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Nguyen TM, Melichova D, Aabel EW, Lie ØH, Klæboe LG, Grenne B, Sjøli B, Brunvand H, Haugaa K, Edvardsen T. Mortality in Patients with Acute Coronary Syndrome-A Prospective 5-Year Follow-Up Study. J Clin Med 2023; 12:6598. [PMID: 37892735 PMCID: PMC10607017 DOI: 10.3390/jcm12206598] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/29/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Our objective was to compare long-term outcomes in patients with non-ST-elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) between two time periods in Southern Norway. There are limited contemporary data comparing long-term follow-up after revascularization in the last decades. This prospective follow-up study consecutively included both NSTEMI and STEMI patients during two time periods, 2014-2015 and 2004-2009. Patients were followed up for a period of 5 years. The primary outcome was all-cause mortality after 1 and 5 years. A total of 539 patients with acute myocardial infarction (AMI), 316 with NSTEMI (234 included in 2014 and 82 included in 2007) and 223 with STEMI (160 included in 2014 and 63 included in 2004). Mortality after NSTEMI was high and remained unchanged during the two time periods (mortality rate at 1 year: 3.5% versus 4.9%, p = 0.50; and 5 years: 11.4% versus 14.6%, p = 0.40). Among STEMI patients, all-cause mortality at 1 year was reduced in 2014 compared to 2004 (1.3% versus 11.1%, p < 0.001; and 5 years: 7.0% versus 22.2%, p = 0.004, respectively). Time to coronary angiography in NSTEMI patients remained unchanged between 2014 and 2007 (28.2 h [IQR 18.1-46.3] versus 30.3 h [IQR 18.0-48.3], p = 0.20), while time to coronary angiography in STEMI patients was improved in 2014 compared with 2004 (2.8 h [IQR 2.0-4.8] versus 21.7 h [IQR 5.4-27.1], p < 0.001), respectively. During one decade of AMI treatment, mortality in patients with NSTEMI remained unchanged while mortality in STEMI patients decreased, both at 1 and 5 years.
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Affiliation(s)
- Thuy Mi Nguyen
- Department of Cardiology, Hospital of Southern of Norway, 4604 Kristiansand, Norway; (T.M.N.); (D.M.); (B.S.); (H.B.)
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Daniela Melichova
- Department of Cardiology, Hospital of Southern of Norway, 4604 Kristiansand, Norway; (T.M.N.); (D.M.); (B.S.); (H.B.)
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Eivind W. Aabel
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Øyvind H. Lie
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Bjørnar Grenne
- Centre for Innovative Ultrasound Solutions and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, 7491 Trondheim, Norway;
- Clinic of Cardiology, St Olavs Hospital, 7006 Trondheim, Norway
| | - Benthe Sjøli
- Department of Cardiology, Hospital of Southern of Norway, 4604 Kristiansand, Norway; (T.M.N.); (D.M.); (B.S.); (H.B.)
| | - Harald Brunvand
- Department of Cardiology, Hospital of Southern of Norway, 4604 Kristiansand, Norway; (T.M.N.); (D.M.); (B.S.); (H.B.)
| | - Kristina Haugaa
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
| | - Thor Edvardsen
- ProCardio, Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (E.W.A.); (Ø.H.L.); (L.G.K.); (K.H.)
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0318 Oslo, Norway
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Pham HM, Nguyen AP, Nguyen HTT, Nguyen TN, Nguyen TX, Nguyen TTH, Nguyen HTT, Nguyen AT, Nguyen QN, Tran GS, Vu HTT. The Frail Scale - A Risk Stratification in Older Patients with Acute Coronary Syndrome. J Multidiscip Healthc 2023; 16:1521-1529. [PMID: 37274424 PMCID: PMC10239255 DOI: 10.2147/jmdh.s409535] [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: 03/16/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023] Open
Abstract
Purpose The aim of this study was to explore the impact of frailty on in-hospital adverse outcomes and net adverse clinical events (NACE) in older patients with acute coronary syndrome. Patients and Methods This observational study included elderly patients (≥60 years old), diagnosed with acute coronary syndrome (ACS) at admission from February 2021 to August 2021. The primary outcome was net adverse clinical events (NACE) defined as a composite of all-cause mortality, stroke, and major bleeding. Secondary outcome was in-hospital adverse outcomes including arrhythmia, acquired pneumonia, stroke, major bleeding, and all-cause mortality. Frailty was assessed using the Frail scale (FS). Data about socio-demographics, comorbidities, body mass index, ACS type, coronary angiography, left ventricular ejection fraction, and length of hospital stay were also collected. Univariate and multivariate logistic regressions were employed to identify the potential association between frailty and outcomes. Results Of the 116 ACS patients, 38 patients were frail (32.76%). Frail subjects were more often female (50%) and older (p < 0.01) and had higher rates of in-hospital adverse outcomes (OR = 2.37, p = 0.05) and NACE (OR = 7.12; p < 0.01). In univariate analysis, the increased frail score was significantly associated with increased odds of NACE (unadjusted OR = 1.98, 95% CI 1.17-3.35 for each score increase in Frail Score). In multivariable logistic regression, models controlling for age, gender, PCI, LVEF, and coronary angiography (adjusted OR 2.19, 95% CI 1.12-4.29 for each score increase in Frail Score). Conclusion This study revealed the reference data of frailty assessment in older patients with ACS in Vietnam. Our result indicated that over 30% of ACS older patients presented with frailty which was associated with an increased risk of in-hospital adverse outcomes and NACE. This study also provided promising information about the simple FRAIL scale's potential role in the risk stratification of older patients with ACS.
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Affiliation(s)
- Hung Manh Pham
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Anh Phuong Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Huong Thi Thu Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Tam Ngoc Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thanh Xuan Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Thu Thi Hoai Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Huong Thi Thanh Nguyen
- Physiology Department, Hanoi Medical University, Hanoi, 100000, Vietnam
- Dinh Tien Hoang Institute of Medicine, Hanoi, 100000, Vietnam
| | - Anh Trung Nguyen
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
| | - Quang Ngoc Nguyen
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
- Department of Cardiology, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Giang Song Tran
- Vietnam National Heart Institute, Bach Mai Hospital, Hanoi, 100000, Vietnam
| | - Huyen Thi Thanh Vu
- Department of Geriatrics, Hanoi Medical University, Hanoi, 100000, Vietnam
- Scientific Research Department, National Geriatric Hospital, Hanoi, 100000, Vietnam
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Widmer RJ, Exaire JE. Extending Our Knowledge of Lifetime Outcomes After ST-Elevation Myocardial Infarction. Am J Cardiol 2023; 191:139-140. [PMID: 36682925 DOI: 10.1016/j.amjcard.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/02/2023] [Indexed: 01/21/2023]
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Zhang M, Yan XN, Hong LF, Jin JL, Dong Q, Qian J, Li JJ. Clinical impact of blood pressure on cardiovascular death in patients 80 years and older following acute myocardial infarction: a prospective cohort study. Hypertens Res 2022; 45:1882-1890. [PMID: 36123399 DOI: 10.1038/s41440-022-01030-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 08/17/2022] [Accepted: 08/23/2022] [Indexed: 12/15/2022]
Abstract
Numerous trials have shown that lowering blood pressure (BP) reduces cardiovascular risk and mortality, yet data about the impact of BP on cardiovascular death risk in patients aged ≥80 years with acute myocardial infarction (AMI) are sparse. This study explored the prognostic value of BP for cardiovascular death during the first 48 h after admission following AMI among patients aged ≥80 years. A total of 1005 patients ≥80 years with AMI were enrolled. Average BP parameters, including systolic, diastolic, and pulse BP, over the first 48 h after admission were calculated. The end point was cardiovascular death. Receiver operating curve (ROC) analysis was used to identify whether BP was relevant to cardiovascular death. The relationship between BP levels and cardiovascular death was evaluated by Cox regression models. ROC analysis showed that average diastolic blood pressure (aDBP), but not systolic and pulse BP, was relevant to cardiovascular death, and the optimal cutoff was 65 mmHg. During the 2.9-year follow-up, patients who died from a cardiovascular cause had lower aDBP levels than those who did not (p = 0.002). Patients with aDBP <65 mmHg had a 1.5-fold higher incidence of cardiovascular death than those with aDBP ≥65 mmHg (35.9% vs. 24.0%; p < 0.001). In multivariable regression analysis, low aDBP remained a strong and independent predictor of cardiovascular death (adjusted hazard ratio 1.907; 95% CI 1.303-2.792). aDBP was independently associated with cardiovascular death in patients aged ≥80 years with AMI, suggesting that aDBP may be a useful index to predict worse outcome in these patients.
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Affiliation(s)
- Meng Zhang
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Xiao-Ni Yan
- Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Institute of Jianghan University, Wuhan, China
| | - Li-Feng Hong
- Division of Cardiology, The Fifth Hospital of Wuhan & Cardiovascular Institute of Jianghan University, Wuhan, China
| | - Jing-Lu Jin
- Department of Endocrinology, Genetics and Metabolism, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Qian Dong
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jie Qian
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Jian-Jun Li
- State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
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Larsen AI, Løland KH, Hovland S, Bleie Ø, Eek C, Fossum E, Trovik T, Juliebø V, Hegbom K, Moer R, Larsen T, Uchto M, Rotevatn S. Guideline-Recommended Time Less Than 90 Minutes From ECG to Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Is Associated with Major Survival Benefits, Especially in Octogenarians: A Contemporary Report in 11 226 Patients from NORIC. J Am Heart Assoc 2022; 11:e024849. [PMID: 36056722 PMCID: PMC9496403 DOI: 10.1161/jaha.122.024849] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Using contemporary data from NORIC (Norwegian Registry of Invasive Cardiology) we investigated the predictive value of patient age and time from ECG diagnosis to sheath insertion (ECG‐2‐sheath) in primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction (STEMI). Methods and Results Data from 11 226 patients collected from all centers offering 24/7/365 primary percutaneous coronary intervention service were explored. For patients aged <80 years the mortality rates were 5.6% and 7.6% at 30 days and 1 year, respectively. For octogenarians the corresponding rates were 15.0% and 24.2%. The Cox hazard ratio was 2.02 (1.93–2.11, P value <0.0001) per 10 years of patient age. Time from ECG‐2‐sheath was significantly associated with mortality with a 3.6% increase per 30 minutes of time. Using achievement of time goal <90 minutes in patients aged >80 years and mortality at 30 days, mortality was 10.5% and 17.7% for <90 or ≥90 minutes, respectively. The number needed to prevent 1 death was 39 in the whole population and 14 in the elderly. Restricted mean survival gains during median 938 days of follow‐up in patients with ECG‐2‐sheath time <90 minutes were 24 and 76 days for patients aged <80 and ≥80 years, respectively. Conclusions Time from ECG‐diagnosis to sheath insertion is strongly correlated with mortality. This applies especially to octogenarians who derive the most in terms of absolute mortality reduction. Registration URL: https://helsedata.no/en/forvaltere/norwegian‐institute‐of‐public‐health/norwegian‐registry‐of‐invasive‐cardiology/.
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Affiliation(s)
- Alf Inge Larsen
- Department of Cardiology Stavanger University Hospital Stavanger Norway.,Institute of Clinical Sciences, University of Bergen Bergen Norway
| | - Kjetil Halvorsen Løland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway.,Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Siren Hovland
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
| | - Øyvind Bleie
- Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Christian Eek
- Department of Cardiology Oslo University Hospital, Rikshospitalet Oslo Norway
| | - Eigil Fossum
- Department of Cardiology Oslo University Hospital Ullevål, Oslo Norway
| | - Thor Trovik
- Department of Cardiology University Hospital of North Norway Tromsø Norway
| | - Vibeke Juliebø
- Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Knut Hegbom
- Clinic for Heart Disease St. Olav's University Hospital Trondheim Norway
| | | | | | - Michael Uchto
- Division of Internal Medicine Nordlandssykehuset Bodø Norway
| | - Svein Rotevatn
- Norwegian Registry of Invasive Cardiology (NORIC) Haukeland University Hospital Bergen Norway
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Short- and long-term survival after ST-elevation myocardial infarction treated with pharmacoinvasive versus primary percutaneous coronary intervention strategy: a prospective cohort study. BMJ Open 2022. [PMCID: PMC9301816 DOI: 10.1136/bmjopen-2022-061590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective Compare survival in patients with ST-elevation myocardial infarction (STEMI) treated with a pharmacoinvasive (PI) or primary percutaneous coronary intervention (pPCI) strategy based on estimated time to PCI. Design Prospective observational cohort study. Consecutive STEMI patients were registered on admission to our PCI centre and classified in a PI or pPCI group, based on the reperfusion strategy chosen in the prehospital or local hospital location. Time and cause of death was provided by the Norwegian Cause of Death registry. Mortality at 30 days, Kaplan-Meier survival and incidence of cardiovascular (CV) death was estimated. Adjusted effect of PI versus pPCI strategy on survival was estimated using logistic and Cox regression and propensity score weighting. Setting Single-centre registry in Norway during 2005–2011, within a regional STEMI network allocating patients to a PI strategy if estimated time to PCI >120 min. Primary outcomes 30-day mortality and survival during follow-up. Secondary outcome Incidence of CV death during follow-up. Results 4061 STEMI patients <80 years were included, 527 (13%) treated with a PI strategy and 3534 (87%) with a pPCI strategy. Median symptom-to-needle time was 110 min (25–75th percentile 75–163) in the PI group vs symptom-to-balloon 230 min (149–435) in the pPCI group. 30-day mortality was 3.2% and 5.0% in the PI and pPCI groups (ORadjusted0.58 (95% CI 0.30 to 1.13)) and 8-year survival was 85.9% (95% CI 80.9% to 89.6%) and 79.3% (95% CI 76.9% to 81.6%), respectively (HRadjusted 0.72 (95% CI 0.53 to 0.99)). Unadjusted incidence of 8-year CV death was 7.0% (95% CI 4.4% to 10.4%) in the PI group vs 12.4% (95% CI 9.9% to 15.2%) in the pPCI group. Adjusted long-term CV death was also lower in the PI group. Conclusion STEMI patients treated with a PI strategy experienced better survival compared with a pPCI strategy, also when adjusting for baseline characteristics. This supports using a PI strategy for eligible STEMI patients when pPCI cannot be performed within 120 min.
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Efficacy and Safety of Different Courses of Tongxinluo Capsule as Adjuvant Therapy for Coronary Heart Disease after Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2022; 11:jcm11112991. [PMID: 35683377 PMCID: PMC9181557 DOI: 10.3390/jcm11112991] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 12/05/2022] Open
Abstract
Tongxinluo capsule (TXLC) is a widely used traditional Chinese medicine for coronary heart disease (CHD). However, the efficacy and safety of different courses of TXLC for CHD after percutaneous coronary intervention (PCI) have not been systematically evaluated yet. The Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database were searched from the inception to 26 August 2021. A meta-analysis was performed using a fixed- or random-effects model. The risk of adverse cardiovascular events, mortality, or adverse effects was evaluated by risk ratio (RR) with 95% confidence interval (CI). Thirty-four studies involving 3652 patients were finally included. After the 6-month treatment, compared with conventional treatment alone, TXLC combined with conventional treatment achieved better efficacy in lowering the risk of angiographic restenosis (RR = 0.37, 95% CI = 0.28−0.48, p < 0.001), myocardial infarction (RR = 0.38, 95% CI = 0.25−0.60, p < 0.001), heart failure (RR = 0.32, 95% CI = 0.18−0.56, p < 0.001), angina (RR = 0.26, 95% CI = 0.17−0.38, p < 0.001), revascularization (RR = 0.20, 95% CI = 0.09−0.46, p < 0.001), all-cause mortality (RR = 0.24, 95% CI = 0.10−0.58, p = 0.001), and mortality due to any cardiovascular event (RR = 0.27, 95% CI = 0.09−0.80, p = 0.018). After the 12-month treatment, TXLC reduced the recurrence risk of angina (RR = 0.40, 95% CI = 0.20−0.80, p = 0.009). However, there was no difference in any outcomes after the 3-month treatment. Besides, no difference was found in the incidence of adverse effects after the 3-month and 6-month treatments (3 months: RR = 0.73, 95% CI = 0.35−1.56, p = 0.418; 6 months: RR = 1.71, 95% CI = 0.74−3.93, p = 0.209). The certainty of evidence ranged from very low to moderate due to the risk of bias, inconsistency, and imprecision. TXLC showed beneficial effects on reducing the adverse cardiovascular events without compromising safety for CHD patients after PCI on the 6-month course. However, due to the unavoidable risk of bias, more high-quality and long-term studies are still needed to further evaluate the efficacy and safety of TXLC in many countries, not only in China.
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Kvakkestad KM, Gran JM, Eritsland J, Holst Hansen C, Fossum E, Andersen GØ, Halvorsen S. Long-Term Survival after Invasive or Conservative Strategy in Elderly Patients with non-ST-Elevation Myocardial Infarction: A Prospective Cohort Study. Cardiology 2019; 144:79-89. [PMID: 31689705 DOI: 10.1159/000503442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 09/18/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The optimal management of elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still discussed. We aimed to study short- and long-term survival in NSTEMI patients ≥75 years managed with an invasive or a conservative strategy. METHODS NSTEMI patients admitted to Oslo University Hospital Ulleval during 2005-2011 were included consecutively in a prospective registry. Vital status until December 31, 2013, was obtained from the Norwegian Cause of Death Registry. Patients ≥75 years were identified, and 30-day and 7-year survival were analyzed. Logistic- and Cox regression was used to estimate OR and hazard ratio (HR) for death in the invasive versus conservative group, adjusting for registered confounders. RESULTS There were 2,064 NSTEMI patients ≥75 years (48.2% women); 1,200 (58.1%) were treated with an invasive strategy, and were younger, more likely to be male and previously revascularized compared to 864 (41.9%) patients treated conservatively (p < 0.0001 for all). Survival at 30-day was 94.9% in the invasive and 76.6% in the conservative group. For 30-day survivors, 7-year survival was 47.4% (95% CI 42.9-51.8) and 11.6% (95% CI 8.3-15.6), respectively. After multivariate adjustment, an invasive strategy was associated with lower long-term risk (adjusted HR [aHR] 0.49 [95% CI 0.41-0.59]). Actual revascularization was associated with lower risk of long-term mortality compared to angiography only (aHRPCI 0.73 [95% CI 0.59-0.90], aHRCABG 0.43 [95% CI 0.28-0.65]). CONCLUSION In this real-life cohort of NSTEMI patients ≥75 years, 30-day survival was 95%, and 7-year survival was 47% with an invasive strategy. Revascularized patients had a superior long-term prognosis. With a conservative strategy, short- and long-term survival was lower, probably due to selection bias and unmeasured confounding.
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Affiliation(s)
- Kristin Marie Kvakkestad
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway, .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway, .,Department of Medicine, Østfold Hospital, Kalnes, Grålum, Norway,
| | - Jon Michael Gran
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and University of Oslo, Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Eigil Fossum
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Hermans MPJ, Eindhoven DC, van Winden LAM, de Grooth GJ, Blauw GJ, Muller M, Schalij MJ. Frailty score for elderly patients is associated with short-term clinical outcomes in patients with ST-segment elevated myocardial infarction treated with primary percutaneous coronary intervention. Neth Heart J 2019; 27:127-133. [PMID: 30771094 PMCID: PMC6393578 DOI: 10.1007/s12471-019-1240-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Consistent with the aging population in the Western world, there is a growing number of elderly patients with ST-segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PCI) is the recommended reperfusion strategy in elderly patients; risk models to determine which of these patients are prone to have poor clinical outcomes are, however, essential. The purpose of this study was to assess the association between frailty and short-term mortality and PCI-related serious adverse events (SAE) in elderly patients. METHODS All STEMI patients (aged ≥70 years) treated with primary PCI in 2013-2015 at the Leiden University Medical Centre were assessed. The Safety Management Programme (VMS) score was used to identify frail elderly patients. The primary endpoint was 30-day all-cause mortality; the secondary endpoint included 30-day clinical death, target vessel failure, major bleeding, contrast induced kidney insufficiency and stroke. RESULTS A total of 206 patients were included (79 ± 6.4 years, 119 [58%] male). The VMS score was ≥1 in 28% of all cases. Primary and secondary endpoint rates were 5 and 23% respectively. VMS score ≥1 was an independent predictor for both 30-day mortality (odds ratio [OR] 9.6 [95% confidence interval, CI 1.6-56.9] p-value = 0.013) and 30-day SAE (OR 2.9 [95% CI 1.1-7.9] p-value = 0.038). CONCLUSIONS VMS score for frailty is independently associated with short-term mortality and PCI-related SAE in elderly patients with STEMI treated with primary PCI. These results suggest that frailty in elderly patients is an important feature to measure and to be taken into account when developing risk models.
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Affiliation(s)
- M P J Hermans
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - D C Eindhoven
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - L A M van Winden
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J de Grooth
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - G J Blauw
- Department of Internal/Geriatric Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - M Muller
- Department of Internal/Geriatric Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - M J Schalij
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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Li M, Li C, Chen S, Sun Y, Hu J, Zhao C, Qiu R, Zhang X, Zhang Q, Tian G, Shang H. Potential Effectiveness of Chinese Patent Medicine Tongxinluo Capsule for Secondary Prevention After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2018; 9:830. [PMID: 30123126 PMCID: PMC6085586 DOI: 10.3389/fphar.2018.00830] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Accepted: 07/10/2018] [Indexed: 01/28/2023] Open
Abstract
Background: Chinese patent medicine Tongxinluo capsule (TXL) is commonly used for cardio-cerebrovascular diseases. Previous research had demonstrated that TXL exhibited great clinical effects on the treatment of acute myocardial infarction (AMI), however there is a lack of systematic review. The purpose of this study was to evaluate the potential effectiveness and safety of TXL for secondary prevention in patients with AMI. Method: We searched 6 databases to identify relevant randomized controlled trials (RCTs) from inceptions to December 30, 2017. Two review authors independently assessed the methodological quality and analyzed data by the RevMan 5.3 software. The publication bias was assessed through funnel plot and Begg's test. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for evaluating the quality of evidence. Results: We included 19 RCTs in this review and performed a meta-analysis based on 16 studies. There were statistical differences of TXL treatment group in reducing primary cardiovascular events (cardiac death [RR = 0.27, 95%CI: 0.08~0.95, I2 = 0%], recurrent myocardial reinfarction [RR = 0.38, 95%CI: 0.20~0.74, I2 = 0%], arrhythmia [RR = 0.44, 95%CI: 0.30~0.66, I2 = 0%], recurrent angina pectoris [RR = 0.34, 95%CI: 0.17~0.69, I2 = 0%]). TXL could improve cardiac function (LVEF [MD = 4.10, 95%CI: 3.95~4.25, I2 = 0%]), regulate blood lipid TC [MD = -0.66, 95%CI: -0.94 ~ -0.37, I2 = 74%], TG [MD = -0.38, 95%CI: -0.62 ~ -0.14, I2 = 70%], LDL-C[-0.40, 95%CI: -0.65 ~ -0.16, I2 = 88%), decrease the level of hs-CRP (4-week: MD = -0.78, 95%CI: -0.97 ~ -0.60, I2 = 20%; Over 4-week: MD = -1.36, 95%CI: -1.55 ~ -1.17, I2 = 20%). However, TXL has little effects on revascularization [RR = 0.45, 95%CI: 0.13~1.56, I2 = 0%], recurrent heart failure (RR = 0.83, 95%CI: 0.27~2.57, I2 = 0%), and HDL-C (MD = 0.14, 95%CI: 0.00 ~0.29, I2 = 73%). Furthermore, TXL treatment group was more prone to suffer gastrointestinal discomfort. Conclusion: Chinese patent medicine TXL seemed beneficial for secondary prevention after AMI. This potential benefit needs to be further assessed through more rigorous RCTs. Systematic review registration number in the PROSPERO register: CRD42017068417.
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Affiliation(s)
- Min Li
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chengyu Li
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Shiqi Chen
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Yang Sun
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Jiayuan Hu
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Chen Zhao
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Ruijin Qiu
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaoyu Zhang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qin Zhang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Guihua Tian
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Hongcai Shang
- Key laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
- Institute of Integration of Traditional Chinese and Western Medicine, Guangzhou Medical University, Guangzhou, China
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11
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Walker DM, Gale CP, Lip G, Martin-Sanchez FJ, McIntyre HF, Mueller C, Price S, Sanchis J, Vidan MT, Wilkinson C, Zeymer U, Bueno H. Editor's Choice - Frailty and the management of patients with acute cardiovascular disease: A position paper from the Acute Cardiovascular Care Association. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:176-193. [PMID: 29451402 DOI: 10.1177/2048872618758931] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Frailty is increasingly seen among patients with acute cardiovascular disease. A combination of an ageing population, improved disease survival, treatable long-term conditions as well as a greater recognition of the syndrome has accelerated the prevalence of frailty in the modern world. Yet, this has not been matched by an expansion of research. National and international bodies have identified acute cardiovascular disease in the frail as a priority area for care and an entity that requires careful clinical decisions, but there remains a paucity of guidance on treatment efficacy and safety, and how to manage this complex group. This position paper from the Acute Cardiovascular Care Association presents the latest evidence about frailty and the management of frail patients with acute cardiovascular disease, and suggests avenues for future research.
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Affiliation(s)
| | - C P Gale
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - G Lip
- 3 Institute for Cardiovascular Sciences, University of Birmingham, UK.,4 Aalborg Thrombosis Research Unit, Aalborg University, Denmark
| | | | | | - C Mueller
- 6 Cardiovascular Research Institute Basel, University of Basel, Switzerland
| | - S Price
- 7 Royal Brompton Hospital, UK
| | - J Sanchis
- 8 Department of Cardiology, University of Valencia, Spain.,9 University of Valencia, CIBER CV, Spain
| | - M T Vidan
- 10 Department of Geriatrics, Universidad Complutense de Madrid Dr Esquerdo, Spain
| | - C Wilkinson
- 2 Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - U Zeymer
- 11 Klinikum Ludwigshafen und Institut for Herzinfarktforschung, Germany
| | - H Bueno
- 12 National Centre for Cardiovascular Research, Spain
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12
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Kvakkestad KM, Sandvik L, Andersen GØ, Sunde K, Halvorsen S. Long-term survival in patients with acute myocardial infarction and out-of-hospital cardiac arrest: A prospective cohort study. Resuscitation 2017; 122:41-47. [PMID: 29155294 DOI: 10.1016/j.resuscitation.2017.11.047] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/04/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022]
Abstract
AIM To compare short- and long-term survival in patients admitted to hospital after acute myocardial infarction (AMI) with and without out-of-hospital cardiac arrest (OHCA). METHODS Prospective cohort study of all AMI patients admitted to Oslo University Hospital Ulleval from September 1, 2005 to December 31, 2011. All-cause mortality was obtained from the Norwegian Cause of Death Registry with censoring date December 31, 2013. Cumulative survival was assessed with the Kaplan-Meier and the Life-table method. Logistic- and Cox regression were used for risk comparisons. RESULTS We identified 404 AMI patients with OHCA and 9425 AMI patients without. AMI patients without OHCA were categorized as ST-elevation myocardial infarction (STEMI, n=4522) or non-STEMI (NSTEMI, n=4903). Mean age was 63.6±standard deviation (SD) 12.5, 63.8±13.1 and 69.7±13.6 years in OHCA, STEMI and NSTEMI, respectively. Coronary angiography with subsequent percutaneous coronary intervention if indicated, was performed in 87% of OHCA, 97% of STEMI and 80% of NSTEMI patients. Thirty-day survival was 63%, 94% and 94%, and 8-year survival was 49%, 74%, and 57%, respectively. Among patients surviving the first 30days, no significant difference in risk during long-term follow-up was found (adjusted Hazard Ratio (aHR)OHCAvsSTEMI 1.15 [95% CI 0.82-1.60], aHROHCAvsNSTEMI 0.89 [95% CI 0.64-1.24]). CONCLUSIONS Long-term survival after OHCA due to AMI was good, with 49% of admitted patients being alive after eight years. Although short-term mortality remained high, OHCA patients alive after 30days had similar long-term risk as AMI patients without OHCA.
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Affiliation(s)
- Kristin M Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, P.O. Box 1122 Blindern, 0317 Oslo, Norway
| | - Geir Øystein Andersen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Kjetil Sunde
- Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway; Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424 Oslo, Norway; Institute of Clinical Medicine, University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway
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13
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Kvakkestad KM, Wang Fagerland M, Eritsland J, Halvorsen S. Gender differences in all-cause, cardiovascular and cancer mortality during long-term follow-up after acute myocardial infarction; a prospective cohort study. BMC Cardiovasc Disord 2017; 17:75. [PMID: 28288586 PMCID: PMC5348805 DOI: 10.1186/s12872-017-0508-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 03/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Gender differences in short-term mortality in acute myocardial infarction (AMI) have been studied extensively, whereas gender differences in long-term mortality and cause of death largely remain unknown. The aim of this study was to assess the long-term risk of all-cause, cardiovascular and cancer death after AMI in women compared to men. METHODS Consecutive AMI patients were enrolled in a prospective registry between 2005 and 2011. Date and cause of death were obtained by linkage with the Norwegian Cause of Death Registry, with censoring date 31 December 2012. AMI patients with ST-segment elevation (STEMI, n = 5159) and without (NSTEMI, n = 4899) were analysed separately. RESULTS The 5-years all-cause mortality rates in STEMI were 29% in women vs. 17% in men, and 42% vs. 29% in NSTEMI, respectively. After adjustment for age and other confounders, women with STEMI had similar (HR 1.13 [95% CI: 0.98-1.32]) and women with NSTEMI lower (HR 0.82 [95% CI: 0.73-0.92]) risk of long-term all-cause mortality compared to men. Competing-risks analysis showed no significant gender differences in age-adjusted risk of cardiovascular death nor of cancer death. In both genders, the annual risk of cardiovascular death was low after 1 year, but exceeded annual risk of cancer death throughout follow-up. CONCLUSION During long-term follow-up, women with STEMI had similar and women with NSTEMI lower adjusted risk of all-cause mortality compared to men. Age-adjusted risk of death due to cardiovascular disease was similar in both genders and higher than risk of death due to cancer throughout the follow-up period.
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Affiliation(s)
- Kristin Marie Kvakkestad
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway.,University of Oslo, Postboks 1072 Blindern, 0316, Oslo, Norway
| | - Morten Wang Fagerland
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Postboks 1110 Blindern, 0317, Oslo, Norway
| | - Jan Eritsland
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Postboks 4950 Nydalen, 0424, Oslo, Norway. .,University of Oslo, Postboks 1072 Blindern, 0316, Oslo, Norway.
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14
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de la Torre Hernández JM, Brugaletta S, Gómez Hospital JA, Baz JA, Pérez de Prado A, López Palop R, Cid B, García Camarero T, Diego A, Gimeno de Carlos F, Fernández Díaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas Valle JM, Elízaga J, Arrebola AL, Ruiz Arroyo JR, Hernández-Hernández F, Salvatella N, Monteagudo M, Gómez Jaume A, Carrillo X, Martín Reyes R, Lozano F, Rumoroso JR, Andraka L, Domínguez AJ. Angioplastia primaria en mayores de 75 años. Perfil de pacientes y procedimientos, resultados y predictores pronósticos en el registro ESTROFA IM + 75. Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.06.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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15
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de la Torre Hernández JM, Brugaletta S, Gómez Hospital JA, Baz JA, Pérez de Prado A, López Palop R, Cid B, García Camarero T, Diego A, Gimeno de Carlos F, Fernández Díaz JA, Sanchis J, Alfonso F, Blanco R, Botas J, Navarro Cuartero J, Moreu J, Bosa F, Vegas Valle JM, Elízaga J, Arrebola AL, Ruiz Arroyo JR, Hernández-Hernández F, Salvatella N, Monteagudo M, Gómez Jaume A, Carrillo X, Martín Reyes R, Lozano F, Rumoroso JR, Andraka L, Domínguez AJ. Primary Angioplasty in Patients Older Than 75 Years. Profile of Patients and Procedures, Outcomes, and Predictors of Prognosis in the ESTROFA IM+75 Registry. ACTA ACUST UNITED AC 2016; 70:81-87. [PMID: 27840148 DOI: 10.1016/j.rec.2016.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 06/13/2016] [Indexed: 01/20/2023]
Abstract
INTRODUCTION AND OBJECTIVES The proportion of elderly patients undergoing primary angioplasty is growing. The present study describes the clinical profile, procedural characteristics, outcomes, and predictors of outcome. METHODS A 31-center registry of consecutive patients older than 75 years treated with primary angioplasty. Clinical and procedural data were collected, and the patients underwent clinical follow-up. RESULTS The study included 3576 patients (39.3% women, 48.5% with renal failure, 11.5% in Killip III or IV, and 29.8% with>6hours of chest pain). Multivessel disease was present in 55.4% and nonculprit lesions were additionally treated in 24.8%. Radial access was used in 56.4%, bivalirudin in 11.8%, thromboaspiration in 55.9%, and drug-eluting stents in 26.6%. The 1-month and 2-year incidences of cardiovascular death were 10.1% and 14.7%, respectively. The 2-year rates of definite or probable thrombosis, repeat revascularization, and BARC bleeding>2 were 3.1%, 2.3%, and 4.2%, respectively. Predictive factors were diabetes mellitus, renal failure, atrial fibrillation, delay to reperfusion>6hours, ejection fraction<45%, Killip class III-IV, radial access, bivalirudin, drug-eluting stents, final TIMI flow of III, and incomplete revascularization at discharge. CONCLUSIONS Notable registry findings include frequently delayed presentation and a high prevalence of adverse factors such as renal failure and multivessel disease. Positive procedure-related predictors include shorter delay, use of radial access, bivalirudin, drug-eluting stents, and complete revascularization before discharge.
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Affiliation(s)
- José M de la Torre Hernández
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
| | - Salvatore Brugaletta
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínic, Barcelona, Spain
| | - Joan A Gómez Hospital
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José A Baz
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Vigo, Vigo, Pontevedra, Spain
| | - Armando Pérez de Prado
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de León, León, Spain
| | - Ramón López Palop
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de San Juan, San Juan de Alicante, Alicante, Spain
| | - Belén Cid
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Tamara García Camarero
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Alejandro Diego
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Salamanca, Salamanca, Spain
| | - Federico Gimeno de Carlos
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Valladolid, Valladolid, Spain
| | - José A Fernández Díaz
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Juan Sanchis
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Valencia, Valencia, Spain
| | - Fernando Alfonso
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de La Princesa, Madrid, Spain
| | - Roberto Blanco
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Cruces, Bilbao, Vizcaya, Spain
| | - Javier Botas
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Javier Navarro Cuartero
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital General de Albacete, Albacete, Spain
| | - José Moreu
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Salud, Toledo, Spain
| | - Francisco Bosa
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - José M Vegas Valle
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Cabueñes, Gijón, Asturias, Spain
| | - Jaime Elízaga
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio L Arrebola
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain
| | - José R Ruiz Arroyo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Clínico de Zaragoza, Zaragoza, Spain
| | | | - Neus Salvatella
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital del Mar, Grup de Recerca Biomèdica en Malalties del Cor, IMIM (Hospital del Mar Research Institute), Barcelona, Spain
| | - Marta Monteagudo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Dr. Peset, Valencia, Spain
| | - Alfredo Gómez Jaume
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Son Espases, Palma de Mallorca, Baleares, Spain
| | - Xavier Carrillo
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Roberto Martín Reyes
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Fundación Jiménez Díaz, Madrid, Spain
| | - Fernando Lozano
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Ciudad Real, Ciudad Real, Spain
| | - José R Rumoroso
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Galdakao, Vizcaya, Spain
| | - Leire Andraka
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital de Basurto, Bilbao, Vizcaya, Spain
| | - Antonio J Domínguez
- Unidad de Cardiología Intervencionista, Servicio de Cardiología, Hospital Virgen de la Victoria, Málaga, Spain
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Jortveit J, Govatsmark RES, Langørgen J, Hole T, Mannsverk J, Olsen S, Risøe C, Halvorsen S. Gender differences in the assessment and treatment of myocardial infarction. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2016; 136:1215-22. [PMID: 27554562 DOI: 10.4045/tidsskr.16.0224] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Previous studies have shown that there are gender-related differences in the assessment and treatment of myocardial infarction, despite international guidelines that prescribe identical treatment for women and men. We investigated whether these differences occurred in Norway. MATERIAL AND METHOD All patients admitted to Norwegian hospitals with myocardial infarction from 1 January 2013 to 31 December 2014 and registered in the Norwegian Myocardial Infarction Registry were included. Data from the registry were used to analyse differences in the assessment, treatment, complications and survival of women and men in different age groups. RESULTS A total of 26 447 myocardial infarctions were registered in the Norwegian Myocardial Infarction Registry in the period 2013 – 2014. Fewer women than men were assessed by means of coronary angiography. Percutaneous coronary intervention (PCI) was used to virtually the same extent for both genders if coronary stenosis was found. Women were recommended secondary prophylactic medication to a lesser extent than men. There were no major differences between men and women in the incidence of complications in the course following myocardial infarction or in survival. INTERPRETATION Fewer women than men suffering acute myocardial infarction were assessed by means of coronary angiography, and women were recommended secondary prophylactic medication less often than men. The reason for the gender differences is not known, but comorbidity and a potentially greater risk of adverse reactions in women may be contributory factors. The different views of doctors providing treatment may also play a part.
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Affiliation(s)
| | | | | | | | - Jan Mannsverk
- Hjertemedisinsk avdeling Universitetssykehuset Nord-Norge
| | - Siv Olsen
- Medisinsk klinikk Universitetssykehuset Nord-Norge, Harstad
| | - Cecilie Risøe
- Kardiologisk avdeling Oslo universitetssykehus, Rikshospitalet
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17
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Bromage DI, Jones DA, Rathod KS, Grout C, Iqbal MB, Lim P, Jain A, Kalra SS, Crake T, Astroulakis Z, Ozkor M, Rakhit RD, Knight CJ, Dalby MC, Malik IS, Mathur A, Redwood S, MacCarthy PA, Wragg A. Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc 2016; 5:e003027. [PMID: 27353606 PMCID: PMC4937253 DOI: 10.1161/jaha.115.003027] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 04/25/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND ST-segment elevation myocardial infarction is increasingly common in octogenarians, and optimal management in this cohort is uncertain. This study aimed to describe the outcomes of octogenarians with ST-segment elevation myocardial infarction treated by primary percutaneous coronary intervention. METHODS AND RESULTS We analyzed 10 249 consecutive patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention between 2005 and 2011 at 8 tertiary cardiac centers across London, United Kingdom. The primary end point was all-cause mortality at a median follow-up of 3 years. In total, 1051 patients (10.3%) were octogenarians, with an average age of 84.2 years, and the proportion increased over the study period (P=0.04). In-hospital mortality (7.7% vs 2.4%, P<0.0001) and long-term mortality (51.6% vs 12.8%, P<0.0001) were increased in octogenarians compared with patients aged <80 years, and age was an independent predictor of mortality in a fully adjusted model (hazard ratio 1.07, 95% CI 1.07-1.09, P<0.0001). Time-stratified analysis revealed an increasingly elderly and more complex cohort over time. Nonetheless, long-term mortality rates among octogenarians remained static over time, and this may be attributable to improved percutaneous coronary intervention techniques, including significantly higher rates of radial access and lower bleeding complications. Variables associated with bleeding complications were similar between octogenarian and younger cohorts. CONCLUSIONS In this large registry, octogenarians undergoing primary percutaneous coronary intervention had a higher rate of complications and mortality compared with a younger population. Over time, octogenarians undergoing primary percutaneous coronary intervention increased in number, age, and complexity. Nevertheless, in-hospital outcomes were reasonable, and long-term mortality rates were static.
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Affiliation(s)
- Daniel I Bromage
- The Hatter Cardiovascular Institute, University College London, London, UK
| | - Daniel A Jones
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | | | - Claire Grout
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - M Bilal Iqbal
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Pitt Lim
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Ajay Jain
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Sundeep S Kalra
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Tom Crake
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | - Zoe Astroulakis
- St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, UK
| | - Mick Ozkor
- UCL Hospitals NHS Foundation Trust, Heart Hospital, London, UK
| | | | | | - Miles C Dalby
- Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK
| | - Iqbal S Malik
- Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, UK
| | - Anthony Mathur
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
| | - Simon Redwood
- BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, UK
| | - Philip A MacCarthy
- Kings College Hospital, King's College Hospital NHS Foundation Trust, London, UK
| | - Andrew Wragg
- Barts Health NHS Trust, St Bartholomew's Hospital, London, UK
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