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Loh X, Sun L, Allen JC, Goh HJ, Kong SC, Huang W, Ding C, Bosco N, Egli L, Actis-Goretta L, Magkos F, Arigoni F, Yeo KK, Leow MKS. Gender differences in fasting and postprandial metabolic traits predictive of subclinical atherosclerosis in an asymptomatic Chinese population. Sci Rep 2022; 12:16890. [PMID: 36207366 PMCID: PMC9546939 DOI: 10.1038/s41598-022-20714-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 09/16/2022] [Indexed: 11/08/2022] Open
Abstract
The prediction utility of Framingham Risk Score in populations with low conventional cardiovascular risk burden is limited, particularly among women. Gender-specific markers to predict cardiovascular risk in overtly healthy people are lacking. In this study we hypothesize that postprandial responses triggered by a high-calorie meal test differ by gender in their ability to triage asymptomatic subjects into those with and without subclinical atherosclerosis. A total of 101 healthy Chinese subjects (46 females, 55 males) at low risk of coronary heart disease completed the study. Subjects underwent cardiovascular imaging and postprandial blood phenotyping after consuming a standardized macronutrient meal. Prediction models were developed using logistic regression and subsequently subjected to cross-validation to obtain a de-optimized receiver operating characteristic (ROC) curve. Distinctive gender differences in postprandial trajectories of glucose, lipids and inflammatory markers were observed. We used gender-specific association with different combinations of postprandial predictors to develop 2 models for predicting risk of subclinical atherosclerosis in males (ROC AUC = 0.7867, 95% CI 0.6567, 0.9166) and females (ROC AUC = 0.9161, 95% CI 0.8340, 0.9982) respectively. We report novel postprandial models for predicting subclinical atherosclerosis in apparently healthy Asian subjects using a gender-specific approach, complementing the conventional Framingham Risk Score.Clinical Trial Registration: The trial was registered at clinicaltrials.gov as NCT03531879.
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Affiliation(s)
- Xinpeng Loh
- Duke-NUS Medical School, 30 Medical Drive, Singapore, 117609, Singapore
| | - Lijuan Sun
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | - John Carson Allen
- Duke-NUS Medical School, 30 Medical Drive, Singapore, 117609, Singapore
| | - Hui Jen Goh
- Singapore Institute for Clinical Sciences, Singapore, Singapore
| | | | - Weiting Huang
- National Heart Center Singapore, Singapore, Singapore
| | - Cherlyn Ding
- Nestlé Research Singapore Hub, Singapore, Singapore
| | - Nabil Bosco
- Nestlé Research Singapore Hub, Singapore, Singapore
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | - Leonie Egli
- Nestlé Institute of Health Sciences, Nestlé Research, Lausanne, Switzerland
| | | | | | | | - Khung Keong Yeo
- Duke-NUS Medical School, 30 Medical Drive, Singapore, 117609, Singapore
- National Heart Center Singapore, Singapore, Singapore
| | - Melvin Khee-Shing Leow
- Duke-NUS Medical School, 30 Medical Drive, Singapore, 117609, Singapore.
- Singapore Institute for Clinical Sciences, Singapore, Singapore.
- Department of Endocrinology, Tan Tock Seng Hospital, Singapore, Singapore.
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
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2
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Outcomes of a multi-ethnic Asian population on combined treatment with clopidogrel and omeprazole in 12,440 patients. J Thromb Thrombolysis 2021; 52:925-933. [PMID: 33959860 DOI: 10.1007/s11239-021-02472-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 12/19/2022]
Abstract
Omeprazole is commonly co-prescribed with clopidogrel. Clopidogrel requires bio-activation by cytochrome P450 CYP2C19. Omeprazole may reduce clopidogrel's antithrombotic efficacy by inhibiting CYP2C19. Studies in Caucasians receiving omeprazole with clopidogrel showed no significant increase in death and myocardial infarction with this drug-drug interaction. There are limited large-scale studies in Asians, who may have a greater prevalence of CYP2C19 loss-of-function polymorphisms. A single centre retrospective cohort study was undertaken based on a review of medication records and prescription data. Patients prescribed clopidogrel from 2009 to 2012 were followed-up with until December 2012 (median:29 months). The primary outcome was all-cause mortality and secondary outcomes were myocardial infarction (MI), cerebrovascular accidents, and subsequent coronary interventions. Of 12,440 patients prescribed clopidogrel, 62%(n = 7714) were on omeprazole (63.8% Chinese, 13.9% Malay, 12.4% Indian, 10.0% others), and 38%(n = 4726) were not on omeprazole or other proton pump inhibitors (62.6% Chinese, 13.5% Malay, 10.7% Indian, 13.2% others). Mortality after co-prescription occurred in 14.3%(n = 1101) of patients, compared to 6.3%(n = 300) of patients prescribed clopidogrel only. Multivariate analysis using propensity score adjusted analysis showed no significant increase in all-cause mortality with co-prescription (adjusted hazards ratio [AHR] 1.13, [95%CI 0.95-1.35]). Patients on co-prescription had a higher risk of subsequent MI (16% vs 3.8%; AHR 2.03 [95%CI 1.70-2.44]), but not of cerebrovascular accidents (5.0% vs 2.0%; AHR 0.98 [95%CI 0.76-1.27]) or coronary interventions (1.7% vs 0.7%; AHR 1.28 [95%CI 0.83-1.96]). The risk of a subsequent MI was higher in the Malay (AHR 2.43 [95%CI 1.68-3.52]) and Chinese (AHR 2.06 [95%CI 1.63-2.60]) population as compared to the Indian (AHR 1.56 [95%CI 1.06-2.31]) population. In conclusion, the use of clopidogrel with omeprazole is associated with an increased risk of MI, but not mortality or stroke, in this multi-ethnic Asian population. These risks appear to vary among different ethnic groups.
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3
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Tern PJW, Ho AKH, Sultana R, Ahn Y, Almahmeed W, Brieger D, Chew DP, Fong AYY, Hwang J, Kim Y, Komuro I, Maemura K, Mohd-Ali R, Quek DKL, Reid C, Tan JWC, Wan-Ahmad WA, Yasuda S, Yeo KK. Comparative overview of ST-elevation myocardial infarction epidemiology, demographics, management, and outcomes in five Asia-Pacific countries: a meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:6-17. [PMID: 32584986 DOI: 10.1093/ehjqcco/qcaa057] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022]
Abstract
The aim of this study is to gain insight into the differences in demographics of ST-elevation myocardial infarction (STEMI) patients in Asia-Pacific, as well as inter-country variation in treatment and mortality outcomes. Systematic review of published studies and reports from known registries in Australia, Japan, Korea, Singapore, and Malaysia that began data collection after the year 2000. Supplementary self-report survey questionnaire on public health data answered by representative cardiologists working in these countries. Twenty studies comprising of 158 420 patients were included in the meta-analysis. The mean age was 61.6 years. Chronic kidney disease prevalence was higher in Japan, while dyslipidaemia was low in Korea. Use of aspirin, P2Y12 inhibitors, and statins were high throughout, but ACEi/ARB and β-blocker prescriptions were lower in Japan and Malaysia. Reperfusion strategies varied greatly, with high rates of primary percutaneous coronary intervention (pPCI) in Korea (91.6%), whilst Malaysia relies far more on fibrinolysis (72.6%) than pPCI (9.6%). Similarly, mortality differed, with 1-year mortality from STEMI was considerably greater in Malaysia (17.9%) and Singapore (11.2%) than in Korea (8.1%), Australia (7.8%), and Japan (6.2%). The countries were broadly similar in development and public health indices. Singapore has the highest gross national income and total healthcare expenditure per capita, whilst Malaysia has the lowest. Primary PCI is available in all countries 24/7/365. Despite broadly comparable public health systems, differences exist in patient profile, in-hospital treatment, and mortality outcomes in these five countries. Our study reveals areas for improvements. The authors advocate further registry-based multi-country comparative studies focused on the Asia-Pacific region.
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Affiliation(s)
- Paul Jie Wen Tern
- Department of Medicine, Singapore General Hospital, Outram Rd, Singapore 169608
| | - Aaron Kwun Hang Ho
- School of Medicine, Gaol Walk, University College Cork, Cork, T12 YN60, Republic of Ireland
| | - Rehena Sultana
- Graduate Medical School, Duke-National University of Singapore, 8 College Rd, Singapore 169857
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Zayed The First St - Jazeerat Al Maryah Sowwah Square, Abu Dhabi, United Arab Emirates
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Hospital Rd, Concord NSW 2139, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Level 5, Room 5E209 Flinders Medical Centre, Bedford Park SA 5042, Australia
| | - Alan Yean Yip Fong
- Department of Cardiology, Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Jinyong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea, 50-1 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7 Chome-3-1 Hongo, Bunkyo City, Tokyo 113-8655, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyomachi, Nagasaki, 852-8521, Japan
| | - Rosli Mohd-Ali
- Department of Cardiology, National Heart Institute, IJN, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - David Kwang Leng Quek
- Department of Cardiology, Pantai Hospital Kuala Lumpur, 8, Jalan Bukit Pantai, Bangsar, 59100 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Christopher Reid
- School of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609
| | - Wan Azman Wan-Ahmad
- Faculty of Medicine, University Malaya Medical Center, Jalan Universiti, 59100 Kuala Lumpur, Selangor, Malaysia
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609
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4
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de Kleijn DPV, Chong SY, Wang X, Yatim SMJM, Fairhurst AM, Vernooij F, Zharkova O, Chan MY, Foo RSY, Timmers L, Lam CSP, Wang JW. Toll-like receptor 7 deficiency promotes survival and reduces adverse left ventricular remodelling after myocardial infarction. Cardiovasc Res 2020; 115:1791-1803. [PMID: 30830156 DOI: 10.1093/cvr/cvz057] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 02/18/2019] [Accepted: 02/28/2019] [Indexed: 12/15/2022] Open
Abstract
AIMS The Toll-like receptor 7 (TLR7) is an intracellular innate immune receptor activated by nucleic acids shed from dying cells leading to activation of the innate immune system. Since innate immune system activation is involved in the response to myocardial infarction (MI), this study aims to identify if TLR7 is involved in post-MI ischaemic injury and adverse remodelling after MI. METHODS AND RESULTS TLR7 involvement in MI was investigated in human tissue from patients with ischaemic heart failure, as well as in a mouse model of permanent left anterior descending artery occlusion in C57BL/6J wild type and TLR7 deficient (TLR7-/-) mice. TLR7 expression was up-regulated in human and mouse ischaemic myocardium after MI. Compared to wild type mice, TLR7-/- mice had less acute cardiac rupture associated with blunted activation of matrix metalloproteinase 2, increased expression of tissue inhibitor of metalloproteinase 1, recruitment of more myofibroblasts, and the formation of a myocardial scar with higher collagen fibre density. Furthermore, inflammatory cell influx and inflammatory cytokine expression post-MI were reduced in the TLR7-/- heart. During a 28-day follow-up after MI, TLR7 deficiency resulted in less chronic adverse left ventricular remodelling and better cardiac function. Bone marrow (BM) transplantation experiments showed that TLR7 deficiency in BM-derived cells preserved cardiac function after MI. CONCLUSIONS In acute MI, TLR7 mediates the response to acute cardiac injury and chronic remodelling probably via modulation of post-MI scar formation and BM-derived inflammatory infiltration of the myocardium.
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Affiliation(s)
- Dominique P V de Kleijn
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore.,Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Suet Yen Chong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore
| | - Xiaoyuan Wang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore
| | - Siti Maryam J M Yatim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore
| | - Anna-Marie Fairhurst
- Singapore Immunology Network (SIgN), A*STAR Research Entities, Singapore, Singapore
| | - Flora Vernooij
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Olga Zharkova
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore
| | - Mark Y Chan
- Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University Heart Centre Singapore (NUHCS), Singapore, Singapore
| | - Roger S Y Foo
- Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore.,Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, Singapore
| | - Leo Timmers
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore (NHCS), Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Cardiology, University Medical Center, Groningen, The Netherlands
| | - Jiong-Wei Wang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Cardiovascular Research Institute (CVRI), National University Heart Centre Singapore (NUHCS), Singapore, Singapore.,Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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5
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Junqueira D, Chan MY, de Carvalho LP. Nationalization of post-MI managed care: a worthy cause but not without its challenges. Int J Cardiol 2019; 296:28-29. [PMID: 31447228 DOI: 10.1016/j.ijcard.2019.08.027] [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: 07/13/2019] [Revised: 08/05/2019] [Accepted: 08/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Debora Junqueira
- Federal University of Sao Paulo State, Sao Paulo, Brazil; Heart Hospital, Sao Paulo, Brazil; Albert Einstein Hospital, Sao Paulo, Brazil
| | - Mark Y Chan
- Cardiovascular Research Institute, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Leonardo P de Carvalho
- Federal University of Sao Paulo State, Sao Paulo, Brazil; Heart Hospital, Sao Paulo, Brazil; Albert Einstein Hospital, Sao Paulo, Brazil.
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6
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Bulluck H, Zheng H, Chan MY, Foin N, Foo DC, Lee CW, Lim ST, Sahlen A, Tan HC, Tan JW, Tong KL, Wong AS, Wong PE, Yeo KK, Foo LL, Chua TS, Koh TH, Hausenloy DJ. Independent Predictors of Cardiac Mortality and Hospitalization for Heart Failure in a Multi-Ethnic Asian ST-segment Elevation Myocardial Infarction Population Treated by Primary Percutaneous Coronary Intervention. Sci Rep 2019; 9:10072. [PMID: 31296912 PMCID: PMC6624280 DOI: 10.1038/s41598-019-46486-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/26/2019] [Indexed: 01/27/2023] Open
Abstract
We aimed to identify independent predictors of cardiac mortality and hospitalization for heart failure (HHF) from a real-world, multi-ethnic Asian registry [the Singapore Myocardial Infarction Registry] of ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention. 11,546 eligible STEMI patients between 2008 and 2015 were identified. In-hospital, 30-day and 1-year cardiac mortality and 1-year HHF rates were 6.4%, 6.8%, 8.3% and 5.2%, respectively. From the derivation cohort (70% of patients), age, Killip class and cardiac arrest, creatinine, hemoglobin and troponin on admission and left ventricular ejection fraction (LVEF) during hospitalization were predictors of in-hospital, 30-day and 1-year cardiac mortality. Previous ischemic heart disease (IHD) was a predictor of in-hospital and 30-day cardiac mortality only, whereas diabetes was a predictor of 1-year cardiac mortality only. Age, previous IHD and diabetes, Killip class, creatinine, hemoglobin and troponin on admission, symptom-to-balloon-time and LVEF were predictors of 1-year HHF. The c-statistics were 0.921, 0.901, 0.881, 0.869, respectively. Applying these models to the validation cohort (30% of patients) showed good fit and discrimination (c-statistic 0.922, 0.913, 0.903 and 0.855 respectively; misclassification rate 14.0%, 14.7%, 16.2% and 24.0% respectively). These predictors could be incorporated into specific risk scores to stratify reperfused STEMI patients by their risk level for targeted intervention.
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Affiliation(s)
- Heerajnarain Bulluck
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom.,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore.,Norfolk and Norwich University Hospital, Department of Cardiology, Norwich, UK
| | - Huili Zheng
- National Registry of Disease Office, Health Promotion Board, Singapore, Singapore
| | - Mark Y Chan
- National University Heart Centre, Singapore, Singapore
| | - Nicolas Foin
- Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore.,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore
| | - David C Foo
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Chee W Lee
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Soo T Lim
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Anders Sahlen
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore.,Karolinska Institutet, Department of Cardiology, Stockholm, Sweden
| | - Huay C Tan
- National University Heart Centre, Singapore, Singapore
| | - Jack W Tan
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khim L Tong
- Changi General Hospital, Singapore, Singapore
| | - Aaron S Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Philip E Wong
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Khung K Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Ling L Foo
- National Registry of Disease Office, Health Promotion Board, Singapore, Singapore
| | - Terrance S Chua
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Tian H Koh
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore
| | - Derek J Hausenloy
- The Hatter Cardiovascular Institute, Institute of Cardiovascular Science, University College London, London, United Kingdom. .,Cardiovascular and Metabolic Disorders Program, Duke-National University of Singapore, Singapore, Singapore. .,National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University Singapore, Singapore, Singapore. .,The National Institute of Health Research University College London Hospitals Biomedical Research Centre, Research & Development, London, UK. .,Tecnologico de Monterrey, Centro de Biotecnologia-FEMSA, Nuevo Leon, Mexico.
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7
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Loh JP, Tan LL, Zheng H, Lau YH, Chan SP, Tan KB, Chua T, Tan HC, Foo D, Lee CW, Tong KL, Foo LL, Hausenloy D, Sahlen A, Yeo KK, Fox KA, Wang TY, Richards AM, Chan MY. First Medical Contact-to-Device Time and Heart Failure Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2018; 11:e004699. [DOI: 10.1161/circoutcomes.118.004699] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Joshua P. Loh
- National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)
- Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)
| | - Li-Ling Tan
- National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)
| | - Huili Zheng
- National Registry of Disease Office, Singapore (H.Z., L.-L.F.)
| | - Yee-How Lau
- Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)
| | | | | | | | - Huay-Cheem Tan
- National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)
| | | | | | | | - Ling-Li Foo
- National Registry of Disease Office, Singapore (H.Z., L.-L.F.)
| | - Derek Hausenloy
- Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)
| | - Anders Sahlen
- Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)
| | - Khung-Keong Yeo
- Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)
| | | | | | - A. Mark Richards
- National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)
| | - Mark Y. Chan
- National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)
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8
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Kim EJ, Kressin NR, Paasche-Orlow MK, Lopez L, Rosen JE, Lin M, Hanchate AD. Racial/ethnic disparities among Asian Americans in inpatient acute myocardial infarction mortality in the United States. BMC Health Serv Res 2018; 18:370. [PMID: 29769083 PMCID: PMC5956856 DOI: 10.1186/s12913-018-3180-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Acute myocardial infarction (AMI) is a common high-risk disease with inpatient mortality of 5% nationally. But little is known about this outcome among Asian Americans (Asians), a fast growing racial/ethnic minority in the country. The objectives of the study are to obtain near-national estimates of differences in AMI inpatient mortality between minorities (including Asians) and non-Hispanic Whites and identify comorbidities and sociodemographic characteristics associated with these differences. Method This is a retrospective analysis of 2010–2011 state inpatient discharge data from 10 states with the largest share of Asian population. We identified hospitalization with a primary diagnosis of AMI using the ICD-9 code and used self-reported race/ethnicity to identify White, Black, Hispanic, and Asian. We performed descriptive analysis of sociodemographic characteristics, medical comorbidities, type of AMI, and receipt of cardiac procedures. Next, we examined overall inpatient AMI mortality rate based on patients’ race/ethnicity. We also examined the types of AMI and a receipt of invasive cardiac procedures by race/ethnicity. Lastly, we used sequential multivariate logistic regression models to study inpatient mortality for each minority group compared to Whites, adjusting for covariates. Results Over 70% of the national Asian population resides in the 10 states. There were 496,472 hospitalizations with a primary diagnosis of AMI; 75% of all cases were Whites, 10% were Blacks, 12% were Hispanics, and 3% were Asians. Asians had a higher prevalence of cardiac comorbidities, including hypertension, diabetes, and kidney failure compared to Whites (p-value< 0.01). There were 158,623 STEMI (ST-elevation AMI), and the proportion of hospitalizations for STEMI was the highest for Asians (35.2% for Asians, 32.7% for Whites, 25.3% for Blacks, and 32.1% for Hispanics). Asians had the highest rates of inpatient AMI mortality: 7.2% for Asians, 6.3% for Whites, 5.4% for Blacks, and 5.9% for Hispanics (ANOVA p-value < 0.01). In adjusted analyses, Asians (OR = 1.11 [95% CI: 1.04–1.19]) and Hispanics (OR = 1.14 [1.09–1.19]) had a higher likelihood of inpatient mortality compared to Whites. Conclusions Asians had a higher risk-adjusted likelihood of inpatient AMI mortality compared to Whites. Further research is needed to identify the underlying reasons for this finding to improve AMI disparities for Asians.
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Affiliation(s)
- Eun Ji Kim
- General Internal Medicine, Zucker School of Medicine at Hofstra/Northwell, 2001 Marcus Avenue Suite S160, Lake Success, NY, 11042, USA.
| | - Nancy R Kressin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
| | - Michael K Paasche-Orlow
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Lenny Lopez
- University of California San Francisco School of Medicine, 4150 Clement Street, San Francisco, CA, 94121, USA
| | - Jennifer E Rosen
- MedStar Washington Hospital Center, 106 Irving Street NW POB South 124, Washington, DC, 20010, USA
| | - Mengyun Lin
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA
| | - Amresh D Hanchate
- General Internal Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown Two, Boston, MA, 02118, USA.,VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA, 02130, USA
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9
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Klitkou ST, Wangen KR. Educational attainment and differences in relative survival after acute myocardial infarction in Norway: a registry-based population study. BMJ Open 2017; 7:e014787. [PMID: 28851768 PMCID: PMC5724085 DOI: 10.1136/bmjopen-2016-014787] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although there is a broad societal interest in socioeconomic differences in survival after an acute myocardial infarction, only a few studies have investigated how such differences relate to the survival in general population groups. We aimed to investigate education-specific survival after acute myocardial infarction and to compare this with the survival of corresponding groups in the general population. METHODS Our study included the entire population of Norwegian patients admitted to hospitals for acute myocardial infarction during 2008-2010, with a 6- year follow-up period. Patient survival was measured relative to the expected survival in the general population for three educational groups: primary, secondary and tertiary. Education, sex, age and calendar year-specific expected survival were obtained from population life tables and adjusted for the presence of infarction-related mortality. RESULTS Six-year patient survivals were 56.3% (55.3-57.2) and 65.5% (65.6-69.3) for the primary and tertiary educational groups (95% CIs), respectively. Also 6-year relative survival was markedly lower for the primary educational group: 70.2% (68.6-71.8) versus 81.2% (77.4-84.4). Throughout the follow-up period, patient survival tended to remain lower than the survival in the general population with the same educational background. CONCLUSION Both patient survival and relative survival after acute myocardial infarction are positively associated with educational level. Our findings may suggest that secondary prevention has been more effective for the highly educated.
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Affiliation(s)
- Søren Toksvig Klitkou
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Knut R Wangen
- Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway
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10
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Baart SJ, van Domburg RT, Janssen-Heijnen ML, Deckers JW, Akkerhuis KM, Daemen J, van Geuns RJ, Boersma E, Kardys I. Impact of Relative Conditional Survival Estimates on Patient Prognosis After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003344. [DOI: 10.1161/circoutcomes.116.003344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Sara J. Baart
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Ron T. van Domburg
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Maryska L.G. Janssen-Heijnen
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Jaap W. Deckers
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - K. Martijn Akkerhuis
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Joost Daemen
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Robert-Jan van Geuns
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Eric Boersma
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Isabella Kardys
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
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11
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Gernaat SAM, Ho PJ, Rijnberg N, Lee SC, Lim SH, Yap YS, Grobbee DE, Hartman M, Verkooijen HM. Risk of death from cardiovascular disease following breast cancer in Southeast Asia: a prospective cohort study. Sci Rep 2017; 7:1365. [PMID: 28465587 PMCID: PMC5430976 DOI: 10.1038/s41598-017-01540-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 03/31/2017] [Indexed: 01/24/2023] Open
Abstract
Breast cancer incidence and survival is high in Southeast Asia. As such, many women diagnosed with breast cancer are at risk of dying of other causes. Given the increased risk of cardiotoxicity induced by breast cancer treatments, it is important to identify patients at high risk of cardiovascular disease (CVD) mortality. The aim of this study was to investigate if this risk varies by age and ethnicity. Patient details were obtained from 5,868 Chinese, Malay, and Indian women diagnosed with in situ or non-metastasized invasive breast cancer at the National University Hospital of Singapore and KK Women's and Children's Hospital in Singapore. Death causes were obtained from the National Registry of Births and Deaths. Flexible parametric survival models estimated CVD mortality rates and hazard ratios. During a median follow-up of six years, 1,010 deaths occurred of which 6.8% were due to CVD. CVD mortality rates of older women peaked within the first year following diagnosis and increased over time since diagnosis. Indian had more than double the risk of CVD mortality than Chinese, independent of age at diagnosis and stage. Taking ethnicity and age into account may promote CVD risk stratification and management in (Southeast Asian) women with breast cancer.
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Affiliation(s)
- S A M Gernaat
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, 3584, CX, The Netherlands.
| | - P J Ho
- National University of Singapore, Saw Swee Hock School of Public Health, Singapore, 117549, Singapore
| | - N Rijnberg
- Academic Medical Center, Division of Internal Medicine, Amsterdam, 1105 AZ, The Netherlands
| | - S C Lee
- National University Cancer Institute, National University Health System, Department of Hematology-oncology, Singapore, 119074, Singapore
| | - S H Lim
- KK Women's and Children's Hospital, KK Breast Department, Singapore, 229899, Singapore
| | - Y S Yap
- National Cancer Centre Singapore, Division of Medical Oncology, Singapore, 169610, Singapore
| | - D E Grobbee
- University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Department of Epidemiology, Utrecht, 3584, CX, The Netherlands
| | - M Hartman
- National University Hospital Singapore, Department of Surgery, Singapore, 119074, Singapore
| | - H M Verkooijen
- University Medical Center Utrecht, Imaging Division, Utrecht, 3584 CX, The Netherlands
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12
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Koo CY, de la Torre AS, Loo G, Torre MSDL, Zhang J, Duran-Cantolla J, Li R, Mayos M, Sethi R, Abad J, Furlan SF, Coloma R, Hein T, Ho HH, Jim MH, Ong TH, Tai BC, Turino C, Drager LF, Lee CH, Barbe F. Effects of Ethnicity on the Prevalence of Obstructive Sleep Apnoea in Patients with Acute Coronary Syndrome: A Pooled Analysis of the ISAACC Trial and Sleep and Stent Study. Heart Lung Circ 2016; 26:486-494. [PMID: 27939743 DOI: 10.1016/j.hlc.2016.09.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/02/2016] [Accepted: 09/12/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is an emerging risk factor for acute coronary syndrome (ACS). We sought to determine the effects of ethnicity on the prevalence of OSA in patients presenting with ACS who participated in an overnight sleep study. METHODS A pooled analysis using patient-level data from the ISAACC Trial and Sleep and Stent Study was performed. Using the same portable diagnostic device, OSA was defined as an apnoea-hypopnoea index of ≥15 events per hour. RESULTS A total of 1961 patients were analysed, including Spanish (53.6%, n=1050), Chinese (25.5%, n=500), Indian (12.0%, n=235), Malay (6.1%, n=119), Brazilian (1.7%, n=34) and Burmese (1.2%, n=23) populations. Significant differences in body mass index (BMI) were found among the various ethnic groups, averaging from 25.3kg/m2 for Indians and 25.4kg/m2 for Chinese to 28.6kg/m2 for Spaniards. The prevalence of OSA was highest in the Spanish (63.1%), followed by the Chinese (50.2%), Malay (47.9%), Burmese (43.5%), Brazilian (41.2%), and Indian (36.1%) patients. The estimated odds ratio of BMI on OSA was highest in the Chinese population (1.17; 95% confidence interval: 1.10-1.24), but was not significant in the Spanish, Burmese or Brazilian populations. The area under the curve (AUC) for the Asian patients (ranging from 0.6365 to 0.6692) was higher than that for the Spanish patients (0.5161). CONCLUSION There was significant ethnic variation in the prevalence of OSA in patients with ACS. The magnitude of the effect of BMI on OSA was greater in the Chinese population than in the Spanish patients.
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Affiliation(s)
- Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
| | - Alicia Sánchez de la Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Germaine Loo
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Manuel Sánchez-de-la Torre
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Junjie Zhang
- Department of Cardiology, Nanjing First Hospital, Nanjing, China
| | - Joaquin Duran-Cantolla
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Bio-Araba Research Institute, Araba University Hospital, Department of Medicine of Basque Country University, Vitoria-Gasteiz, Spain
| | - Ruogu Li
- Department of Cardiology, Shanghai Chest Hospital, Shanghai, China
| | - Mercé Mayos
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain; Sleep Unit, Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rishi Sethi
- Department of Cardiology, King George's Medical University, Lucknow, India
| | - Jorge Abad
- Respiratory Department, Hospital Universitari Germans Trias I Pujol, Badalona, Barcelona, Catalonia, Spain
| | - Sofia F Furlan
- Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Ramón Coloma
- Respiratory Department, Hospital General Universitario de Albacete, Spain
| | - Thet Hein
- No (1) 1000 bedded Defence Services General Hospital, Mingaladon, Yangon, Myanmar
| | - Hee-Hwa Ho
- Department of Cardiology, Tan Tock Seng Hospital, Singapore
| | - Man-Hong Jim
- Cardiac Medical Unit, The Grantham Hospital, Hong Kong
| | - Thun-How Ong
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Bee-Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Cecilia Turino
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain
| | - Luciano F Drager
- Hypertension Unit-Heart Institute (InCor), University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore
| | - Ferran Barbe
- Respiratory Department, Hospital Universitari Arnau de Vilanova and Santa Maria, IRB Lleida, Lleida, Spain; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
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13
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Wah W, Pek PP, Ho AFW, Fook-Chong S, Zheng H, Loy EY, Chua TSJ, Koh TH, Chow KY, Earnest A, Pang J, Ong MEH. Symptom-to-door delay among patients with ST-segment elevation myocardial infarction in Singapore. Emerg Med Australas 2016; 29:24-32. [PMID: 27728959 DOI: 10.1111/1742-6723.12689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Symptom-to-door time (S2D) is one of the important components of ischaemic time, which might affect the infarct size and outcomes of acute myocardial infarction. The aim of the present study was to identify patients' characteristics associated with delayed symptom-onset-to-arrival at EDs in ST-segment elevation myocardial infarction (STEMI) patients in Singapore. METHODS Retrospective data of STEMI patients presenting to the ED of all public hospitals with onsite primary percutaneous coronary intervention facilities between 2010 and 2012 were obtained from the Singapore Myocardial Infarction Registry. Based on the S2D of 120 min, characteristics of patients were compared between short S2D (≤120 min) and long S2D (>120 min). Multivariate logistic and linear regression analyses were performed. RESULTS Out of 3848 patients, 1682 patients had an S2D of ≤120 min, and 2166 had an S2D >120 min. In the multivariate analyses, older age, Malay ethnicity, diabetes mellitus, presenting symptoms of back and epigastric pain were independently associated with long S2D. Patients who utilised the emergency medical services, presented after office hours and with symptoms of chest pain, breathlessness, diaphoresis and past history of percutaneous transluminal coronary angioplasty/primary percutaneous coronary intervention, were independently associated with short S2D. Patients with long S2D had lower probability of receiving reperfusion treatment with delayed symptom-to-balloon and door-to-balloon time and higher probabilities of complications and mortality. CONCLUSION The present study shows that longer S2D was associated with older age, ethnicity, diabetes mellitus, delay in receiving early reperfusion treatment and poorer prognosis.
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Affiliation(s)
- Win Wah
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Andrew Fu Wah Ho
- Emergency Medicine Residency Program, SingHealth Services, Singapore
| | | | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - En Yun Loy
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | | | - Tian Hai Koh
- Department of Cardiology, National Heart Centre, Singapore
| | - Khuan Yew Chow
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | - Junxiong Pang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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14
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Gao F, Lam CSP, Yeo KK, Machin D, de Carvalho LP, Sim LL, Koh TH, Foo D, Ong HY, Tong KL, Tan HC, Earnest A, Chua T, Chan MYY. Influence of Ethnicity, Age, and Time on Sex Disparities in Long-Term Cause-Specific Mortality After Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:JAHA.116.003760. [PMID: 27792637 PMCID: PMC5121478 DOI: 10.1161/jaha.116.003760] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background We examined the influence of sex, ethnicity, and time on competing cardiovascular and noncardiovascular causes of death following acute myocardial infarction in a multiethnic Asian cohort. Methods and Results For 12 years, we followed a prospective nationwide cohort of 15 151 patients (aged 22–101 years, median age 63 years; 72.3% male; 66.7% Chinese, 19.8% Malay, 13.5% Indian) who were hospitalized for acute myocardial infarction between 2000 and 2005. There were 6463 deaths (4534 cardiovascular, 1929 noncardiovascular). Compared with men, women had a higher risk of cardiovascular death (age‐adjusted hazard ratio [HR] 1.3, 95% CI 1.2–1.4) but a similar risk of noncardiovascular death (HR 0.9, 95% CI 0.8–1.0). Sex differences in cardiovascular death varied by ethnicity, age, and time. Compared with Chinese women, Malay women had the greatest increased hazard of cardiovascular death (HR 1.4, 95% CI 1.2–1.6) and a marked imbalance in death due to heart failure or cardiomyopathy (HR 3.4 [95% CI 1.9–6.0] versus HR 1.5 [95% CI 0.6–3.6] for Indian women). Compared with same‐age Malay men, Malay women aged 22 to 49 years had a 2.5‐fold (95% CI 1.6–3.8) increased hazard of cardiovascular death. Sex disparities in cardiovascular death tapered over time, least among Chinese patients and most among Indian patients; the HR comparing cardiovascular death of Indian women and men decreased from 1.9 (95% CI 1.5–2.4) at 30 days to 0.9 (95% CI 0.5–1.6) at 10 years. Conclusion Age, ethnicity, and time strongly influence the association between sex and specific cardiovascular causes of mortality, suggesting that health care policy to reduce sex disparities in acute myocardial infarction outcomes must consider the complex interplay of these 3 major modifying factors.
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Affiliation(s)
- Fei Gao
- National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore Duke-NUS Graduate Medical School, Singapore
| | | | - David Machin
- Medical Statistics Group, School of Health and Related Research, University of Sheffield, UK Department of Cancer Studies and Molecular Medicine, Leicester Royal Infirmary, University of Leicester, UK
| | - Leonardo P de Carvalho
- National University Heart Centre Singapore, National University of Singapore, Singapore Albert Einstein Hospital, Sao Paulo, Brazil
| | | | | | | | | | | | - Huay Cheem Tan
- National University Heart Centre Singapore, National University of Singapore, Singapore
| | - Arul Earnest
- Duke-NUS Graduate Medical School, Singapore Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | | | - Mark Yan Yee Chan
- National University Heart Centre Singapore, National University of Singapore, Singapore
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15
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de Hoog VC, Lim SH, Bank IEM, Gijsberts CM, Ibrahim IB, Kuan WS, Ooi SBS, Chua T, den Ruijter HM, Pasterkamp G, Tai ES, Gao F, Doevendans PA, Wildbergh TX, Mosterd A, Richards AM, de Kleijn DPV, Timmers L. Ethnic differences in clinical outcome of patients presenting to the emergency department with chest pain. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 5:32-40. [DOI: 10.1177/2048872615623064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Vince C de Hoog
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- ICIN – Netherlands Heart Institute, The Netherlands
- Department of Medicine, National University of Singapore, Singapore
| | - Swee Han Lim
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Ingrid EM Bank
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- Department of Cardiology, Meander Medical Center, The Netherlands
| | - Crystel M Gijsberts
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- ICIN – Netherlands Heart Institute, The Netherlands
| | - Irwani B Ibrahim
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Win Sen Kuan
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Shirley BS Ooi
- Department of Emergency Medicine, National University Hospital, Singapore
| | | | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- Department of Clinical Chemistry and Hematology, UMC Utrecht, The Netherlands
| | - E Shyong Tai
- Department of Medicine, National University of Singapore, Singapore
| | - Fei Gao
- National Heart Center Singapore, Singapore
- Center for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore
| | | | | | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, The Netherlands
- Department of Cardiology, UMC Utrecht, The Netherlands
| | - A Mark Richards
- Medicine NUS and Cardiovascular Research Institute, NUHS, Singapore
- Christchurch Heart Institute, University of Otago, New Zealand
| | - Dominique PV de Kleijn
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- ICIN – Netherlands Heart Institute, The Netherlands
- Surgery NUS and Cardiovascular Research Institute, NUHS, Singapore
| | - Leo Timmers
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, The Netherlands
- Department of Cardiology, UMC Utrecht, The Netherlands
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16
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Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction. Am J Cardiol 2016; 118:319-25. [PMID: 27328956 DOI: 10.1016/j.amjcard.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-matched background population could unmask residual mortality risk in young patients with MI that would otherwise not be apparent when merely comparing the mortality risk of young and older patients with MI. We studied 15,151 patients with AMI from 2000 to 2005, of which 601 patients were ≤40 years (young MI). The relative survival ratio (RSR) was calculated as the ratio of the observed survival of patients with MI divided by the expected survival, estimated from the background population (n = 3,771,700) matched for age, gender, and follow-up year. An RSR of <1.0 or >1.0 indicates poorer or better survival, respectively, than the background population. The 12-year all-cause and cardiovascular mortality of young versus older patients was 12.8% versus 50.7% (p <0.001) and 9.2% versus 34.5% (p <0.001), respectively. The adjusted hazard ratio (95% confidence interval) for all-cause and cardiovascular mortality comparing young with older patients was 0.20 (0.16 to 0.27) and 0.27 (0.20 to 0.36), respectively. The RSR (95% confidence interval) of young and older patients was, respectively, 0.969 (0.950 to 0.980) and 0.804 (0.797 to 0.811) at 1 year, 0.942 (0.918 to 0.960) and 0.716 (0.707 to 0.726) at 5 years, and 0.908 (0.878 to 0.938) and 0.638 (0.620 to 0.654) at 9 years. In conclusion, despite a fivefold lower long-term mortality than older patients with MI, young patients with MI remain at significantly greater risk of long-term mortality than an age-matched background population.
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17
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Venkataraman K, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh GCH. Rehabilitation Outcomes After Inpatient Rehabilitation for Lower Extremity Amputations in Patients With Diabetes. Arch Phys Med Rehabil 2016; 97:1473-1480. [PMID: 27178094 DOI: 10.1016/j.apmr.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 04/05/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To identify factors associated with functional gain, discharge destination, and long-term survival after inpatient rehabilitation in patients with lower extremity amputation and diabetes. DESIGN Retrospective medical records review. SETTING All community hospitals. PARTICIPANTS Patients with diabetes (N=256) admitted for inpatient rehabilitation after lower extremity amputation. INTERVENTIONS Not applicable. MAIN OUTCOMES MEASURES Absolute functional gain (AFG) using the Shah-modified Barthel Index, discharge destination, and long-term survival for each patient. RESULTS Length of stay (B=.15; 95% confidence interval [CI], .08-.21; P<.001) and admission functional status (B=-.09; 95% CI, -.18 to -.01; P=.032) were significantly associated with AFG. Availability of caregiver (foreign domestic worker: odds ratio [OR], 16.39; 95% CI, 4.65-57.78; P<.001; child: OR, 3.82; 95% CI, 1.31-11.12; P=.014; spouse: OR, 2.82; 95% CI, 1.07-7.46; P=.037 vs none), Charlson Comorbidity Index of 1 (OR, 4.32; 95% CI, 1.34-13.93; P=.014 vs ≥4), and younger age (OR, .96; 95% CI, .93-.99; P=.02) were significantly associated with being discharged home. Admission functional status (hazard ratio [HR], .98; 95% CI, .97-.99; P<.001), AFG (HR, .99; 95% CI, 0.97-1.00; P=.058), Charlson Comorbidity Index (1 vs ≥4: HR, .42; 95% CI, .24-.77; P=.004), ischemic heart disease (HR, 2.25; 95% CI, 1.27-4.00; P=.006), discharge destination (other vs home: HR, 1.82; 95% CI, 1.02-3.23; P=.041), age (HR, 1.02; 95% CI, 1.00-1.03; P=.082), and ethnicity (Malay vs Chinese: HR, .37; 95% CI, .16-.87; P=.022) predicted survival postamputation. CONCLUSIONS Admission functional status predicted both functional gain during rehabilitation and survival in these patients. We also found ethnic differences in outcomes, with Malays having better survival after amputation. Lastly, there appears to be greater reliance on foreign domestic workers as caregivers, with patients with foreign domestic workers as their primary caregiver having the highest odds of being discharged home.
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Affiliation(s)
- Kavita Venkataraman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Ngan Phoon Fong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Kin Ming Chan
- Medical Services, Ang Mo Kio Thye Hua Kwan Hospital, Singapore
| | | | - Edward Menon
- Medical Services, St Andrew's Community Hospital, Singapore
| | - Chye Hua Ee
- Elder Care and Health Consultancy, Singapore
| | | | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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18
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Chan MY, Du X, Eccleston D, Ma C, Mohanan PP, Ogita M, Shyu KG, Yan BP, Jeong YH. Acute coronary syndrome in the Asia-Pacific region. Int J Cardiol 2016; 202:861-9. [DOI: 10.1016/j.ijcard.2015.04.073] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 03/26/2015] [Accepted: 04/09/2015] [Indexed: 11/28/2022]
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19
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Jin K, Ding D, Gullick J, Koo F, Neubeck L. A Chinese Immigrant Paradox? Low Coronary Heart Disease Incidence but Higher Short-Term Mortality in Western-Dwelling Chinese Immigrants: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002568. [PMID: 26683217 PMCID: PMC4845291 DOI: 10.1161/jaha.115.002568] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 10/25/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Chinese form a large proportion of the immigrant population in Western countries. There is evidence that Chinese immigrants experience an increased risk of coronary heart disease (CHD) after immigration in part due to cultural habits and acculturation. This is the first systematic review and meta-analysis that aims to examine the risk of CHD in people of Chinese ethnicity living in Western countries, in comparison with whites and another major immigrant group, South Asians. METHODS AND RESULTS Literature on the incidence, mortality, and prognosis of CHD among Chinese living in Western countries was searched systematically in any language using 6 electronic databases up to December 2014. Based on the meta-analysis, Chinese had lower incidence of CHD compared with whites (odds ratio 0.29; 95% CI: 0.24-0.34) and South Asians (odds ratio 0.37; 95% CI: 0.24-0.57) but higher short-term mortality after first hospitalization for acute myocardial infarction compared with whites (odds ratio 1.34; 95% CI, 1.04-1.73) and South Asians (odds ratio 1.82; 95% 1.33-2.50). There was no significant difference between Chinese immigrants and whites in long-term outcomes (mortality and recurrent events) after acute myocardial infarction. CONCLUSIONS These findings provide an important focus for resource planning to enhance early secondary prevention of CHD to improve short-term survival outcomes among Western-dwelling Chinese immigrants.
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Affiliation(s)
- Kai Jin
- Sydney Nursing SchoolUniversity of SydneyNSWAustralia
| | - Ding Ding
- Prevention Research CollaborationSydney School of Public HealthUniversity of SydneyNSWAustralia
| | | | - Fung Koo
- Sydney Nursing SchoolUniversity of SydneyNSWAustralia
| | - Lis Neubeck
- Sydney Nursing SchoolUniversity of SydneyNSWAustralia
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