1
|
Hoang TH, Maiskov VV, Merai IA, Kobalava ZD. Prevalence, Clinical Features, Treatment, and Outcomes in Patients With Myocardial Infarction With Non-Obstructive Coronary Arteries. KARDIOLOGIIA 2024; 64:56-63. [PMID: 39102574 DOI: 10.18087/cardio.2024.7.n2526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 07/28/2023] [Indexed: 08/07/2024]
Abstract
AIM To study clinical and demographic characteristics, treatment options, and clinical outcomes in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) compared with patients with myocardial infarction with obstructive coronary arteries (MIOCA). MATERIAL AND METHODS This single-center prospective observational study included 712 successive patients diagnosed with acute myocardial infarction (MI), who routinely underwent direct coronary angiography. Based on the presence of stenosing coronary atherosclerosis, the patients were divided into two groups: MIOCA (coronary stenosis ≥50%) and MINOCA (coronary stenosis <50% without other, alternative causes). Clinical outcomes included in-hospital and long-term overall mortality, and cardiovascular rehospitalization. The median follow-up was 1.5 years. RESULTS MINOCA was diagnosed in 73 (10.3%) patients, 37 (50%) of whom were women. The median age of patients with MINOCA was 61 years and in the MIOCA group 65 years. No significant differences in cardiovascular risk factors were found between patients with MINOCA and MIOCA. In 53.4% of cases, the cause of MINOCA was a discrepancy between the myocardial oxygen demand and supply, and in 35.6% of cases, the cause was hypertensive crisis and pulmonary edema. The factors associated with MINOCA included an age ≤58 years, female gender, absence of the ST-segment elevation, absence of areas of impaired local contractility, and presence of aortic stenosis and bronchopulmonary infection. Patients with MINOCA were less likely to be prescribed acetylsalicylic acid, P2Y12 inhibitors, dual antiplatelet therapy, beta-blockers, and statins (p<0.05). Data on long-term outcomes were available for 87.5% of patients (n=623). The prognosis of patients with MIOCA was comparable for in-hospital mortality (1.5% vs. 6.2%; p=0.161) and long-term overall mortality (6.1% vs. 14.7%; p=0.059). Cardiovascular rehospitalizations were more frequent in the MINOCA group (33.3% vs. 21.5%; p=0.042). CONCLUSION The prevalence of MINOCA in our study was 10.3% among all patients with acute MI. MINOCA patients had comparable generally recognized cardiovascular risk factors with MIOCA patients. MINOCA patients had a comparable prognosis for in-hospital and long-term mortality and more often required cardiovascular rehospitalization.
Collapse
Affiliation(s)
- T H Hoang
- Pham Ngoc Thach University of Medicine; Tam Duc Cardiology Hospital
| | - V V Maiskov
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - I A Merai
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| | - Zh D Kobalava
- Russian University of Peoples' Friendship; Vinogradov Municipal Clinical Hospital
| |
Collapse
|
2
|
Narendren A, Whitehead N, Burrell LM, Yudi MB, Yeoh J, Jones N, Weinberg L, Miles LF, Lim HS, Clark DJ, Al-Fiadh A, Farouque O, Koshy AN. Management of Acute Coronary Syndromes in Older People: Comprehensive Review and Multidisciplinary Practice-Based Recommendations. J Clin Med 2024; 13:4416. [PMID: 39124683 PMCID: PMC11312870 DOI: 10.3390/jcm13154416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 07/20/2024] [Accepted: 07/22/2024] [Indexed: 08/12/2024] Open
Abstract
Managing health care for older adults aged 75 years and older can pose unique challenges stemming from age-related physiological differences and comorbidities, along with elevated risk of delirium, frailty, disability, and polypharmacy. This review is aimed at providing a comprehensive analysis of the management of acute coronary syndromes (ACS) in older patients, a demographic substantially underrepresented in major clinical trials. Because older patients often exhibit atypical ACS symptoms, a nuanced diagnostic and risk stratification approach is necessary. We aim to address diagnostic challenges for older populations and highlight the diminished sensitivity of traditional symptoms with age, and the importance of biomarkers and imaging techniques tailored for older patients. Additionally, we review the efficacy and safety of pharmacological agents for ACS management in older people, emphasizing the need for a personalized and shared decision-making approach to treatment. This review also explores revascularization strategies, considering the implications of invasive procedures in older people, and weighing the potential benefits against the heightened procedural risks, particularly with surgical revascularization techniques. We explore the perioperative management of older patients experiencing myocardial infarction in the setting of noncardiac surgeries, including preoperative risk stratification and postoperative care considerations. Furthermore, we highlight the critical role of a multidisciplinary approach involving cardiologists, geriatricians, general and internal medicine physicians, primary care physicians, and allied health, to ensure a holistic care pathway in this patient cohort.
Collapse
Affiliation(s)
- Ahthavan Narendren
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Cardiology, Northern Health, Epping, VIC 3076, Australia
| | - Natalie Whitehead
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
| | - Louise M. Burrell
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Matias B. Yudi
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
| | - Julian Yeoh
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
| | - Nicholas Jones
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Laurence Weinberg
- Department of Critical Care, The University of Melbourne, Melbourne, VIC 3010, Australia; (L.W.); (L.F.M.)
- Department of Anaesthesia, Austin Health, Heidelberg, VIC 3084, Australia
| | - Lachlan F. Miles
- Department of Critical Care, The University of Melbourne, Melbourne, VIC 3010, Australia; (L.W.); (L.F.M.)
- Department of Anaesthesia, Austin Health, Heidelberg, VIC 3084, Australia
| | - Han S. Lim
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Cardiology, Northern Health, Epping, VIC 3076, Australia
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - David J. Clark
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Ali Al-Fiadh
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Omar Farouque
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
| | - Anoop N. Koshy
- Department of Cardiology, Austin Health, Heidelberg, VIC 3084, Australia; (A.N.); (N.W.); (L.M.B.); (M.B.Y.); (J.Y.); (N.J.); (H.S.L.); (D.J.C.); (A.A.-F.); (O.F.)
- Department of Medicine, The University of Melbourne, Melbourne, VIC 3052, Australia
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, VIC 3052, Australia
| |
Collapse
|
3
|
Yao H, Touré C, Ekou A, Sepih E, Cottin Y, Zeller M, Putot A, N'Guetta R. Type 2 Myocardial Infarction in a Sub-Saharan Africa Population: Challenging the Current Concepts-Data From REACTIV. J Am Heart Assoc 2024; 13:e032149. [PMID: 38979833 PMCID: PMC11292756 DOI: 10.1161/jaha.123.032149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 06/13/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND From a large observational acute coronary syndrome registry in Côte d'Ivoire, we aimed to assess incidence, clinical presentation, management, and in-hospital outcomes for type 2 myocardial infarction (T2MI) compared with type 1 MI. METHODS AND RESULTS We conducted a cross-sectional monocentric study using data from REACTIV (Registre des Infarctus de Côte d'Ivoire) at the Abidjan Heart Institute. All patients hospitalized with MI between 2018 and 2022 who underwent coronary angiography were included. For each patient, sociodemographic data, cardiovascular risk factors and history, and clinical and paraclinical presentation were collected at admission. In-hospital outcomes, including major adverse cardiovascular events and mortality, were reported. Among 541 consecutive patients hospitalized with MI, 441 met the definition of type 1 MI or T2MI. T2MI accounted for 14.1% of cases. Patients with T2MI showed a trend toward slightly younger age (54 versus 58 years, P=0.09). Patients with T2MI seemed to have less severe coronary artery disease, with less frequent multivessel disease (P<0.001). Main triggering factors for T2MI were coronary embolism (24.2%), severe hypertension with or without left ventricular hypertrophy (22.6%), and tachyarrhythmia (16.1%). In-hospital event rates were low in both MI types. Although the difference was nonsignificant, death rates for patients with type 1 MI tended to be higher than for patients with T2MI, as well as occurrence of major adverse cardiovascular events. CONCLUSIONS Our study revealed disparities in clinical characteristics, angiographic features, cause, and in-hospital outcomes in T2MI in our population compared with Western populations. These results suggest the heterogeneity of T2MI and the potential causative and demographic variability depending on geographical area.
Collapse
Affiliation(s)
- Hermann Yao
- PEC2, EA 7460, UFR Health SciencesUniversity of Bourgogne Franche ComtéDijonFrance
- Abidjan Heart InstituteAbidjanCôte d’Ivoire
| | | | | | | | - Yves Cottin
- Cardiology DepartmentUniversity Hospital Center Dijon BourgogneDijonFrance
| | - Marianne Zeller
- PEC2, EA 7460, UFR Health SciencesUniversity of Bourgogne Franche ComtéDijonFrance
| | - Alain Putot
- PEC2, EA 7460, UFR Health SciencesUniversity of Bourgogne Franche ComtéDijonFrance
- Internal Medicine DepartmentMont Blanc HospitalSallanchesFrance
| | | |
Collapse
|
4
|
Ma J, Bian S, Li A, Chen Q. Characteristics and Prognosis of Type 2 Myocardial Infarction Through Worsening Renal Function and NT-proBNP in Older Adults with Pneumonia. Clin Interv Aging 2024; 19:589-597. [PMID: 38562970 PMCID: PMC10984204 DOI: 10.2147/cia.s438541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background Type 2 myocardial infarction (MI) is becoming more recognized. This study aimed to assess the factors linked to type 2 MI in older adults with pneumonia and further determine the predictive factors of 90-day adverse events (refractory heart failure, cardiogenic shock, and all-cause mortality). Methods A single-center retrospective analysis was conducted among older adults with pneumonia. The primary outcome was the prevalence of type 2 MI. The secondary objective was to assess the adverse events in these patients with type 2 MI within 90 days. Results A total of 2618 patients were included. Of these, 361 patients (13.8%) suffered from type 2 MI. Multivariable predictors of type 2 MI were chronic kidney disease (CKD), age-adjusted Charlson comorbidity index (ACCI) score, and NT-proBNP > 4165pg/mL. Moreover, the independent predictive factors of 90-day adverse events included NT-proBNP > 4165pg/mL, age, ACCI score, and CKD. The Kaplan-Meier adverse events curves revealed that the type 2 MI patients with CKD and NT-proBNP > 4165pg/mL had a higher risk than CKD or NT-proBNP > 4165pg/mL alone. Conclusion Type 2 MI in older pneumonia hospitalization represents a heterogeneous population. Elevated NT-proBNP level and prevalence of CKD are important predictors of type 2 MI and 90-day adverse events in type 2 MI patients.
Collapse
Affiliation(s)
- Jinling Ma
- Department of Geriatric Cardiology, the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Suyan Bian
- Department of Geriatric Cardiology, the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Ang Li
- Department of Geriatric Cardiology, the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| | - Qian Chen
- Department of Geriatric Cardiology, the Second Medical Center and National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, People’s Republic of China
| |
Collapse
|
5
|
Yao H, Zeller M, N’Guetta R, Cottin Y, Putot A. Coronary Artery Disease: A Key Issue in Type 2 Myocardial Infarction: Systematic Review and Recent Findings. J Clin Med 2023; 12:6412. [PMID: 37835056 PMCID: PMC10573533 DOI: 10.3390/jcm12196412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/27/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
Underlying coronary artery disease (CAD) is increasingly considered to be a key issue in the pathophysiology of type 2 myocardial infarction (T2MI). In T2MI, which is attributable to a mismatch between oxygen supply/demand, CAD is common and appears to be more severe than in type 1 myocardial infarction (T1MI). Little is known about the heterogeneous mechanisms that cause supply/demand imbalance and non-coronary triggers leading to myocardial ischemia or about how they are potentially modulated by the presence and severity of CAD. CAD seems to be underrecognized and undertreated in T2MI, even though previous studies have demonstrated both the short and long-term prognostic value of CAD in T2MI. In this literature review, we attempt to address the prevalence and severity of CAD, challenges in the discrimination between T2MI and T1MI in the presence of CAD, and the prognostic value of CAD among patients with T2MI.
Collapse
Affiliation(s)
- Hermann Yao
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, 25000 Dijon, France;
- Interventional Cardiology Department, Abidjan Heart Institute, Abidjan 01 BP V 206, Côte d’Ivoire;
| | - Marianne Zeller
- PEC2, EA 7460, UFR Health Sciences, University of Bourgogne Franche Comté, 25000 Dijon, France;
| | - Roland N’Guetta
- Interventional Cardiology Department, Abidjan Heart Institute, Abidjan 01 BP V 206, Côte d’Ivoire;
| | - Yves Cottin
- Cardiology Department, University Hospital Center Dijon Bourgogne, 21000 Dijon, France;
| | - Alain Putot
- Internal Medicine Department, Mont Blanc Hospital, 74703 Sallanches, France;
| |
Collapse
|
6
|
Sattar Y, Taha A, Patel N, Victor V, Titus A, Aziz S, Gonuguntla K, Thyagaturu H, Atti L, Micho T, Almas T, Alraies MC, Balla S. Cardiovascular outcomes of type 2 myocardial infarction among COVID-19 patients: a propensity matched national study. Expert Rev Cardiovasc Ther 2023; 21:365-371. [PMID: 37038300 DOI: 10.1080/14779072.2023.2200933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
BACKGROUND Myocardial infarction Type II (T2MI) is a prevalent cause of troponin elevation secondary to a variety of conditions causing stress/demand mismatch. The impact of T2MI on outcomes in patients hospitalized with COVID-19 is not well studied. METHODS The Nationwide Inpatient Sample database from the year 2020 was queried to identify COVID-19 patients with T2MI during the index hospitalization. Clinical Modification (ICD-10-CM) codes "U07.1" and "I21.A1" were used as disease identifiers for COVID-19 and T2MI respectively. Multivariate adjusted Odds ratio (aOR) and propensity score matching (PSM) was done to compare outcomes among COVID patients with and without T2MI. The primary outcome was in-hospital mortality. RESULTS A total of 1,678,995 COVID-19-weighted hospitalizations were identified in the year 2020, of which 41,755 (2.48%) patients had T2MI compared to 1,637,165 (97.5%) without T2MI. Patients with T2MI had higher adjusted odds of in-hospital mortality (aOR 1.44, PSM 32.27%, 95% CI 1.34-1.54) sudden cardiac arrest (aOR 1.29, PSM 6.6 %, 95% CI 1.17-1.43) and CS (aOR 2.16, PSM 2.73%, 95% CI 1.85-2.53) compared to patients without T2MI. The rate of coronary angiography (CA) in T2MI with COVID was 1.19 %, with significant use of CA among patients with T2MI complicated by CS compared to those without CS (4% vs 1.1%, p<0.001). Additionally, COVID-19 patients with T2MI had an increased prevalence of sepsis compared to COVID-19 without T2MI (48% vs 24.1%, p<0.001). CONCLUSION COVID-19 patients with T2MI had worse cardiovascular outcomes with significantly higher in-hospital mortality, SCA, and CS compared to those without T2MI. Long-term mortality and morbidity among COVID-19 patients who had T2MI will need to be clarified in future studies.
Collapse
Affiliation(s)
| | - Amro Taha
- Weiss Memorial Hospital, Chicago, IL, USA
| | - Neel Patel
- New York Medical College/Landmark Medical Center, Woonsocket, RI, USA
| | | | - Anoop Titus
- Canton Medical Education Foundation, Canton, Ohio, USA
| | - Shazia Aziz
- Carle Foundation Hospital, Urbana, Illinois, USA
| | | | | | - Lalitsiri Atti
- Sri Venkateswara Medical College, Dr. NTR University of Health Sciences, India
| | - Tarec Micho
- Department of Internal Medicine, Div of Hospitalist Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | | |
Collapse
|
7
|
Damluji AA, Forman DE, Wang TY, Chikwe J, Kunadian V, Rich MW, Young BA, Page RL, DeVon HA, Alexander KP. Management of Acute Coronary Syndrome in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation 2023; 147:e32-e62. [PMID: 36503287 DOI: 10.1161/cir.0000000000001112] [Citation(s) in RCA: 64] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diagnostic and therapeutic advances during the past decades have substantially improved health outcomes for patients with acute coronary syndrome. Both age-related physiological changes and accumulated cardiovascular risk factors increase the susceptibility to acute coronary syndrome over a lifetime. Compared with younger patients, outcomes for acute coronary syndrome in the large and growing demographic of older adults are relatively worse. Increased atherosclerotic plaque burden and complexity of anatomic disease, compounded by age-related cardiovascular and noncardiovascular comorbid conditions, contribute to the worse prognosis observed in older individuals. Geriatric syndromes, including frailty, multimorbidity, impaired cognitive and physical function, polypharmacy, and other complexities of care, can undermine the therapeutic efficacy of guidelines-based treatments and the resiliency of older adults to survive and recover, as well. In this American Heart Association scientific statement, we (1) review age-related physiological changes that predispose to acute coronary syndrome and management complexity; (2) describe the influence of commonly encountered geriatric syndromes on cardiovascular disease outcomes; and (3) recommend age-appropriate and guideline-concordant revascularization and acute coronary syndrome management strategies, including transitions of care, the use of cardiac rehabilitation, palliative care services, and holistic approaches. The primacy of individualized risk assessment and patient-centered care decision-making is highlighted throughout.
Collapse
|
8
|
Thevenin M, Putot S, Manckoundia P, Putot A. Transfusion in Older Anemic Patients: Should the Troponin Value Be Taken into Account? Am J Med 2022; 135:1008-1015.e1. [PMID: 35469733 DOI: 10.1016/j.amjmed.2022.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 03/28/2022] [Accepted: 03/28/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Anemia is common in older individuals, but it is not known whether the prognostic impact of transfusion differs according to cardiac troponin concentration. METHODS During this 2-year retrospective study in an acute geriatric unit, 514 patients with hemoglobin <10 g/dL and troponin sampling were included. Thirty-day and 1-year mortality were compared according to transfusion status and troponin and hemoglobin levels. RESULTS Of the 514 anemic patients included (median age 88 years), 157 (31%) had elevated troponin concentrations. These patients were more likely to die at 30 days (49% vs 27%, P < .001) and 1 year (65% vs 51%, P = .004) than patients with normal values. Among patients with elevated troponin concentrations, 30-day mortality tended to be lower in transfused than in not-transfused patients (hazard ratio 0.48; 95% confidence interval, 0.21-1.08; P = .07). This association was not found in patients without troponin elevation (hazard ratio 1.09; 95% CI, 0.61-1.93; P = .8). Transfusion was associated with 30-day survival in patients with hemoglobin ≤8 g/dL. It was also associated with excess 1-year mortality in patients with hemoglobin >8 g/dL. CONCLUSIONS This pilot study suggests that transfusion could be associated with better 30-day outcomes in older anemic patients with anemia-related myocardial injury. Thus, troponin levels could be involved in decision-making relative to transfusion in anemic older patients. Clinical trials are needed to establish the benefit of transfusion in patients with elevated troponins.
Collapse
Affiliation(s)
- Manon Thevenin
- Acute Geriatric Unit, Dijon University Hospital, Dijon, France
| | - Sophie Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France
| | | | - Alain Putot
- Acute Geriatric Unit, La Réunion University Hospital, Saint Pierre, La Réunion, France; Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), University of Burgundy, Dijon, France.
| |
Collapse
|
9
|
Preexisting atrial fibrillation and myocardial infarction: only 10% of infarcts directly linked to atrial fibrillation. Cardiovasc Endocrinol Metab 2022; 11:e0267. [PMID: 35784582 PMCID: PMC9242400 DOI: 10.1097/xce.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022]
Abstract
The aim of the study was to evaluate the incidence and prognosis of type 1 myocardial infarction (T1MI) and type 2 MI (T2MI) in patients with acute MI and known atrial fibrillation (AF) to identify MI directly linked to AF. Among the 669 patients, four patients with hyperthyroidism were excluded, and among the remaining 665 patients, about two-thirds were diagnosed with T1MI, and the remaining third were diagnosed with T2MI. AF was the direct cause of MI in 9.8% of our overall population [1.8% of T1MI type C (coronary embolism), 4.9% of T2MI type A and 3.1% of T2MI type B]. Among patients with T2MI, 30-day mortality was lower when the trigger was AF than for the other triggers, for both type 2A (6% vs. 11%) and type 2B (0% vs. 13%). Most cases of AF-related MI are, thus, T2MI, for which therapeutic guidelines are lacking. Given the diverse triggers in T2MI, a specific approach using etiological patterns is needed to properly determine the optimal therapeutic.
Collapse
|
10
|
Mid-Term Mortality in Older Anemic Patients with Type 2 Myocardial Infarction: Does Blood Transfusion sImprove Prognosis? J Clin Med 2022; 11:jcm11092423. [PMID: 35566550 PMCID: PMC9104580 DOI: 10.3390/jcm11092423] [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: 03/14/2022] [Revised: 04/12/2022] [Accepted: 04/24/2022] [Indexed: 11/17/2022] Open
Abstract
(1) Anemia often predisposes older patients to type 2 myocardial infarction (T2MI). However, the management of this frequent association remains uncertain. We aimed to evaluate the impact of red blood cell transfusion during the acute phase of T2MI in older anemic inpatients. (2) Methods and results: We performed a retrospective study using a French regional database. One hundred and seventy-eight patients aged 65 years or older, presenting with a T2MI and anemia, were selected. Patients were split into two groups: one that received a red blood cell transfusion (≥1 red blood cell unit) and one that did not. A propensity score was built to adjust for potential confounders, and the association between transfusion and 30-day mortality was evaluated with an inverse propensity score weighted Cox model. Transfusion was not associated with 30-day all-cause mortality (propensity score weighted hazard ratio (HR) 1.59 (0.55-4.56), p = 0.38). However, 1-year all-cause mortality was significantly higher in the transfusion group (propensity score weighted HR 2.47 (1.22-4.97), p = 0.011). (3) Conclusion: Our findings in older adults with anemia suggest that blood transfusion in the acute phase of T2MI could not be associated with improved short-term prognosis. Prospective studies are urgently needed to assess the impact of transfusion on longer-term prognosis.
Collapse
|
11
|
Putot A, Putot S, Chagué F, Cottin Y, Zeller M, Manckoundia P. New horizons in Type 2 myocardial infarction: pathogenesis, assessment and management of an emerging geriatric disease. Age Ageing 2022; 51:6565797. [PMID: 35397160 DOI: 10.1093/ageing/afac085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 11/13/2022] Open
Abstract
Type 2 myocardial infarction (MI) is characterised by a functional imbalance between myocardial oxygen supply and demand in the absence of a thrombotic process, leading to myocardial necrosis. This type of MI was relatively unknown among clinicians until the third universal definition of MI was published in 2017, differentiating Type 2 from Type 1 MI, which follows an acute atherothrombotic event. The pathogenesis, diagnostic and therapeutic aspects of Type 2 MI are described in the present review. Type 2 MI is a condition that is strongly linked to age because of vascular ageing concerning both epicardic vessels and microcirculation, age-related atherosclerosis and stress maladaptation. This condition predominantly affects multimorbid individuals with a history of cardiovascular disease. However, the conditions that lead to the functional imbalance between oxygen supply and demand are frequently extra-cardiac (e.g. pneumonia or anaemia). The great heterogeneity of the underlying etiological factors requires a comprehensive approach that is tailored to each case. In the absence of evidence for the benefit of invasive reperfusion strategies, the treatment of Type 2 MI remains to date essentially based on the restoration of the balance between oxygen supply and demand. For older co-morbid patients with Type 2 MI, geriatricians and cardiologists need to work together to optimise etiological investigations, treatment and prevention of predisposing conditions and precipitating factors.
Collapse
Affiliation(s)
- Alain Putot
- Unité Post Urgence Gériatrique, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire – EA7460, Université de Bourgogne Franche Comté, 21000 Dijon, France
| | - Sophie Putot
- Unité Post Urgence Gériatrique, Centre Hospitalier Universitaire Sud Réunion, 97410 Saint Pierre, France
| | - Frédéric Chagué
- Service de Cardiologie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
| | - Yves Cottin
- Service de Cardiologie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
| | - Marianne Zeller
- Laboratoire Physiopathologie et Epidémiologie Cérébro-Cardiovasculaire – EA7460, Université de Bourgogne Franche Comté, 21000 Dijon, France
| | - Patrick Manckoundia
- Service de Médecine Interne Gériatrie, Centre Hospitalier Universitaire Dijon Bourgogne, 21000 Dijon, France
| |
Collapse
|
12
|
White K, Kinarivala M, Scott I. Diagnostic features, management and prognosis of type 2 myocardial infarction compared to type 1 myocardial infarction: a systematic review and meta-analysis. BMJ Open 2022; 12:e055755. [PMID: 35177458 PMCID: PMC8860077 DOI: 10.1136/bmjopen-2021-055755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
IMPORTANCE Distinguishing type 2 (T2MI) from type 1 myocardial infarction (T1MI) in clinical practice can be difficult, and the management and prognosis for T2MI remain uncertain. OBJECTIVE To compare precipitating factors, risk factors, investigations, management and outcomes for T2MI and T1MI. DATA SOURCES Medline and Embase databases as well as reference list of recent articles were searched January 2009 to December 2020 for term 'type 2 myocardial infarction'. STUDY SELECTION Studies were included if they used a universal definition of MI and reported quantitative data on at least one variable of interest. DATA EXTRACTION AND SYNTHESIS Data were pooled using random-effect meta-analysis. Risk of bias was assessed using Newcastle-Ottawa quality assessment tool. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. All review stages were conducted by two reviewers. MAIN OUTCOMES AND MEASURES Risk factors, presenting symptoms, cardiac investigations such as troponin and angiogram, management and outcomes such as mortality. RESULTS 40 cohort studies comprising 98 930 patients with T1MI and 13 803 patients with T2MI were included. Compared with T1MI, patients with T2MI were: more likely to have pre-existing chronic kidney disease (OR 1.87; 95% CI 1.53 to 2.28) and chronic heart failure (OR 2.35; 95% CI 1.82 to 3.03), less likely to present with typical cardiac symptoms of chest pain (OR 0.19; 95% CI 0.13 to 0.26) and more likely to present with dyspnoea (OR 2.64; 95% CI 1.86 to 3.74); more likely to demonstrate non-specific ST-T wave changes on ECG (OR 2.62; 95% CI 1.81 to 3.79) and less likely to show ST elevation (OR 0.22; 95% CI 0.17 to 0.28); less likely to undergo coronary angiography (OR 0.09; 95% CI 0.06 to 0.12) and percutaneous coronary intervention (OR 0.06; 95% CI 0.04 to 0.10) or receive cardioprotective medications, such as statins (OR 0.25; 95% CI 0.16 to 0.38) and beta-blockers (OR 0.45; 95% CI 0.33 to 0.63). T2MI had greater risk of all cause 1-year mortality (OR 3.11; 95% CI 1.91 to 5.08), with no differences in short-term mortality (OR 1.34; 95% CI 0.63 to 2.85). CONCLUSION AND RELEVANCE This review has identified clinical, management and survival differences between T2MI and T1MI with greater precision and scope than previously reported. Differential use of coronary revascularisation and cardioprotective medications highlight ongoing uncertainty of their utility in T2MI compared with T1MI.
Collapse
Affiliation(s)
- Kyle White
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Mansey Kinarivala
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Ian Scott
- Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- School of Clinical Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
13
|
Han X, Jeong MH, Bai L, Ahn JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Long-term clinical outcomes of type 1 vs. type 2 myocardial infarction in patients who underwent angiography: data from the Korea acute myocardial infarction-national institute of health registry. Cardiovasc Diagn Ther 2022; 12:55-66. [PMID: 35282670 PMCID: PMC8898687 DOI: 10.21037/cdt-21-434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/25/2021] [Indexed: 09/15/2023]
Abstract
BACKGROUND In the cause of increase the clinical research observational evidence on type 2 myocardial infraction (T2MI), the study compared the characteristics of T2MI and T1MI with respect to major adverse cardiac events (MACE) and mortality as long-term outcomes from a large, nationwide, prospective Korean cohort registry. METHODS From 13,105 consecutively enrolled individuals in the Korea Acute Myocardial Infarction-National Institute of Health (KAMIR-NIH) registry between October 2011 and December 2015, 11,053 acute myocardial infarction (AMI) patients were divided into the T1MI (n=10,545) and T2MI (n=508) groups. All patients completed ≥3 years of follow-up. RESULTS The Kaplan-Meier curve analysis and Cox proportional hazard regression models showed that the cumulative rate of MACE was similar between the 2 groups (11.4% vs. 13.4%, log-rank P=0.185) at 3 years. However, the T2MI group showed higher rates of all-cause death [12.6% vs. 9.4%, log-rank P=0.019; hazard ratio (HR), 1.42; 95% CI: 1.08-1.85; P=0.012] and non-cardiac death (3.5% vs. 5.3%, log-rank P=0.043; HR, 1.55; 95% CI: 1.01-2.37; P=0.043) than the T1MI group. Male sex (HR 1.540; 95% CI: 1.218-1.947, P<0.001), old age (≥65 years; HR, 3.546; 95% CI: 2.645-4.753, P<0.001), low hemoglobin level (<12 g/dL; HR, 2.335; 95% CI: 1.841-2.961, P<0.001), high heart rate (>100 beats/min; HR, 1.852; 95% CI: 1.436-2.388, P<0.001), low glomerular filtration rate (GFR) (<60 mL/min/1.73 m2; HR, 2.373; 95% CI: 1.874-3.005, P<0.001), high body mass index (>25 kg/m2; HR, 0.644; 95% CI: 0.514-0.805, P<0.001), and low left ventricular ejection fraction (LVEF) (<40%; HR, 1.487; 95% CI: 1.095-2.020, P=0.011) were the independent predictors for 3-year non-cardiac mortality. CONCLUSIONS Although the 2 groups did not differ in MACE, the total mortality rate was higher in T2MI than in T1MI, especially non-cardiac mortality. The independent predictors for non-cardiac mortality were male sex, old age, anemia, low GFR, tachycardia, obesity, and low LVEF.
Collapse
Affiliation(s)
- Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Liyan Bai
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Joon Ho Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - other KAMIR-NIH Registry Investigators
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| |
Collapse
|
14
|
Clinical characteristics and outcome of elderly patients admitted in emergency department with an oxygen mismatch and type 2 myocardial infarction or myocardial injury. Aging Clin Exp Res 2022; 34:429-437. [PMID: 34247343 DOI: 10.1007/s40520-021-01932-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Aging is a risk factor for type 2 myocardial infarction or myocardial injury, but few data are available on the elderly. We aimed to determine the factors associated with these pathologies and mortality in the elderly population and its age classes. METHODS A retrospective cohort of all patients with oxygen mismatch (anemia, hypoxia, tachycardia, hypo/hypertension) for whom a troponin drawn was performed at admission in 2 emergency departments. Medical records were reviewed and classified as having type 2 myocardial infarction, acute or chronic myocardial injury, or no myocardial injury. RESULTS Of the 824 patients who presented with oxygen mismatch, 675 (81.9%) were older than 65 years. Age over 85 years was a risk factor for acute non-ischemic myocardial injury (odds ratio, 95% confidence interval 2.23, 1.34-3.73). Non-ischemic myocardial injury was associated with hypoxemia, tachycardia, and acute renal failure in those older than 85 years, but only with acute infection in the 75-84-year-old group. Type 2 myocardial infarction was associated only with acute renal failure in the oldest group and, in the 75-84-year-old group, with acute heart failure and shock. Patients older than 85 years with acute myocardial injury, with or without infarction, had a higher in-hospital mortality, but subsequently, mortality depends more on the comorbidities than on age. CONCLUSION Factors associated with type 2 myocardial infarction and acute non-ischemic myocardial injury in elderly admitted with oxygen mismatch vary notably between age classes. They are associated with in-hospital mortality but not with subsequent mortality when other cormorbities are taken into account.
Collapse
|
15
|
[Acute coronary syndrome in the elderly emergency department: diagnosis and management]. SOINS. GÉRONTOLOGIE 2021; 26:19-23. [PMID: 34462107 DOI: 10.1016/j.sger.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acute coronary syndrome (ACS) is a pathology frequently encountered in emergency rooms, especially in the elderly. Caregivers must know how to recognize an ACS despite an often heterogeneous and atypical presentation. Management should include an overall assessment of the patient in order to decide on the best management for the patient.
Collapse
|
16
|
Causes of Anemia in Polish Older Population-Results from the PolSenior Study. Cells 2021; 10:cells10082167. [PMID: 34440936 PMCID: PMC8392520 DOI: 10.3390/cells10082167] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin B12, folate, iron deficiency (IDA), chronic kidney disease (CKD), and anemia of inflammation (AI) are among the main causes of anemia in the elderly. WHO criteria of nutritional deficiencies neglect aging-related changes in absorption, metabolism, and utilization of nutrients. Age-specific criteria for the diagnosis of functional nutritional deficiency related to anemia are necessary. We examined the nationally representative sample of Polish seniors. Complete blood count, serum iron, ferritin, vitamin B12, folate, and renal parameters were assessed in 3452 (1632 women, 1820 men) participants aged above 64. Cut-off points for nutritional deficiencies were determined based on the WHO criteria (method-A), lower 2.5 percentile of the studied population (method-B), and receiver operating characteristic (ROC) analysis (method-C). Method-A leads to an overestimation of the prevalence of vitamin B12 and folate deficiency, while method-B to their underestimation with over 50% of unexplained anemia. Based on method-C, anemia was classified as nutritional in 55.9%. In 22.3% of cases, reasons for anemia remained unexplained, the other 21.8% were related to CKD or AI. Mild cases were less common in IDA, and more common in non-deficiency anemia. Serum folate had an insignificant impact on anemia. It is necessary to adopt the age-specific criteria for nutrient deficiency in an old population.
Collapse
|
17
|
Greigert H, Zeller M, Putot A, Steinmetz E, Terriat B, Maza M, Falvo N, Muller G, Arnould L, Creuzot-Garcher C, Ramon A, Martin L, Tarris G, Ponnelle T, Audia S, Bonnotte B, Cottin Y, Samson M. Myocardial infarction during giant cell arteritis: A cohort study. Eur J Intern Med 2021; 89:30-38. [PMID: 33610415 DOI: 10.1016/j.ejim.2021.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/02/2021] [Accepted: 02/04/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cardiovascular risk is increased in giant cell arteritis (GCA). We aimed to characterize myocardial infarction (MI) in a GCA cohort, and to compare the GCA and non-GCA population affected by MI. METHODS In patients with a biopsy-proven diagnosis of GCA between 1 January 2001 and 31 December 2016 in Côte D'Or (France), we identified patients with MI by crossing data from the territorial myocardial infarction registry (Observatoire des Infarctus de Côte d'Or) database. Five controls (non-GCA + MI) were paired with one case (GCA + MI) after matching for age, sex, cardiovascular risk factors and prior cardiovascular disease. MI were characterized as type 1 MI (T1MI), resulting from thrombus formation due to atherothrombotic disease, or type 2 MI (T2MI), due to a myocardial supply/demand mismatch. GCA-related MI was defined as MI occurring within 3 months of a GCA flare (before or after). RESULTS Among 251 biopsy-proven GCA patients, 13 MI cases were identified and paired with 65 controls. MI was GCA-related in 6/13 cases, accounting for 2.4% (6/251) of our cohort. T2MI was more frequently GCA-related than GCA-unrelated (80% vs. 16.7%, p = 0.080), and GCA diagnosis was the only identified triggering factor in 75% of GCA-related T2MI. GCA-unrelated MI were more frequently T1MI and occurred in patients who had received a higher cumulative dose of prednisone (p = 0.032). GCA was not associated with poorer one-year survival. CONCLUSIONS GCA-related MI are mainly T2MI probably caused by systemic inflammation rather than coronaritis. GCA-unrelated MI are predominantly T1MI associated with atherothrombotic coronary artery disease.
Collapse
Affiliation(s)
- Hélène Greigert
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Department of Vascular Medicine, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | | | - Alain Putot
- PEC2, EA 7460 Dijon, France; Department of Geriatric Internal Medicine, Dijon University Hospital, Dijon, France
| | - Eric Steinmetz
- Department of Cardiovascular and Thoracic Surgery, Dijon University Hospital, Dijon, France
| | - Béatrice Terriat
- Department of Vascular Medicine, Dijon University Hospital, Dijon, France
| | | | - Nicolas Falvo
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Géraldine Muller
- Department of Internal Medicine and Systemic Diseases, Dijon University Hospital, Dijon, France
| | - Louis Arnould
- Department of Ophthalmology, Dijon University Hospital, Dijon, France
| | | | - André Ramon
- Department of Rheumatology, Dijon University Hospital, Dijon, France
| | - Laurent Martin
- Department of Pathology, Dijon University Hospital, Dijon, France
| | - Georges Tarris
- Department of Pathology, Dijon University Hospital, Dijon, France
| | | | - Sylvain Audia
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Bernard Bonnotte
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France
| | - Yves Cottin
- Cardiology Department, Dijon University Hospital, Dijon, France
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France; Université Bourgogne Franche-Comté, INSERM, EFS BFC, UMR1098, RIGHT Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique, F-21000 Dijon, France.
| |
Collapse
|
18
|
Han X, Bai L, Jeong MH, Ahn JH, Hyun DY, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Higher Long-Term Mortality in Patients with Non-ST-Elevation Myocardial Infarction than ST-Elevation Myocardial Infarction after Discharge. Yonsei Med J 2021; 62:400-408. [PMID: 33908210 PMCID: PMC8084695 DOI: 10.3349/ymj.2021.62.5.400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/25/2023] Open
Abstract
PURPOSE This study aimed to compare mortality rates after discharge between the patients with non-ST-elevation myocardial infarction (NSTEMI) and those with ST-elevation myocardial infarction (STEMI), and identify each mortality risk factors in these two types of myocardial infarction. MATERIALS AND METHODS Between 2011 and 2015, 13105 consecutive patients were enrolled in the Korea Acute Myocardial Infarction-National Institute of Health registry (KAMIR-NIH); 12271 patients with acute myocardial infarction met the inclusion criteria and were further stratified into the STEMI (n=5828) and NSTEMI (n=6443) groups. The occurrence of mortality and cardiac mortality at 3 years were compared between groups, and the factors associated with mortality for NSTEMI and STEMI were evaluated. RESULTS The comparison between these two groups and long-term follow-up outcomes showed that the cumulative rates of all-cause and cardiac mortality were higher in the NSTEMI group than in the STEMI group [all-cause mortality: 10.9% vs. 5.8%; hazards ratio (HR), 0.464; 95% confidence interval (CI), 0.359-0.600, p<0.001; cardiac mortality: 6.6% vs. 3.5%, HR, 0.474; 95% CI, 0.344-0.654, p<0.001, respectively). In the NSTEMI group, low left ventricular ejection fraction (LVEF; <40%), no percutaneous coronary intervention (PCI), old age (≥65 years), and low hemoglobin level (<12 g/dL) were identified as risk factors for 3-year mortality. In the STEMI group, old age, low glomerular filtration rate (<60 mL/min/1.73 m²), low LVEF, high heart rate (>100 beats/min), no PCI, and low hemoglobin level were identified as the risk factors for 3-year mortality. CONCLUSION The NSTEMI group had higher mortality compared to the STEMI group during the 3-year clinical follow-up after discharge. Low LVEF and no PCI were the main risk factors for mortality in the NSTEMI group. In contrast, old age and renal dysfunction were the risk factors for long-term mortality in the STEMI group.
Collapse
Affiliation(s)
- Xiongyi Han
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Liyan Bai
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Department of Cardiology, Yanbian University Hospital, Yanji, China
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea.
| | - Joon Ho Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Dae Young Hyun
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | | |
Collapse
|
19
|
Belkouche A, Yao H, Putot A, Chagué F, Rochette L, Danchin N, Fauchier L, Zeller M, Cottin Y. The Multifaceted Interplay between Atrial Fibrillation and Myocardial Infarction: A Review. J Clin Med 2021; 10:E198. [PMID: 33430505 PMCID: PMC7826531 DOI: 10.3390/jcm10020198] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 12/26/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
This review was conducted to emphasize the complex interplay between atrial fibrillation (AF) and myocardial infraction (MI). In type 1 (T1) MI, AF is frequent and associated with excess mortality. Moreover, AF after hospital discharge for T1MI is not rare, suggesting the need to improve AF screening and to develop therapeutic strategies for AF recurrence. Additionally, AF is a common trigger for type 2 MI (T2MI), and recent data have shown that tachyarrhythmia or bradyarrhythmia could be a causal factor in, respectively, 13-47% or 2-7% of T2MI. In addition, AF is involved in T2MI pathogenesis as a result of severe anemia related to anticoagulants. AF is also an underestimated and frequent cause of coronary artery embolism (CE), as a situation at risk of myocardial infarction with non-obstructive coronary arteries. AF-causing CE is difficult to diagnose and requires specific management. Moreover, patients with both AF and chronic coronary syndromes represent a therapeutic challenge because the treatment of AF include anticoagulation, depending on the embolic risk, and ischemic heart disease management paradoxically includes antiplatelet therapy.
Collapse
Affiliation(s)
- Alban Belkouche
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Hermann Yao
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Alain Putot
- Department of Geriatry, University Teaching Hospital Dijon Bourgogne, 21000 Dijon, France;
| | - Frédéric Chagué
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| | - Luc Rochette
- Team PEC2, EA 7460, University of Burgundy, 21078 Dijon, France; (L.R.); (M.Z.)
| | - Nicolas Danchin
- Department of Cardiology, University Teaching Hospital of Georges Pompidou, 75015 Paris, France;
| | - Laurent Fauchier
- Department of Cardiology, University Teaching Hospital of Trousseau and University François Rabelais, 37000 Tours, France;
| | - Marianne Zeller
- Team PEC2, EA 7460, University of Burgundy, 21078 Dijon, France; (L.R.); (M.Z.)
| | - Yves Cottin
- Department of Cardiology, University Teaching Hospital of Dijon Bourgogne, 21000 Dijon, France; (A.B.); (H.Y.); (F.C.)
| |
Collapse
|
20
|
Putot A, Hacquin A, Barben J, Putot S, Chagué F, Zeller M, Cottin Y, Jouanny P, Manckoundia P. Comment on: Revascularization Versus Medical Therapy in Patients Aged 80 Years and Older with Acute Myocardial Infarction. J Am Geriatr Soc 2020; 69:274-275. [PMID: 33184846 DOI: 10.1111/jgs.16938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 09/30/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France.,Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Bourgogne Franche Comté, Dijon, France
| | - Arthur Hacquin
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France.,Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Bourgogne Franche Comté, Dijon, France
| | - Jeremy Barben
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France
| | - Sophie Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France
| | - Frédéric Chagué
- Cardiology Department, University Hospital of Dijon Bourgogne, Dijon, France
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Bourgogne Franche Comté, Dijon, France
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Bourgogne Franche Comté, Dijon, France.,Cardiology Department, University Hospital of Dijon Bourgogne, Dijon, France
| | - Pierre Jouanny
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, France
| |
Collapse
|
21
|
Dipanda M, Barben J, Nuémi G, Vadot L, Nuss V, Vovelle J, Putot A, Manckoundia P. Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department. Geriatrics (Basel) 2020; 5:geriatrics5030044. [PMID: 32751095 PMCID: PMC7555628 DOI: 10.3390/geriatrics5030044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/24/2020] [Accepted: 07/28/2020] [Indexed: 11/30/2022] Open
Abstract
We assessed the prescriptions of patients hospitalized in a geriatric unit and subsequently discharged. This prospective and observational study was conducted over a two-month period in the geriatrics department (acute and rehabilitation units) of a university hospital. Patients discharged from this department were included over a two-month period. Prescriptions were analyzed at admission and discharge from the geriatrics department (DGD), and six weeks after DGD. We included 209 patients, 63% female, aged 86.8 years. The mean number of medications prescribed was significantly higher at DGD than at admission (7.8 vs. 7.1, p = 0.003). During hospitalization, 1217 prescriptions were changed (average 5.8 medications/patient): 52.8% were initiations, 39.3% were discontinuations, and 7.9% were dose adjustments. A total of 156 of the 209 patients initially enrolled completed the study. Among these patients, 81 (51.9%) had the same prescriptions six weeks after DGD. In univariate analysis, medications were changed more frequently in patients with cognitive impairment (p = 0.04) and in patients for whom the hospital report did not indicate in-hospital modifications (p = 0.007). Multivariate analysis found that six weeks after DGD, there were significantly more drug changes for patients for whom there were changes in prescription during hospitalization (p < 0.001). A total of 169 medications were changed (mean number of medications changed per patient: 1.1): 52.7% discontinuations, 34.3% initiations, and 13% dosage modifications. The drug regimens were often changed during hospitalization in the geriatrics department, and a majority of these changes were maintained six weeks after DGD. Improvements in patient adherence and hospital-general practitioner communication are necessary to promote continuity of care and to optimize patient supervision after hospital discharge.
Collapse
Affiliation(s)
- Mélanie Dipanda
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Jérémy Barben
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Gilles Nuémi
- Department of Biostatistics and Bioinformatics, Dijon Bourgogne University Hospital, 21079 Dijon, France;
| | - Lucie Vadot
- Department of Pharmacy, Research and Vigilance, Dijon Bourgogne University Hospital, 21079 Dijon, France;
| | - Valentine Nuss
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Jérémie Vovelle
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Alain Putot
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
| | - Patrick Manckoundia
- “Pôle Personnes Âgées”, Hospital of Champmaillot, Dijon Bourgogne University Hospital, 21079 Dijon, France; (M.D.); (J.B.); (V.N.); (J.V.); (A.P.)
- INSERM U-1093, Cognition, Action and Sensorimotor Plasticity, University of Burgundy Franche-Comté, 21079 Dijon, France
- Correspondence: ; Tel.: +33-333-8029-3970; Fax: +33-333-8029-3621
| |
Collapse
|
22
|
Putot A, Chagué F, Manckoundia P, Brunel P, Beer JC, Cottin Y, Zeller M. Post-Infectious Myocardial Infarction: Does Percutaneous Coronary Intervention Improve Outcomes? A Propensity Score-Matched Analysis. J Clin Med 2020; 9:E1608. [PMID: 32466424 PMCID: PMC7355802 DOI: 10.3390/jcm9061608] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023] Open
Abstract
Acute infection is a frequent trigger of myocardial infarction (MI). However, whether percutaneous coronary intervention (PCI) improves post-infectious MI prognosis is a major but unsolved issue. In this prospective multicenter study from coronary care units, we performed propensity score-matched analysis to compare outcomes in patients with and without PCI for post-infectious MI with angiography-proven significant coronary stenosis (>50%). Among 4573 consecutive MI patients, 476 patients (10%) had a concurrent diagnosis of acute infection at admission, of whom 375 underwent coronary angiography and 321 patients had significant stenosis. Among the 321 patients, 195 underwent PCI. Before the matching procedure, patients without PCI had a similar age and sex ratio but a higher rate of risk factors (hypertension, diabetes, chronic renal failure, and prior coronary artery disease), pneumonia, and SYNTAX score than patients without PCI. After propensity score matching, neither in-hospital mortality (13% with PCI vs. 8% without PCI; p = 0.4) nor one-year mortality (24% with PCI vs. 19% without PCI, p = 0.5) significantly differed between the two groups. In this first prospective cohort of post-infectious MI in coronary care units, PCI might not improve short- and long-term prognosis in patients with angiography-proven significant coronary stenosis. If confirmed, these results do not argue for systematic invasive procedures after post-infectious MI.
Collapse
Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
| | - Frédéric Chagué
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Philippe Brunel
- Cardiology Department, Hopital privé Dijon Bourgogne, 21000 Dijon, France;
| | - Jean-Claude Beer
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France;
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France; (F.C.); (Y.C.); (M.Z.)
| |
Collapse
|
23
|
Putot A, Jeanmichel M, Chagué F, Avondo A, Ray P, Manckoundia P, Zeller M, Cottin Y. Type 1 or Type 2 Myocardial Infarction in Patients with a History of Coronary Artery Disease: Data from the Emergency Department. J Clin Med 2019; 8:E2100. [PMID: 31810178 PMCID: PMC6947269 DOI: 10.3390/jcm8122100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 11/18/2019] [Accepted: 11/25/2019] [Indexed: 02/02/2023] Open
Abstract
A type 2 myocardial infarction (T2MI) is the result of an imbalance between oxygen supply and demand, without acute atherothrombosis. T2MI is frequent in emergency departments (ED), but has not been extensively evaluated in patients with previously known coronary artery disease (CAD). Our study assessed the incidence and characteristics of T2MI compared to type 1 (T1MI) in CAD patients admitted to an ED. Among 33,669 consecutive patients admitted to the ED, 2830 patients with T1MI or T2MI were systematically included after prospective adjudication by the attending clinician according to the universal definition. Among them, 619 (22%) patients had a history of CAD. Using multivariable analysis, CAD history was found to be an independent predictive factor of T2MI versus T1MI (odds ratio (95% confidence interval) = 1.38 (1.08-1.77), p = 0.01). Among CAD patients, those with T2MI (n = 254) were older (median age: 82 vs. 72 years, p < 0.001), and had more frequent comorbidities and more frequent three-vessel disease at the coronary angiography (56% vs. 43%, p = 0.015). Percutaneous coronary intervention was by far less frequent after T2MI than after T1MI (28% vs. 67%, p < 0.001), and in-hospital mortality was twice as high in T2MI (15% vs. 7% for T1MI, p < 0.001). Among biomarkers, the C reactive protein (CRP)/troponin Ic ratio predicted T2MI remarkably well (C-statistic (95% confidence interval) = 0.84 (0.81-0.87, p < 0.001). In a large unselected cohort of MI patients in the ED, a quarter of patients had previous CAD, which was associated with a 40% higher risk of T2MI. CRP/troponin ratios could be used to help distinguish T2MI from T1MI.
Collapse
Affiliation(s)
- Alain Putot
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France
| | - Mélanie Jeanmichel
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| | - Frédéric Chagué
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| | - Aurélie Avondo
- Emergency Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| | - Patrick Ray
- Emergency Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| | - Patrick Manckoundia
- Geriatrics Internal Medicine Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| | - Marianne Zeller
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France
| | - Yves Cottin
- Physiopathologie et Epidémiologie Cérébro-Cardiovasculaires (PEC2), EA 7460, University of Burgundy and Franche Comté, 21079 Dijon CEDEX, France
- Cardiology Department, University Hospital of Dijon Bourgogne, 21079 Dijon CEDEX, France
| |
Collapse
|