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Ospel JM, Diprose WK, Ganesh A, Martins S, Nguyen T, Psychogios M, Mansour O, Al-Ajlan F, Yang P, Pandian J, Gopinathan A, Sandset EC, Kennedy J, Volders D, Fahed R, Tjoumakaris S, Bhogal P, Kurz M, Yavagal D, Inoa V, Hill MD, Goyal M. Challenges to Widespread Implementation of Stroke Thrombectomy. Stroke 2024; 55:2173-2183. [PMID: 38979609 DOI: 10.1161/strokeaha.124.045889] [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] [Indexed: 07/10/2024]
Abstract
Endovascular treatment (EVT) for acute ischemic stroke is one of the most efficacious and effective treatments in medicine, yet globally, its implementation remains limited. Patterns of EVT underutilization exist in virtually any health care system and range from a complete lack of access to selective undertreatment of certain patient subgroups. In this review, we outline different patterns of EVT underutilization and possible causes. We discuss common challenges and bottlenecks that are encountered by physicians, patients, and other stakeholders when trying to establish and expand EVT services in different scenarios and possible pathways to overcome these challenges. Lastly, we discuss the importance of implementation research studies, strategic partnerships, and advocacy efforts to mitigate EVT underutilization.
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Affiliation(s)
- Johanna Maria Ospel
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - William K Diprose
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Aravind Ganesh
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Sheila Martins
- Neurology Department, Hospital Moinhos de Vento, Porto Alegre, Brazil (S.M.)
| | - Thanh Nguyen
- Departments of Radiology and Neurology, Boston Medical Center, MA (T.N.)
| | - Marios Psychogios
- Department of Neuroradiology, University Hospital Basel, Switzerland (M.P.)
| | - Ossama Mansour
- Alexandria Faculty of Medicine, Department of Neurology, Alexandria University, Egypt (O.M.)
| | - Fahad Al-Ajlan
- Neuroscience Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia (F.A.-A.)
| | - Pengfei Yang
- Department of Neurovascular Center, Naval Medical University Changhai Hospital, Shanghai, China (P.Y.)
| | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College and Hospital, Vellore, India (J.P.)
| | - Anil Gopinathan
- Division of Interventional Radiology, Department of Diagnostic Imaging, National University Health System, Singapore (A. Gopinathan)
| | | | - James Kennedy
- Oxford University Hospital NHS Foundation Trust, Oxford, United Kingdom (J.K.)
| | - David Volders
- Department of Radiology, Dalhousie University, Halifax, Canada (D.V.)
| | - Robert Fahed
- Division Neurology, Department of Medicine, The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada (R.F.)
| | - Stavropoula Tjoumakaris
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (S.T.)
| | - Pervinder Bhogal
- Department of Neuroradiology, The Royal London Hospital, Barts NHS Trust, United Kingdom (P.B.)
| | - Martin Kurz
- Department of Neurology, Stavanger University Hospital, Norway (M.K.)
| | - Dileep Yavagal
- Department of Neurology, University of Miami Miller School of Medicine, FL (D.Y.)
| | - Violiza Inoa
- Department of Neurology, University of Tennessee Health Science Center, Memphis (V.I.)
| | - Michael D Hill
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Mayank Goyal
- Department of Diagnostic Imaging (J.M.O., M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Clinical Neurosciences (J.M.O., W.K.D., A. Ganesh, M.D.H., M.G.), Cumming School of Medicine, University of Calgary, Alberta, Canada
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Muharram FR, Multazam CECZ, Harmadha WS, Andrianto A, Salsabilla SA, Dakota I, Andriantoro H, Firman D, Montain MM, Prakoso R, Anggraeni D. Distribution of catheterisation laboratories in Indonesia 2017-2022: a nationwide survey. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2024; 26:100418. [PMID: 38764713 PMCID: PMC11101891 DOI: 10.1016/j.lansea.2024.100418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 02/06/2024] [Accepted: 04/24/2024] [Indexed: 05/21/2024]
Abstract
Background Geographical terrains of Indonesia pose a major hindrance to transportation. The difficulty of transportation affects the provision of acute time-dependent therapy such as percutaneous coronary intervention (PCI). Also, Indonesia's aging population would have a significant impact on the prevalence of acute coronary syndrome in the next decade. Therefore, the analysis and enhancement of cardiovascular care are crucial. The catheterisation laboratory performs PCI procedures. In the current study, we mapped the number and distribution of catheterisation laboratories in Indonesia. Methods A direct survey was used to collect data related to catheterisation laboratory locations in July 2022. The population data was sourced from the Ministry of Home Affairs. The recent growth of catheterisation laboratories was examined and evaluated based on geographical areas. The main instruments for comparing regions and changes throughout time are the ratio of catheterisation laboratories per 100,000 population and the Gini index (a measure of economic and healthcare inequality. Gini index ranges from 0 to 1, with greater values indicating more significant levels of inequality). Regression analysis was carried out to see how the number of catheterisation laboratories was affected by health demand (prevalence) and economic capacity (Gross Domestic Regional Product [GDRP] per Capita). Findings The number of catheterisation laboratories in Indonesia significantly increased from 181 to 310 during 2017-2022, with 44 of the 119 new labs built in an area that did not have one. Java has the most catheterisation laboratories (208, 67%). The catheterisation laboratory ratio in the provinces of Indonesia ranges from 0.0 in West Papua and Maluku to 4.46 in Jakarta; the median is 1.09 (IQR 0.71-1.18). The distribution remains a problem, as shown by the high catheterisation laboratory Gini index (0.48). Regression shows that distribution of catheterisation laboratories was significantly affected by GDRP and the prevalence of heart disease. Interpretation The number of catheterisation laboratories in Indonesia has increased significantly recently, however, maldistribution remains a concern. To improve Indonesia's cardiovascular emergency services, future development of catheterisation laboratories must be better planned considering the facility's accessibility and density. Funding Airlangga Research Fund - Universitas Airlangga.
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Affiliation(s)
- Farizal Rizky Muharram
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | | | | | - Andrianto Andrianto
- Faculty of Medicine, Airlangga University, Soetomo General Hospital, Surabaya, Indonesia
| | | | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Doni Firman
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Maya Marinda Montain
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Radityo Prakoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
| | - Dilla Anggraeni
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Centre Harapan Kita, West Jakarta, Indonesia
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Gioppatto S, Prado PS, Elias MAL, de Carvalho VH, Paiva CRDC, Alexim GDA, Reis RTB, Nogueira ACC, de Sousa Munhoz Soares AA, Nadruz W, de Carvalho LSF, Sposito AC. The Clinical and Economic Impact of Delayed Reperfusion Therapy: Real-World Evidence. Arq Bras Cardiol 2024; 121:e20230650. [PMID: 38747748 PMCID: PMC11081405 DOI: 10.36660/abc.20230650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 01/22/2024] [Accepted: 02/01/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Early reperfusion therapy is acknowledged as the most effective approach for reducing case fatality rates in patients with ST-segment elevation myocardial infarction (STEMI). OBJECTIVE Estimate the clinical and economic consequences of delaying reperfusion in patients with STEMI. METHODS This retrospective cohort study evaluated mortality rates and the total expenses incurred by delaying reperfusion therapy among 2622 individuals with STEMI. Costs of in-hospital care and lost productivity due to death or disability were estimated from the perspective of the Brazilian Unified Health System indexed in international dollars (Int$) adjusted by purchase power parity. A p < 0.05 was considered statistically significant. RESULTS Each additional hour of delay in reperfusion therapy was associated with a 6.2% increase (95% CI: 0.3% to 11.8%, p = 0.032) in the risk of in-hospital mortality. The overall expenses were 45% higher among individuals who received treatment after 9 hours compared to those who were treated within the first 3 hours, primarily driven by in-hospital costs (p = 0.005). A multivariate linear regression model indicated that for every 3-hour delay in thrombolysis, there was an increase in in-hospital costs of Int$497 ± 286 (p = 0.003). CONCLUSIONS The findings of our study offer further evidence that emphasizes the crucial role of prompt reperfusion therapy in saving lives and preserving public health resources. These results underscore the urgent need for implementing a network to manage STEMI cases.
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Affiliation(s)
- Silvio Gioppatto
- Universidade Estadual de CampinasDepartamento de CardiologiaCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp) - Departamento de Cardiologia, Campinas, SP – Brasil
| | - Paulo Sousa Prado
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília, Brasília, DF – Brasil
| | | | | | | | - Gustavo de Almeida Alexim
- Hospital de Base do Distrito FederalBrasíliaDFBrasilHospital de Base do Distrito Federal, Brasília, DF – Brasil
| | | | - Ana Claudia Cavalcante Nogueira
- Universidade de BrasíliaBrasíliaDFBrasilUniversidade de Brasília, Brasília, DF – Brasil
- Hospital de Base do Distrito FederalBrasíliaDFBrasilHospital de Base do Distrito Federal, Brasília, DF – Brasil
- Instituto Aramari ApoBrasíliaDFBrasilInstituto Aramari Apo, Brasília, DF – Brasil
| | | | - Wilson Nadruz
- Universidade Estadual de CampinasDepartamento de CardiologiaCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp) - Departamento de Cardiologia, Campinas, SP – Brasil
| | - Luiz Sergio F. de Carvalho
- Universidade Estadual de CampinasDepartamento de CardiologiaCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp) - Departamento de Cardiologia, Campinas, SP – Brasil
| | - Andrei C. Sposito
- Universidade Estadual de CampinasDepartamento de CardiologiaCampinasSPBrasilUniversidade Estadual de Campinas (Unicamp) - Departamento de Cardiologia, Campinas, SP – Brasil
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Arias-Mendoza A, Gopar-Nieto R, Juarez-Tolen J, Ordóñez-Olvera JC, Gonzalez-Pacheco H, Briseño-De la Cruz JL, Sierra-Lara Martinez D, Mendoza-García S, Altamirano-Castillo A, Montañez-Orozco A, Arzate-Ramirez A, Baeza-Herrera LA, Ortega-Hernandez JA, Miranda-Cerda G, Cruz-Martinez JE, Baranda-Tovar FM, Zabal-Cerdeira C, Araiza-Garaygordobil D. Long-Term Outcomes of Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Study from Mexico City. Am J Cardiol 2024; 218:7-15. [PMID: 38402926 DOI: 10.1016/j.amjcard.2024.02.016] [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: 02/22/2023] [Revised: 01/08/2024] [Accepted: 02/04/2024] [Indexed: 02/27/2024]
Abstract
Although primary percutaneous coronary intervention (pPCI) is the treatment of choice in ST-elevation myocardial infarction (STEMI), challenges may arise in accessing this intervention for certain geodemographic groups. Pharmacoinvasive strategy (PIs) has demonstrated comparable outcomes when delays in pPCI are anticipated, but real-world data on long-term outcomes are limited. The aim of the present study was to compare long-term outcomes among real-world patients with STEMI who underwent either PIs or pPCI. This was a prospective registry including patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary objective was cardiovascular mortality at 12 months according to the reperfusion strategy (pPCI vs PIs) and major cardiovascular events (cardiogenic shock, recurrent myocardial infarction, and congestive heart failure), and Bleeding Academic Research Consortium type 3 to 5 bleeding events were also evaluated. A total of 799 patients with STEMI were included; 49.1% underwent pPCI and 50.9% received PIs. Patients in the PIs group presented with more heart failure on admission (Killip-Kimbal >I 48.1 vs 39.7, p = 0.02) and had a lower proportion of pre-existing heart failure (0.2% vs 1.8%, p = 0.02) and atrial fibrillation (0.25% vs 1.2%, p = 0.02). No statistically significant difference was observed in cardiovascular mortality at the 12-month follow-up (hazard ratio for PIs 0.74, 95% confidence interval 0.42 to 1.30, log-rank p = 0.30) according to the reperfusion strategy used. The composite of major cardiovascular events (hazard ratio for PIs 0.98, 95% confidence interval 0.75 to 1.29, p = 0.92) and Bleeding Academic Research Consortium type 3 to 5 bleeding rates were also comparable. A low socioeconomic status, Killip-Kimball >2, age >60 years, and admission creatinine >2.0 mg/100 ml were predictors of the composite end point after multivariate analysis. In conclusion, this prospective real-world registry provides additional support that long-term major cardiovascular outcomes and bleeding are not different between patients who underwent PIs versus primary PCI.
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Affiliation(s)
- Alexandra Arias-Mendoza
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Rodrigo Gopar-Nieto
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Jessica Juarez-Tolen
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Juan Carlos Ordóñez-Olvera
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Héctor Gonzalez-Pacheco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Jose Luis Briseño-De la Cruz
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Daniel Sierra-Lara Martinez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Salvador Mendoza-García
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Alfredo Altamirano-Castillo
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Alvaro Montañez-Orozco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Arturo Arzate-Ramirez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Luis A Baeza-Herrera
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Jorge A Ortega-Hernandez
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Greta Miranda-Cerda
- Emergency department, Hospital General Dr. Manuel Gea González, Ciudad de México, México City
| | | | | | - Carlos Zabal-Cerdeira
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City
| | - Diego Araiza-Garaygordobil
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez", Ciudad de México, México City.
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Jing J, Fang S, Li Y, Liu W, Wang C, Lan Y, Wang Y, Yang C. An enhanced cardio-protective effect of nanoparticles loaded with active components from Polygonum orientale L. against isoproterenol-induced myocardial ischemia in rats. Int J Pharm 2024; 655:124047. [PMID: 38531434 DOI: 10.1016/j.ijpharm.2024.124047] [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: 11/07/2023] [Revised: 03/12/2024] [Accepted: 03/23/2024] [Indexed: 03/28/2024]
Abstract
In this study, nanoparticles loaded with active components from Polygonum orientale L. (PO), a traditional Chinese herb known for its anti-myocardial ischemic properties, were investigated for cardio-protective properties. Specifically, OVQ-Nanoparticles (OVQ-NPs) with Orientin (Ori), Vitexin (Vit), and Quercetin (Que) was obtained by double emulsion-solvent evaporation method. The OVQ-NPs exhibited a spherical shape, with a uniform size distribution of 136.77 ± 3.88 nm and a stable ζ-potential of -13.40 ± 2.24 mV. Notably, these nanoparticles exhibited a favorable sustained-release characteristic, resulting in an extended circulation time within the living organism. Consequently, the administration of these nanoparticles resulted in significant improvements in electrocardiograms and heart mass index of myocardial ischemic rats induced by isoproterenol, as well as decreased serum levels of CK, LDH, and AST. Furthermore, the results of histopathological examination, such as H&E staining and TUNEL staining, confirmed a reduced level of cardiac tissue pathology and apoptosis. Moreover, the quantification of biochemical indicators (SOD, MDA, GSH, NO, TNF-α, and IL-6) demonstrated that OVQ-NPs effectively mitigated myocardial ischemia by regulating oxidative stress and inflammatory pathways. In conclusion, OVQ-NPs demonstrate promising therapeutic potential as an intervention for myocardial ischemia, providing a new perspective on traditional Chinese medicine treatment in this area.
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Affiliation(s)
- Jincheng Jing
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Pharmacy, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Shumei Fang
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Pharmacy, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Yueting Li
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Wenting Liu
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Pharmacy, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Cong Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; School of Pharmacy, Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Yanyu Lan
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang 550004, Guizhou, China
| | - Yonglin Wang
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang 550004, Guizhou, China.
| | - Chang Yang
- State Key Laboratory of Functions and Applications of Medicinal Plants/Guizhou Provincial Key Laboratory of Pharmaceutics, Guizhou Medical University, Guiyang 550004, Guizhou, China; Engineering Research Center for the Development and Application of Ethnic Medicine and TCM (Ministry of Education), Guizhou Medical University, Guiyang 550004, Guizhou, China.
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Lopez-Rojas LM, Paredes Paucar CP, Rojas De La Cuba P, Yábar Galindo WG, Martos Salcedo JO, Custodio-Sánchez P. [Reply yo the letter to the editor : "Keeping an eye on the pharmacoinvasive strategy"]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2024; 5:e368. [PMID: 39015188 PMCID: PMC11247967 DOI: 10.47487/apcyccv.v5i2.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 04/15/2024] [Indexed: 07/18/2024]
Affiliation(s)
- L. Marco Lopez-Rojas
- Hospital Nacional Alberto Sabogal Sologuren - EsSalud. Lima, Perú.Hospital Nacional Alberto Sabogal Sologuren - EsSaludLimaPerú
| | - Cynthia Paola Paredes Paucar
- Hospital Germans Trias i Pujol, Unidad de Insuficiencia Cardiaca. Barcelona, España.Hospital Germans Trias i PujolUnidad de Insuficiencia CardiacaBarcelonaEspaña
| | - Paol Rojas De La Cuba
- Hospital Nacional Guillermo Almenara Irigoyen-EsSalud. Lima, Perú.Hospital Nacional Guillermo Almenara Irigoyen-EsSaludLimaPerú
| | - W. Germán Yábar Galindo
- Hospital Nacional Guillermo Almenara Irigoyen-EsSalud. Lima, Perú.Hospital Nacional Guillermo Almenara Irigoyen-EsSaludLimaPerú
| | - Jorge Orlando Martos Salcedo
- Hospital Regional Docente de Cajamarca-MINSA. Servicio de Cardiología. Cajamarca, Perú.Hospital Regional Docente de Cajamarca-MINSAServicio de CardiologíaCajamarcaPerú
| | - Piero Custodio-Sánchez
- Hospital Nacional Almanzor Aguinaga Asenjo - EsSalud. Unidad de cardiología intervencionista. Chiclayo, Perú.Hospital Nacional Almanzor Aguinaga Asenjo - EsSaludUnidad de cardiología intervencionistaChiclayoPerú
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Li X, Yu C, Lei L, Liu X, Chen Y, Wang Y, Qiu S, Xiu J. Association of Pre-PCI Blood Pressure and No-Reflow in Patients with Acute ST-Elevation Coronary Infarction. Glob Heart 2024; 19:28. [PMID: 38464557 PMCID: PMC10921965 DOI: 10.5334/gh.1309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/12/2024] [Indexed: 03/12/2024] Open
Abstract
Background Previous studies have established blood pressure (BP) as a pivotal factor influencing no-reflow following primary percutaneous coronary intervention (PCI) in patients with ST-elevation acute coronary infarction (STEMI). However, no relevant study has been conducted to investigate the optimal range of BP associated with the lowest risk of no-reflow among STEMI patients so far. Therefore, our objective was to evaluate the association between pre-PCI BP and the occurrence of no-reflow in patients with STEMI. Method We included 1025 STEMI patients undergoing primary PCI. The BP pre-PCI was categorized into 20-mmHg increments. Logistic models were employed to assess the association of no-reflow with systolic blood pressure (SBP) or diastolic blood pressure (DBP). Three sensitivity analyses were conducted to further confirm the robustness of the association between blood pressure and no-reflow. Results SBP or DBP exhibited a U-shaped curve association with no-reflow. No-reflow was higher in patients with lower SBP (<100 mmHg) (adjusted hazard ratio (OR) 3.64, 95% confidence interval (CI) 1.84,7.21; p < 0.001) and lower DBP (<60 mmHg) (OR 3.28, 95% CI 1.63,6.49; p < 0.001) [reference: 120 ≤SBP <140; 80 ≤DBP <100 mmHg], respectively. Furthermore, no-reflow was higher in patients with higher SBP (≥160 mmHg) (OR 2.07, 95% CI 1.27,3.36; p = 0.003) and DBP (≥100 mmHg) (OR 3.36, 95% CI 2.07,5.46; p < 0.001), respectively. The results of sensitivity analyses were consistent with the above findings. Conclusion Maintaining a pre-PCI SBP within the range of 120 to 140 mmHg and a DBP within the range of 80 to 100 mmHg may be confer benefits to patients with STEMI in no-reflow.
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Affiliation(s)
- Xiaobo Li
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
- Department of Cardiology, Xiangdong Hospital, Hunan Normal University, Liling, Hunan, China
| | - Chen Yu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Li Lei
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xuewei Liu
- The Tenth Affiliated Hospital of Southern Medical University (Dongguan People’s Hospital), Southern Medical University, Dongguan, Guangdong, China
| | - Yejia Chen
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yutian Wang
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - ShiFeng Qiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jiancheng Xiu
- Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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Harvey A, Howitt C, Campbell JM, Forde SAA, Hambleton I, Bascombe I, Anderson SG, Scantlebury D, Delice R, Sobers NP. Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados. Cureus 2024; 16:e56729. [PMID: 38646357 PMCID: PMC11032732 DOI: 10.7759/cureus.56729] [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] [Accepted: 03/18/2024] [Indexed: 04/23/2024] Open
Abstract
Objective To determine trends, identify predictors of acute myocardial infarction (AMI) incidence and mortality, and explore performance metrics for AMI care in Barbados. Methods Data on all cases diagnosed with AMI were collected by the Barbados National Registry for Non-Communicable Diseases (BNR) from the island's only tertiary hospital, the Queen Elizabeth Hospital, and the National Vital Registration Department. Participants who survived hospital admission were then followed up at 28 days and one year post event via telephone survey and retrieval of death certificates. Age-standardized incidence and mortality rates were calculated. Determinants of mortality at 28 days were examined in multivariable logistic regression models. Median and interquartile ranges (IQR) were calculated for performance metrics (e.g., time from pain onset to reperfusion). Results In a 10-year period between 2010 and 2019, 4,065 cases of myocardial infarction were recorded. The median age of the sample was 73 years (IQR: 61,83), and approximately half (47%) were female. Over a 10-year period, standardized incidence increased in women on average yearly by three per 100,000 (95% CI: 1 to 6; p=0.02), while in men, the average increase per year was six per 100,000 (95% CI: 4 to 8; p<0.001). There was no increase in 28-day mortality in women; mortality in men increased each year by 2.5 per 100,000 (95% CI: 0.4 to 4.5; p=0.02). The time from arrival at the hospital to the ECG was 44 minutes IQR (20,113). Conclusion AMI incidence and mortality are increasing in Barbados, and men have a higher velocity of mortality rate increase than women, which contradicts global data.
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Affiliation(s)
- Arianne Harvey
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Christina Howitt
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Jacqueline M Campbell
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Shelly-Ann A Forde
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Ian Hambleton
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Ivanna Bascombe
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Simon G Anderson
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
| | - Dawn Scantlebury
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Rudolph Delice
- Faculty of Medical Sciences, The University of the West Indies, Bridgetown, BRB
| | - Natasha P Sobers
- George Alleyne Chronic Disease Research Centre, Caribbean Institute for Health Research, The University of the West Indies, Bridgetown, BRB
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9
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Hou J, Deng Q, Qiu X, Liu S, Li Y, Huang C, Wang X, Zhang Q, Deng X, Zhong Z, Zhong W. Proteomic analysis of plasma proteins from patients with cardiac rupture after acute myocardial infarction using TMT-based quantitative proteomics approach. Clin Proteomics 2024; 21:18. [PMID: 38429673 PMCID: PMC10908035 DOI: 10.1186/s12014-024-09474-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 02/23/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Cardiac rupture (CR) is a rare but catastrophic mechanical complication of acute myocardial infarction (AMI) that seriously threatens human health. However, the reliable biomarkers for clinical diagnosis and the underlying signaling pathways insights of CR has yet to be elucidated. METHODS In the present study, a quantitative approach with tandem mass tag (TMT) labeling and liquid chromatography-tandem mass spectrometry was used to characterize the differential protein expression profiles of patients with CR. Plasma samples were collected from patients with CR (n = 37), patients with AMI (n = 47), and healthy controls (n = 47). Candidate proteins were selected for validation by multiple reaction monitoring (MRM) and enzyme-linked immunosorbent assay (ELISA). RESULTS In total, 1208 proteins were quantified and 958 differentially expressed proteins (DEPs) were identified. The difference in the expression levels of the DEPs was more noticeable between the CR and Con groups than between the AMI and Con groups. Bioinformatics analysis showed most of the DEPs to be involved in numerous crucial biological processes and signaling pathways, such as RNA transport, ribosome, proteasome, and protein processing in the endoplasmic reticulum, as well as necroptosis and leukocyte transendothelial migration, which might play essential roles in the complex pathological processes associated with CR. MRM analysis confirmed the accuracy of the proteomic analysis results. Four proteins i.e., C-reactive protein (CRP), heat shock protein beta-1 (HSPB1), vinculin (VINC) and growth/differentiation factor 15 (GDF15), were further validated via ELISA. By receiver operating characteristic (ROC) analysis, combinations of these four proteins distinguished CR patients from AMI patients with a high area under the curve (AUC) value (0.895, 95% CI, 0.802-0.988, p < 0.001). CONCLUSIONS Our study highlights the value of comprehensive proteomic characterization for identifying plasma proteome changes in patients with CR. This pilot study could serve as a valid foundation and initiation point for elucidation of the mechanisms of CR, which might aid in identifying effective diagnostic biomarkers in the future.
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Affiliation(s)
- Jingyuan Hou
- Research Experimental Center, Meizhou Clinical Institute of Shantou University Medical College, Meizhou, Guangdong, 514031, China
- GuangDong Engineering Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, Guangdong, 514031, China
| | - Qiaoting Deng
- Research Experimental Center, Meizhou Clinical Institute of Shantou University Medical College, Meizhou, Guangdong, 514031, China
| | - Xiaohong Qiu
- Meizhou clinical Medical School, Guangdong Medical University, Meizhou, Guangdong, 514031, China
| | - Sudong Liu
- Research Experimental Center, Meizhou Clinical Institute of Shantou University Medical College, Meizhou, Guangdong, 514031, China
| | - Youqian Li
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China
| | - Changjing Huang
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China
| | - Xianfang Wang
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China
| | - Qunji Zhang
- Research Experimental Center, Meizhou Clinical Institute of Shantou University Medical College, Meizhou, Guangdong, 514031, China
| | - Xunwei Deng
- Research Experimental Center, Meizhou Clinical Institute of Shantou University Medical College, Meizhou, Guangdong, 514031, China
| | - Zhixiong Zhong
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China.
| | - Wei Zhong
- Center for Cardiovascular Diseases, Meizhou People's Hospital, Meizhou, Guangdong, 514031, China.
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10
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Armario X, Carron J, Simpkin AJ, Elhadi M, Kennedy C, Abdel-Wahab M, Bleiziffer S, Lefèvre T, Wolf A, Pilgrim T, Villablanca PA, Blackman DJ, Van Mieghem NM, Hengstenberg C, Swaans MJ, Prendergast BD, Patterson T, Barbanti M, Webb JG, Behan M, Resar J, Chen M, Hildick-Smith D, Spence MS, Zweiker D, Bagur R, Teles R, Ribichini FL, Jagielak D, Park DW, Kornowski R, Wykrzykowska JJ, Bunc M, Estévez-Loureiro R, Poon K, Götberg M, Jeger RV, Ince H, Packer EJS, Angelillis M, Nombela-Franco L, Guo Y, Savontaus M, Al-Moghairi AM, Parasca CA, Kliger C, Roy D, Molnár L, Silva M, White J, Yamamoto M, Carrilho-Ferreira P, Toggweiler S, Voudris V, Ohno Y, Rodrigues I, Parma R, Ojeda S, Toutouzas K, Regueiro A, Grygier M, AlMerri K, Cruz-González I, Fridrich V, de la Torre Hernández JM, Noble S, Kala P, Asmarats L, Kurt IH, Bosmans J, Erglis M, Casserly I, Iskandarani D, Bhindi R, Kefer J, Yin WH, Rosseel L, Kim HS, O'Connor S, Hellig F, Sztejfman M, Mendiz O, Pineda AM, Seth A, Pllaha E, de Brito FS, Bajoras V, Balghith MA, Lee M, Eid-Lidt G, Vandeloo B, Vaz VD, Alasnag M, Ussia GP, Tay E, Mayol J, Gunasekaran S, Sardella G, Buddhari W, Kao HL, Dager A, Tzikas A, Gudmundsdottir IJ, Edris A, Gutiérrez Jaikel LA, Arias EA, Al-Hijji M, Ertürk M, Conde-Vela C, Boljević D, Ferrero Guadagnoli A, Hermlin T, ElGuindy AM, Lima-Filho MDO, de Moura Santos L, Perez L, Maluenda G, Akyüz AR, Alhaddad IA, Amin H, So CY, Al Nooryani AA, Vaca C, Albistur J, Nguyen QN, Arzamendi D, Grube E, Modine T, Tchétché D, Hayashida K, Latib A, Makkar RR, Piazza N, Søndergaard L, McEvoy JW, Mylotte D. Impact of the COVID-19 Pandemic on Global TAVR Activity: The COVID-TAVI Study. JACC Cardiovasc Interv 2024; 17:374-387. [PMID: 38180419 DOI: 10.1016/j.jcin.2023.10.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/16/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND The COVID-19 pandemic adversely affected health care systems. Patients in need of transcatheter aortic valve replacement (TAVR) are especially susceptible to treatment delays. OBJECTIVES This study sought to evaluate the impact of the COVID-19 pandemic on global TAVR activity. METHODS This international registry reported monthly TAVR case volume in participating institutions prior to and during the COVID-19 pandemic (January 2018 to December 2021). Hospital-level information on public vs private, urban vs rural, and TAVR volume was collected, as was country-level information on socioeconomic status, COVID-19 incidence, and governmental public health responses. RESULTS We included 130 centers from 61 countries, including 65,980 TAVR procedures. The first and second pandemic waves were associated with a significant reduction of 15% (P < 0.001) and 7% (P < 0.001) in monthly TAVR case volume, respectively, compared with the prepandemic period. The third pandemic wave was not associated with reduced TAVR activity. A greater reduction in TAVR activity was observed in Africa (-52%; P = 0.001), Central-South America (-33%; P < 0.001), and Asia (-29%; P < 0.001). Private hospitals (P = 0.005), urban areas (P = 0.011), low-volume centers (P = 0.002), countries with lower development (P < 0.001) and economic status (P < 0.001), higher COVID-19 incidence (P < 0.001), and more stringent public health restrictions (P < 0.001) experienced a greater reduction in TAVR activity. CONCLUSIONS TAVR procedural volume declined substantially during the first and second waves of the COVID-19 pandemic, especially in Africa, Central-South America, and Asia. National socioeconomic status, COVID-19 incidence, and public health responses were associated with treatment delays. This information should inform public health policy in case of future global health crises.
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Affiliation(s)
- Xavier Armario
- Department of Cardiology, Galway University Hospital, Galway, Ireland; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jennifer Carron
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Andrew J Simpkin
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Mohamed Elhadi
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | - Ciara Kennedy
- Department of Cardiology, Galway University Hospital, Galway, Ireland
| | | | - Sabine Bleiziffer
- Heart and Diabetes Center Northrhine-Westfalia, Clinic for Thoracic and Cardiovascular Surgery, Bad Oeynhausen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | - John G Webb
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Miles Behan
- Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Jon Resar
- John Hopkins Hospital, Baltimore, Maryland, USA
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Rodrigo Bagur
- University Hospital, London Health Sciences Center, London, Ontario, Canada
| | - Rui Teles
- Hospital de Santa Cruz, CHLO, Nova Medical School, CEDOC, Lisbon, Portugal
| | | | | | | | | | | | - Matjaz Bunc
- Ljubljana University Medical Center, Ljubljana, Slovenia
| | | | - Karl Poon
- The Prince Charles Hospital, Brisbane, Australia
| | - Matthias Götberg
- Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden
| | | | | | | | | | | | - Yingqiang Guo
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | | | - Chad Kliger
- Lenox Hill/Northwell Health, New York, New York, USA
| | - David Roy
- St. Vincent's Hospital, Sydney, Australia
| | - Levente Molnár
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mariana Silva
- Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | | | - Masanori Yamamoto
- Toyohashi Heart Center, Toyohashi, Japan; Nagoya Heart Center, Nagoya, Japan; Gifu Heart Center, Gifu, Japan
| | | | | | | | - Yohei Ohno
- Tokai University School of Medicine, Isehara, Japan
| | | | | | - Soledad Ojeda
- Hospital Universitario Reina Sofía, Universidad de Córdoba, Instituto Maimónides de Investigación Biomédica de Córdoba, Córdoba, Spain
| | | | | | - Marek Grygier
- Poznan University School of Medical Sciences, Poznan, Poland
| | | | | | - Viliam Fridrich
- National Institute of Cardiovascular Diseases, Bratislava, Slovakia
| | | | | | - Petr Kala
- Centrum Kardiovaskulární a Transplantační Chirurgie, Brno, Czechia
| | | | | | | | | | - Ivan Casserly
- Mater Misericordiae University Hospital, Dublin, Ireland; Mater Private Hospital, Dublin, Ireland
| | | | | | - Joelle Kefer
- Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | | | | | - Hyo-Soo Kim
- Seoul National University Hospital, Seoul, South Korea
| | | | | | | | | | - Andres M Pineda
- University of Florida College of Medicine Jacksonville, Jacksonville, Florida, USA
| | - Ashok Seth
- Fortis Escorts Heart Institute, New Delhi, India
| | | | | | - Vilhelmas Bajoras
- Division of Cardiology and Vascular Diseases, Vilnius University Hospital Santaros Clinics, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Michael Lee
- Queen Elizabeth Hospital, Hong Kong, Hong Kong
| | - Guering Eid-Lidt
- Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico
| | - Bert Vandeloo
- Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Belgium
| | | | | | - Gian Paolo Ussia
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | - Edgar Tay
- National University Heart Center, Singapore, Singapore
| | | | | | | | | | - Hsien-Li Kao
- National Taiwan University Hospital, Taipei, Taiwan
| | | | | | | | - Ahmad Edris
- Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | | | | | | | - Mehmet Ertürk
- Istanbul Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, University of Health Science, Istanbul, Turkey
| | | | | | | | | | | | - Moysés de Oliveira Lima-Filho
- Hospital das Clínicas de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brazil
| | | | - Luis Perez
- Hospital Clínico Regional Guillermo Grant Benavente, Concepción, Chile
| | - Gabriel Maluenda
- Hospital San Borja Arriaran, Santiago, Chile; Clínica Alemana, Santiago, Chile
| | - Ali Rıza Akyüz
- Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Health Sciences University, Trabzon, Turkey
| | | | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Royal Medical Services, Awali, Bahrain
| | - Chak-Yu So
- Prince of Wales Hospital, Hong Kong, Hong Kong
| | | | - Carlos Vaca
- Instituto de Cardiología Intervencionista Cardiovida SRL, Santa Cruz, Bolivia
| | - Juan Albistur
- Hospital de Clínicas Dr Manuel Quintela, Montevideo, Uruguay
| | | | | | | | | | | | | | - Azeem Latib
- Montefiore Medical Center, Bronx, New York, USA
| | - Raj R Makkar
- Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Nicolo Piazza
- McGill University Health Center, Montréal, Quebec, Canada
| | | | - John William McEvoy
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland
| | - Darren Mylotte
- Department of Cardiology, Galway University Hospital, Galway, Ireland; School of Medicine, University of Galway, Galway, Ireland.
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11
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Ashraf S, Farooq U, Shahbaz A, Khalique F, Ashraf M, Akmal R, Siddal MT, Ashraf M, Ashraf S, Ashraf S, Ghufran M, Akram MK, Saboor QA. Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary Care Center in a Third World Country. Curr Probl Cardiol 2024; 49:102049. [PMID: 37666350 DOI: 10.1016/j.cpcardiol.2023.102049] [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: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Usama Farooq
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Amir Shahbaz
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Faisal Khalique
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Maryam Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Muhammad Talha Siddal
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Moneeb Ashraf
- Department of Pharmacology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Shoaib Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ghufran
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Kiwan Akram
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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12
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Rodríguez-Ramos MA, Santos-Medina M, Dueñas-Herrera A, Prohías Martínez JA, Rivas-Estany E. A collaborative approach to develop indicators for quality of care for ST segment Elevation Myocardial Infarction in networks without coronary intervention: A position paper. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:91-100. [PMID: 37599539 DOI: 10.3233/jrs-220057] [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] [Indexed: 08/22/2023]
Abstract
BACKGROUND Data about performance measures (PM) in patients with ST segment Elevation Myocardial Infarction (STEMI) in low- and middle-income countries is really scarce. One of the reasons is the lack of appropriate measures for these scenarios where coronary intervention is not the standard treatment. OBJECTIVE This study aimed to develop a set of PM and quality markers for patients with STEMI in these countries. METHODS Two investigators systematically reviewed existing guidelines and scientific literature to identify potential PM by referring to documents searched through PubMed from 2010 through 2019, using terms "Myocardial Infarction", "STEMI", "quality indicator", and "performance measure". A modified Delphi technique, involving multidisciplinary panel interview, was used. A 15-member multidisciplinary expert panel individually rated each potential indicator on a scale of 1 (lowest) to 5 (highest) during three rounds. All indicators that received a median score ≥4.5, in final round without significant disagreement were included as PM. RESULTS Through the consensus-building process, 84 potential indicators were found, of which 10 were proposed as performance measures and 2 as quality metrics, as follows: Pre-Hospital Electrocardiogram; Patients with reperfusion therapy; Pre-hospital Reperfusion; Ischemic time less than 120 minutes; System delay time less than 90 minutes; In-hospital Mortality; Complete in-hospital Treatment; Complete in-hospital Treatment in patients with Heart Failure; 30 day-Re-admissions; 30 day-mortality; Patients with in-hospital stress test performed; and, Patients included in rehabilitation programs. CONCLUSION This document provides the official set of PM of attention in ST segment Elevation Myocardial Infarction of the Cuban Society of Cardiology and Cuban National Group of Cardiology.
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Affiliation(s)
| | | | - Alfredo Dueñas-Herrera
- Department of Preventive Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
| | | | - Eduardo Rivas-Estany
- Department of Preventive Cardiology, Institute of Cardiology and Cardiovascular Surgery, Havana, Cuba
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13
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Custodio-Sánchez P, Miranda-Noé D, López-Rojas LM, Paredes Paucar CP, Yábar Galindo WG, Rojas De La Cuba P, Martos Salcedo JO, Chacón-Diaz M. [Proposal for initial management of uncomplicated ST elevation myocardial infarction in centers without percutaneous coronary intervention capacity in Peru]. ARCHIVOS PERUANOS DE CARDIOLOGIA Y CIRUGIA CARDIOVASCULAR 2023; 4:164-183. [PMID: 38298415 PMCID: PMC10824752 DOI: 10.47487/apcyccv.v4i4.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/18/2023] [Indexed: 02/02/2024]
Abstract
ST-segment elevation myocardial infarction (STEMI) is a clinical entity whose adequate treatment will depend on its prompt recognition, accurate diagnosis, and management in reperfusion networks. The first contact with these patients is generally done in centers without reperfusion capacity, attended by non-cardiologist doctors, and in centers far from hospitals with greater resolution capacity, something that is well known in our country. This manuscript proposes a strategy for the diagnosis and treatment of STEMI in centers without percutaneous coronary intervention capacity of the public health system in Peru, emphasizing not losing sight of electrocardiographic patterns compatible with coronary artery occlusion, adequate fibrinolysis and management of its complications, the treatment of infarction in special populations and highlighting the importance of the pharmacoinvasive strategy as the main form of reperfusion treatment in our country.
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Affiliation(s)
- Piero Custodio-Sánchez
- Unidad de Cardiología Intervencionista, Hospital Nacional Almanzor Aguinaga Asenjo, Chiclayo, Perú.Unidad de Cardiología IntervencionistaHospital Nacional Almanzor Aguinaga AsenjoChiclayoPerú
| | - David Miranda-Noé
- Servicio de Cardiología Clínica. Instituto Nacional Cardiovascular INCOR, Lima, Perú.Servicio de Cardiología ClínicaInstituto Nacional Cardiovascular INCORLimaPerú
| | - L. Marco López-Rojas
- Hospital Nacional Hipólito Unanue, Lima, Perú.Hospital Nacional Hipólito UnanueLimaPerú
| | - Cynthia Paola Paredes Paucar
- Unidad de insuficiencia cardiaca, Hospital Germans Trias i Pujol, Barcelona, España.Unidad de insuficiencia cardiacaHospital Germans Trias i PujolBarcelonaEspaña
| | - W. Germán Yábar Galindo
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.Hospital Nacional Guillermo Almenara IrigoyenLimaPerú
| | - Paol Rojas De La Cuba
- Hospital Nacional Guillermo Almenara Irigoyen, Lima, Perú.Hospital Nacional Guillermo Almenara IrigoyenLimaPerú
| | - Jorge Orlando Martos Salcedo
- Servicio de Cardiología. Hospital Regional Docente de Cajamarca, Cajamarca, Perú.Servicio de CardiologíaHospital Regional Docente de CajamarcaCajamarcaPerú
| | - Manuel Chacón-Diaz
- Unidad Cardiovascular. Clínica Delgado AUNA, Lima, Perú.Unidad CardiovascularClínica Delgado AUNALimaPerú
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14
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Gao Y, Wang Y, Li M, Gao C. Bioinformatics analysis of potential common pathogenic mechanisms for systemic lupus erythematosus and acute myocardial infarction. Lupus 2023; 32:1296-1309. [PMID: 37800460 DOI: 10.1177/09612033231202659] [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] [Indexed: 10/07/2023]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) patients have a higher risk of acute myocardial infarction (AMI) compared to the general population. However, the underlying common mechanism of this association is not fully understood. This study aims to investigate the molecular mechanism of this complication. METHODS Gene expression profiles of SLE (GSE50772) and AMI (GSE66360) were obtained from the Gene Expression Omnibus (GEO) database. Common differentially expressed genes (DEGs) in SLE and AMI were identified, and functional annotation, protein-protein interaction (PPI) network analysis, module construction, and hub gene identification were performed. Additionally, transcription factor (TF)-gene regulatory network and TF-miRNA regulatory network were constructed for the hub genes. RESULTS 70 common DEGs (7 downregulated genes and 63 upregulated genes) were identified and were mostly enriched in signaling pathways such as the IL-17 signaling pathway, TNF signaling pathway, lipid metabolism, and atherosclerosis. Using cytoHubba, 12 significant hub genes were identified, including IL1B, TNF, FOS, CXCL8, JUN, PTGS2, FN1, EGR1, CXCL1, DUSP1, MMP9, and ZFP36. CONCLUSIONS This study reveals a common pathogenesis of SLE and AMI and provides new perspectives for further mechanism research. The identified common pathways and hub genes may have important clinical implications for the prevention and treatment of AMI in SLE patients.
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Affiliation(s)
- Yang Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Yunxia Wang
- Department of Radiology, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Muwei Li
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, Henan, China
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Hashmi SA, Khowaja R, Ali M, Mangi AR, Khowaja A, Riaz G, Hashmi SMM, Haider AR, Hussain SDA, Agha S. Prognostic Significance of Nucleated RBCs in Predicting Mortality Among ST-Elevation Myocardial Infarction Patients Admitted to the ICU. Cureus 2023; 15:e45445. [PMID: 37859905 PMCID: PMC10583491 DOI: 10.7759/cureus.45445] [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] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Background The nucleated red blood cells (NRBCs) are a readily available hematological parameter with potential for risk stratification for mortality. Therefore, our objective was to assess the predictive significance of NRBCs for ICU mortality among ST-elevation myocardial infarction (STEMI) patients admitted to an ICU. Additionally, we aimed to compare the predictive capacity of NRBCs with that of the acute physiology and chronic health evaluation (APACHE) II score and the sequential organ failure assessment (SOFA) score. Methodology This descriptive cross-sectional study was conducted in the ICU of the National Institute of Cardiovascular Diseases (NICVD) in Karachi, Pakistan, from the 1st of February to the 30th of June, 2023. We included adult patients (≥18 years) diagnosed with STEMI who were subsequently admitted to the ICU. NRBCs were assessed in all patients over up to five days at 24-hour intervals, and the highest NRBC levels were used for the final analysis. Furthermore, the APACHE II score and the SOFA score were also documented. Patients were monitored throughout their ICU stay, and any adverse events or complications, such as re-intubation, bleeding necessitating transfusion, requirement for renal replacement therapy, arrhythmias, re-infarction, and mortality, were recorded. Results This study included 151 patients, of whom 97 (64.2%) were male, with an average age of 61.1 ± 10.7 years. Patients with positive NRBCs had higher mean SOFA scores (7.4 ± 2.9 vs. 5.4 ± 2.6; p < 0.001) and APACHE II scores (14.6 ± 6.3 vs. 12.6 ± 5.5; p = 0.037) compared to those with negative NRBCs. The culprit vessel showed greater mean stenosis (%) in patients with positive NRBCs (98.8 ± 3.0% vs. 96.8 ± 5.7%; p = 0.004). Post-procedure thrombolysis in myocardial infarction (TIMI) flow grade III was lower in patients with positive NRBCs (77.8% vs. 91.8% for positive vs. negative NRBCs, respectively). Moreover, patients with positive NRBCs experienced significantly higher mortality rates (63% vs. 8.2%; p < 0.001), a higher occurrence of arrhythmias (35.2% vs. 19.6%; p = 0.034), and an increased requirement for vasopressors/inotropic support (96.3% vs. 71.1%; p < 0.001) compared to those with negative NRBCs. NRBCs demonstrated superior discriminatory ability compared to the SOFA and APACHE II scores, with an area under the curve of 0.818 (95% CI: 0.738-0.899) for NRBCs, 0.774 (95% CI: 0.692-0.857) for SOFA, and 0.707 (95% CI: 0.613-0.801) for APACHE II. Positive NRBCs exhibited a sensitivity of 81.0% and a specificity of 81.7% in predicting ICU mortality. Conclusion In conclusion, positive NRBCs emerge as a robust and reliable prognostic indicator, strongly associated with an elevated risk of ICU mortality in STEMI patients. Moreover, the predictive power of positive NRBCs surpasses that of both SOFA and APACHE II scoring systems.
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Affiliation(s)
- Syeda Akefah Hashmi
- Critical Care Medicine, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Raheela Khowaja
- Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Maria Ali
- Transfusion Medicine, Regional Blood Centre Karachi, Karachi, PAK
| | - Ali R Mangi
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Aamir Khowaja
- Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | - Gohar Riaz
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Ali Raza Haider
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
| | | | - Sidrah Agha
- Adult Cardiology, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK
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16
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Kumar R, Ammar A, Kumar A, Ali A, Talpur MFH, Rahooja K, Chachar K, Wadhwa A, Sial JA, Saghir T, Khan S, Hakeem A, Qamar N, Karim M. Acute hyperglycemia, a rabble-rouser or innocent bystander? A prospective analysis of clinical implications of acute hyperglycemia in STE-ACS patients. BMC Cardiovasc Disord 2023; 23:406. [PMID: 37596526 PMCID: PMC10439549 DOI: 10.1186/s12872-023-03440-3] [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: 01/06/2023] [Accepted: 08/09/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Acute hyperglycemia is considered an independent prognosticator of both in-hospital and long-term outcomes in patients with acute coronary syndrome (ACS). This study aimed To analyze the incidence of acute hyperglycemia and its impact on the adverse in-hospital outcome in patients with STE-ACS undergoing primary percutaneous coronary intervention (PCI). METHODS In this study, we enrolled patients presenting with STE-ACS and undergoing primary PCI at a tertiary care cardiac center. Acute hyperglycemia was defined as random plasma glucose (RBS) > 200 mg/dl at the time of presentation to the emergency room. RESULTS Of the 4470 patients, 78.8% were males, and the mean age was 55.52 ± 11 years. In total, 39.4% (1759) were found to have acute hyperglycemia, and of these, 59% (1037) were already diagnosed with diabetes. Patients with acute hyperglycemia were observed to have a higher incidence of heart failure (8.2% vs. 5.5%; p < 0.001), contrast-induced nephropathy (10.9% vs. 7.4%; p < 0.001), and in-hospital mortality (5.7% vs. 2.5%; p < 0.001). On multivariable analysis, acute hyperglycemia was found to be an independent predictor of mortality with an adjusted odds ratio of 1.81 [1.28-2.55]. Multi-vessel disease (1.73 [1.17-2.56]), pre-procedure left ventricular end-diastolic pressure (LVEDP) (1.02 [1.0-1.03]), and Killip class III/IV (4.55 [3.09-6.71]) were found to be the additional independent predictors of in-hospital mortality. CONCLUSIONS Acute hyperglycemia, regardless of diabetic status, is an independent predictor of in-hospital mortality among patients with STE-ACS undergoing primary PCI. Acute hyperglycemia, along with other significant predictors such as multi-vessel involvement, LVEDP, and Killip class III/IV, can be considered for the risk stratification of these patients.
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Affiliation(s)
- Rajesh Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
| | - Ali Ammar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ashok Kumar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Ahsan Ali
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | | | - Kubbra Rahooja
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Kalsoom Chachar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Anesh Wadhwa
- Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Jawaid Akbar Sial
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Tahir Saghir
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Sohail Khan
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Abdul Hakeem
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Nadeem Qamar
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
| | - Musa Karim
- National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan
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Khedr A, Hennawi HA, Khan MK, Elbanna M, Jama AB, Proskuriakova E, Mushtaq H, Mir M, Boike S, Rauf I, Eissa A, Urtecho M, Koritala T, Jain N, Goyal L, Surani S, Khan SA. Effect of fibrinolytic therapy on ST-elevation myocardial infarction clinical outcomes during the COVID-19 pandemic: A systematic review and meta-analysis. World J Cardiol 2023; 15:309-323. [PMID: 37397830 PMCID: PMC10308269 DOI: 10.4330/wjc.v15.i6.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 03/30/2023] [Accepted: 05/19/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND ST-elevation myocardial infarction (STEMI) is the result of transmural ischemia of the myocardium and is associated with a high mortality rate. Primary percutaneous coronary intervention (PPCI) is the recommended first-line treatment strategy for patients with STEMI. The timely delivery of PPCI became extremely challenging for STEMI patients during the coronavirus disease 2019 (COVID-19) pandemic, leading to a projected steep rise in mortality. These delays were overcome by the shift from first-line therapy and the development of modern fibrinolytic-based reperfusion. It is unclear whether fibrinolytic-based reperfusion therapy is effective in improving STEMI endpoints.
AIM To determine the incidence of fibrinolytic therapy during the COVID-19 pandemic and its effects on STEMI clinical outcomes.
METHODS PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials were queried from January 2020 up to February 2022 to identify studies investigating the effect of fibrinolytic therapy on the prognostic outcome of STEMI patients during the pandemic. Primary outcomes were the incidence of fibrinolysis and the risk of all-cause mortality. Data were meta-analyzed using the random effects model to derive odds ratios (OR) and 95% confidence intervals. Quality assessment was carried out using the Newcastle-Ottawa scale.
RESULTS Fourteen studies including 50136 STEMI patients (n = 15142 in the pandemic arm; n = 34994 in the pre-pandemic arm) were included. The mean age was 61 years; 79% were male, 27% had type 2 diabetes, and 47% were smokers. Compared with the pre-pandemic period, there was a significantly increased overall incidence of fibrinolysis during the pandemic period [OR: 1.80 (1.18 to 2.75); I2= 78%; P = 0.00; GRADE: Very low]. The incidence of fibrinolysis was not associated with the risk of all-cause mortality in any setting. The countries with a low-and middle-income status reported a higher incidence of fibrinolysis [OR: 5.16 (2.18 to 12.22); I2 = 81%; P = 0.00; GRADE: Very low] and an increased risk of all-cause mortality in STEMI patients [OR: 1.16 (1.03 to 1.30); I2 = 0%; P = 0.01; GRADE: Very low]. Meta-regression analysis showed a positive correlation of hyperlipidemia (P = 0.001) and hypertension (P < 0.001) with all-cause mortality.
CONCLUSION There is an increased incidence of fibrinolysis during the pandemic period, but it has no effect on the risk of all-cause mortality. The low- and middle-income status has a significant impact on the all-cause mortality rate and the incidence of fibrinolysis.
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Affiliation(s)
- Anwar Khedr
- Department of Internal Medicine, BronxCare Health System, Bronx, NY 10457, United States
| | - Hussam Al Hennawi
- Department of Internal Medicine, Jefferson Abington Hospital, Abington, PA 19001, United States
| | - Muhammed Khuzzaim Khan
- Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Pakistan
| | - Mostafa Elbanna
- Department of Internal Medicine, Rochester Regional Health, Rochester, NY 14621, United States
| | - Abbas B Jama
- Department of Critical Care, Mayo Clinic Health System, Mankato, MN 56001, United States
| | | | - Hisham Mushtaq
- Department of Internal Medicine, St. Vincent's Medical Center, Bridgeport, CT 06606, United States
| | - Mikael Mir
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Sydney Boike
- Department of Medicine, University of Minnesota, Minneapolis, MN 55455, United States
| | - Ibtisam Rauf
- Department of Medicine, St. George's University, School of Medicine, St George SW17 0RE, Grenada
| | - Aalaa Eissa
- Department of Medicine, KFS University, KFS 33511, Egypt
| | - Meritxell Urtecho
- Department of Medicine, Robert D and Patricia E. Kern Center of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, United States
| | - Thoyaja Koritala
- Department of Hospital Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Nitesh Jain
- Department of Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
| | - Lokesh Goyal
- Department of Hospital Medicine, Christus Sphon Hospital-shoreline, Corpus Christo, TX 78404, United States
| | - Salim Surani
- Department of Pulmonary, Critical Care & Sleep Medicine, Texas A&M University, College Station, TX 77843, United States
| | - Syed A Khan
- Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
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18
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Zoni CR, Mukherjee D, Gulati M. Proposed new classification for acute coronary syndrome: Acute coronary syndrome requiring immediate reperfusion. Catheter Cardiovasc Interv 2023; 101:1177-1181. [PMID: 37061867 DOI: 10.1002/ccd.30667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/30/2023] [Accepted: 04/06/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Cesar R Zoni
- Division Cardiothoracic Surgery, Department of Surgery, UConn Health, Farmington, Connecticut, USA
| | - Debabrata Mukherjee
- Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA
| | - Martha Gulati
- Barbra Streisand Women's Heart Center, Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA
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19
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Koh HP, Md Redzuan A, Mohd Saffian S, Hassan H, R Nagarajah J, Ross NT. Mortality outcomes and predictors of failed thrombolysis following STEMI thrombolysis in a non-PCI capable tertiary hospital: a 5-year analysis. Intern Emerg Med 2023; 18:1169-1180. [PMID: 36648707 PMCID: PMC9843664 DOI: 10.1007/s11739-023-03202-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023]
Abstract
Pharmacological reperfusion remains the primary strategy for ST-elevation myocardial infarction (STEMI) in low- and medium-income countries. Literature has reported inconsistent incidences and outcomes of failed thrombolysis (FT). This study aimed to identify the incidence, mortality outcomes and predictors of FT in STEMI pharmacological reperfusion. This single-centre retrospective cohort study analyzed data on consecutive STEMI patients who received thrombolytic therapy from 2016 to 2020 in a public tertiary hospital. Total population sampling was used in this study. Logistic regression analyses were used to assess independent predictors of the mortality outcomes and FT. We analyzed 941 patients with a mean age of 53.0 ± 12.2 years who were predominantly male (n = 846, 89.9%). The in-hospital mortality was 10.3% (n = 97). FT occurred in 86 (9.1%) patients and was one of the predictors of mortality (aOR 3.847, p < 0.001). Overall, tenecteplase use (aOR 1.749, p = 0.021), pre-existing hypertension (aOR 1.730, p = 0.024), history of stroke (aOR 4.176, p = 0.004), and heart rate ≥ 100 bpm at presentation (aOR 2.333, p < 0.001) were the general predictors of FT. The predictors of FT with streptokinase were Killip class ≥ II (aOR 3.197, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 3.536, p = 0.001). History of stroke (aOR 6.144, p = 0.004) and heart rate ≥ 100 bpm at presentation (aOR 2.216, p = 0.015) were the predictors of FT in STEMI patients who received tenecteplase. Mortality following STEMI thrombolysis remained high in our population and was attributed to FT. Identified predictors of FT enable early risk stratification to evaluate the patients' prognosis to manage them better.
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Affiliation(s)
- Hock Peng Koh
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia.
| | - Adyani Md Redzuan
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | | | - Hasnita Hassan
- Emergency and Trauma Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Jivanraj R Nagarajah
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Jalan Pahang, 50586, Kuala Lumpur, Malaysia
| | - Noel Thomas Ross
- Medical Department, Hospital Kuala Lumpur, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
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20
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Heidari Moghadam R, Salehi N, Mahmoudi S, Shojaei L, Nasiri S, Siabani S, Janjani P, Rouzbahani M, Tadbiri H, Nalini M. Determinants of Left Ventricular Systolic Function One Year after Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction in a Middle-Income Country. ARCHIVES OF IRANIAN MEDICINE 2023; 26:92-99. [PMID: 37543929 PMCID: PMC10685896 DOI: 10.34172/aim.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/28/2022] [Indexed: 08/08/2023]
Abstract
BACKGROUND Little is known about the predictors of left ventricular ejection fraction (LVEF) -an important predictor of mortality- after primary percutaneous coronary intervention (PCI) in low- and middle-income countries. METHODS In a prospective cohort study at Imam Ali hospital, Kermanshah, Iran, we enrolled consecutive ST-elevation myocardial infarction (STEMI) patients treated with primary PCI (2016-2018) and followed them up to one year. LVEF levels were measured by echocardiography, at baseline and one-year follow-up. Determinants of preserved/improved LVEF were assessed using multi-variable logistic regression models. RESULTS Of 803 patients (mean age 58.53±11.7 years, 20.5% women), baseline LVEF levels of ≤35% were reported in 44%, 35- 50% in 40%, and ≥50% in 16% of patients. The mean ± SD of LVEF increased from 38.13%±9.2% at baseline to 41.49%±9.5% at follow-up. LVEF was preserved/improved in 629 (78.3%) patients. Adjusted ORs (95% CIs) for predictors of preserved/improved LVEF showed positive associations with creatinine clearance, 1.01 (1.00-1.02) and adherence to clopidogrel, 2.01 (1.33-3.02); and inverse associations with history of myocardial infarction (MI), 0.44 (0.25-0.78); creatine kinase MB (CK-MB), 0.997 (0.996- 0.999); door-balloon time (3rd vs. 1st tertile), 0.62 (0.39-0.98); number of diseased vessels (2 and 3 vs. 1: 0.63 (0.41-0.99) and 0.58 (0.36-0.93), respectively); and baseline LVEF (35-50% and ≥50% vs. ≤35%: 0.45 (0.28-0.71) and 0.19 (0.11-0.34), respectively). CONCLUSION Adherence to clopidogrel, short door-balloon time, high creatinine clearance, and lower baseline LVEF were associated with preserved/improved LVEF, while history of MI, high CK-MB, and multi-vessel disease were predictors of reduced LVEF. Long-term drug adherence should be considered for LVEF improvement in low- and middle-income countries.
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Affiliation(s)
- Reza Heidari Moghadam
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Susan Mahmoudi
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Lida Shojaei
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Sirus Nasiri
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Soraya Siabani
- Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Parisa Janjani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Hooman Tadbiri
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
| | - Mahdi Nalini
- Cardiovascular Research Center, Health Institute, Kermanshah University of Medical Sciences, Imam Ali Hospital, Kermanshah, Iran
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21
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Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients. Glob Heart 2023; 18:2. [PMID: 36760803 PMCID: PMC9881442 DOI: 10.5334/gh.1182] [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: 08/26/2022] [Accepted: 01/03/2023] [Indexed: 01/24/2023] Open
Abstract
Background Regional ST-segment-elevation myocardial infarction (STEMI) networks facilitate timely performance of primary percutaneous coronary intervention (PPCI), reduce mortality and improve outcomes. Few data exist on the feasibility and impact of regional STEMI networks in developing countries. Aim of the Work The aim of this study was to examine the feasibility and impact of establishing a regional STEMI network on the management and outcomes of STEMI patients in north Cairo. Patients and Methods A prospective observational study conducted on 352 patients presenting in North Cairo with confirmed diagnosis of STEMI within 48 hours of symptoms. Patients were divided into group I (n = 140) before and group II (n = 212) after establishment of the STEMI network. Both groups were compared as regards patients' demographics, presentation, management and short-term outcomes. The north Cairo regional STEMI network was established among four governmental hospitals and the governmental ambulance was used for interhospital transfer. WhatsApp® was used for trans-network team communication. Results Mean age of the study population was 55.4 ± 11.02 years and 286 (81.3%) were males. Mean time from chest pain to first medical contact did not change between the two groups (240 minutes; P = 0.36) while door to balloon mean time was reduced (from 54.3 to 44.1 minutes: P = 0.01). Use of thrombolytic therapy declined from 51 (36.4%) to 16 (7.5%) (P < 0.001) while primary PCI increased from 59.8% to 77.1% (p < 0.001). Left ventricular ejection fraction improved from 51.3 ± 10.7 to 55.4 ± 9.1 (P < 0.001), the mean time of CCU stay was reduced from a mean of 3.0 to 2.0 days (P < 0.001) and in-hospital mortality improved from 6.4% to 2.8% (P = 0.10). Conclusion The establishment of the STEMI network in north Cairo was feasible and improved patients' outcomes. Use of primary PCI increased and in-hospital mortality improved from after establishment of STEMI network.
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Rakab A, Swed S, Alibrahim H, Bohsas H, Abouainain Y, Abbas KS, Khair Eldien Jabban Y, Sawaf B, Rageh B, Alkhawaldeh M, Al-Fayyadh I, Rakab MS, Fathey S, Hafez W, Gerbil A, El-Shafei EHH. Assessment of the competence in electrocardiographic interpretation among Arabic resident doctors at the emergency medicine and internal medicine departments: A multi-center online cross-sectional study. Front Med (Lausanne) 2023; 10:1140806. [PMID: 37168264 PMCID: PMC10165895 DOI: 10.3389/fmed.2023.1140806] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 05/13/2023] Open
Abstract
Background This study aims to assess the electrocardiographic interpretation abilities of resident doctors at internal medicine and emergency medicine departments in eight Arabic countries. Methods An online cross-sectional study was conducted between October 7, 2022 and October 21, 2022 in eight Arabic countries. The questionnaire consisted of two main sections: the first section included sociodemographic information, while the second section contained 12 clinical case questions of the most severe cardiac abnormalities with their electrocardiography (ECG) recordings. Results Out of 2,509 responses, 630 were eligible for the data analysis. More than half of the participants were males (52.4%). Internal medicine residents were (n = 530, 84.1%), whereas emergency medicine residents were (n = 100, 15.9%). Almost participants were in their first or second years of residency (79.8%). Only 36.2% of the inquired resident doctors had attended an ECG course. Most participants, 85.6%, recognized the ECG wave order correctly, and 50.5% of the participants scored above 7.5/10 on the ECG interpretation scale. The proportions of participants who were properly diagnosed with atrial fibrillation, third-degree heart block, and atrial tachycardia were 71.1, 76.7, and 56.6%, respectively. No statistically significant difference was defined between the internal and emergency medicine residents regarding their knowledge of ECG interpretation (p value = 0.42). However, there was a significant correlation between ECG interpretation and medical residency year (p value < 0.001); the fourth-year resident doctors had the highest scores (mean = 9.24, SD = 1.6). As well, participants in the third and second years of postgraduate medical residency have a probability of adequate knowledge of ECG interpretation more than participants in the first year of residency (OR = 2.1, p value = 0.001) and (OR = 1.88, p value = 0.002), respectively. Conclusion According to our research findings, resident doctors in departments of internal medicine and emergency medicine in Arabic nations have adequate ECG interpretation abilities; nevertheless, additional development is required to avoid misconceptions about critical cardiac conditions.
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Affiliation(s)
- Amine Rakab
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- *Correspondence: Amine Rakab,
| | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | | | | | | | | | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Bushra Rageh
- Faculty of Medicine, Sanaa University, Sanaa, Yemen
| | | | | | | | | | - Wael Hafez
- NMC Royal Hospital, Abu Dhabi, United Arab Emirates
- Medical Research Division, Department of Internal Medicine, The National Research Center, Cairo, Egypt
| | - Amr Gerbil
- NMC Royal Hospital, Abu Dhabi, United Arab Emirates
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Li S, Dong X, Li D, Zhang H, Zhou S, Maimaitiming M, Ma J, Li N, Zhou Q, Jin Y, Zheng ZJ. Inequities in ambulance allocation associated with transfer delay and mortality in acute coronary syndrome patients: evidence from 89 emergency medical stations in China. Int J Equity Health 2022; 21:178. [PMID: 36527098 PMCID: PMC9756777 DOI: 10.1186/s12939-022-01777-3] [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: 04/11/2022] [Accepted: 10/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Allocation of healthcare resources has a great influence on treatment and outcome of patients. This study aimed to access the inequality of ambulance allocation across regions, and estimate the associations between ambulance density and pre-hospital transfer time and mortality of acute coronary syndromes (ACS) patients. METHODS This cross-sectional study was based on an integrated database of electronic medical system for 3588 ACS patients from 31 hospitals, ambulance information of 89 emergency medical stations, and public geographical information of 8 districts in Shenzhen, China. The primary outcomes were the associations between ambulance allocation and transfer delay and in-hospital mortality of ACS patients. The Theil index and Gini coefficient were used to assess the fairness and inequality degree of ambulance allocation. Logistic regression was used to model the associations. RESULTS There was a significant inequality in ambulance allocation in Shenzhen (Theil index: 0.59), and the inequality of inter-districts (Theil index: 0.38) was greater than that of intra-districts (Theil index: 0.21). The gap degree of transfer delay, ambulance allocation, and mortality across districts resulted in a Gini coefficient of 0.35, 0.53, 0.65, respectively. Ambulance density was negatively associated with pre-hospital transfer time (OR = 0.79, 95%CI: 0.64,0.97, P = 0.026), with in-hospital mortality (OR = 0.31, 95%CI:0.14,0.70, P = 0.005). The ORs of Theil index in transfer time and in-hospital mortality were 1.09 (95%CI:1.01,1.10, P < 0.001) and 1.80 (95%CI:1.15,3.15, P = 0.009), respectively. CONCLUSIONS Regional inequities existed in ambulance allocation and has a significant impact on pre-hospital transfer delay and in-hospital mortality of ACS patients. It was suggested to increase the ambulance accessibility and conduct health education for public.
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Affiliation(s)
- Siwen Li
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China ,grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Xuejie Dong
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Dongmei Li
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Hongjuan Zhang
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Shuduo Zhou
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Mailikezhati Maimaitiming
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Junxiong Ma
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Na Li
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Qiang Zhou
- Shenzhen Center for Prehospital Care, 3 Meigang South Street, West Nigang Road, Futian District, Shenzhen, 518025 China
| | - Yinzi Jin
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
| | - Zhi-Jie Zheng
- grid.11135.370000 0001 2256 9319Department of Global Health, School of Public Health, Peking University, 38 Xue Yuan Road, Haidian District, Beijing, 100191 China ,grid.11135.370000 0001 2256 9319Institute for Global Health and Development, Peking University, Beijing, China
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Nadarajah R, Wu J, Hurdus B, Asma S, Bhatt DL, Biondi-Zoccai G, Mehta LS, Ram CVS, Ribeiro ALP, Van Spall HG, Deanfield JE, Lüscher TF, Mamas M, Gale CP. The collateral damage of COVID-19 to cardiovascular services: a meta-analysis. Eur Heart J 2022; 43:3164-3178. [PMID: 36044988 PMCID: PMC9724453 DOI: 10.1093/eurheartj/ehac227] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 04/02/2022] [Accepted: 04/20/2022] [Indexed: 07/21/2023] Open
Abstract
AIMS The effect of the COVID-19 pandemic on care and outcomes across non-COVID-19 cardiovascular (CV) diseases is unknown. A systematic review and meta-analysis was performed to quantify the effect and investigate for variation by CV disease, geographic region, country income classification and the time course of the pandemic. METHODS AND RESULTS From January 2019 to December 2021, Medline and Embase databases were searched for observational studies comparing a pandemic and pre-pandemic period with relation to CV disease hospitalisations, diagnostic and interventional procedures, outpatient consultations, and mortality. Observational data were synthesised by incidence rate ratios (IRR) and risk ratios (RR) for binary outcomes and weighted mean differences for continuous outcomes with 95% confidence intervals. The study was registered with PROSPERO (CRD42021265930). A total of 158 studies, covering 49 countries and 6 continents, were used for quantitative synthesis. Most studies (80%) reported information for high-income countries (HICs). Across all CV disease and geographies there were fewer hospitalisations, diagnostic and interventional procedures, and outpatient consultations during the pandemic. By meta-regression, in low-middle income countries (LMICs) compared to HICs the decline in ST-segment elevation myocardial infarction (STEMI) hospitalisations (RR 0.79, 95% confidence interval [CI] 0.66-0.94) and revascularisation (RR 0.73, 95% CI 0.62-0.87) was more severe. In LMICs, but not HICs, in-hospital mortality increased for STEMI (RR 1.22, 95% CI 1.10-1.37) and heart failure (RR 1.08, 95% CI 1.04-1.12). The magnitude of decline in hospitalisations for CV diseases did not differ between the first and second wave. CONCLUSIONS There was substantial global collateral CV damage during the COVID-19 pandemic with disparity in severity by country income classification.
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Affiliation(s)
- Ramesh Nadarajah
- Corresponding author. Tel: +44 113 343 3241, , Twitter @Dr_R_Nadarajah
| | - Jianhua Wu
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- School of Dentistry, University of Leeds, Leeds, UK
| | - Ben Hurdus
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Samira Asma
- Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, Switzerland
| | - Deepak L. Bhatt
- Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Giuseppe Biondi-Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- Mediterranea Cardiocentro, Napoli, Italy
| | - Laxmi S. Mehta
- Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - C. Venkata S. Ram
- Apollo Hospitals and Medical College, Hyderabad, Telangana, India
- University of Texas Southwestern Medical School, Dallas, TX, USA
- Faculty of Medical and Health Sciences, Macquarie University, Sydney, Australia
| | - Antonio Luiz P. Ribeiro
- Cardiology Service and Telehealth Center, Hospital das Clínicas, and Department of Internal Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Harriette G.C. Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
- Population Health Research Institute, Hamilton, Canada
| | - John E. Deanfield
- National Institute for Cardiovascular Outcomes Research, Barts Health NHS Trust, London, UK
- Institute of Cardiovascular Sciences, University College, London, UK
| | - Thomas F. Lüscher
- Imperial College, National Heart and Lung Institute, London, UK
- Royal Brompton & Harefield Hospital, Imperial College, London, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Institute for Prognosis Research, University of Keele, Keele, UK
| | - Chris P. Gale
- Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, 6 Clarendon Way, Leeds LS2 9DA, UK
- Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
- Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Gupta R, Makkar JS, Sharma SK, Agarwal A, Sharma KK, Bana A, Kasliwal A, Sidana SK, Degawat PR, Bhagat KK, Natani V, Khedar RS, Sharma SK. Association of health insurance status with coronary risk factors, coronary artery disease, interventions and outcomes in India. INTERNATIONAL JOURNAL OF CARDIOLOGY CARDIOVASCULAR RISK AND PREVENTION 2022; 14:200146. [PMID: 36060285 PMCID: PMC9434410 DOI: 10.1016/j.ijcrp.2022.200146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/14/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022]
Abstract
Objective Coronary artery disease (CAD) related hospitalization and interventions are associated with catastrophic out-of-pocket health expenditure in India. To evaluate differences in risk factors, disease severity, management and outcomes in uninsured vs insured CAD patients we performed a study. Methods Successive CAD patients who underwent percutaneous intervention (PCI) at our centre were enrolled from January 2018 to June 2021. Clinical, angiographic and intervention data were periodically uploaded in the American College of Cardiology CathPCI platform. Descriptive statistics are reported. Results 4672 CAD patients (men 3736, women 936) were included; uninsured were 2166 (46%), government insurance was in 1635 (36%) and private insurance in 871 (18%). Mean age was 60.1 ± 11 years, uninsured <50y were 21.6% vs 14.0% and 20.3% with government and private insurance. Among the uninsured prevalence of raised total and non-HDL cholesterol, any tobacco use, ST-elevation myocardial infarction (STEMI) and ejection fraction <30% were more (p < 0.01). In the STEMI group (n = 1985), rates of primary PCI were the highest in those with private insurance (38.7%) compared to others. Multivessel stenting (≥2 stents) was more among the insured patients. Median length of hospital stay was similar in the three groups. In-hospital mortality was slightly more in the uninsured (1.43%), compared to government (0.88) and privately insured (0.82) (p = 0.242). The cost of hospitalization and procedures was the highest among uninsured (US$ 2240, IQR 1877–2783) compared to government (US$ 1977, IQR 1653–2437) and privately insured (US$ 2013, IQR 1668–2633) (p < 0.001). Conclusions Uninsured CAD patients in India are younger with more risk factors, acute coronary syndrome, STEMI, multivessel disease and coronary stenting compared to those with government or private insurance. The uninsured bear significantly greater direct costs with slightly greater mortality.
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Leveraging Clinical Digitized Data to Understand Temporal Characteristics and Outcomes of Acute Myocardial Infarctions at a Tertiary Care Medical Centre in Pakistan from 1988–2018 – Methods and Results. Glob Heart 2022; 17:58. [PMID: 36051315 PMCID: PMC9389955 DOI: 10.5334/gh.1147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective: Few data exist on trends in acute myocardial infarction (AMI) patterns spanning recent epidemiological shifts in low middle-income countries (LMICs). To understand temporal disease patterns of AMI characteristics and outcomes between 1988–2018, we used digitized legacy clinical data at a large tertiary care centre in Pakistan. Methods: We reviewed digital health information capture systems maintained across the Aga Khan University Hospital and obtained structured elements to create a master dataset. We included index admissions of patients >18 years that were discharged between January 1, 1988, and December 31, 2018, with a primary discharge diagnosis of AMI (using ICD-9 diagnoses). The outcome evaluated was in-hospital mortality. Clinical characteristics derived from the electronic database were validated against chart review in a random sample of cases (k 0.53–1.00). Results: The final population consisted of 14,601 patients of which 30.6% (n = 4,470) were female, 52.4% (n = 7,651) had ST elevation MI and 47.6% (n = 6,950) had non-ST elevation MI. The median (IQR) age at presentation was 61 (52–70) years. Overall unadjusted in-hospital mortality was 10.3%. Across the time period, increasing trends were noted for the following characteristics: age, proportion of women, prevalence of hypertension, diabetes, proportion with NSTEMI (all ptrend < 0.001). In-hospital mortality rates declined significantly between 1988–1997 and 2008–2018 (13.8% to 9.2%, p < 0.001). Conclusions: The patterns of AMI have changed over the last three decades with a concomitant decline in in-hospital mortality at a tertiary care centre in Pakistan. Clinical digitized data presents a unique opportunity for gaining insights into disease patterns in LMICs.
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Zhang S, Ma Q, Jiao Y, Wu J, Yu T, Hou Y, Sun Z, Zheng L, Sun Z. Prognostic value of myocardial salvage index assessed by cardiovascular magnetic resonance in reperfused ST-segment elevation myocardial infarction. Front Cardiovasc Med 2022; 9:933733. [PMID: 36051284 PMCID: PMC9425200 DOI: 10.3389/fcvm.2022.933733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 07/20/2022] [Indexed: 12/19/2022] Open
Abstract
AimsCardiovascular magnetic resonance (CMR) is a powerful tool to quantify the myocardial area at risk (AAR) and infarct size (IS), and evaluate the extent of myocardial salvage in acute ST-segment elevation myocardial infarction (STEMI). This study aimed to assess the prognostic value of myocardial salvage index (MSI) assessed by CMR in reperfused STEMI and investigate whether MSI could improve the predictive efficacy of the Global Registry of Acute Coronary Events (GRACE) risk score.Methods and results:About 104 consecutive patients who were hospitalized with first-time STEMI and received reperfusion therapy were prospectively enrolled. The primary endpoint was the incident of major adverse cardiovascular event (MACE) including all-cause mortality, non-fatal myocardial reinfarction and congestive heart failure within 36 months after the index event. Cox regression analysis was used to evaluate the prognostic association of MSI with MACE risk. About 21 (20.2%) patients developed MACE during the 3-year follow-up period, and patients with MSI < median had a higher incidence of MACE than those with MSI ≥ median [16 (30.8%) vs. 5 (9.6%), P = 0.007]. After adjusting all the parameters associated with MACE in univariate Cox analysis, MSI assessed by CMR remained independently significant as a predictor of MACE in multivariate Cox analysis (hazard ratio 0.963, 95% CI: 0.943–0.983; P < 0.001). Adding MSI to the GRACE risk score significantly increased the prognostic accuracy of the GRACE risk score (area under the curve: 0.833 vs. 0.773; P = 0.044), with a net reclassification improvement of 0.635 (P = 0.009) and an integrated discrimination improvement of 0.101 (P = 0.002).ConclusionThis study confirmed that MSI assessed by CMR had a good long-term prognostic value in reperfused STEMI and improve the prognostic performance of the GRACE risk score.
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Affiliation(s)
- Shiru Zhang
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Quanmei Ma
- Department of Radiology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Radiology, Ganzhou Municipal Hospital, Ganzhou, China
| | - Yundi Jiao
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jiake Wu
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tongtong Yu
- Department of Cardiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhijun Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Liqiang Zheng,
| | - Zhaoqing Sun
- Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang, China
- Zhaoqing Sun,
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Hendrickson MJ, Arora S, Vaduganathan M, Fonarow GC, MP G, Bansal A, Batra V, Kunal S, Bhatt DL, Gupta M, Qamar A. Prevalence and prognostic implications of reduced left ventricular ejection fraction among patients with STEMI in India. ESC Heart Fail 2022; 9:3836-3845. [PMID: 35950269 PMCID: PMC9773730 DOI: 10.1002/ehf2.14055] [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: 05/06/2022] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS To describe clinical characteristics and outcomes for those with STEMI and reduced left ventricular ejection fraction (LVEF) in low-income and middle-income countries (LMICs). METHODS AND RESULTS Adults presenting with STEMI to two government-owned tertiary care centres in Delhi, India were prospectively enrolled in the North India ST-elevation myocardial infarction (NORIN-STEMI) registry. LVEF was evaluated at presentation and clinical characteristics were compared across LVEF categories. Overall, 3597 patients were included, of whom 468 (13%) had LVEF >50%, 1482 (41%) had mildly reduced LVEF (40-49%), 1357 (38%) had moderately reduced LVEF (30-39%), and 290 (8%) had severely reduced LVEF (<30%). Presentation delay >24 h, prior MI, and hyperlipidaemia were associated with decreasing LVEF category. Although most patients with reduced LVEF were discharged on appropriate guideline-directed therapies, adherence at 1 year was low (ACE inhibitor/ARB 91% to 41%, beta blocker 98% to 78%, aldosterone receptor antagonist 69% to 6%). After multivariable adjustment, a Cox regression model showed moderately reduced LVEF (HR 1.77, 95% CI 1.20, 2.60) and severely reduced LVEF (HR 3.63, 95% CI 2.41, 5.48) were associated with increased risk of all-cause mortality compared with LVEF ≥50%. CONCLUSIONS On presentation for STEMI, almost 90% of NORIN-STEMI participants had at least mildly reduced LVEF and almost half had LVEF <40%. Patients with LVEF <40% had significantly higher risk of mortality at 1 year, and adherence to guideline-directed therapies at 1 year was poor. Systematic initiatives to improve access to timely revascularization and guideline-directed therapies are essential in advancing STEMI care in LMICs.
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Affiliation(s)
| | - Sameer Arora
- Division of CardiologyUniversity of North Carolina School of MedicineChapel HillNCUSA
| | - Muthiah Vaduganathan
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Gregg C. Fonarow
- Division of CardiologyUniversity of California Los AngelesLos AngelesCAUSA
| | - Girish MP
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Ankit Bansal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Vishal Batra
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Shekhar Kunal
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Deepak L. Bhatt
- Brigham and Women's Hospital Heart and Vascular InstituteHarvard Medical SchoolBostonMAUSA
| | - Mohit Gupta
- GB Pant Institute of Postgraduate Medical Education and ResearchNew DelhiIndia
| | - Arman Qamar
- Section of Interventional Cardiology and Vascular Medicine, NorthShore University Health SystemUniversity of Chicago Pritzker School of MedicineEvanstonILUSA
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Liu Y, Ye T, Chen K, Wu G, Xia Y, Wang X, Zong G. A nomogram risk prediction model for no-reflow after primary percutaneous coronary intervention based on rapidly accessible patient data among patients with ST-segment elevation myocardial infarction and its relationship with prognosis. Front Cardiovasc Med 2022; 9:966299. [PMID: 36003914 PMCID: PMC9393359 DOI: 10.3389/fcvm.2022.966299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/19/2022] [Indexed: 11/26/2022] Open
Abstract
Background No-reflow occurring after primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) can increase the incidence of major adverse cardiovascular events (MACE). The present study aimed to construct a nomogram prediction model that can be quickly referred to before surgery to predict the risk for no-reflow after PCI in STEMI patients, and to further explore its prognostic utility in this patient population. Methods Research subjects included 443 STEMI patients who underwent primary PCI between February 2018 and February 2021. Rapidly available clinical data obtained from emergency admissions were collected. Independent risk factors for no-reflow were analyzed using a multivariate logistic regression model. Subsequently, a nomogram for no-reflow was constructed and verified using bootstrap resampling. A receiver operating characteristic (ROC) curve was plotted to evaluate the discrimination ability of the nomogram model and a calibration curve was used to assess the concentricity between the model probability curve and ideal curve. Finally, the clinical utility of the model was evaluated using decision curve analysis. Results The incidence of no-reflow was 18% among patients with STEMI. Killip class ≥2 on admission, pre-operative D-dimer and fibrinogen levels, and systemic immune–inflammation index (SII) were independent risk factors for no-reflow. A simple and quickly accessible prediction nomogram for no-reflow after PCI was developed. This nomogram demonstrated good discrimination, with an area under the ROC curve of 0.716. This nomogram was further validated using bootstrapping with 1,000 repetitions; the C-index of the bootstrap model was 0.706. Decision curve analysis revealed that this model demonstrated good fit and calibration and positive net benefits. Kaplan–Meier survival curve analysis revealed that patients with higher model scores were at a higher risk of MACE. Multivariate Cox regression analysis revealed that higher model score(s) was an independent predictor of MACE (hazard ratio 2.062; P = 0.004). Conclusions A nomogram prediction model that can be quickly referred to before surgery to predict the risk for no-reflow after PCI in STEMI patients was constructed. This novel nomogram may be useful in identifying STEMI patients at higher risk for no-reflow and may predict prognosis in this patient population.
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Affiliation(s)
- Yehong Liu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Ting Ye
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Ke Chen
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
- Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Gangyong Wu
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
- Wuxi Clinical College of Anhui Medical University, Wuxi, China
| | - Yang Xia
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Xiao Wang
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
| | - Gangjun Zong
- Department of Cardiology, The 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, China
- Wuxi Clinical College of Anhui Medical University, Wuxi, China
- *Correspondence: Gangjun Zong
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Gopinath B, Kumar A, Sah R, Bhoi S, Jamshed N, Ekka M, Aggarwal P, Deorari A, Bhargava B, Kappagantu V. Strengthening emergency care systems to improve patient care for ST-elevation myocardial infarction (STEMI) at a high-volume tertiary care centre in India. BMJ Open Qual 2022; 11:bmjoq-2021-001764. [PMID: 35914815 PMCID: PMC9345032 DOI: 10.1136/bmjoq-2021-001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 07/24/2022] [Indexed: 12/02/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) is a highly time-sensitive and life-threatening condition. Early recognition and timely management are challenging in a busy emergency department (ED), especially in low/middle-income countries where emergency systems are often fragmented. The aim of our quality improvement (QI) project was to increase the percentage of patients with STEMI undergoing primary percutaneous coronary intervention (PCI) with door to balloon (D2B) time of <90 min by 30% over 12 months. Methods As part of the first step in QI, baseline data were collected at different points in the process of care. Using process maps and fishbone analysis, delays in patient registration, ECG and communication with cardiology were identified as some bottlenecks, and change ideas were tested using plan–do–study–act cycles using point-of-care QI methodology. The majority of the change ideas focused on interventions in the ED like strengthening triage, training frontline staff, early diagnosis and quick transportation of patients. Results During the baseline phase, 22.22% of patients were found to have a D2B time of <90 min. We achieved an increase of 47.78% in patients receiving PCI within 90 min and hence increased to 70% at the end of the intervention phase. Data collected for 4 months after the intervention phase were found to have sustained the effort. Conclusion Significant improvement in the door to reperfusion time resulted from a meticulous assessment of emergency care processes by drawing process flow chart and implementation of change ideas like introduction of fast-track policy for patients with chest pain, reducing staff turnover in the triage area, formal training of staff, continuous engagement with cardiology team and by interchanging of processes which led to a reduction in time to ECG.
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Affiliation(s)
- Bharath Gopinath
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sah
- Department of Emergency Medicine, BP Koirala Institute of Health Sciences, Dharan, Kathmandu, Nepal
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Praveen Aggarwal
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Deorari
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | | | - Vignan Kappagantu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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Impact of COVID-19 pandemic on STEMI thrombolysis and Emergency Department's performance in a non-PCI capable tertiary hospital. Am J Emerg Med 2022; 60:9-14. [PMID: 35872375 PMCID: PMC9287574 DOI: 10.1016/j.ajem.2022.07.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/07/2022] [Accepted: 07/09/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Some guidelines had recommended “thrombolysis first” in ST-elevated myocardial infarction (STEMI) during the Coronavirus Disease 2019 (COVID-19) outbreak. The impact of COVID-19 solely on STEMI thrombolysis is lacking as most studies reported outcomes related to percutaneous coronary intervention (PCI) setting. Thus, this study aimed to assess the impact of the COVID-19 pandemic on STEMI thrombolysis outcomes and the Emergency Department's performance in a non-PCI capable centre. Methods This single-centre retrospective study analysed data on consecutive STEMI patients who received thrombolytic therapy from May 2019 to December 2020 (20 months) in a non-PCI capable tertiary hospital. Total population sampling was used in this study. We compared all patients' characteristics and outcomes ten months before and during the pandemic. Regression models were used to assess the impact of COVID-19 pandemic on door-to-needle time (DNT), mortality, bleeding events, and the number of overnight stays. Results and discussion We analysed 323 patients with a mean age of 52.9 ± 12.9 years and were predominantly male (n = 280, 88.9%). There was a 12.5% reduction in thrombolysis performed during the pandemic. No significant difference in timing from symptoms onset to thrombolysis and DNT was observed. In-hospital mortality was significantly higher during the pandemic (OR 2.02, 95% CI 1.02–4.00, p = 0.044). Bleeding events post thrombolysis remained stable and there was no significant difference in the number of overnight stays during the pandemic. Conclusion STEMI thrombolysis cases were reduced during the COVID-19 pandemic, with an inverse increase in mortality despite the preserved Emergency Department performance in timely thrombolysis.
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Maslov PZ, Sabharwal B, Ahmadi A, Baliga R, Narula J. Religious Fasting and the Vascular Health. Indian Heart J 2022; 74:270-274. [PMID: 35917971 PMCID: PMC9453020 DOI: 10.1016/j.ihj.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Machine learning based model for risk prediction after ST-Elevation myocardial infarction: Insights from the North India ST elevation myocardial infarction (NORIN-STEMI) Registry. Int J Cardiol 2022; 362:6-13. [DOI: 10.1016/j.ijcard.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/20/2022] [Accepted: 05/11/2022] [Indexed: 11/18/2022]
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Bergmark BA, Mathenge N, Merlini PA, Lawrence-Wright MB, Giugliano RP. Acute coronary syndromes. Lancet 2022; 399:1347-1358. [PMID: 35367005 PMCID: PMC8970581 DOI: 10.1016/s0140-6736(21)02391-6] [Citation(s) in RCA: 116] [Impact Index Per Article: 58.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 12/14/2022]
Abstract
Although substantial progress has been made in the diagnosis and treatment of acute coronary syndromes, cardiovascular disease remains the leading cause of death globally, with nearly half of these deaths due to ischaemic heart disease. The broadening availability of high-sensitivity troponin assays has allowed for rapid rule-out algorithms in patients with suspected non-ST-segment elevated myocardial infarction (NSTEMI). Dual antiplatelet therapy is recommended for 12 months following an acute coronary syndrome in most patients, and additional secondary prevention measures including intensive lipid-lowering therapy (LDL-C <1·4 mmol/L), neurohormonal agents, and lifestyle modification, are crucial. The scientific evidence for diagnosis and management of acute coronary syndromes continues to evolve rapidly, including adapting to the COVID-19 pandemic, which has impacted all aspects of care. This Seminar provides a clinically relevant overview of the pathobiology, diagnosis, and management of acute coronary syndromes, and describes key scientific advances.
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Affiliation(s)
- Brian A Bergmark
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Njambi Mathenge
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Piera A Merlini
- 4th Division of Cardiology, Cardiocenter De Gasperis, ASST GOM Niguarda and Bicocca University, Milan, Italy
| | - Marilyn B Lawrence-Wright
- Division of Cardiology, Department of Medicine, The University of the West Indies at Mona, Kingston, Jamaica
| | - Robert P Giugliano
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Mullasari AS, Victor SM, Alexander T. STEMI India: reimagining STEMI networks in low- and middle-income countries: Reimagining STEMI. ASIAINTERVENTION 2022; 8:17-23. [PMID: 35350796 PMCID: PMC8922460 DOI: 10.4244/aij-d-22-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 06/06/2023]
Abstract
Effective treatment for ST-elevation myocardial infarction (STEMI) includes the 24/7 availability of reperfusion therapy, which is crucial for good clinical outcomes. In low- and middle-income countries, this is hindered by disparities in resource utilisation, irregularities in access to health care and organisational gaps. Due to the inaccessibility of primary percutaneous coronary intervention (PCI) for most patients, the more feasible and practical approach of pharmacoinvasive management must be incorporated into the systems of care for STEMI. This review focuses on the development of STEMI India, a not-for-profit organisation that aims to advance the field of STEMI management by imparting and disseminating the latest information from around the world on STEMI management to all those involved in STEMI care. The STEMI India model system of care includes a 3-model framework, based on infrastructure and workforce availability, and tailored to meet the needs of the society it caters to. After the successful implementation of the "Tamil Nadu STEMI" project, a nationwide system of care for STEMI has been developed, which has been endorsed by the Cardiological Society of India (CSI) and the Association of Physicians of India (API).
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Abstract
IMPORTANCE Acute coronary syndromes (ACS) are characterized by a sudden reduction in blood supply to the heart and include ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina. Each year, an estimated more than 7 million people in the world are diagnosed with ACS, including more than 1 million patients hospitalized in the US. OBSERVATIONS Chest discomfort at rest is the most common presenting symptom of ACS and affects approximately 79% of men and 74% of women presenting with ACS, although approximately 40% of men and 48% of women present with nonspecific symptoms, such as dyspnea, either in isolation or, more commonly, in combination with chest pain. For patients presenting with possible ACS, electrocardiography should be performed immediately (within 10 minutes of presentation) and can distinguish between STEMI and non-ST-segment elevation ACS (NSTE-ACS). STEMI is caused by complete coronary artery occlusion and accounts for approximately 30% of ACS. ACS without significant ST-segment elevation on electrocardiography, termed NSTE-ACS, account for approximately 70% of ACS, are caused by partial or intermittent occlusion of the artery and are associated with ST-segment depressions (approximately 31%), T-wave inversions (approximately 12%), ST-segment depressions combined with T-wave inversions (16%), or neither (approximately 41%). When electrocardiography suggests STEMI, rapid reperfusion with primary percutaneous coronary intervention (PCI) within 120 minutes reduces mortality from 9% to 7%. If PCI within 120 minutes is not possible, fibrinolytic therapy with alteplase, reteplase, or tenecteplase at full dose should be administered for patients younger than 75 years without contraindications and at half dose for patients 75 years or older (or streptokinase at full dose if cost is a consideration), followed by transfer to a facility with the goal of PCI within the next 24 hours. High-sensitivity troponin measurements are the preferred test to evaluate for NSTEMI. In high-risk patients with NSTE-ACS and no contraindications, prompt invasive coronary angiography and percutaneous or surgical revascularization within 24 to 48 hours are associated with a reduction in death from 6.5% to 4.9%. CONCLUSIONS AND RELEVANCE Each year, an estimated more than 7 million people are diagnosed with ACS worldwide. For patients with STEMI, coronary catheterization and PCI within 2 hours of presentation reduces mortality, with fibrinolytic therapy reserved for patients without access to immediate PCI. For high-risk patients with NSTE-ACS without contraindications, prompt invasive coronary angiography followed by percutaneous or surgical revascularization is associated with lower rates of death.
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Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital Heart and Vascular Institute, Harvard Medical School, Boston, Massachusetts
| | - Renato D Lopes
- Division of Cardiology, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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Shaheen S, Helal A, Anan I. Barriers to the Implementation of Primary PCI in the Management of STEMI in Egypt. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2021. [DOI: 10.15212/cvia.2021.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPCI) be the mainstay reperfusion strategy for the treatment of ST-segment elevation myocardial infarction (STEMI) if it is performed in the proper time window. However, the Egyptian
health care system is still struggling to provide such an important service. The aim of the present study, through a quantitative questionnaire, is to explore the current practice of STEMI management in Egypt, and to identify the barriers, opportunities, and potential areas for improvement.Methods
and Results: The questionnaire was conducted in Egypt via face-to-face qualitative in-depth interviews with cardiologists from 14 PPCI-capable hospitals and 26 non-PPCI-capable hospitals. Participants were selected in view of their experience and knowledge. The study identified potential
barriers to the implementation of PPCI among STEMI patients in Egypt. These barriers included the prehospital patient delay and emergency medical service delay, delay in the emergency department and delay in patient transfer to the CCU, unavailable equipment, catheterization laboratory activation
delay, lack of trained interventional cardiologists, lack of regional STEMI networks and hospital policies, and insufficient ICU beds.Conclusion: Limited resources and health care system inadequacies have led to potential barriers that prevent suboptimal implementation of PPCI in
Egypt. Efforts from all health care providers should be directed to overcome these identified barriers.
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Affiliation(s)
- Sameh Shaheen
- Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ayman Helal
- Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Islam Anan
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
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Tripathi B, Aggarwal V, Abbott JD, Kumbhani DJ, Giri J, Kalra A, Sardar P, Chatterjee S. Mechanical Complications in ST-Elevation Myocardial Infarction (STEMI) Based on Different Reperfusion Strategies. Am J Cardiol 2021; 156:79-84. [PMID: 34311972 DOI: 10.1016/j.amjcard.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 05/27/2021] [Accepted: 06/01/2021] [Indexed: 11/15/2022]
Abstract
Contemporary trends of mechanical complications like papillary muscle rupture (PMR), ventricular septal defect/rupture (VSR), and free wall rupture (FWR) in ST-elevation m'yocardial infarction (STEMI), especially in the era of primary percutaneous coronary interventions (PPCI) has not been definitively investigated. We utilized the National Inpatient Sample (NIS) database from years 2003 to 2017 using International Classification of Disease 9th and 10th revision (ICD-9 and ICD-10) codes to identify STEMI patients undergoing PPCI, fibrinolysis alone, and fibrinolysis with subsequent PCI. We identified those developing in-hospital PMR /VSD / FWR. We identified a total of 2,034,153 STEMI patients where 93.5% had PPCI, 3.2% had fibrinolysis alone, and 3.3% had fibrinolysis with subsequent PCI. Rates of all mechanical complications was low for all three different reperfusion strategies evaluated, with downward trends (p <0.05) over time. No statistically significant difference in the rates of mechanical complication was noted among patients treated with different reperfusion strategies on multivariable logistic regression models. In conclusion, in a contemporary cohort of US patients-majority of whom were managed with PPCI, the rates of overall mechanical complications after STEMI were low even with initial use of fibrinolytics and exhibited a downward temporal trend.
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Affiliation(s)
- Byomesh Tripathi
- Division of Cardiovascular Medicine, University of Arizona, Phoenix, Arizona
| | - Vikas Aggarwal
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan
| | - Jinnette Dawn Abbott
- Division of Cardiology, Lifespan Cardiovascular Institute, Brown University and Rhode Island Hospitals, Providence, Rhode Island
| | - Dharam J Kumbhani
- Division of Cardiology, University of Texas Southwestern School of Medicine, Dallas, Texas
| | - Jay Giri
- Division of Cardiovascular Medicine, Perelman School of Medicine, Philadelphia and The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Regional Section of Interventional Cardiology at Cleveland Clinic Akron General, College of Medicine of Case Western Reserve University
| | - Partha Sardar
- Division of Cardiology, Ochsner Clinic, New Orleans, Louisiana
| | - Saurav Chatterjee
- Division of Cardiovascular Medicine, North Shore-Long Island Jewish Medical Centers, Northwell Health, Zucker School of Medicine New York, New York.
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Chichareon P, Nilmoje T, Suriyaamorn W, Preechawettayakul I, Suwanugsorn S. Predicting mortality in cardiac care unit patients: external validation of the Mayo cardiac intensive care unit admission risk score. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2021; 10:1065-1073. [PMID: 34448824 DOI: 10.1093/ehjacc/zuab070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/15/2021] [Accepted: 08/05/2021] [Indexed: 11/12/2022]
Abstract
AIMS The Mayo Cardiac Intensive Care Unit Admission Risk Score (M-CARS) had excellent performance in predicting in-hospital mortality in the US population. We sought to validate the M-CARS for in-hospital and post-discharge mortality in Asian patients admitted to the cardiac care unit (CCU). METHODS AND RESULTS Patients admitted to the CCU of a tertiary care centre between July 2015 and December 2019 were included into the study. Patients with intra-hospital transfer to the CCU due to intensive care unit overflow, postoperative cardiac surgery, or for monitoring after elective procedures were excluded. Cardiac arrest, cardiogenic shock, respiratory failure, Braden skin score, blood urea nitrogen, anion gap, and red cell distribution width, were used to calculate the M-CARS. Patients were stratified into three groups, according to the M-CARS (<2, 2-6, >6). Of 1988 patients in the study, 30.1% were female with a median age of 65 years. Prevalence of cardiogenic shock and respiratory failure at admission were 2.8% and 4.5%, respectively. One hundred and seventeen patients died during the admission (mortality rate of 5.9%). The in-hospital mortality rate in patients with M-CARS of <2, 2-6, and >6 was 1.1%, 9.8%, and 35.5%, respectively. C-statistic of M-CARS for in-hospital mortality was 0.840 (95% CI 0.805-0.873); whereas, it was 0.727 (95% CI 0.690-0.761) for 1-year post-discharge mortality. Calibration plot showed good agreement between predicted and observed in-hospital mortality in the majority of patients. CONCLUSIONS The M-CARS was useful in our study, in terms of discrimination and calibration. M-CARS identified high-risk patients in CCU, who had unacceptably high mortality rate during hospital stay and thereafter.
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Affiliation(s)
- Ply Chichareon
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand.,Naradhiwas Rajanagarindra Heart Center, Songklanagarind Hospital, Songkhla 90110, Thailand
| | - Thanapon Nilmoje
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Wisanuwee Suriyaamorn
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Ittipon Preechawettayakul
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
| | - Saranyou Suwanugsorn
- Cardiology Unit, Division of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
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Salwan R, Seth A. Development of ST-elevation Myocardial Infarction Programs in Developing Countries: Global Challenges and Solutions. Interv Cardiol Clin 2021; 10:401-411. [PMID: 34053626 DOI: 10.1016/j.iccl.2021.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Cardiovascular disease (CVD) is the leading cause of death worldwide; approximately 80% of CVD deaths occur in low-income and middle-income countries (LMICs). The epidemiologic transition to a high burden of ischemic heart disease (IHD) has happened with greater rapidity in LMICs than in high-income countries. The absolute number of individuals with premature IHD has increased substantially. Higher event rates are observed compared with high-income countries. The technological capability to do extraordinary things for patients has increased, as has patient demand, in a setting of constrained resources and expensive health care of variable quality.
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Affiliation(s)
- Roopa Salwan
- Max Super Speciality Hospital, Saket, New Delhi 110017, India
| | - Ashok Seth
- Fortis Escorts Heart Institute, Okhla Road, New Delhi 110025, India.
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Lecour S. Remote ischaemic conditioning modulates platelet reactivity: the need to optimize the therapy is more important than ever before. Cardiovasc Res 2021; 117:346-347. [PMID: 32717021 DOI: 10.1093/cvr/cvaa229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sandrine Lecour
- Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Anzio road, 7925 Observatory, Cape Town, South Africa
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Ma J, Dong X, Jin Y, Zheng ZJ. Health Care Quality Improvement for ST-Segment Elevation Myocardial Infarction: A Retrospective Study Based on Propensity-Score Matching Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116045. [PMID: 34199816 PMCID: PMC8200089 DOI: 10.3390/ijerph18116045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 05/29/2021] [Accepted: 05/30/2021] [Indexed: 11/25/2022]
Abstract
Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively (p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.
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Affiliation(s)
- Junxiong Ma
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; (J.M.); (X.D.); (Z.-J.Z.)
- Institute for Global Health, Peking University, Beijing 100191, China
| | - Xuejie Dong
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; (J.M.); (X.D.); (Z.-J.Z.)
- Institute for Global Health, Peking University, Beijing 100191, China
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; (J.M.); (X.D.); (Z.-J.Z.)
- Institute for Global Health, Peking University, Beijing 100191, China
- Correspondence: ; Tel.: +86-150-0108-1989; Fax: +86-108-280-2144
| | - Zhi-Jie Zheng
- Department of Global Health, School of Public Health, Peking University, Beijing 100191, China; (J.M.); (X.D.); (Z.-J.Z.)
- Institute for Global Health, Peking University, Beijing 100191, China
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The Edge of Time in Acute Myocardial Infarction. J Am Coll Cardiol 2021; 77:1871-1874. [PMID: 33858623 DOI: 10.1016/j.jacc.2021.03.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/01/2021] [Accepted: 03/01/2021] [Indexed: 12/27/2022]
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Krishnan S V, Ravi M, Abraham SV, Palatty BU, Balakrishnan JM. Door to balloon time in patients presenting with acute ST elevation myocardial infarction and time factors influencing it; an observational study from a tertiary care teaching hospital in India. Indian Heart J 2021; 73:359-361. [PMID: 34154756 PMCID: PMC8322808 DOI: 10.1016/j.ihj.2021.02.008] [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: 10/25/2020] [Revised: 01/30/2021] [Accepted: 02/12/2021] [Indexed: 11/21/2022] Open
Abstract
The objective of this prospective observational study was to assess the door-to-balloon time (D2B), in acute ST-segment elevation myocardial infarction (STEMI) patients and the time factors influencing it. The following timeframes were measured during the study: ED to ECG time, ED to coronary care unit time (ED2CCU), consent time, post-consent to balloon time (POSTCONSENT2B) and D2B. Effective D2B was 54 ± 12.2 min. Of the dependent variables, D2B had a strong positive correlation (ρ = 0.903) with consent time. This study sheds light on consent time a previously unrecognized entity as a significantly influencing factor for the D2B time.
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Affiliation(s)
- Vimal Krishnan S
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104, Udupi, Karnataka, India.
| | - Manoj Ravi
- Department of Cardiology, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India
| | - Siju V Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India
| | - Babu Urumese Palatty
- Department of Emergency Medicine, Jubilee Mission Medical College & Research Institute, Thrissur, Kerala, India
| | - Jayaraj Mymbilly Balakrishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education (MAHE), Manipal, 576104, Udupi, Karnataka, India
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Peer N, Baatiema L, Kengne AP. Ischaemic heart disease, stroke, and their cardiometabolic risk factors in Africa: current challenges and outlook for the future. Expert Rev Cardiovasc Ther 2020; 19:129-140. [PMID: 33305637 DOI: 10.1080/14779072.2021.1855975] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Although cardiovascular diseases (CVDs) are among the leading causes of death in Sub-Saharan Africa (SSA), prevention is not a priority and effective treatments are not widely available. This perspective discusses the burden, challenges, and potential opportunities for improvement of CVD prevention and control efforts in SSA. AREAS COVERED This paper focuses on ischemic heart disease and stroke, and their key contributors of obesity, hypertension, diabetes and dyslipidaemia which are well-established, rapidly rising, and significant contributors to disease burden in SSA. However, their prevention, detection, treatment and control of are currently disorganized, inconsistent, unreliable, and insufficient with most SSA countries not geared to respond to this growing problem. National policies are frequently lacking or, if available, remain poorly implemented, for the control of these conditions. Primary healthcare systems have not adapted to cope with these rising CVD burdens and remain weak, underfunded and under resourced. Numerous barriers at the healthcare service, healthcare provider, and patient levels prevent optimal CVD risk factor care. EXPERT OPINION Innovative approaches such as task-shifting with the reallocation of care to lower-level healthcare workers and the potential use of inexpensive technological options should be encouraged to provide equitable CVD preventive and curative solutions to SSA's poor.
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Affiliation(s)
- Nasheeta Peer
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Leonard Baatiema
- Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Ghana
| | - Andre-Pascal Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Durban and Cape Town, South Africa.,Department of Medicine, University of Cape Town, Cape Town, South Africa
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Araiza-Garaygordobil D, Gopar-Nieto R, Cabello-López A, Martinez-Amezcua P, Eid-Lidt G, Baeza-Herrera LA, Gonzalez-Pacheco H, Briseño-De la Cruz JL, Sierra-Lara Martinez D, Mendoza-García S, Altamirano-Castillo A, Arias-Mendoza A. Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City. CJC Open 2020; 3:409-418. [PMID: 34027343 PMCID: PMC8129473 DOI: 10.1016/j.cjco.2020.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting. Methods This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days. Results We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding (P = 0.15). Conclusions In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited.
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Affiliation(s)
- Diego Araiza-Garaygordobil
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Rodrigo Gopar-Nieto
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Alejandro Cabello-López
- Occupational Health Research Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Guering Eid-Lidt
- Department of Interventional Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Luis A Baeza-Herrera
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Héctor Gonzalez-Pacheco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | | | | | - Salvador Mendoza-García
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | | | - Alexandra Arias-Mendoza
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
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Khraishah H, Alahmad B, Secemsky E, Young MN, ElGuindy A, Siedner MJ, Kassab M, Kholte D, Khanbhai K, Janabi M, Kennedy K, Albaghdadi MS. Comparative Effectiveness of Reperfusion Strategies in Patients with ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) Trial. Glob Heart 2020; 15:68. [PMID: 33150133 PMCID: PMC7566530 DOI: 10.5334/gh.868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/17/2020] [Indexed: 01/30/2023] Open
Abstract
Introduction Substantial heterogeneity exists in reperfusion strategies for patients with ST-segment myocardial infarction (STEMI) in low- and middle-income countries (LMICs). We sought to compare outcomes associated with primary percutaneous coronary intervention (PPCI) and non-primary percutaneous coronary intervention (nPPCI) reperfusion strategies in patients with STEMI in Kerala, India. Methods We performed a retrospective analysis of patients with STEMI (n = 8665) from the Acute Coronary Syndrome Quality Improvement in Kerala (ACS QUIK) randomized trial receiving either PPCI (n = 6623) or nPPCI (n = 2042). nPPCI included all PCI strategies implemented when PPCI was not available including all post-fibrinolysis PCI strategies and PCI without fibrinolysis. Clinical outcomes among patients undergoing PPCI and nPPCI were compared after propensity-score matching. The main outcomes were the rates of in-hospital and 30-day major adverse cardiovascular events (MACE), defined as the composite of death, reinfarction, stroke, and major bleeding. Results In the propensity-score matched cohort (n = 1266 in each group), nPPCI had longer symptom onset to hospital arrival time (347.5 vs. 195.0 minutes, p < 0.001), door to balloon time (108 minutes vs. 75 minutes, p < 0.001), and were less likely to receive a coronary stent (89.4% vs. 95%, p < 0.001), including drug-eluting stents (89.5% vs. 94.4%, p < 0.001). There were no clinically meaningful differences in discharge medical therapy. However, patients treated with nPPCI were less commonly referred for cardiac rehabilitation (20.2% vs. 24.2%; p = 0.019). In-hospital (3.6% vs. 3.3%, p = 0.74%) and 30-day (4.4% vs. 4.6%, p = 0.77) MACE did not differ between nPPCI and PPCI matched groups. Conclusion In a large, contemporary population of STEMI patients from a LMIC, patients treated with a nPPCI reperfusion strategy had comparable short- and intermediate-term outcomes compared to PPCI despite differences in hospital presentation time and coronary stent use. These findings are reassuring but highlight the need for continued quality improvement in the delivery of STEMI care in resource-limited settings.
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Affiliation(s)
- Haitham Khraishah
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, US
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
| | - Barrak Alahmad
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, US
| | - Eric Secemsky
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA, US
| | - Michael N. Young
- Cardiology Division, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth, Lebanon, NH, US
| | | | - Mark J. Siedner
- Division of Infectious Diseases and Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
| | - Mohamad Kassab
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
| | - Dhaval Kholte
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
| | - Khuzeima Khanbhai
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, TZ
| | - Mohamed Janabi
- Department of Adult Cardiology, Jakaya Kikwete Cardiac Institute, Dar es Salaam, TZ
| | - Kevin Kennedy
- Mid America Heart Institute, St Luke’s Hospital, Kansas City, Missouri, US
| | - Mazen S. Albaghdadi
- Cardiovascular Research Center, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, US
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48
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Engel Gonzalez P, Omar W, Patel KV, de Lemos JA, Bavry AA, Koshy TP, Mullasari AS, Alexander T, Banerjee S, Kumbhani DJ. Fibrinolytic Strategy for ST-Segment–Elevation Myocardial Infarction. Circ Cardiovasc Interv 2020; 13:e009622. [DOI: 10.1161/circinterventions.120.009622] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The ongoing coronavirus disease 2019 pandemic has resulted in additional challenges for systems designed to perform expeditious primary percutaneous coronary intervention for patients presenting with ST-segment–elevation myocardial infarction. There are 2 important considerations: the guideline-recommended time goals were difficult to achieve for many patients in high-income countries even before the pandemic, and there is a steep increase in mortality when primary percutaneous coronary intervention cannot be delivered in a timely fashion. Although the use of fibrinolytic therapy has progressively decreased over the last several decades in high-income countries, in circumstances when delays in timely delivery of primary percutaneous coronary intervention are expected, a modern fibrinolytic-based pharmacoinvasive strategy may need to be considered. The purpose of this review is to systematically discuss the contemporary role of an evidence-based fibrinolytic reperfusion strategy as part of a pharmacoinvasive approach, in the context of the emerging coronavirus disease 2019 pandemic.
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Affiliation(s)
- Pedro Engel Gonzalez
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - Wally Omar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - Kunal V. Patel
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - James A. de Lemos
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - Anthony A. Bavry
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - Thomas P. Koshy
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
| | - Ajit S. Mullasari
- The Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India (A.S.M.)
| | - Thomas Alexander
- Department of Cardiology, Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India (T.A.)
| | - Subhash Banerjee
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
- VA North Texas Health Care System, Dallas (S.B.)
| | - Dharam J. Kumbhani
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas (P.E.G., W.O., K.V.P., J.A.d.L., A.A.B., T.P.K., S.B., D.J.K.)
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