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Martins E, Magne J, Pradel V, Faugeras G, Bosle S, Cailloce D, Darodes N, Fleurant E, Karam H, Petitcolin PB, Pages PA, Rousselle V, Virot P, Aboyans V. The mortality rates in registries of patients with STEMI are highly affected by inclusion criteria and population characteristics. Acta Cardiol 2021; 76:504-512. [PMID: 33478343 DOI: 10.1080/00015385.2020.1848970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Different mortality rates are reported in registries of patients with ST-segment elevation myocardial infarction (STEMI), but comparisons between registries are challenging. AIMS To determine whether the higher mortality rate in our regional French registry (SCALIM) is related to different inclusion criteria and demographic characteristics. METHODS The SCALIM registry included all patients with STEMI within the first 24 h in the region of Limousin, France (06/2011-01/2015). To compare mortality rates with other contemporary registries in France and European neighbouring countries, the others' inclusion criteria were applied to the SCALIM registry. RESULTS Among 1501 patients included, in-hospital and 1-month mortality were 8.2% and 8.8% respectively, significantly higher than many other registries. The use of inclusion criteria from EMUST (France), MINAP (UK) or LOMBARDIMA (Italy) markedly decreased the number of enrolled patients by 64%, 36%, and 21%, respectively. When those inclusion criteria were applied to the SCALIM registry, difference in in-hospital and 1-month mortality rates between other registries and ours remained significant. In the multivariate analysis, age, initial acute pulmonary oedema (Killip class ≥2), complication occurring before percutaneous coronary intervention, absence of transfer to an interventional cardiology centre for primary angioplasty and lack of reperfusion therapy within 12 h were associated with higher risk of 1-month mortality (all p < 0.05). Age (65 versus 63.3 years, p < 0.001) was higher and reperfusion rate (84.2 versus 74.7%, p < 0.001) was significantly lower in SCALIM than FAST-MI, the national French registry on STEMI patients. Interestingly, the 3% of patients included in SCALIM who would be excluded from FAST-MI registry had 91% mortality at one month. CONCLUSION Higher mortality rate in our regional SCALIM registry is in part due to differences in inclusion criteria and demographic data. Consensus should be made to harmonise inclusion criteria in STEMI registries for the sake of comparability.
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Affiliation(s)
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Limoges, France
- INSERM 1094, Faculté de médecine de Limoges Service de Cardiologie, Limoges, France
| | | | | | | | | | | | | | - Henri Karam
- CHU Limoges, Hôpital Dupuytren, Limoges Service des urgences, France
| | | | | | | | | | - Victor Aboyans
- CHU Limoges, Hôpital Dupuytren, Limoges, France
- INSERM 1094, Faculté de médecine de Limoges Service de Cardiologie, Limoges, France
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Malanchini G, Stefanini GG, Malanchini M, Lombardi F. Higher in-hospital mortality during weekend admission for acute coronary syndrome: a large-scale cross-sectional Italian study. J Cardiovasc Med (Hagerstown) 2018; 20:74-80. [PMID: 30540646 DOI: 10.2459/jcm.0000000000000743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS An increased mortality risk during weekend hospital admission has been consistently observed. In the present study, we evaluated whether the current improvement in management of acute coronary syndromes (ACS) has reduced this phenomenon. METHODS AND RESULTS We extracted data from the Italian National Healthcare System Databank of 80 391 ACS admissions in the region of Lombardia between 2010 and 2014. ICD-9 codes were used to assess the diagnosis. We performed a multiple logistic regression analysis to compare the mortality rates between weekend and weekday admissions.Mean age of the study population was 67.6 years; 30.1% of patients were women. ST segment elevation myocardial infarction (STEMI) accounts for 42.2% of admissions. The total in-hospital mortality was 3.05% and was positively predicted by weekend admission [odds ratio (OR) 1.13, P = 0.006], age and female sex. The weekend effect on mortality was only significant for STEMI (OR 1.11, P = 0.04) in comparison to non-STEMI (NSTEMI) or unstable angina.The trend of the risk of death was found to be negatively correlated with age: the risk of death was significantly higher in all age clusters younger than 75 (OR 1.22, P < 0.01) and even greater in the very young subgroup under 45 years of age (OR 2.09, P = 0.03). CONCLUSION Our data indicate that increased mortality risk is still present during weekend admissions. This phenomenon is particularly evident in younger patients and in individuals admitted for STEMI.
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Affiliation(s)
- Giovanni Malanchini
- Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan
| | | | | | - Federico Lombardi
- Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan
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Achilli F, Malafronte C, Cesana F, Maggiolini S, Mauro C, De Ferrari GM, Lenatti L, Tespili M, Pasqualini P, Gentile F, Capogrossi MC, Maggioni A, Maseri A, Pontone G, Colombo GI, Pompilio G. Granulocyte-colony stimulating factor for large anterior ST-elevation myocardial infarction: rationale and design of the prospective randomized phase III STEM-AMI OUTCOME trial. Am Heart J 2015; 170:652-658.e7. [PMID: 26386788 DOI: 10.1016/j.ahj.2015.07.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 07/02/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Granulocyte-colony stimulating factor (G-CSF) has been clinically tested in ST-elevation myocardial infarction (STEMI) with mixed results. Our 3-year follow-up data from STEM-AMI trial documented a sustained benefit of G-CSF on adverse ventricular remodeling after large anterior STEMI, when administered early and at a high-dose in patients with left ventricular (LV) dysfunction. The Aim of the present trial is to establish whether G-CSF improves hard clinical long-term outcomes. METHODS The STEM-AMI OUTCOME is a prospective, multicenter, randomized, open-label, phase III trial. It will include 1,530 patients with anterior STEMI undergoing primary percutaneous coronary intervention 2 to 24 hours after symptoms onset and with LV ejection fraction ≤45% after successful reperfusion. Patients will be randomized 1:1 to G-CSF and/or standard treatment. The primary end point is a reduced occurrence of all-cause death, recurrence of myocardial infarction, or hospitalization due to heart failure in G-CSF-treated patients. Left ventricular remodeling will be assessed via cardiac ultrasound and a substudy with cardiac magnetic resonance will be carried out in 120 subjects. Accrual and follow-up periods will last 3 and 2 years, respectively. CONCLUSIONS The STEM-AMI OUTCOME study is designed to be a rigorous controlled phase III trial with adequate statistical power to conclusively assess efficacy of G-CSF treatment in STEMI.
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Affiliation(s)
- Felice Achilli
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy.
| | - Cristina Malafronte
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy
| | - Francesca Cesana
- Cardiology Unit and Intensive and Coronary Care Unit, San Gerardo Hospital, Monza, Italy
| | | | - Ciro Mauro
- Department of Cardiology, Cardarelli Hospital, Napoli, Italy
| | - Gaetano M De Ferrari
- Cardiology Unit and Intensive and Coronary Care Unit, Fondazione Policlinico San Matteo IRCCS, Pavia, Italy
| | - Laura Lenatti
- Department of Cardiology, Alessandro Manzoni Hospital, Lecco, Italy
| | | | | | - Francesco Gentile
- Department of Cardiology, Bassini Hospital, Cinisello Balsamo, Italy
| | - Maurizio C Capogrossi
- Laboratory of Vascular Pathology, Istituto Dermopatico dell'Immacolata IRCCS, Rome, Italy
| | - Aldo Maggioni
- Research Center of the Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | | | - Gianluca Pontone
- Department of Cardiovascular Imaging, Cardiac Magnetic Resonance Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Gualtiero I Colombo
- Immunology and Functional Genomics Unit, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Giulio Pompilio
- Vascular Biology and Regenerative Medicine Unit, Centro Cardiologico Monzino IRCCS, and Cardiovascular Section, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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Brunetti ND, Di Pietro G, Aquilino A, Bruno AI, Dellegrottaglie G, Di Giuseppe G, Lopriore C, De Gennaro L, Lanzone S, Caldarola P, Antonelli G, Di Biase M. Pre-hospital electrocardiogram triage with tele-cardiology support is associated with shorter time-to-balloon and higher rates of timely reperfusion even in rural areas: data from the Bari- Barletta/Andria/Trani public emergency medical service 118 registry on primary angioplasty in ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL: ACUTE CARDIOVASCULAR CARE 2014; 3:204-213. [DOI: 10.1177/2048872614527009] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Brunetti ND, Dellegrottaglie G, Di Giuseppe G, Di Biase M. Remote tele-medicine cardiologist support for care manager nursing of chronic cardiovascular disease: preliminary report. Int J Cardiol 2014; 176:552-6. [DOI: 10.1016/j.ijcard.2014.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 07/05/2014] [Indexed: 11/26/2022]
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Brunetti N, De gennaro L, Dellegrottaglie G, Di Giuseppe G, Antonelli G, Di Biase M. All for one, one for all: Remote telemedicine hub pre-hospital triage for public Emergency Medical Service 1-1-8 in a regional network for primary PCI in Apulia, Italy. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.eurtel.2013.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ielasi A, Anzuini A. Successful management of a huge thrombus in coronary aneurysmatic dilatation after failed mechanical thrombectomy during acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2014; 15:80-1. [DOI: 10.2459/jcm.0b013e32835852fa] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Grieco N, Sesana G, Corrada E, Ieva F, Paganoni A, Marzegalli M. Mortality and ST resolution in patients admitted with STEMI: the MOMI survey of emergency service experience in a complex urban area. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2012; 1:192-9. [PMID: 24062907 PMCID: PMC3760542 DOI: 10.1177/2048872612453923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 06/08/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency. METHODS AND RESULTS In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment. CONCLUSIONS The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.
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Abstract
In Italy, as in other European countries, public service healthcare presents some disparities that are related to geographical, economic, organizational and structural issues. Although some Italian regions have excellent networks for the treatment of ST-elevation myocardial infarction (STEMI), others still have to develop a model that allows each STEMI patient to receive the best reperfusion treatment. A recent nationwide registry from the Italian Society of Interventional Cardiology (SICI-GISE) showed that efficient STEMI networks cover approximately 50% of the Italian territory. For these reasons, Italy joined the Stent for Life initiative in August 2010 with the primary goal of implementing and defining tailored action programs in order to ensure that the majority of the Italian STEMI population have access to life-saving primary percutaneous coronary intervention.
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Affiliation(s)
- Leonardo De Luca
- Division of Cardiology, Department of Cardiovascular Sciences, European Hospital, Rome, Italy
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Boccuzzi GG, Di Maggio L, Massara C, Garbo R, Savio D. Intravascular ultrasound-guided rotational atherectomy for heavily calcified renal artery stenosis. J Cardiovasc Med (Hagerstown) 2010; 13:338-42. [PMID: 20186070 DOI: 10.2459/jcm.0b013e328334341a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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