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Oraii A, Shafeghat M, Ashraf H, Soleimani A, Kazemian S, Sadatnaseri A, Saadat N, Danandeh K, Akrami A, Balali P, Fatahi M, Karbalai Saleh S. Risk assessment for mortality in patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention: A retrospective cohort study. Health Sci Rep 2024; 7:e1867. [PMID: 38357486 PMCID: PMC10864735 DOI: 10.1002/hsr2.1867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims Primary percutaneous coronary intervention (PCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI) patients. This study aims to evaluate predictors of in-hospital and long-term mortality among patients with STEMI undergoing primary PCI. Methods In this registry-based study, we retrospectively analyzed patients with STEMI undergoing primary PCI enrolled in the primary angioplasty registry of Sina Hospital. Independent predictors of in-hospital and long-term mortality were determined using multivariate logistic regression and Cox regression analyses, respectively. Results A total of 1123 consecutive patients with STEMI were entered into the study. The mean age was 59.37 ± 12.15 years old, and women constituted 17.1% of the study population. The in-hospital mortality rate was 5.0%. Multivariate analyses revealed that older age (odds ratio [OR]: 1.06, 95% confidence interval [CI]: 1.02-1.10), lower ejection fraction (OR: 0.97, 95% CI: 0.92-0.99), lower mean arterial pressure (OR: 0.95, 95% CI: 0.93-0.98), and higher white blood cells (OR: 1.17, 95% CI: 1.06-1.29) as independent risk predictors for in-hospital mortality. Also, 875 patients were followed for a median time of 21.8 months. Multivariate Cox regression demonstrated older age (hazard ratio [HR] = 1.04, 95% CI: 1.02-1.06), lower mean arterial pressure (HR = 0.98, 95% CI: 0.97-1.00), and higher blood urea (HR = 1.01, 95% CI: 1.00-1.02) as independent predictors of long-term mortality. Conclusion We found that older age and lower mean arterial pressure were significantly associated with the increased risk of in-hospital and long-term mortality in STEMI patients undergoing primary PCI. Our results indicate a necessity for more precise care and monitoring during hospitalization for such high-risk patients.
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Affiliation(s)
- Alireza Oraii
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Melika Shafeghat
- School of MedicineTehran University of Medical SciencesTehranIran
- Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Haleh Ashraf
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
- Research Development Center, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Abbas Soleimani
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Sina Kazemian
- Cardiac Primary Prevention Research Center, Cardiovascular Diseases Research InstituteTehran University of Medical SciencesTehranIran
| | - Azadeh Sadatnaseri
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Naser Saadat
- Department of Cardiology, Sina HospitalTehran University of Medical SciencesTehranIran
| | - Khashayar Danandeh
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Ashley Akrami
- Chicago College of Osteopathic MedicineMidwestern UniversityDowners GroveIllinoisUSA
| | - Pargol Balali
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Mohamadreza Fatahi
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
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Kebede B, Getachew M, Agegnew S, Dagnew EM, Abebe D, Belayneh A, Tegegne BA, Kebede T, Kiflu M, Biyazin Y, Alamneh YM. Acute coronary syndrome and its treatment outcomes in Ethiopia: a systematic review and meta-analysis. J Pharm Policy Pract 2023; 16:98. [PMID: 37550741 PMCID: PMC10408155 DOI: 10.1186/s40545-023-00603-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 07/24/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is the principal cause of death in developing countries including Ethiopia. No study reports the overall patterns of risk factors and burden of in-hospital mortality in Ethiopia. This study, therefore, aimed to assess the magnitude of risk factors, management, and in-hospital mortality of ACS in Ethiopia. METHODS Electronic searching of articles was conducted using PubMed, Science Direct, EMBASE, Scopus, Hinari, and Google Scholar to access articles conducted in Ethiopia. The Preferred Reporting Items for Systematic Reviews checklist was used for identification, eligibility screening, and selection of articles. Data were extracted with an abstraction form prepared with Microsoft Excel and exported to STATA for analysis. Funnel plot, Begg's test, and Egger's test were used to determine publication bias. Heterogeneity between the studies was checked by I2 statistic. The pooled prevalence of risk factors and in-hospital mortality of ACS were estimated using a random-effects meta-analysis model. RESULTS Most (59.367%) of the patients had ST-segment elevation myocardial infarction (STEMI). Hypertension (54.814%) was the leading risk factor for ACS followed by diabetes mellitus (38.549%). Aspirin (56.903%) and clopidogrel (55.266%) were most frequently used in patients with STEMI ACS, respectively. The pooled proportion of in-hospital mortality of ACS was 14.82% which was higher in patients with STEMI (16.116%). CONCLUSION The rate of in-hospital mortality is still high which was higher in patients with STEMI. Initiation of treatment must consider the heterogeneity of each patient's risk factor and reperfusion therapy should be implemented in our setting.
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Affiliation(s)
- Bekalu Kebede
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Melese Getachew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia.
| | - Samuel Agegnew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Ephrem Mebratu Dagnew
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Dehnnet Abebe
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Anteneh Belayneh
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Bantayehu Addis Tegegne
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Tiringo Kebede
- Department of Nursing, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Mekides Kiflu
- Pharmacy Department, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Yalemgeta Biyazin
- Department of Pediatrics and Child Health Nursing, Health Science College, Debre Markos University, Debre Markos, Ethiopia
| | - Yoseph Merkeb Alamneh
- Department of Biomedical Sciences, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
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Beyranvand MR, Manhoobi H, Shahraz S, Kolahi AA. Myocardial Infarction in Iran: Epidemiology, Management, and Prognosis. J Tehran Heart Cent 2023; 18:82-86. [PMID: 37637282 PMCID: PMC10459342 DOI: 10.18502/jthc.v18i2.13316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/07/2023] [Indexed: 08/29/2023] Open
Abstract
Background Cardiovascular diseases, specifically acute myocardial infarction (AMI), are the leading cause of death worldwide. In this review, we explain the characteristics of AMI in Iran. Methods We searched PubMed, Google, and Google Scholar for articles containing myocardial infarction, STEMI, and MI+ Iran in English and Persian words. Results The age-standardized incidence rate of MI was 73.3 per 100 000. The mean±SD age of patients was 61.20±13.40 years. In-hospital mortality of patients with AMI in the IMIR was 12.1%. Concerning AMI complications reported in the IMIR, 5.8% of patients experienced ventricular tachycardia, and 2.5% experienced ventricular fibrillation. The 1-year mortality rate in the IPACE2 study was 4.3%. Conclusion Only a few national studies are available in Iran regarding patients with AMI. A federal surveillance program continuously monitoring and tracking coronary events is essential to improve the general population's health.
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Affiliation(s)
- Mohammad Reza Beyranvand
- Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hootan Manhoobi
- Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Ali-Asghar Kolahi
- Social Determinants of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Hashemi-Meshkini A, Tajik A, Ayati N, Nikfar S, Koochak R, Yaghoubifard S, Abbasi A, Varmaghani M. Cost-Effectiveness Comparison between Ticagrelor and Clopidogrel in Acute Coronary Syndrome in Iran. J Tehran Heart Cent 2023; 18:94-101. [PMID: 37637281 PMCID: PMC10459340 DOI: 10.18502/jthc.v18i2.13318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/16/2023] [Indexed: 08/29/2023] Open
Abstract
Background The present study aimed to determine the cost-effectiveness of ticagrelor compared with clopidogrel in Iranian patients with acute coronary syndrome (ACS). Methods A 1-year decision tree model combined with a 20-year Markov transition model was used to simulate the long-term cost and effectiveness of both ticagrelor and clopidogrel in Iran based on an Iranian payer's perspective. Clinical efficacy data were extracted from the PLATO trial and other published studies. Costs were estimated based on local prices in public sectors. Deterministic and probabilistic sensitivity analyses were used to test the robustness of base-case results over the uncertainties of model inputs. All calculations, analyses, and modeling were done in TreeAge 2011 and Microsoft Excel 2013. Results Compared with clopidogrel, the treatment of Iranian ACS patients with ticagrelor for 20 years resulted in an additional cost of US$ 2.39 in a hypothetical cohort of 1000 patients. However, ticagrelor led to 7.2 quality-adjusted life-years (QALYs) gained per 1000 hypothetical patients. Accordingly, the estimated incremental cost-effectiveness ratio for this analysis was US$ 332.032 per 1 QALY gained. Conclusion Ticagrelor was a cost-effective antiplatelet medicine compared with clopidogrel in Iranian patients with ACS. This could help Iran's policymakers to allocate resources more efficiently to ACS.
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Affiliation(s)
- Amir Hashemi-Meshkini
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmohammad Tajik
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nayyereh Ayati
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shekoufeh Nikfar
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
- Evidence-Based Evaluation of Cost-Effectiveness and Clinical Outcomes Group, Pharmaceutical Sciences Research Center (PSRC), and the Pharmaceutical Management and Economics Research Center (PMERC), the Institute of Pharmaceutical Sciences (TIPS), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Saeed Yaghoubifard
- Department of Pharmacoeconomics and Pharmaceutical Administration, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Azam Abbasi
- Department of Management Sciences and Health Economics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mehdi Varmaghani
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Kim J, Song YB, Oh JH, Cho DK, Lee JB, Kim SH, Jeong JO, Bae JH, Kim BO, Cho JH, Suh IW, Kim DI, Park HK, Park JS, Choi WG, Lee WS, Choi KH, Park TK, Lee JM, Yang JH, Choi JH, Choi SH, Gwon HC, Doh JH, Hahn JY. Effects of Prolonged Dual Antiplatelet Therapy in ST-Segment Elevation vs. Non-ST-Segment Elevation Myocardial Infarction. Circ J 2021; 85:817-825. [PMID: 33431720 DOI: 10.1253/circj.cj-20-0704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The benefits and risks of prolonged dual antiplatelet therapy (DAPT) have not been studied extensively across a broad spectrum of acute coronary syndromes. In this study we investigated whether treatment effects of prolonged DAPT were consistent in patients presenting with ST-segment elevation myocardial infarction (STEMI) vs. non-STEMI (NSTEMI).Methods and Results:As a post hoc analysis of the SMART-DATE trial, effects of ≥12 vs. 6 months DAPT were compared among 1,023 patients presenting with STEMI and 853 NSTEMI patients. The primary outcome was a composite of recurrent myocardial infarction (MI) or stent thrombosis at 18 months after the index procedure. Compared with the 6-month DAPT group, the rate of the composite endpoint was significantly lower in the ≥12-month DAPT group (1.2% vs. 3.8%; hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12-0.77; P=0.012). The treatment effect of ≥12- vs. 6-month DAPT on the composite endpoint was consistent among NSTEMI patients (0.2% vs. 1.2%, respectively; HR 0.20, 95% CI 0.02-1.70; P=0.140; Pinteraction=0.718). In addition, ≥12-month DAPT increased Bleeding Academic Research Consortium (BARC) Type 2-5 bleeding among both STEMI (4.4% vs. 2.0%; HR 2.18, 95% CI 1.03-4.60; P=0.041) and NSTEMI (5.1% vs. 2.2%; HR 2.37, 95% CI 1.08-5.17; P=0.031; Pinteraction=0.885) patients. CONCLUSIONS Compared with 6-month DAPT, ≥12-month DAPT reduced recurrent MI or stent thrombosis regardless of the type of MI at presentation.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Young Bin Song
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Ju-Hyeon Oh
- Samsung Changwon Hospital, Sungkyunkwan University School of Medicine
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ki Hong Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Taek Kyu Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Joo Myung Lee
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Ho Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung-Hyuk Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Hyeon-Cheol Gwon
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | | | - Joo-Yong Hahn
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine
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Dewi PEN, Thavorncharoensap M. Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue.
AIM: This study aims to review the utilization rate of statin among patients with ACS.
METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist.
RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients.
CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.
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Nozari Y, Geraiely B, Alipasandi K, Mortazavi SH, Omidi N, Aghajani H, Amirzadegan A, Pourhoseini H, Salarifar M, Alidoosti M, Haji-Zeinali AM, Nematipour E, Nomali M. Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Cross-Sectional Study. Interact J Med Res 2020; 9:e20352. [PMID: 33325826 PMCID: PMC7773509 DOI: 10.2196/20352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/16/2020] [Accepted: 09/12/2020] [Indexed: 11/13/2022] Open
Abstract
Background Performing primary percutaneous coronary intervention (PCI) as a preferred reperfusion strategy for patients with ST-segment elevation myocardial infarction (STEMI) may be associated with major adverse cardiocerebrovascular events (MACCEs). Thus, timely primary PCI has been emphasized in order to improve outcomes. Despite guideline recommendations on trying to reduce the door-to-balloon time to <90 minutes in order to reduce mortality, less attention has been paid to other components of time to treatment, such as the symptom-to-balloon time, as an indicator of the total ischemic time, which includes the symptom-to-door time and door-to-balloon time, in terms of clinical outcomes of patients with STEMI undergoing primary PCI. Objective We aimed to determine the association between each component of time to treatment (ie, symptom-to-door time, door-to-balloon time, and symptom-to-balloon time) and in-hospital MACCEs among patients with STEMI who underwent primary PCI. Methods In this observational study, according to a prospective primary PCI 24/7 service registry, adult patients with STEMI who underwent primary PCI in one of six catheterization laboratories of Tehran Heart Center from November 2015 to August 2019, were studied. The primary outcome was in-hospital MACCEs, which was a composite index consisting of cardiac death, revascularization (ie, target vessel revascularization/target lesion revascularization), myocardial infarction, and stroke. It was compared at different levels of time to treatment (ie, symptom-to-door and door-to-balloon time <90 and ≥90 minutes, and symptom-to-balloon time <180 and ≥180 minutes). Data were analyzed using SPSS software version 24 (IBM Corp), with descriptive statistics, such as frequency, percentage, mean, and standard deviation, and statistical tests, such as chi-square test, t test, and univariate and multivariate logistic regression analyses, and with a significance level of <.05 and 95% CIs for odds ratios (ORs). Results Data from 2823 out of 3204 patients were analyzed (mean age of 59.6 years, SD 11.6 years; 79.5% male [n=2243]; completion rate: 88.1%). Low proportions of symptom-to-door time ≤90 minutes and symptom-to-balloon time ≤180 minutes were observed among the study patients (579/2823, 20.5% and 691/2823, 24.5%, respectively). Overall, 2.4% (69/2823) of the patients experienced in-hospital MACCEs, and cardiac death (45/2823, 1.6%) was the most common cardiac outcome. In the univariate analysis, the symptom-to-balloon time predicted in-hospital MACCEs (OR 2.2, 95% CI 1.1-4.4; P=.03), while the symptom-to-door time (OR 1.4, 95% CI 0.7-2.6; P=.34) and door-to-balloon time (OR 1.1, 95% CI 0.6-1.8, P=.77) were not associated with in-hospital MACCEs. In the multivariate analysis, only symptom-to-balloon time ≥180 minutes was associated with in-hospital MACCEs and was a predictor of in-hospital MACCEs (OR 2.3, 95% CI 1.1-5.2; P=.04). Conclusions A longer symptom-to-balloon time was the only component associated with higher in-hospital MACCEs in the present study. Efforts should be made to shorten the symptom-to-balloon time in order to improve in-hospital MACCEs. International Registered Report Identifier (IRRID) RR2-10.2196/13161
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Affiliation(s)
- Younes Nozari
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Geraiely
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Kian Alipasandi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Hamideh Mortazavi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Negar Omidi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hassan Aghajani
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Amirzadegan
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Pourhoseini
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali-Mohammad Haji-Zeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ebrahim Nematipour
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahin Nomali
- Department of Epidemiology & Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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Khosravi A, Mansouri A, Shahsanayi F, Paydari N, Heshmat-Ghahdarijani K, Mansourian M, Nouri F, Taheri M, Farshidi H, Kazemi T, Khaledifar A, Assareh A, Behnammoghadam M, Peighambari MM, Nematipour E, Sarrafzadegan N, Noohi F. Rationale and Design of the Persian CardioVascular Disease Registry (PCVDR): Scale-Up of Persian Registry Of CardioVascular DiseasE (PROVE). Curr Probl Cardiol 2020; 46:100577. [PMID: 32359888 DOI: 10.1016/j.cpcardiol.2020.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 02/22/2020] [Indexed: 11/30/2022]
Abstract
We aimed to present the methodology of a national registry entitled "Persian CardioVascular Disease Registry (PCVDR)." Persian Registry Of cardioVascular diseasE (PROVE) was a demonstration registry conducted in Isfahan since 2014 to test the feasibility and practicality of PCVDR in Iran. Built on that experience, the first phase of PCVDR that consist of angiography and percutaneous coronary intervention (PCI) registry at national level started in March 2017. Currently, PCVDR is in place in 19 hospitals, located in 7 provinces. Five questionnaires including basic information, angiography, and PCI techniques, discharge and follow-up were completed for registered patients. Since beginning until October 7th, 2019, the number of angiography and PCI cases registered in all provinces were 37,120 and 16,277, respectively. Of all PCI cases registered, 11,846 patients (72.8%) were followed up until 12 months. We expect that this registry be expanded to cover most hospitals and centers with cardiology departments in the country.
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Desta DM, Nedi T, Hailu A, Atey TM, Tsadik AG, Asgedom SW, Kasahun GG, Ayalew E. Treatment outcome of acute coronary syndrome patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia; A retrospective cross-sectional study. PLoS One 2020; 15:e0228953. [PMID: 32053702 PMCID: PMC7018065 DOI: 10.1371/journal.pone.0228953] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/26/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Acute coronary syndrome (ACS) is increasingly becoming a common cause of cardiovascular mortality in developing countries. Even though, there is an introduction of limited percutaneous coronary intervention and thrombolytic therapies, in-hospital mortality due to ACS still remains high in sub-Saharan countries. OBJECTIVE The aim of the study was to assess treatment outcome of ACS patients admitted to Ayder Comprehensive Specialized Hospital, Mekelle, Ethiopia. METHODS A retrospective cross-sectional study was done by collecting data from patients' medical records using a data abstraction tool. Data were analyzed using logistic regression to determine crude and adjusted odds ratio. At 95% confidence interval, p-value<0.05 was considered as statistically significant. RESULTS Of the total 151 patients, in-hospital mortality was found to be 24.5%, and hypertension was the most frequent (46.4%) risk factor of ACS. Concerning the management practice, catheterization and primary percutaneous coronary intervention were done in 27.1%, and 3.9% respectively. Additionally, in emergency setting loading dose of aspirin and clopidogrel were used in about 63.8% and 62.8%, respectively. The other frequently used medications were beta-blockers (86.9%), angiotensin converting enzymes/angiotensin receptor blockers (84.1%) and statins (84.1%). Streptokinase was administered in 6.3% of patients with ST-elevated myocardial infarction and heparins in 78.1% of them. The commonly prescribed discharge medications were aspirin (98.2%), statins (94.7%) and clopidogrel (92%). Non-use of beta-blockers (p = 0.014), in-hospital complication of cardiogenic shock (p = 0.001) and left ventricular ejection fraction of ≤ 30% (p = 0.032) were independent predictors of in-hospital mortality. CONCLUSION The proportion of in-hospital mortality due to ACS was found to be high. Therefore, timely evidence based therapy should be implemented in the setup.
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Affiliation(s)
- Desilu Mahari Desta
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abraha Hailu
- Department of Internal Medicine, School of Medicine, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mehari Atey
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Afewerki Gebremeskel Tsadik
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Solomon Weldegebriel Asgedom
- Clinical Pharmacy Unit, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | | | - Eskinder Ayalew
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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11
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Yekefallah L, Pournorooz M, Noori H, Alipur M. Evaluation of Door-To-Balloon Time for Performing Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients Transferred by Pre-Hospital Emergency System in Tehran. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2019; 24:281-285. [PMID: 31333742 PMCID: PMC6621504 DOI: 10.4103/ijnmr.ijnmr_130_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: The suggested treatment for patients with ST-segment elevation is the Primary Percutaneous Coronary Intervention (PPCI) for coronary reperfusion. This study aimed to evaluate the contribution of pre-hospital and hospital emergency systems in the interval time for PPCI among patients with the ST-segment elevation myocardial infarction (STEMI) in selected hospitals of Tehran city. Materials and Methods: This cross-sectional study was carried out on patients with typical chest pain transferred to the emergency wards of three large general hospitals in Tehran city by Emergency Medical Services. They received the PPCI. The information about admission time to the triage, time of conducting electrocardiography (ECG), diagnosis time of STEMI, and time of the PPCI were recorded and analyzed using descriptive and inferential statistics. Results: In this study, 121 patients were evaluated, and of which 94 (77.68%) were men and 27 (22.32%) were women. The average time (SD) of patient admission in the triage until to receive the PPCI (door-to-balloon) was 104.60 (62.30) min. Conclusions: The door-to-balloon time was 104.60 min. If ECG is taken by pre-hospital emergency nursing staff and diagnosis of STEMI is performed by the pre-hospital emergency service, and the patient is delivered directly to the angiography department, the door-to-balloon time is significantly reduced.
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Affiliation(s)
- Leili Yekefallah
- Department of Nursing, Social Determinants of Health Research Center, School of Nursing and Midwifery, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mahdi Pournorooz
- Department of Intensive Care Nursing, Qazvin University of Medical Sciences, Qazvin, Iran
| | | | - Mahmood Alipur
- Department of Biostatistics, Qazvin University of Medical Sciences, Qazvin, Iran
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12
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Poorhosseini H, Saadat M, Salarifar M, Mortazavi SH, Geraiely B. Pre-Hospital Delay and Its Contributing Factors in Patients with ST-Elevation Myocardial Infarction; a Cross sectional Study. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2019; 7:e29. [PMID: 31432039 PMCID: PMC6637811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The outcome of ST-elevation myocardial infarction (STEMI) is significantly influenced by the total tissue ischemic time. In spite of efforts for reducing the in-hospital delay by full-time provision of primary percutaneous coronary intervention (P-PCI) in the 24/7 program, pre-hospital delay still persists. As a first report in Iran, we aimed to assess the duration of pre-hospital delay and its contributing factors in STEMI patients in the P-PCI era. METHODS The present cross-sectional study evaluated 2103 STEMI patients who underwent primary PCI from 2016 to 2018. Demographic, personal and socioeconomic factors, index event characteristics, past medical history, pain onset and door times of patients were recorded and independent factors of pre-hospital delay were calculated. RESULTS Median (IQR) of pain to door (P2D) time was 279 (120-630) minutes. In multivariate analysis, female gender [Beta=0.064 (95%CI: 0.003-0.125); p=0.038], being uneducated [Beta=0.213 (95%CI: 0.115-0.311); p<0.001], the onset of chest pain between 00:00 to 6:00 [Beta=0.130 (95%CI: 0.058-0.202); p<0.001] or 7:00 to 12:00 [Beta=0.119 (95%CI: 0.049-0.190); p=0.001], self-transportation [Beta=0.098 (95%CI: 0.015-0.181); p=0.020] or referral from another hospital [Beta=0.253 (95%CI: 0.117-0.389); p<0.001], atypical chest pain [Beta=0.170 (95%CI: 0.048-0.293); p=0.006], history of hypertension [Beta=0.052 (95%CI: 0.002-0.102); p=0.041], and opium abuse [Beta=0.076 (95%CI: 0.007-0.146); p=0.031] were associated with a significantly higher log(P2D), while history of CABG was associated with shorter P2D. CONCLUSION Our study showed that P2D is still very high in Iran and revealed the high-risk groups associated with longer P2D. Effective actions should be implemented to increase the public awareness about the symptoms of STEMI, and the importance of immediate appropriate help-seeking.
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Affiliation(s)
- Hamidreza Poorhosseini
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Saadat
- Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Salarifar
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
| | | | - Babak Geraiely
- Interventional Cardiology Department, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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13
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Nozari Y, Geraiely B, Alipasandi K, Jalali A, Omidi N, Aghajani H, Hajizeinali A, Alidoosti M, Pourhoseini H, Salarifar M, Amirzadegan A, Nematipour E, Nomali M. Time to Treatment and In-Hospital Major Adverse Cardiac Events Among Patients With ST-Segment Elevation Myocardial Infarction Who Underwent Primary Percutaneous Coronary Intervention (PCI) According to the 24/7 Primary PCI Service Registry in Iran: Protocol for a Cross-Sectional Study. JMIR Res Protoc 2019; 8:e13161. [PMID: 30821693 PMCID: PMC6418487 DOI: 10.2196/13161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/28/2022] Open
Abstract
Background Patients with ST-segment elevation myocardial infarction (STEMI) experience major adverse cardiac events (MACEs) following primary percutaneous coronary intervention (PCI). Although the relationship between time to treatment (eg, door-to-balloon time, symptom onset-to-balloon time, and symptom onset-to-door time) and 1-month all-cause mortality was assessed previously, its relationship with in-hospital MACEs and the effect of some clinical characteristics on this relationship were not considered. Furthermore, previous studies that were conducted in developed countries with a different quality of care cannot be applied in Iran, as Iran is a developing country and the studies were not performed according to the 24/7 primary PCI service registry. Objective The objective of this study protocol is to determine the relationship between time to treatment and in-hospital MACEs. Methods This cross-sectional study will take place at the Tehran Heart Center (THC), which is affiliated with Tehran University of Medical Sciences (TUMS) in Tehran, Iran. Data related to patients with STEMI, who underwent primary PCI between March 2015 and March 2019, that have been prospectively recorded in the THC’s 24/7 primary PCI service registry will be analyzed. The study outcome is the occurrence of in-hospital MACEs. Data analysis will be conducted using SPSS for Windows, version 16.0 (SPSS Inc). We will perform chi-square tests, independent-samples t tests, or the Mann-Whitney U test, as well as univariate and multivariate binary logistic regression with a significance level of less than .05 and 95% CI for odds ratios. Results From March 2015 to September 2017, 1586 patients were included in the THC service registry, consecutively. We will conduct a retrospective analysis of this registry on patient entries between March 2015 and March 2019 and data will be analyzed and published by the end of 2019. Conclusions To our knowledge, this is the first observational study based on the 24/7 primary PCI service registry in Iran. The findings of this study may reveal current problems regarding time to treatment in STEMI management in the THC. Results from this study may help determine appropriate preventive strategies that need to be applied in order to reduce time-to-treatment delays and improve patients’ outcomes following primary PCI in the setting of STEMI at the THC and similar clinical centers. International Registered Report Identifier (IRRID) DERR1-10.2196/13161
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Affiliation(s)
- Younes Nozari
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Babak Geraiely
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Kian Alipasandi
- Department of Cardiology, School of Medicine, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Arash Jalali
- Department of Research and Biostatistics, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Negar Omidi
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hassan Aghajani
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alimohammad Hajizeinali
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Alidoosti
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Hamidreza Pourhoseini
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mojtaba Salarifar
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Alireza Amirzadegan
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ebrahim Nematipour
- Department of Interventional Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mahin Nomali
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
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14
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Ismail N, Jordan KP, Rao S, Kinnaird T, Potts J, Kadam UT, Mamas MA. Incidence and prognostic impact of post discharge bleeding post acute coronary syndrome within an outpatient setting: a systematic review. BMJ Open 2019; 9:e023337. [PMID: 30787079 PMCID: PMC6398751 DOI: 10.1136/bmjopen-2018-023337] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 11/19/2018] [Accepted: 01/23/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The primary objective was to determine the incidence of bleeding events post acute coronary syndrome (ACS) following hospital discharge. The secondary objective was to determine the prognostic impact of bleeding on mortality, major adverse cardiovascular events (MACE), myocardial re-infarction and rehospitalisation in the postdischarge setting. DESIGN A narrative systematic review. DATA SOURCE Medline, Embase, Amed and Central (Cochrane) were searched up to August 2018. STUDY SELECTION For the primary objective, randomised controlled trials (RCT) and observational studies reporting on the incidence of bleeding post hospital discharge were included. For the secondary objective, RCTs and observational studies that compared patients with bleeding versus those without bleeding post hospital discharge vis-à-vis mortality, MACE, myocardial re-infarction and rehospitalisation were included. RESULTS 53 studies (36 observational studies and 17 RCTs) with a combined cohort of 714 458 participants for the primary objectives and 187 317 for the secondary objectives were included. Follow-up ranged from 1 month to just over 4 years. The incidence of bleeding within 12 months post hospital discharge ranged from 0.20% to 37.5% in observational studies and between 0.96% and 39.4% in RCTs. The majority of bleeds occurred in the initial 3 months after hospital discharge with bruising the most commonly reported event. Major bleeding increased the risk of mortality by nearly threefold in two studies. One study showed an increased risk of MACE (HR 3.00,95% CI 2.75 to 3.27; p<0.0001) with bleeding and another study showed a non-significant association with rehospitalisation (HR 1.20,95% CI 0.95 to 1.52; p=0.13). CONCLUSION Bleeding complications following ACS management are common and continue to occur in the long term after hospital discharge. These bleeding complications may increase the risk of mortality and MACE, but greater evidence is needed to assess their long-term effects. PROSPERO REGISTRATION NUMBER CRD42017062378.
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Affiliation(s)
- Nafiu Ismail
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Kelvin P Jordan
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Sunil Rao
- The Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Tim Kinnaird
- Department of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Jessica Potts
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
| | - Umesh T Kadam
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Mamas A Mamas
- Research Institute for Primary Care and Health Sciences, Keele University, Newcastle, UK
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15
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Chow CK, Brieger D, Ryan M, Kangaharan N, Hyun KK, Briffa T. Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study. HEART ASIA 2019; 11:e011122. [PMID: 30728864 PMCID: PMC6340555 DOI: 10.1136/heartasia-2018-011122] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/30/2018] [Accepted: 11/01/2018] [Indexed: 01/08/2023]
Abstract
Objective To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes. Methods CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months’ follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death. Results The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62). Conclusions Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.
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Affiliation(s)
- Clara K Chow
- Westmead Applied Research Centre, Faculty of Medicine & Health, University of Sydney, Sydney, New South Wales, Australia.,The George Institue of Global Health, Perth, Western Australia, Australia
| | - David Brieger
- Concord Repatriation General Hospital & The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Ryan
- Deparatment of Cardiology, Shoalhaven District Memorial Hospital, Nowra, New South Wales, Australia
| | | | - Karice K Hyun
- ANZAC Research Institute, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Tom Briffa
- The George Institue of Global Health, Perth, Western Australia, Australia
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16
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Akimbaeva Z, Ismailov Z, Akanov AA, Radišauskas R, Padaiga Ž. Assessment of coronary care management and hospital mortality from ST-segment elevation myocardial infarction in the Kazakhstan population: Data from 2012 to 2015. MEDICINA-LITHUANIA 2017; 53:58-65. [PMID: 28256299 DOI: 10.1016/j.medici.2017.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 12/02/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to assess and evaluate factors related to coronary care management and hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) hospitalized in the Kazakhstan County and city hospitals in which percutaneous coronary intervention (PCI) was performed during the period of 2012-2015. MATERIALS AND METHODS A total of 22,176 adult patients (18> years) with acute STEMI were hospitalized from January 2012 to December 2015. All the investigated STEMI patients underwent PCI. RESULTS The mean age of STEMI patients was 61.52±11.48 years, 72.2% of the patients were male and 75.2% living in the rural regions. The mean time from hospitalization to PCI was 2104.41±5060.68min (median 95.0 and IQR 1034.5). The mean and median of time from hospitalization to PCI tended to decrease from 2747.7±5793.9min and 155.0min in 2012 to 1874.7±4759.2min and 73.5min in 2015. Among all STEMI events the percentage of patients from hospitalization to PCI within 0-59min was up to 39.0% during all study period. From 2012 to 2015, the percentage of STEMI patients with short time (0-59min) of hospitalization to PCI tended to increase in average by 11.4% per year (P=0.09). Among all STEMI patients hospital mortality from 2012 to 2015 did not change significantly and ranged from 9.0% in 2012 to 8.6% in 2015. By multiple logistic regression analysis, study years (2012), gender (female), age (60> years), time from hospitalization to PCI (60>min) and number of bed-days were statistically significant factors associated with patients' hospital mortality from STEMI with PCI. CONCLUSIONS The present study demonstrated that hospitalization delay in the treatment of STEMI patients in Kazakhstan population was without significant changes, meanwhile the number of patients perfused within 1h from hospitalization to PCI tended to increase during 2012-2015. The higher hospital mortality was associated with study year, female gender, older age, longer-time from hospitalization to PCI and shorter hospitalization.
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Affiliation(s)
| | | | | | - Ričardas Radišauskas
- Institute of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania.
| | - Žilvinas Padaiga
- Department of Preventive Medicine, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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17
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Engel J, Damen NL, van der Wulp I, de Bruijne MC, Wagner C. Adherence to Cardiac Practice Guidelines in the Management of Non-ST-Elevation Acute Coronary Syndromes: A Systematic Literature Review. Curr Cardiol Rev 2017; 13:3-27. [PMID: 27142050 PMCID: PMC5324326 DOI: 10.2174/1573403x12666160504100025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the management of non-ST-elevation acute coronary syndrome (NSTACS) a gap between guideline-recommended care and actual practice has been reported. A systematic overview of the actual extent of this gap, its potential impact on patient-outcomes, and influential factors is lacking. OBJECTIVE To examine the extent of guideline adherence, to study associations with the occurrence of adverse cardiac events, and to identify factors associated with guideline adherence. METHOD Systematic literature review, for which PUBMED, EMBASE, CINAHL, and the Cochrane library were searched until March 2016. Further, a manual search was performed using reference lists of included studies. Two reviewers independently performed quality-assessment and data extraction of the eligible studies. RESULTS Adherence rates varied widely within and between 45 eligible studies, ranging from less than 5.0 % to more than 95.0 % for recommendations on acute and discharge pharmacological treatment, 34.3 % - 93.0 % for risk stratification, and 16.0 % - 95.8 % for performing coronary angiography. Seven studies indicated that higher adherence rates were associated with lower mortality. Several patient-related (e.g. age, gender, co-morbidities) and organization-related (e.g. teaching hospital) factors influencing adherence were identified. CONCLUSION This review showed wide variation in guideline adherence, with a substantial proportion of NST-ACS patients possibly not receiving guideline-recommended care. Consequently, lower adherence might be associated with a higher risk for poor prognosis. Future research should further investigate the complex nature of guideline adherence in NST-ACS, its impact on clinical care, and factors influencing adherence. This knowledge is essential to optimize clinical management of NSTACS patients and could guide future quality improvement initiatives.
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Affiliation(s)
- Josien Engel
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center. Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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