hemodynamically collapsed patients, were utilized in 17.2% (53/309) and 2.6% (8/409) patients, respectively. Stent implantation was successfully performed in all patients. Thirty-day mortality rate was 4.5% (14/309) [cardiac death: 2.9% (9/309) vs. non-cardiac death: 1.6% (5/309)] without significant difference among four groups [2.3% (1) vs. 2.7% (5) vs. 9.3% (7) vs. 12.5% (1), p = 0.071]. Multivariate analysis identified acute kidney injury (AKI) as the strongest independent predictor of 30-day mortality (p<0.0001), while body mass index (BMI) and white blood cell (WBC) count were independently predictive of 30-day mortality (p = 0.003 and 0.012, respectively). CONCLUSION Catheter-based LM stenting demonstrated high rates of procedural success and excellent 30-day clinical outcomes. AKI, BMI, and WBC count were significantly and independently predictive of 30-day mortality.
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Affiliation(s)
- Wei-Chieh Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shyh-Ming Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Jen Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Jei Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-I Cheng
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ling Hang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Institute of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- * E-mail:
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18
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Meimoun P, M'barek D, Dragomir C, Luycx-Bore A, Elmkies F, Boulanger J, Zemir H, Martis S, Neykova A, Tzvetkov B, Clerc J. [Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty]. Ann Cardiol Angeiol (Paris) 2013; 62:293-300. [PMID: 24054406 DOI: 10.1016/j.ancard.2013.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. METHODS Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. RESULTS Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. CONCLUSION In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.
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Affiliation(s)
- P Meimoun
- Service de cardiologie-USIC, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiegne, France.
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Iyengar SS, Nair T, Hiremath JS, Jadhav U, Katyal VK, Kumbla D, Sathyamurthy I, Jain RK, Srinivasan M. Pharmacologic reperfusion therapy with indigenous tenecteplase in 15,222 patients with ST elevation myocardial infarction - the Indian Registry. Indian Heart J 2013; 65:436-41. [PMID: 23993004 PMCID: PMC3860598 DOI: 10.1016/j.ihj.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 06/19/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To study the efficacy and safety of single intravenous bolus administration of indigenously developed tenecteplase (TNK-tPA) in the management of patients with ST-elevation myocardial infarction (STEMI) in clinical practice. METHODS Observational, prescription-event monitoring study. RESULTS Data of 15,222 patients who had STEMI and received weight adjusted TNK injection was analyzed. Overall 95.43% patients had clinically successful thrombolysis (CST). In the different subgroups, hypertensives, diabetics, smokers and hyperlipidemic patients had CST rates comparable to the general patient data. CST rates were significantly lower in the elderly patients (>70 years; 92.11%; p < 0.0001), in patients with history of Ischemic Heart Disease (IHD, 93.86%; p = 0.0004) and in patients receiving delayed treatment (>6 h after onset of chest pain; 85.38%; p < 0.0001). CST was significantly higher in patients who received an early thrombolysis (<3 h after onset of chest pain; 96.54%; p = 0.006). Overall mortality was 1.69%, while it was significantly higher in the elderly (4.42%), patients with history of IHD (2.67%), females (2.93%) and in those who received delayed treatment (4.98%). The overall incidences of intracranial hemorrhage (ICH), bleeding excluding ICH, stroke and ventricular tachyarrhythmia were 0.39%, 2.01%, 0.16% and 2.35% respectively. Age >70 years, diabetes, hyperlipidemia and history of IHD were associated with a higher incidence of heart failure, myocardial re-infarction or ventricular tachyarrhythmias. However, incidence of ICH and bleeding other than ICH was comparable amongst all patient subgroups. CONCLUSION This study confirms the safety and efficacy of indigenous tenecteplase in Indian patients with STEMI, including high risk subgroups. It also highlights the fact that delayed treatment denotes denial of benefits of pharmacologic reperfusion therapy.
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Affiliation(s)
- S S Iyengar
- Head, Department of Cardiology, Manipal Heart Institute, Bangalore 56001, India.
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Sen S, Davies JE, Malik IS, Foale RA, Mikhail GW, Hadjiloizou N, Hughes A, Mayet J, Francis DP. Why Does Primary Angioplasty Not Work in Registries? Quantifying the Susceptibility of Real-World Comparative Effectiveness Data to Allocation Bias. Circ Cardiovasc Qual Outcomes 2012; 5:759-66. [DOI: 10.1161/circoutcomes.112.966853] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background—
Meta-analysis of registries (comparative effectiveness research) shows that primary angioplasty and fibrinolysis have equivalent real-world survival. Yet, randomized, controlled trials consistently find primary angioplasty superior. Can unequal allocation of higher-risk patients in registries have masked primary angioplasty benefit?
Methods and Results—
First, we constructed a model to demonstrate the potential effect of allocation bias. We then analyzed published registries (55022 patients) for allocation of higher-risk patients (Killip class ≥1) to determine whether the choice of reperfusion therapy was affected by the risk level of the patient. Meta-regression was used to examine the relationship between differences in allocation of high-risk patient to primary angioplasty or fibrinolysis and mortality. Initial modeling suggested that registry outcomes are sensitive to allocation bias of high-risk patients. Across the registries, the therapy receiving excess high-risk patients had worse mortality. Unequal distribution of high-risk status accounted for most of the between-registry variance (adjusted
R
2
meta
=83.1%). Accounting for differential allocation of higher-risk patients, primary angioplasty gave 22% lower mortality (odds ratio, 0.78; 95% confidence interval, 0.64–0.97;
P
=0.029). We derive a formula, called the number needed to abolish, highlighting situations in which comparative effectiveness studies are particularly vulnerable to this bias.
Conclusions—
In ST-segment elevation myocardial infarction, clinicians’ preference for management of a few high-risk patients can shift mortality substantially. Comparative effectiveness research in any disease is vulnerable to this, especially diseases with an immediately identifiable high-risk subgroup that clinicians prefer to allocate to 1 therapy. For this reason, preliminary indications from registry-based comparative effectiveness research should be definitively tested by randomized, controlled trials.
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Affiliation(s)
- Sayan Sen
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Justin E. Davies
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Iqbal S. Malik
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Rodney A. Foale
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Ghada W. Mikhail
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Nearchos Hadjiloizou
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Alun Hughes
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Jamil Mayet
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
| | - Darrel P. Francis
- From the Imperial College Healthcare National Health Service Trust, St. Mary’s Hospital, Imperial College London, London, UK
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[Acute heart failure]. Med Klin Intensivmed Notfmed 2012; 107:397-423; quiz 424-5. [PMID: 22689257 DOI: 10.1007/s00063-012-0118-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 05/14/2012] [Indexed: 01/10/2023]
Abstract
Acute decompensated heart failure (ADHF) is a major public health problem throughout the world and its importance is continuing to grow. More than 50% of ADHF patients have coronary artery disease, which is generally associated with a history of hypertension. Recent data suggest that half of the patients presenting with acute heart failure have preserved left ventricular systolic function. The diagnosis of ADHF may be difficult at times, and the clinical assessment and patient profiling is essential for appropriate therapy. Immediate therapeutic goals are not only to improve symptoms, restore oxygenation and stabilize hemodynamic conditions, but also to improve short- and long-term survival. In addition to general supportive measures such as oxygen supplementation, noninvasive ventilation, analgesia, diuretics, vasodilators together with inotropic agents and/or vasopressors remain the cornerstone of therapy in patients with ADHF.
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Tsai TH, Sung PH, Chang LT, Sun CK, Yeh KH, Chung SY, Chua S, Chen YL, Wu CJ, Chang HW, Ko SF, Yip HK. Value and Level of Galectin-3 in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention. J Atheroscler Thromb 2012; 19:1073-82. [DOI: 10.5551/jat.12856] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tzu-Hsien Tsai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Pei-Hsun Sung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Li-Teh Chang
- Basic Science, Nursing Department, Meiho Institute of Technology
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University
| | - Kuo-Ho Yeh
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Sheng-Ying Chung
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Sarah Chua
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Yung-Lung Chen
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Chiung-Jen Wu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
| | - Hsuen-Wen Chang
- Department of Biological Sciences, National Sun Yat-Sen University
| | - Sheung-Fat Ko
- Department of Radiology Kaohsiung Chang Gung Memorial Hospital, Chang Gung, University College of Medicine
| | - Hon-Kan Yip
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine
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Chen YL, Chang CL, Chen HC, Sun CK, Yeh KH, Tsai TH, Chen CJ, Chen SM, Yang CH, Hang CL, Wu CJ, Yip HK. Major adverse upper gastrointestinal events in patients with ST-segment elevation myocardial infarction undergoing primary coronary intervention and dual antiplatelet therapy. Am J Cardiol 2011; 108:1704-9. [PMID: 21924391 DOI: 10.1016/j.amjcard.2011.07.039] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/24/2011] [Accepted: 07/24/2011] [Indexed: 01/03/2023]
Abstract
The aim of this study was to investigate the incidence of composite short-term and long-term major adverse upper gastrointestinal (UGI) events (MAUGIEs; defined as gastric ulcer, duodenal ulcer, gastroduodenal ulcer, or UGI bleeding) in patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and routinely received dual-antiplatelet therapy. From May 2002 to September 2010, a total of 1,368 consecutive patients who experienced ST-segment elevation myocardial infarction and underwent primary percutaneous coronary intervention were prospectively enrolled in the study. The incidence of in-hospital UGI bleeding complications and composite MAUGIEs was 8.9% and 9.9%, respectively. The in-hospital mortality rate was significantly higher in patients with in-hospital MAUGIEs than in those without (p <0.001). Multivariate analysis showed that age, advanced Killip score (≥3), and respiratory failure were the strongest independent predictors of in-hospital composite MAUGIEs (all p <0.003). The cumulative composite of MAUGIEs after uneventful discharge in patients without adverse UGI events who continuously received dual-antiplatelet therapy for 3 to 12 months, followed by aspirin therapy, was 10.4% during long-term (mean 4.0 years) follow-up. In conclusion, the results of this study show a remarkably high incidence of composite short-term and long-term MAUGIEs in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention and received routine dual-antiplatelet therapy. Age, advanced Killip score, and respiratory failure were significantly and independently predictive of in-hospital composite MAUGIEs.
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Outcomes of patients with Killip class III acute myocardial infarction after primary percutaneous coronary intervention: Erratum. Crit Care Med 2011. [DOI: 10.1097/ccm.0b013e318217126b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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