1
|
Vasquez MA, Lambrakos LK, Velasquez A, Goldberger JJ, Mitrani RD. Contemporary outcomes of acute ischemic stroke in atrial fibrillation patients on anticoagulation. J Stroke Cerebrovasc Dis 2024; 33:107790. [PMID: 38788986 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Long-term anticoagulation (AC) therapy reduces the risk of stroke in patients with Atrial Fibrillation (AF). However, data on the impact of AC on in-hospital stroke outcomes is lacking. METHODS The National Inpatient Sample was used to identify adult inpatients with AF and a primary diagnosis of ischemic stroke between 2016 and 2020. Data was stratified between AC users and nonusers. A multivariate regression model was used to describe the in-hospital outcomes, adjusting for significant comorbidities. RESULTS A total of 655,540 hospitalizations with AF and a primary hospitalization diagnosis of ischemic stroke were included, of which 194,560 (29.7 %) were on long-term AC. Patients on AC tended to be younger (mean age, 77 vs. 78), had a higher average CHA2DS2VASc score (4.48 vs. 4.20), higher rates of hypertension (91 % vs. 88 %), hyperlipidemia (64 % vs. 59 %), and heart failure (34 % vs. 30 %) compared to patients not on long-term AC. Use of AC was associated with decreased in-hospital mortality (aOR [95 % CI]: 0.62 [0.60-0.63]), decreased stroke severity (mean NIHSS, 8 vs. 10), decreased use of tPA (aOR 0.42 [0.41-0.43]), mechanical thrombectomy (aOR 0.85 [0.83-0.87]), intracranial hemorrhage (aOR 0.69 [0.67-0.70]), gastrointestinal bleeding (aOR 0.74 [0.70-0.77]), and discharge to skilled nursing facilities (aOR 0.90 [0.89-0.91]), compared to patients not on AC (P<0.001 for all comparisons). CONCLUSION Among patients with AF admitted for acute ischemic stroke, AC use prior to stroke was associated with decreased in-hospital mortality, decreased stroke severity, decreased discharge to SNF, and fewer stroke-related and bleeding complications.
Collapse
Affiliation(s)
- Moises A Vasquez
- Department of Internal Medicine, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Ave, C-600D, Miami, FL 33136, USA.
| | - Litsa K Lambrakos
- Department of Medicine, Department of Cardiovascular Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alex Velasquez
- Department of Medicine, Department of Cardiovascular Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeffrey J Goldberger
- Department of Medicine, Department of Cardiovascular Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Raul D Mitrani
- Department of Medicine, Department of Cardiovascular Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
2
|
Ramphul K, Aggarwal S, Verma R, Lohana P, Sombans S, Ramphul Y, Mejias SG, Kumar D, Kwansa NA, Pekyi-Boateng PK. Acute myocardial infarction among teenagers in the United States between 2016 and 2020: a retrospective analysis from the National Inpatient Sample. Arch Med Sci Atheroscler Dis 2023; 8:e177-e181. [PMID: 38283925 PMCID: PMC10811542 DOI: 10.5114/amsad/168637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/21/2023] [Indexed: 01/30/2024] Open
Abstract
Introduction There is a lack of data on the characteristics of teenagers admitted with acute myocardial infarction (AMI). Recent studies have hinted that with changes in lifestyle and easier access to substances of abuse, people may be prone to several cardiovascular complications at an earlier age. Material and methods Our analysis was based on the 2016-2020 National Inpatient Samples. Logistic models allowed us to investigate the adjusted odds ratios (aOR) of AMI among teenagers. We explored outcomes and complications such as cardiogenic shock, extracorporeal membrane oxygenation (ECMO), coronary artery bypass graft surgery (CABG), percutaneous coronary intervention (PCI), and mortality in these patients. Results A total of 2170 cases of AMI were recorded between 2016 and 2020 (53.3 cases per 100,000 admissions among teenagers). Weekend admissions (26.3% vs. 20.9%, aOR = 1.298, p < 0.001), smokers (15.9% vs. 10.1%, aOR = 1.198, p = 0.007), cannabis users (18.9% vs. 8.4%, aOR = 1.558, p < 0.001), or cocaine users (5.3% vs. 0.6%, aOR = 4.84, p < 0.001) showed increased odds of recording a diagnosis of AMI. Females showed lower odds than males (32.7% vs. 65%, aOR = 0.264, 95% CI: 0.24-0.291, p < 0.001). Admissions were more likely among teenagers with hypertension (9.9% vs. 2.5%, aOR = 3.382, p < 0.001). Those not covered by Medicaid or private insurances were more likely to be admitted for AMI than Medicaid beneficiaries (12.4% vs. 8.2%, aOR = 1.278, p < 0.001). Finally, teenagers classified as Blacks showed higher odds than whites of being admitted for AMI (aOR = 1.37, p < 0.001). A total of 270 (12.5%) deaths were also noted. Conclusions Various characteristics among teenagers influence their risk for AMI. Further studies and campaigns on educating teenagers about risk factors may provide long-term benefits.
Collapse
Affiliation(s)
| | | | | | | | - Shaheen Sombans
- Department of Paediatrics, Bharati Vidyapeeth Univ Med College and Hosp, Hyderabad, India
| | | | | | - Deepak Kumar
- Department of Internal Medicine, Masafi Hospital, Fujairah, UAE
| | | | | |
Collapse
|
3
|
Fonseca AC. Stroke and Recent Myocardial Infarction, Reduced Left Ventricular Ejection Fraction, Left Ventricular Thrombus, and Wall Motion Abnormalities. Curr Cardiol Rep 2023; 25:1687-1697. [PMID: 38079058 PMCID: PMC10810933 DOI: 10.1007/s11886-023-02009-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/26/2024]
Abstract
PURPOSE OF REVIEW To review the evidence regarding stroke and recent myocardial infarction (MI), reduced left ventricular ejection fraction, left ventricular thrombus (LVT), and wall motion abnormalities (WMA). RECENT FINDINGS The risk of ischemic stroke associated with acute MI has been greatly reduced with reperfusion treatments that improved myocardium salvage. Acute ischemic stroke is an uncommon complication of diagnostic coronary angiography and percutaneous coronary intervention. For established LVT, anticoagulation is superior to antiplatelet medications to reduce the risk of ischemic stroke. The duration of anticoagulation should be at least 3 to 6 months. Direct oral anticoagulants have been used off-label in this context. In patients with low ejection fraction or WMA, there is no evidence that anticoagulation is superior to antiplatelet treatment in preventing ischemic stroke. In patients with ischemic stroke and recent MI (< 3 months), type of MI (STEMI or NSTEMI), timing, and location should be considered when deciding whether intravenous thrombolysis should be used for stroke treatment. Mechanical thrombectomy should be considered as a therapeutic alternative to intravenous thrombolysis in patients with acute ischemic stroke due to large-vessel occlusion and recent MI. Most guidelines regarding prevention of ischemic stroke in patients with these cardiac causes of stroke are derived from expert opinion. There is a need for high quality evidence to support stroke prevention treatments in these patients.
Collapse
Affiliation(s)
- Ana Catarina Fonseca
- Stroke Unit, Department of Neurology, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Avenida Professor Egas Moniz, 1640-035, Lisboa, Portugal.
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
- Centro de Estudos Egas Moniz, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.
| |
Collapse
|
4
|
Gin J, Yeoh J, Thijs V, Clark D, Ho JK, Horrigan M, Farouque O, Al-Fiadh A. Coronary Angiography Complicated by Acute Ischaemic Stroke and the Use of Thrombolysis: a Cardiology Perspective and Narrative Review of Current Literature. Curr Cardiol Rep 2023; 25:1499-1512. [PMID: 37847358 DOI: 10.1007/s11886-023-01962-y] [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] [Accepted: 09/11/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE OF REVIEW Coronary angiography-associated acute ischaemic stroke (CAAIS) is an uncommon event but is associated with significant mortality and morbidity. The incidence of CAAIS has increased with a rise in the volume of coronary angiography (CA) and percutaneous coronary intervention (PCI) performed. Intravenous thrombolysis (IVT) is utilized in the general management of acute ischaemic stroke; however, it is associated with a higher risk of intracranial hemorrhage (ICH). As CA or PCI is performed more often in an aging population or high-risk patients that also carry an increased risk of ICH, it is vital to minimize additional complications from the treatment of CAAIS. This article aims to review the pathophysiological mechanisms for CAAIS, clarify the current evidence regarding IVT use in this setting, and thus assist cardiologists in the management of CAAIS. RECENT FINDINGS The pathophysiology for CAAIS may be different from acute ischaemic stroke in the general population. Embolic phenomena from dislodgement of calcium or other debris during manipulation of instrumentation during CA or PCI are likely mechanisms. This may contribute to altered thrombus composition, which affects the efficacy of IVT as suggested in recent studies. Furthermore, IVT in the management of CAAIS has not been evaluated specifically. The utilization of IVT should be carefully considered in CAAIS given a paucity of evidence demonstrating safety and efficacy in this setting. A multidisciplinary pathway that emphasizes the involvement of cardiologists in the treatment decision-making process would aid in thoughtful risk-benefit evaluation for IVT use in CAAIS and reduce adverse patient outcomes. Future studies to assess the impact of this pathway on CAAIS outcomes would be beneficial.
Collapse
Affiliation(s)
- Julian Gin
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia.
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Vincent Thijs
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Neurology, Austin Health, Melbourne, VIC, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - David Clark
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Jan Kee Ho
- Department of Neurology, Austin Health, Melbourne, VIC, Australia
| | - Mark Horrigan
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Ali Al-Fiadh
- Department of Cardiology, Austin Health, Melbourne, VIC, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
5
|
Murakami T, Sakakura K, Jinnouchi H, Taniguchi Y, Tsukui T, Watanabe Y, Yamamoto K, Seguchi M, Wada H, Fujita H. Acute Ischemic Stroke and Transient Ischemic Attack in ST-Segment Elevation Myocardial Infarction Patients Who Underwent Primary Percutaneous Coronary Intervention. J Clin Med 2023; 12:jcm12030840. [PMID: 36769488 PMCID: PMC9917385 DOI: 10.3390/jcm12030840] [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: 12/11/2022] [Revised: 01/11/2023] [Accepted: 01/18/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Acute ischemic stroke (AIS) is a rare but critical complication following ST-elevation myocardial infarction (STEMI). The risk of AIS or transient ischemic attack (TIA) may be amplified by invasive procedures, including primary percutaneous coronary intervention (PCI). This study aimed to investigate the factors associated with in-hospital AIS/TIA in patients with STEMI who required primary PCI. METHODS We included 941 STEMI patients who underwent primary PCI and divided them into an AIS/TIA group (n = 39) and a non-AIS/TIA group (n = 902), according to new-onset AIS/TIA. The primary interest was to find the factors associated with AIS/TIA by multivariate logistic regression analysis. We also compared clinical outcomes between the AIS/TIA and non-AIS/TIA groups. RESULTS The incidence of in-hospital deaths was significantly higher in the AIS/TIA group (46.2%) than in the non-AIS/TIA group (6.3%) (p < 0.001). Multivariate analysis revealed that cardiogenic shock (OR 3.228, 95% CI 1.492-6.986, p = 0.003), new-onset atrial fibrillation (AF) (OR 2.280, 95% CI 1.033-5.031, p = 0.041), trans-femoral approach (OR 2.336, 95% CI 1.093-4.992, p = 0.029), use of ≥4 catheters (OR 3.715, 95% CI 1.831-7.537, p < 0.001), and bleeding academic research consortium (BARC) type 3 or 5 bleeding (OR 2.932, 95% CI 1.256-6.846, p = 0.013) were significantly associated with AIS/TIA. CONCLUSION In STEMI patients with primary PCI, new-onset AIS/TIA was significantly associated with cardiogenic shock, new-onset AF, trans-femoral approach, the use of ≥4 catheters, and BARC type 3 or 5 bleeding. We should recognize these modifiable and unmodifiable risk factors for AIS/TIA in the treatment of STEMI.
Collapse
|
6
|
Adem F, Abdi S, Amare F, Mohammed MA. In-hospital mortality from acute coronary syndrome in Africa: a systematic review and meta-analysis. SAGE Open Med 2023; 11:20503121221143646. [PMID: 36685798 PMCID: PMC9850135 DOI: 10.1177/20503121221143646] [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: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 01/18/2023] Open
Abstract
Objective There is an increasing recognition of the burden of cardiovascular disease in Africa. However, little is known about the pooled prevalence of acute coronary syndrome (ACS)-associated in-hospital mortality and contributing factors. Methods PubMed, Medline, Embase, Web of Science (Core Collection), and supplementary sources including Google Scholar, World Cat, Research Gate, and Cochrane Library were searched. Chi-square test and I 2-statistic were used to assess heterogeneity. Egger's and Begg's tests and funnel plots were used to assess publication bias. Data were analyzed using Stata software (version 15.0). Result Twenty nine studies with a total sample of 11,788 were included. The pooled estimate of all-cause in-hospital mortality was 22% (pooled proportion (PP) = 0.22; 95% confidence interval (CI): 0.17-0.27. The In-hospital mortality rate was lower at the cardiac centers (PP = 0.14; CI: 0.05-0.23) compared to referral hospitals (PP = 0.24; CI: 0.17-0.31]) The mortality rate was comparable in Eastern (PP = 0.23; CI: 0.19-0.27) and Northern Africa (PP = 0.22; CI: 0.16-0.28). The incidence of in-hospital heart failure, cardiogenic shock, arrhythmia, bleeding, acute stroke, and reinfarction were 42, 17.0, 20.0, 16.0, 4.0, and 5.0%, respectively. Conclusion All-cause in-hospital mortality rate associated with ACS is high in Africa. The mortality rate at cardiac centers was 10% lower when compared with referral hospitals. Establishing coronary units, strengthening existing cardiac services, and improving availability and access to cardiovascular medicines could help in reducing the burden of ACS in the continent.
Collapse
Affiliation(s)
- Fuad Adem
- Department of Clinical Pharmacy,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia,Fuad Adem, Haramaya University College of
Health and Medical Sciences, Harar, Haramaya, Oromia 238, Ethiopia.
| | - Semir Abdi
- Department of Internal Medicine,
College of Health and Medical Sciences, Haramaya University, Haramaya, Oromia,
Ethiopia
| | - Firehiwot Amare
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed A Mohammed
- Faculty of Medical and Health Sciences,
School of Pharmacy, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
7
|
Elzanaty AM, Khalil M, Meenakshisundaram C, Alharbi A, Patel N, Maraey A, Zafarullah F, Elgendy IY, Eltahawy E. Outcomes of Coronary Artery Bypass Grafting in Patients With Previous Mediastinal Radiation. Am J Cardiol 2023; 186:80-86. [PMID: 36356429 DOI: 10.1016/j.amjcard.2022.10.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/25/2022] [Accepted: 10/08/2022] [Indexed: 11/09/2022]
Abstract
Studies have shown that patients with radiation therapy-associated coronary artery disease tend to have worse outcomes with percutaneous revascularization. Previous irradiation has been linked with future internal mammary artery graft disease. Studies investigating the outcomes of coronary artery bypass surgery (CABG) among patients with previous radiation are limited. The Nationwide Readmission Database for the years 2016 to 2019 was queried for hospitalizations with CABG and history of mediastinal radiation. Complex samples multivariable logistic and linear regression models were used to determine the association between the history of mediastinal radiation and in-hospital mortality, 90 days all-cause unplanned readmission rates, and acute coronary syndrome readmission rates. A total of 533,702 hospitalizations (2,070 in the irradiation history group and 531,632 in the control group) were included in this analysis. Patients with radiation therapy history were less likely to have traditional coronary artery disease risk factors and more likely to have associated valvular disease. Patients with a history of irradiation had similar in-hospital mortality and 90-day readmission risk at the expense of higher hospitalizations costs (β coefficient: $2,764; p = 0.005). They had a higher likelihood of readmission with acute coronary syndrome within 90 days (adjusted odds ratio 1.67, p = 0.02). In a conclusion, a history of mediastinal irradiation is not associated with increased rates of short-term mortality or increased all-cause readmission risk after CABG. However, it may be associated with increased acute coronary syndrome readmission rates.
Collapse
Affiliation(s)
- Ahmed M Elzanaty
- Division of Cardiovascular Medicine and Department of Internal Medicine, University of Toledo, Toledo, Ohio.
| | - Mahmoud Khalil
- Department of Internal Medicine, Lincoln Medical Center, New York, New York
| | | | | | - Neha Patel
- Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Ahmed Maraey
- Department of Internal Medicine, University of North Dakota, Bismarck, North Dakota
| | - Fnu Zafarullah
- Division of Cardiovascular Medicine and Department of Internal Medicine, University of Toledo, Toledo, Ohio
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Ehab Eltahawy
- Division of Cardiovascular Medicine and Department of Internal Medicine, University of Toledo, Toledo, Ohio
| |
Collapse
|
8
|
Bao CH, Zhang C, Wang XM, Pan YB. Concurrent acute myocardial infarction and acute ischemic stroke: Case reports and literature review. Front Cardiovasc Med 2022; 9:1012345. [PMID: 36386323 PMCID: PMC9663457 DOI: 10.3389/fcvm.2022.1012345] [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: 08/05/2022] [Accepted: 10/18/2022] [Indexed: 11/22/2022] Open
Abstract
Acute myocardial infarction (AMI) and acute ischemic stroke (AIS) are the main causes of disability and mortality worldwide. Although reperfusion therapy is the most effective treatment for the two diseases, it is still a great challenge for treating the two diseases at the same time. Here we share 2 cases: one patient was hospitalized for AMI, developed AIS after receiving percutaneous coronary intervention (PCI), and suffered from cardiac rupture after alteplase thrombolytic therapy. The other patient was admitted for AIS, who had sudden chest pain during the thrombolytic process of alteplase. Considering AMI, emergency PCI was performed, and he was finally discharged.
Collapse
|
9
|
Hu X, Ning X, Zhao Q, Zhang Z, Zhang C, Xie M, Huang W, Cai Y, Xiang Q, Ou C. Islet-1 Mesenchymal Stem Cells-Derived Exosome-Incorporated Angiogenin-1 Hydrogel for Enhanced Acute Myocardial Infarction Therapy. ACS APPLIED MATERIALS & INTERFACES 2022; 14:36289-36303. [PMID: 35920579 DOI: 10.1021/acsami.2c04686] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Although stem cell-derived exosomes have been recognized as new candidates for cell-free treatment in myocardial infarction (MI), the challenge to improve the exosome retention in ischemic tissue remains. Our previous research indicated that islet-1(ISL1) overexpression enhances the paracrine function of mesenchymal stem cells (MSCs) and promotes angiogenesis in a model of MI. In this study, genetically engineered ISL1-MSC-derived exosomes (ISL1-MSCs-Exo) were collected, and the contents were analyzed by exosomal RNA sequencing. Next, we investigated if ISL1-MSCs-Exo could exert therapeutic effects and their incorporation into a new angiogenin-1 hydrogel (Ang-1 gel) could boost the retention of exosomes and further enhance their protective effects. Our results demonstrated that ISL1-MSCs-Exo could play a therapeutic role in vitro and in vivo, which might be due to changed exosomal contents. Ang-1 gel increased the retention and enhanced the anti-apoptosis, proliferation, and angiogenic capacity of ISL1-MSCs-Exo in endothelial cells. Echocardiography revealed that Ang-1 gel significantly augment the therapeutic effects of ISL1-MSCs-Exo for MI. The main mechanism might result from increased retention of ISL1-MSCs-Exo, herein enhanced pro-angiogenetic effects in an ischemic heart. Taken together, our findings indicated that ISL1-MSCs-Exo had endothelium-protective and pro-angiogenic abilities alone and Ang-1 gel could notably retain ISL1-MSCs-Exo at ischemic sites, which improved the survival and angiogenesis of endothelial cells and accelerated the recovery of MI. These results not only shed light on the therapeutic mechanism of ISL1-MSCs-Exo incorporated with Ang-1 gel but also offer a promising therapeutic option for ischemic disease.
Collapse
Affiliation(s)
- Xinyi Hu
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
- Department of Cardiology, Laboratory of Heart Center, Heart Center, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510080, China
| | - Xiaodong Ning
- Department of Cardiology, Laboratory of Heart Center, Heart Center, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510080, China
| | - Qianqian Zhao
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhen Zhang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Chi Zhang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Manting Xie
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Weijun Huang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Yanbin Cai
- Department of Cardiology, Laboratory of Heart Center, Heart Center, Guangdong Provincial Biomedical Engineering Technology Research Center for Cardiovascular Disease, Sino-Japanese Cooperation Platform for Translational Research in Heart Failure, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510080, China
| | - Qiuling Xiang
- Center for Stem Cell Biology and Tissue Engineering, Key Laboratory for Stem Cells and Tissue Engineering of Ministry of Education, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Caiwen Ou
- Guangdong Provincial Key Laboratory of Shock and Microcirculation, Dongguan Hospital of Southern Medical University, Southern Medical University, Guangzhou, Guangdong 510080, China
| |
Collapse
|
10
|
Feng S, Li R, Zhou Q, Qu F, Hu W, Liu X. Bioinformatics analysis to identify potential biomarkers and therapeutic targets for ST-segment–elevation myocardial infarction-related ischemic stroke. Front Neurol 2022; 13:894289. [PMID: 36034287 PMCID: PMC9403764 DOI: 10.3389/fneur.2022.894289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 07/18/2022] [Indexed: 11/28/2022] Open
Abstract
Background Acute myocardial infarction (AMI) is one of the major causes of mortality and disability worldwide, and ischemic stroke (IS) is a serious complication after AMI. In particular, patients with ST-segment–elevation myocardial infarction (STEMI) are more susceptible to IS. However, the interrelationship between the two disease mechanisms is not clear. Using bioinformatics tools, we investigated genes commonly expressed in patients with STEMI and IS to explore the relationship between these diseases, with the aim of uncovering the underlying biomarkers and therapeutic targets for STEMI-associated IS. Methods Differentially expressed genes (DEGs) related to STEMI and IS were identified through bioinformatics analysis of the Gene Expression Omnibus (GEO) datasets GSE60993 and GSE16561, respectively. Thereafter, we assessed protein-protein interaction networks, gene ontology term annotations, and pathway enrichment for DEGs using various prediction and network analysis methods. The predicted miRNAs targeting the co-expressed STEMI- and IS-related DEGs were also evaluated. Results We identified 210 and 29 DEGs in GSE60993 and GSE16561, respectively. CD8A, TLR2, TLR4, S100A12, and TREM1 were associated with STEMI, while the hubgenes, IL7R, CCR7, FCGR3B, CD79A, and ITK were implicated in IS. In addition, binding of the transcripts of the co-expressed DEGs MMP9, ARG1, CA4, CRISPLD2, S100A12, and GZMK to their corresponding predicted miRNAs, especially miR-654-5p, may be associated with STEMI-related IS. Conclusions STEMI and IS are related and MMP9, ARG1, CA4, CRISPLD2, S100A12, and GZMK genes may be underlying biomarkers involved in STEMI-related IS.
Collapse
Affiliation(s)
| | | | | | | | - Wei Hu
- *Correspondence: Xinfeng Liu
| | | |
Collapse
|
11
|
Cabral M, Ponciano A, Santos B, Morais J. Cardiocerebral Infarction: A Combination to Prevent. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
12
|
Gan’shina TS, Kurza EV, Maslennikov DV, Gnezdilova AV, Kurdyumov IN, Turilova AI, Pyatin BM, Mirzoyan RS. Cerebrovascular Efficacy of 5-Hydroxyadamantan-2-One Succinic Acid Ester in Combined Vascular Pathology of Brain and Heart. Pharm Chem J 2022. [DOI: 10.1007/s11094-022-02614-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
13
|
Vallabhajosyula S, Kumar V, Sundaragiri PR, Cheungpasitporn W, Miller PE, Patlolla SH, Gersh BJ, Lerman A, Jaffe AS, Shah ND, Holmes DR, Bell MR, Barsness GW. Management and Outcomes of Acute Myocardial Infarction-Cardiogenic Shock in Uninsured Compared With Privately Insured Individuals. Circ Heart Fail 2022; 15:e008991. [PMID: 35240866 PMCID: PMC9930186 DOI: 10.1161/circheartfailure.121.008991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There are limited data on uninsured patients presenting with acute myocardial infarction-cardiogenic shock (AMI-CS). This study sought to compare the management and outcomes of AMI-CS between uninsured and privately insured individuals. METHODS Using the National Inpatient Sample (2000-2016), a retrospective cohort of adult (≥18 years) uninsured admissions (primary payer-self-pay or no charge) were compared with privately insured individuals. Interhospital transfers were excluded. Outcomes of interest included in-hospital mortality, temporal trends in admissions, use of cardiac procedures, do-not-resuscitate status, palliative care referrals, and resource utilization. RESULTS Of 402 182 AMI-CS admissions, 21 966 (5.4%) and 93 814 (23.3%) were uninsured and privately insured. Compared with private insured individuals, uninsured admissions were younger, male, from a lower socioeconomic status, had lower comorbidity, higher rates of acute organ failure, ST-segment elevation AMI-CS (77.3% versus 76.4%), and concomitant cardiac arrest (33.8% versus 31.9%; all P<0.001). Compared with 2000, in 2016, there were more uninsured (adjusted odds ratio, 1.15 [95% CI, 1.13-1.17]; P<0.001) and less privately insured admissions (adjusted odds ratio, 0.85 [95% CI, 0.83-0.87]; P<0.001). Uninsured individuals received less frequent coronary angiography (79.5% versus 81.0%), percutaneous coronary intervention (60.8% versus 62.2%), mechanical circulatory support (54% versus 55.5%), and had higher palliative care (3.8% versus 3.2%) and do-not-resuscitate status use (4.4% versus 3.2%; all P<0.001). Uninsured admissions had higher in-hospital mortality (adjusted odds ratio, 1.62 [95% CI, 1.55-1.68]; P<0.001) and resource utilization. CONCLUSIONS Uninsured individuals have higher in-hospital mortality and lower use of guideline-directed therapies in AMI-CS compared with privately insured individuals.
Collapse
Affiliation(s)
- Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Vinayak Kumar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Pranathi R Sundaragiri
- Department of Primary Care Internal Medicine, Wake Forest Baptist Health, High Point, North Carolina
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - P Elliott Miller
- Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Bernard J Gersh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Allan S Jaffe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nilay D Shah
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, Minnesota,Department of Health Services Research, Mayo Clinic, Rochester, Minnesota
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| |
Collapse
|
14
|
Ng AKY, Ng PY, Ip A, Lau KK, Siu CW. Risk of ischaemic and haemorrhagic stroke in Chinese undergoing percutaneous coronary intervention treated with potent P2Y12 inhibitor versus clopidogrel. Stroke Vasc Neurol 2022; 7:310-318. [PMID: 35264399 PMCID: PMC9453842 DOI: 10.1136/svn-2021-001294] [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: 08/31/2021] [Accepted: 02/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Stroke after acute coronary syndrome (ACS) can be devastating. It is uncertain whether the risks of ischaemic stroke or intracranial haemorrhage (ICH) are associated with different choices of P2Y12 inhibitors (potent P2Y12 inhibitors such as ticagrelor and prasugrel vs clopidogrel). Even though East Asians are known to have different thrombotic and haemorrhagic profiles from Caucasians, data on Chinese patients are sparse. Method This was a retrospective cohort study conducting in Chinese patients with ACS who underwent first-ever percutaneous coronary intervention from 14 hospitals in Hong Kong between 2010 and 2017. The primary efficacy endpoint was ischaemic stroke. The secondary efficacy endpoint was a composite outcome of thrombotic events including all-cause mortality, non-fatal myocardial infarction and ischaemic stroke. The primary safety endpoint was ICH. The secondary safety endpoint was a composite of major bleeding events. Results After adjustment of baseline characteristics by 1:1 propensity score matching, a total of 6220 patients (3110 on each group) were analysed. Compared with clopidogrel, potent P2Y12 inhibitors were associated with a lower risk of ischaemic stroke (HR 0.57; 95% CI 0.37 to 0.87; p=0.008) and a lower risk of thrombotic events (HR 0.77; 95% CI 0.66 to 0.90; p=0.001). Potent P2Y12 inhibitor was associated with similar risk of ICH (HR 0.65; 95% CI 0.34 to 1.25, p=0.20) and major bleeding (HR 0.83; 95% CI 0.68 to 1.01, p=0.069). Conclusions Potent P2Y12 inhibitors were associated with a lower adjusted risk of ischaemic stroke and thrombotic events, compared with clopidogrel. The risks of ICH and major bleeding were similar.
Collapse
Affiliation(s)
| | - Pauline Yeung Ng
- Department of Adult Intensive Care, Queen Mary Hospital, Hong Kong, Hong Kong.,Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - April Ip
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Kui Kai Lau
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
| | - Chung-Wah Siu
- Department of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
15
|
Powers WJ. Strokelore: Early Anticoagulation for Large Ischemic Strokes. J Stroke Cerebrovasc Dis 2021; 30:106085. [PMID: 34571352 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- William J Powers
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States.
| |
Collapse
|
16
|
The Impact of China's Zero Markup Drug Policy on Hospitalization Expenses for Inpatients in Tertiary Public Hospitals: Evidence Based on Quantile Difference-in-Difference Models. Healthcare (Basel) 2021; 9:healthcare9070908. [PMID: 34356286 PMCID: PMC8307609 DOI: 10.3390/healthcare9070908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives: The aim of this study was to determine the impact of the Zero Markup drug (ZMD) policy on hospitalization expenses for inpatients in tertiary Chinese hospitals. Methods: Using the administrative data from hospital electronic health records (EHRs) between 2015 and 2017, we implemented the quantile difference-in-differences (QDID) estimators to evaluate the impact of the ZMD policy on hospitalization expenses while controlling for patient-level and hospital-level characteristics. Results: According to the QDID models, the introduction of ZMD policy significantly induced lower drug costs for all inpatients especially at the 50th (-USD 507.84 (SE = USD 90.91), 75th (-USD 844.77 (SE = USD 149.70), and 90th (-USD 1400.00 (SE = USD 209.97)) percentiles of the overall distributions. However, the total hospitalization, diagnostic, treatment, material and services expenses for inpatients were significantly higher for the treated group than the control group. This tendency was more pronounced for inpatients in tertiary hospitals with lower expenses (in the 10th, 25th and 50th percentiles). Conclusion: The implementation of ZMD policy alone may not be enough to change the medical service providers’ profit-driven behavior. The targeted supervision of hospital costs by the Chinese health administration department should be strengthened to avoid unreasonable hospital charges.
Collapse
|
17
|
Subramaniam AV, Patlolla SH, Cheungpasitporn W, Sundaragiri PR, Miller PE, Barsness GW, Bell MR, Holmes DR, Vallabhajosyula S. Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e019907. [PMID: 34013741 PMCID: PMC8483555 DOI: 10.1161/jaha.120.019907] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/22/2021] [Indexed: 11/16/2022]
Abstract
Background The role of race and ethnicity in the outcomes of cardiac arrest (CA) complicating acute myocardial infarction (AMI) is incompletely understood. Methods and Results This was a retrospective cohort study of adult admissions with AMI-CA from the National Inpatient Sample (2012-2017). Self-reported race/ethnicity was classified as White, Black, and others (Hispanic, Asian or Pacific Islander, Native American, Other). Outcomes of interest included in-hospital mortality, coronary angiography, percutaneous coronary intervention, palliative care consultation, do-not-resuscitate status use, hospitalization costs, hospital length of stay, and discharge disposition. Of the 3.5 million admissions with AMI, CA was noted in 182 750 (5.2%), with White, Black, and other races/ethnicities constituting 74.8%, 10.7%, and 14.5%, respectively. Black patients admitted with AMI-CA were more likely to be female, with more comorbidities, higher rates of non-ST-segment-elevation myocardial infarction, and higher neurological and renal failure. Admissions of patients of Black and other races/ethnicities underwent coronary angiography (61.9% versus 70.2% versus 73.1%) and percutaneous coronary intervention (44.6% versus 53.0% versus 58.1%) less frequently compared to patients of white race (p<0.001). Admissions of patients with AMI-CA had significantly higher unadjusted mortality (47.4% and 47.4%) as compared with White patients admitted (40.9%). In adjusted analyses, Black race was associated with lower in-hospital mortality (odds ratio [OR], 0.95; 95% CI, 0.91-0.99; P=0.007) whereas other races had higher in-hospital mortality (OR, 1.11; 95% CI, 1.08-1.15; P<0.001) compared with White race. Admissions of Black patients with AMI-CA had longer length of hospital stay, higher rates of palliative care consultation, less frequent do-not-resuscitate status use, and fewer discharges to home (all P<0.001). Conclusions Racial and ethnic minorities received less frequent guideline-directed procedures and had higher in-hospital mortality and worse outcomes in AMI-CA.
Collapse
Affiliation(s)
| | | | | | | | - P. Elliott Miller
- Division of Cardiovascular MedicineDepartment of MedicineYale University School of MedicineNew HavenCT
| | | | | | | | - Saraschandra Vallabhajosyula
- Department of Cardiovascular MedicineMayo ClinicRochesterMN
- Division of Pulmonary and Critical Care MedicineDepartment of MedicineMayo ClinicRochesterMN
- Center for Clinical and Translational ScienceMayo Clinic Graduate School of Biomedical SciencesRochesterMN
- Section of Interventional CardiologyDivision of Cardiovascular MedicineDepartment of MedicineEmory University School of MedicineAtlantaGA
| |
Collapse
|
18
|
Aggarwal G, Patlolla SH, Aggarwal S, Cheungpasitporn W, Doshi R, Sundaragiri PR, Rabinstein AA, Jaffe AS, Barsness GW, Cohen M, Vallabhajosyula S. Temporal Trends, Predictors, and Outcomes of Acute Ischemic Stroke in Acute Myocardial Infarction in the United States. J Am Heart Assoc 2021; 10:e017693. [PMID: 33399018 PMCID: PMC7955313 DOI: 10.1161/jaha.120.017693] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background There are limited contemporary data prevalence and outcomes of acute ischemic stroke (AIS) complicating acute myocardial infarction (AMI). Methods and Results Adult (>18 years) AMI admissions using the National Inpatient Sample database (2000–2017) were evaluated for in‐hospital AIS. Outcomes of interest included in‐hospital mortality, hospitalization costs, length of stay, discharge disposition, and use of tracheostomy and percutaneous endoscopic gastrostomy. The discharge destination was used to classify survivors into good and poor outcomes. Of a total 11 622 528 AMI admissions, 183 896 (1.6%) had concomitant AIS. As compared with 2000, in 2017, AIS rates increased slightly among ST‐segment–elevation AMI (adjusted odds ratio, 1.10 [95% CI, 1.04–1.15]) and decreased in non–ST‐segment–elevation AMI (adjusted odds ratio, 0.47 [95% CI, 0.46–0.49]) admissions (P<0.001). Compared with those without, the AIS cohort was on average older, female, of non‐White race, with greater comorbidities, and higher rates of arrhythmias. The AMI‐AIS admissions received less frequent coronary angiography (46.9% versus 63.8%) and percutaneous coronary intervention (22.7% versus 41.8%) (P<0.001). The AIS cohort had higher in‐hospital mortality (16.4% versus 6.0%; adjusted odds ratio, 1.75 [95% CI, 1.72–1.78]; P<0.001), longer hospital length of stay, higher hospitalization costs, greater use of tracheostomy and percutaneous endoscopic gastrostomy, and less frequent discharges to home (all P<0.001). Among AMI‐AIS survivors (N=153 318), 57.3% had a poor functional outcome at discharge with relatively stable temporal trends. Conclusions AIS is associated with significantly higher in‐hospital mortality and poor functional outcomes in AMI admissions.
Collapse
Affiliation(s)
- Gaurav Aggarwal
- Department of Medicine Jersey City Medical Center Jersey City NJ
| | | | - Saurabh Aggarwal
- Division of Cardiovascular Medicine Unity Point Clinic Des Moines IA
| | - Wisit Cheungpasitporn
- Division of Nephrology Department of Medicine University of Mississippi School of Medicine Jackson MS
| | - Rajkumar Doshi
- Department of Medicine University of Nevada Reno School of Medicine Reno NV
| | | | - Alejandro A Rabinstein
- Division of Neurocritical Care and Hospital Neurology Department of Neurology Mayo Clinic Rochester MN
| | - Allan S Jaffe
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN
| | | | - Marc Cohen
- Department of Cardiovascular Medicine Rutgers-New Jersey Medical School Newark NJ
| | - Saraschandra Vallabhajosyula
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN.,Division of Pulmonary and Critical Care Medicine Department of Medicine Mayo Clinic Rochester MN.,Center for Clinical and Translational Science Mayo Clinic Graduate School of Biomedical Sciences Rochester MN.,Section of Interventional Cardiology Division of Cardiovascular Medicine Department of Medicine Emory University School of Medicine Atlanta GA
| |
Collapse
|