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Kasim S, Malek S, Cheen S, Safiruz MS, Ahmad WAW, Ibrahim KS, Aziz F, Negishi K, Ibrahim N. In-hospital risk stratification algorithm of Asian elderly patients. Sci Rep 2022; 12:17592. [PMID: 36266376 PMCID: PMC9584943 DOI: 10.1038/s41598-022-18839-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/22/2022] [Indexed: 01/13/2023] Open
Abstract
Limited research has been conducted in Asian elderly patients (aged 65 years and above) for in-hospital mortality prediction after an ST-segment elevation myocardial infarction (STEMI) using Deep Learning (DL) and Machine Learning (ML). We used DL and ML to predict in-hospital mortality in Asian elderly STEMI patients and compared it to a conventional risk score for myocardial infraction outcomes. Malaysia's National Cardiovascular Disease Registry comprises an ethnically diverse Asian elderly population (3991 patients). 50 variables helped in establishing the in-hospital death prediction model. The TIMI score was used to predict mortality using DL and feature selection methods from ML algorithms. The main performance metric was the area under the receiver operating characteristic curve (AUC). The DL and ML model constructed using ML feature selection outperforms the conventional risk scoring score, TIMI (AUC 0.75). DL built from ML features (AUC ranging from 0.93 to 0.95) outscored DL built from all features (AUC 0.93). The TIMI score underestimates mortality in the elderly. TIMI predicts 18.4% higher mortality than the DL algorithm (44.7%). All ML feature selection algorithms identify age, fasting blood glucose, heart rate, Killip class, oral hypoglycemic agent, systolic blood pressure, and total cholesterol as common predictors of mortality in the elderly. In a multi-ethnic population, DL outperformed the TIMI risk score in classifying elderly STEMI patients. ML improves death prediction by identifying separate characteristics in older Asian populations. Continuous testing and validation will improve future risk classification, management, and results.
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Affiliation(s)
- Sazzli Kasim
- grid.412259.90000 0001 2161 1343Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,grid.412259.90000 0001 2161 1343Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia ,grid.412259.90000 0001 2161 1343Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
| | - Sorayya Malek
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Song Cheen
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Shahreeza Safiruz
- grid.10347.310000 0001 2308 5949Department of Artificial Intelligence, Faculty of Computer Science and Information Technology, University of Malaya, Kuala Lumpur, Malaysia
| | - Wan Azman Wan Ahmad
- National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia ,grid.413018.f0000 0000 8963 3111Division of Cardiology, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Khairul Shafiq Ibrahim
- grid.412259.90000 0001 2161 1343Cardiology Department, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,grid.412259.90000 0001 2161 1343Cardiac Vascular and Lung Research Institute, Universiti Teknologi MARA (UiTM), Shah Alam, Malaysia ,National Heart Association of Malaysia, Heart House, Kuala Lumpur, Malaysia
| | - Firdaus Aziz
- grid.10347.310000 0001 2308 5949Bioinformatics Division, Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - Kazuaki Negishi
- grid.1013.30000 0004 1936 834XSydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Sydney, NSW Australia ,grid.413243.30000 0004 0453 1183Nepean Hospital, Sydney, NSW Australia
| | - Nurulain Ibrahim
- grid.412259.90000 0001 2161 1343Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh Campus, Sungai Buloh, Malaysia
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Obeidat OS, Makhamreh H, Al-Muhaisen RZ, Obeidat LR, Kitana FI, Amarin JZ, Ebada MA, Murad MA, Alhameedi T, Haj-Yasin D, Hammoudeh A. Clinical Characteristics and Prognosis of Young Middle Eastern Adults with ST-Elevation Myocardial Infarction: One-Year Follow-Up. Heart Views 2021; 22:88-95. [PMID: 34584618 PMCID: PMC8445134 DOI: 10.4103/heartviews.heartviews_67_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 02/08/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS Few studies have investigated premature ST-elevation myocardial infarction (STEMI) in the Middle East. We aimed to compare the clinical characteristics and one-year prognosis of young (<45 years) and older (≥45 years) Middle Eastern adults with STEMI. METHODS AND MATERIAL A total of 706 patients with STEMI, who were prospectively enrolled in the First Jordanian Percutaneous Coronary Intervention Registry, were stratified into two groups (<45 or ≥45 years). Baseline clinical variables and one-year major adverse cardiovascular events (MACE) were evaluated. RESULTS Young patients (<45 years) comprised 17.4% of STEMI patients (123 of 706). Compared with older patients (≥45 years), young patients were mostly male (96% vs 82%, P<0.001), smokers (86% vs 49%, P<0.001) and less likely to have multi-vessel disease (26% vs 44%, P=0.001). Anterior STEMI was the most common diagnosis and left anterior descending artery was the most common culprit vessel in both groups. There were no significant differences between the younger and older patients in in-hospital (20% vs 19%, P=0.12) and one-year MACE (24% vs 26%, P=0.68). However, none (0%) of the young died during one-year follow-up while 21 (4%) of the older patients died (P=0.036). CONCLUSIONS Young adult patients in the Middle East with STEMI are more likely to be smoking men with multiple risk factors and single vessel disease by angiography. Although, younger patients had similar one-year MACE to older patients, their mortality rate appears to be better. A larger study is warranted to investigate this vulnerable group of patients to prevent future events.
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Affiliation(s)
- Omar Sami Obeidat
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | - Hanna Makhamreh
- Department of Internal Medicine, The University of Jordan, Amman, Jordan
| | | | | | | | | | | | - Mhd Anas Murad
- School of Medicine, The University of Jordan, Amman, Jordan
| | - Tuqa Alhameedi
- School of Medicine, The University of Jordan, Amman, Jordan
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Alkindi F, El-Menyar A, Rafie I, Arabi A, Al Suwaidi J, Singh R, Albinali H, Gehani AA. Clinical Presentations and Outcomes in Patients Presenting With Acute Cardiac Events and Right Bundle Branch Block. Angiology 2019; 71:256-262. [DOI: 10.1177/0003319719892159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We conducted a retrospective analysis of 50 974 patients admitted with acute cardiac events with and without right bundle branch block (RBBB) over 23 years. Compared to non-RBBB, patients with RBBB (n = 386; 0.8%) were 3 years older ( P = .001), more likely to present with breathlessness rather than chest pain ( P = .001), and had more diabetes mellitus ( P = .001). Patients with RBBB had significantly higher cardiac enzymes ( P = .001); however, there were no significant differences in the presentation with ST-segment elevation myocardial infarction (24.6% vs 22.2%), non-ST-segment elevation myocardial infarction (23.7% vs 22.4%), and unstable angina (51.7% vs 55.4%). Patients with RBBB were more likely to have congestive heart failure (CHF; 9.6% vs 3.2%, P = .001), cardiogenic shock (10.6% vs 1.7%, P = .001), and ventricular tachyarrhythmias (7.3% vs 2.2%, P = .001). Left ventricular ejection fraction and hospital length of stay were comparable between the groups. All-cause mortality was 5 times greater in patients with RBBB (21% vs 4.2%, P = .001). Right bundle branch block was independent predictor of mortality (adjusted odd ratio 5.14; 95% confidence interval: 3.90-6.70). Subanalysis comparing normal QRS, RBBB, and left BBB showed that RBBB was associated with the worst outcomes except for CHF. Although RBBB presents in only about 1% of patients with cardiac disease, it was found to be an independent predictor of hospital mortality.
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Affiliation(s)
| | - Ayman El-Menyar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
- Clinical Research, Trauma & Vascular Surgery, Hamad General Hospital, Doha, Qatar
| | - Ihsan Rafie
- Cardiology Department, Heart Hospital, Doha, Qatar
| | | | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Doha, Qatar
- Clinical Medicine, Weill Cornell Medical College, Doha, Qatar
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Clinical outcomes of elderly South-East Asian patients in primary percutaneous coronary intervention for ST-elevation myocardial infarction. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:830-835. [PMID: 27928224 PMCID: PMC5131197 DOI: 10.11909/j.issn.1671-5411.2016.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Objective To evaluate the clinical characteristics and in-hospital outcomes of elderly South-East Asian patients undergoing primary percutaneous coronary intervention (PPCI). Methods From January 2009 to December 2012, 1268 patients (86.4% male, mean age of 58.4 ± 12.2 years) presented to our hospital for ST-elevation myocardial infarction (STEMI) and underwent PPCI. They were divided into two groups: elderly group defined as age ≥ 70 years and non-elderly group defined as age < 70 years. Data were collected retrospectively on baseline clinical characteristics, door-to-balloon (D2B) time, angiographic findings, therapeutic modality and hospital course. Results The elderly group constituted 19% of the study population with mean age 76.6 ± 5.0 years. There was a higher proportion of female gender and ethnic Chinese patients in the elderly group when compared with the non-elderly group. The former was less likely to be smokers and have a significantly higher prevalence of hypertension. The mean D2B time was significantly longer in the elderly group. They also had a significantly higher incidence of triple vessel disease and obstructive left main disease. The use of radial artery access, glycoprotein 2b/3a inhibitors and drug-eluting stents during PPCI were also significantly lower. In-hospital mortality was significantly higher in the elderly group. The rate of cardiogenic shock and inhospital complications were also significantly higher. Conclusions Our registry showed that in-hospital mortality rate in elderly South-East Asian patients undergoing PPCI for STEMI was high. Further studies into the optimal STEMI management strategy for these elderly patients are warranted.
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Alkindi F, El-Menyar A, Al-Suwaidi J, Patel A, Gehani AA, Singh R, Albinali H, Arabi A. Left Bundle Branch Block in Acute Cardiac Events: Insights From a 23-Year Registry. Angiology 2014; 66:811-7. [PMID: 25477500 DOI: 10.1177/0003319714560223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Between 1991 and 2013, we evaluated the demographics, presentations, and final diagnosis of patients hospitalized with acute cardiac events and left bundle branch block (LBBB). Of 50 992 patients, 768 (1.5%) had LBBB. Compared with non-LBBB patients, patients with LBBB were mostly older, female, diabetic, and had hypertension and chronic kidney failure (CKF; P < .001 for all). Dyspnea (P < .001) and dizziness (P = .037) were more frequent in patients with LBBB. The most frequent cause of admission with LBBB was congestive heart failure (CHF; 54.2%), followed by ST-elevation myocardial infarction (STEMI; 13.3%), valvular heart disease (9.4%), unstable angina (8.3%) and Non-STEMI (7.7%). On multivariate analysis, CKF (odds ratio [OR]: 2.02, 95% confidence interval [CI]: 1.09-3.70) and LBBB (OR: 2.96, 95% CI: 2.01-4.42) were predictors of in-hospital mortality in the entire study population. Further analysis of patients with LBBB showed that CKF (OR: 2.93, 95% CI: 1.40-6.12) was the only predictor of in-hospital mortality. Regardless the presenting symptoms, CHF was the final diagnosis in most cases with LBBB.
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Affiliation(s)
- Fahad Alkindi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Ayman El-Menyar
- Department of Clinical Medicine, Weill Cornell Medical School, Ar-Rayyan, Qatar Clinical Research, Trauma Section, Hamad Medical Corporation, Doha, Qatar Internal Medicine, Cardiology Section, Ahmed Maher Teaching Hospital, Cairo, Egypt
| | - Jassim Al-Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Ashfaq Patel
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Abdurrazzak A Gehani
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Rajvir Singh
- Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar Albinali
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
| | - Abdulrahman Arabi
- Department of Cardiology and Cardiovascular Surgery, Heart Hospital, HMC, Doha, Qatar
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Esteban MR, Montero SM, Sánchez JJA, Hernández HP, Pérez JJG, Afonso JH, Pérez DCR, Díaz BB, de León AC. Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J 2014; 8:61-7. [PMID: 25152777 PMCID: PMC4141177 DOI: 10.2174/1874192401408010061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022] Open
Abstract
Background: To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis. Methods: Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome. Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.
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Affiliation(s)
| | - Sara M Montero
- Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José J A Sánchez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Del C R Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Buenaventura B Díaz
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio C de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain ; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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Lu HT, Nordin RB. Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian National Cardiovascular Disease (NCVD) Database Registry (March 2006 - February 2010). BMC Cardiovasc Disord 2013; 13:97. [PMID: 24195639 PMCID: PMC4229312 DOI: 10.1186/1471-2261-13-97] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 10/30/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The National Cardiovascular Disease (NCVD) Database Registry represents one of the first prospective, multi-center registries to treat and prevent coronary artery disease (CAD) in Malaysia. Since ethnicity is an important consideration in the occurrence of acute coronary syndrome (ACS) globally, therefore, we aimed to identify the role of ethnicity in the occurrence of ACS among high-risk groups in the Malaysian population. METHODS The NCVD involves more than 15 Ministry of Health (MOH) hospitals nationwide, universities and the National Heart Institute and enrolls patients presenting with ACS [ST-elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI) and unstable angina (UA)]. We analyzed ethnic differences across socio-demographic characteristics, hospital medications and invasive therapeutic procedures, treatment of STEMI and in-hospital clinical outcomes. RESULTS We enrolled 13,591 patients. The distribution of the NCVD population was as follows: 49.0% Malays, 22.5% Chinese, 23.1% Indians and 5.3% Others (representing other indigenous groups and non-Malaysian nationals). The mean age (SD) of ACS patients at presentation was 59.1 (12.0) years. More than 70% were males. A higher proportion of patients within each ethnic group had more than two coronary risk factors. Malays had higher body mass index (BMI). Chinese had highest rate of hypertension and hyperlipidemia. Indians had higher rate of diabetes mellitus (DM) and family history of premature CAD. Overall, more patients had STEMI than NSTEMI or UA among all ethnic groups. The use of aspirin was more than 94% among all ethnic groups. Utilization rates for elective and emergency percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) were low among all ethnic groups. In STEMI, fibrinolysis (streptokinase) appeared to be the dominant treatment options (>70%) for all ethnic groups. In-hospital mortality rates for STEMI across ethnicity ranges from 8.1% to 10.1% (p = 0.35). Among NSTEMI/UA patients, the rate of in-hospital mortality ranges from 3.7% to 6.5% and Malays recorded the highest in-hospital mortality rate compared to other ethnic groups (p = 0.000). In binary multiple logistic regression analysis, differences across ethnicity in the age and sex-adjusted ORs for in-hospital mortality among STEMI patients was not significant; for NSTEMI/UA patients, Chinese [OR 0.71 (95% CI 0.55, 0.91)] and Indians [OR 0.57 (95% CI 0.43, 0.76)] showed significantly lower risk of in-hospital mortality compared to Malays (reference group). CONCLUSIONS Risk factor profiles and ACS stratum were significantly different across ethnicity. Despite disparities in risk factors, clinical presentation, medical treatment and invasive management, ethnic differences in the risk of in-hospital mortality was not significant among STEMI patients. However, Chinese and Indians showed significantly lower risk of in-hospital mortality compared to Malays among NSTEMI and UA patients.
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Affiliation(s)
- Hou Tee Lu
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway campus, 8 Jalan Masjid Abu Bakar, 80100, Johor Bahru, Johor, Malaysia
- Department of Cardiology, Sultanah Aminah Hospital, Jalan Abu Bakar, 80100, Johor Bahru, Johor, Malaysia
| | - Rusli Bin Nordin
- Clinical School Johor Bahru, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Sunway campus, 8 Jalan Masjid Abu Bakar, 80100, Johor Bahru, Johor, Malaysia
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