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Tona WM, Tamiru MT, Beyene DA, Tegegne GT, Alemkere G, Shashu BA, Tadesse TA. Clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention: a multicenter study in Ethiopia. Acta Cardiol 2024:1-9. [PMID: 38884451 DOI: 10.1080/00015385.2024.2365607] [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: 04/06/2024] [Accepted: 06/02/2024] [Indexed: 06/18/2024]
Abstract
AIMS This study aimed to evaluate the clinical outcomes and associated factors in patients who underwent percutaneous coronary intervention (PCI). METHODS This five-year retrospective cross-sectional study analyzed data from 241 patients who underwent urgent and primary PCI. Outcome measures included in-hospital mortality, major adverse cardiac and cerebrovascular events (MACCEs), postprocedural complications, and survival rates. Data were analysed using the Statistical Package for Social Sciences version 25. Cox proportional hazard regression models were used to assess predictors of in-hospital mortality. Kaplan-Meier analysis and the log-rank test were used to assess the overall survival rates and median survival time and to compare the survival probability curves for independent predictors. Hazard ratios (HRs) and 95% confidence intervals (CIs) were presented. RESULTS One hundred forty-two patients underwent elective PCI with drug-eluting stent implantation (75.1%) as the reperfusion method. The in-hospital mortality and non-fatal MACCE rates were 3.7% and 24.1%, respectively. The predictors of in-hospital mortality were female sex (AHR = 8.39, 95% CI: 1.20-58.68, p = 0.03), preprocedural obesity (AHR = 6.54, 95% CI: 1.10-40.60, p = 0.04), previous myocardial infarction (AHR = 9.68, 95% CI: 1.66-56.31, p = 0.01), chronic heart failure (AHR = 9.21, 95% CI: 1.38-61.78, p = 0.02), and a previous history of stroke (AHR = 18.99, 95% CI: 1.59-227.58, p = 0.02). Notably, this study reported a high one-year survival rate. CONCLUSION Urgent and primary PCIs are critical interventions for patients with MI in Ethiopia, showing promising outcomes such as low in-hospital mortality and a high one-year survival rate. These findings underscore the importance of optimising access to PCI and related treatments to improve patient outcomes.
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Affiliation(s)
- Wondimu Melesse Tona
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Health and Medical Science, Hawassa University, Hawassa, Ethiopia
| | - Melaku Tileku Tamiru
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dessale Abate Beyene
- Department of Pharmacy, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Gobezie Temsegen Tegegne
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Getachew Alemkere
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekele Alemayehu Shashu
- Department of Internal Medicine, School of Medicine, College of Health and Medical Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Tamrat Assefa Tadesse
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
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Xu X, Wang Z, Yang J, Fan X, Yang Y. Burden of cardiac arrhythmias in patients with acute myocardial infarction and their impact on hospitalization outcomes: insights from China acute myocardial infarction (CAMI) registry. BMC Cardiovasc Disord 2024; 24:218. [PMID: 38654151 PMCID: PMC11036585 DOI: 10.1186/s12872-024-03889-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The coexistence of cardiac arrhythmias in patients with acute myocardial infarction (AMI) usually exhibits poor prognosis. However, there are few contemporary data available on the burden of cardiac arrhythmias in AMI patients and their impact on in-hospital outcomes. METHODS The present study analyzed data from the China Acute Myocardial Infarction (CAMI) registry involving 23,825 consecutive AMI patients admitted to 108 hospitals from January 2013 to February 2018. Cardiac arrhythmias were defined as the presence of bradyarrhythmias, sustained atrial tachyarrhythmias, and sustained ventricular tachyarrhythmias that occurred during hospitalization. In-hospital outcome was defined as a composite of all-cause mortality, cardiogenic shock, re-infarction, stroke, or heart failure. RESULTS Cardiac arrhythmia was presented in 1991 (8.35%) AMI patients, including 3.4% ventricular tachyarrhythmias, 2.44% bradyarrhythmias, 1.78% atrial tachyarrhythmias, and 0.73% ≥2 kinds of arrhythmias. Patients with arrhythmias were more common with ST-segment elevation myocardial infarction (83.3% vs. 75.5%, P < 0.001), fibrinolysis (12.8% vs. 8.0%, P < 0.001), and previous heart failure (3.7% vs. 1.5%, P < 0.001). The incidences of in-hospital outcomes were 77.0%, 50.7%, 43.5%, and 41.4%, respectively, in patients with ≥ 2 kinds of arrhythmias, ventricular tachyarrhythmias, bradyarrhythmias, and atrial tachyarrhythmias, and were significantly higher in all patients with arrhythmias than those without arrhythmias (48.9% vs. 12.5%, P < 0.001). The presence of any kinds of arrhythmia was independently associated with an increased risk of hospitalization outcome (≥ 2 kinds of arrhythmias, OR 26.83, 95%CI 18.51-38.90; ventricular tachyarrhythmias, OR 8.56, 95%CI 7.34-9.98; bradyarrhythmias, OR 5.82, 95%CI 4.87-6.95; atrial tachyarrhythmias, OR4.15, 95%CI 3.38-5.10), and in-hospital mortality (≥ 2 kinds of arrhythmias, OR 24.44, 95%CI 17.03-35.07; ventricular tachyarrhythmias, OR 13.61, 95%CI 10.87-17.05; bradyarrhythmias, OR 7.85, 95%CI 6.0-10.26; atrial tachyarrhythmias, OR 4.28, 95%CI 2.98-6.16). CONCLUSION Cardiac arrhythmia commonly occurred in patients with AMI might be ventricular tachyarrhythmias, followed by bradyarrhythmias, atrial tachyarrhythmias, and ≥ 2 kinds of arrhythmias. The presence of any arrhythmias could impact poor hospitalization outcomes. REGISTRATION Clinical Trial Registration: Identifier: NCT01874691.
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Affiliation(s)
- Xu Xu
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhao Wang
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jingang Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaohan Fan
- Department of Cardiology, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- , Department of Cardiology, Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Janjani P, Salehi N, Rouzbahani M, Siabani S, Olfatifar M. Creatinine clearance is key to solving the enigma of sex difference in in-hospital mortality after STEMI: Propensity score matching and mediation analysis. PLoS One 2023; 18:e0284668. [PMID: 37134063 PMCID: PMC10155957 DOI: 10.1371/journal.pone.0284668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND The precise impact of sex difference on in-hospital mortality in ST-elevation myocardial infarction (STEMI) patients are unclear, and the studies are no longer consistent. Therefore, we sought to evaluate the impact of sex differences in a cohort of STEMI patients. METHODS We analyzed the data of 2647 STEMI patients enrolled in the Kermanshah STEMI Cohort from July 2017 to May 2020. To accurately clarify the relationship between sex and hospital mortality, propensity score matching (PSM) and causal mediation analysis was applied to the selected confounder and identified intermediate variables, respectively. RESULTS Before matching, the two groups differed on almost every baseline variable and in-hospital death. After matching with 30 selected variables, 574 male and female matched pairs were significantly different only for five baseline variables and women were no longer at greater risk of in-hospital mortality (10.63% vs. 9.76%, p = 0.626). Among the suspected mediating variables, creatinine clearance (CLCR) alone accounts for 74% (0.665/0.895) of the total effect equal to 0.895(95% CI: 0.464-1.332). In this milieu, the relationship between sex and in-hospital death was no longer significant and reversed -0.233(95% CI: -0.623-0.068), which shows the full mediating role of CLCR. CONCLUSION Our research could help address sex disparities in STEMI mortality and provide a consequence. Moreover, CLCR alone can fully explain this relationship, which can highlight the importance of CLCR in predicting the short-term outcomes of STEMI patients and provide a useful indicator for clinicians.
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Affiliation(s)
- Parisa Janjani
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nahid Salehi
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohammad Rouzbahani
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Soraya Siabani
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Department of Health Education and Health Promotion, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Meysam Olfatifar
- Cardiovascular Research Center, Health Institute, Imam-Ali hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Gastroenterology and Hepatology Diseases Research Center, Qom University of Medical Sciences, Qom, Iran
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Pajjuru VS, Thandra A, Walters RW, Papudesi BN, Aboeata A, Vallabhajosyula S, Altin SE, Sutton NR, Alla VM, Goldsweig AM. Sex disparities in in-hospital outcomes of left ventricular aneurysm complicating acute myocardial infarction: A United States nationwide analysis. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 13:100104. [PMID: 38560084 PMCID: PMC10978193 DOI: 10.1016/j.ahjo.2022.100104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/21/2022] [Accepted: 01/21/2022] [Indexed: 04/04/2024]
Abstract
Background Previous studies have reported sex-specific differences in the presentation, mechanisms, and outcomes of acute myocardial infarction (AMI). We assessed differences between women and men in the incidence and in-hospital outcomes of left ventricular (LV) aneurysm complicating AMI. Methods Hospitalizations for AMI with LV aneurysm were identified retrospectively in the National Inpatient Sample (NIS) from 2001 to 2017. Incidence and trends in in-hospital mortality, complications, length of stay and costs were analyzed in women and men. Results A total of 16,334 AMI hospitalizations with concomitant LV aneurysm were identified including 6994 (42.8%) women and 9340 (57.2%) men. Among these hospitalizations, women had a higher incidence of LV aneurysm compared to men (0.16% vs. 0.14%; p < 0.001). Unadjusted in-hospital mortality was higher in women than men (12.7% vs. 7.2%; p < 0.001). After adjusting for demographic and baseline characteristics and excluding inter-hospital transfers, women with AMI complicated by LV aneurysm had 49% greater odds of in-hospital mortality than men (OR 1.49, 95% confidence interval 1.06-2.10, p = 0.02). Women with LV aneurysm were less likely than men to undergo percutaneous coronary intervention (28.5% vs. 35.4%; p < 0.001), bypass surgery (15.8% vs. 25.1%; p < 0.001), coronary atherectomy (0.8% vs. 1.9%; p = 0.009) and LV aneurysm surgery (7.8% vs. 11.1%; p = 0.001). Conclusions In this large population-based cohort study, women had a slightly higher incidence but dramatically higher in-hospital mortality associated with LV aneurysm complicating AMI compared to men. Further research is necessary to validate strategies to ensure that women receive guideline-directed therapy for AMI and LV aneurysm to address the sex disparity in mortality.
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Affiliation(s)
- Venkata S. Pajjuru
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Abhishek Thandra
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Ryan W. Walters
- Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | | | - Ahmed Aboeata
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Saraschandra Vallabhajosyula
- Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - S. Elissa Altin
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University, New Haven, CT, USA
| | - Nadia R. Sutton
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Venkata M. Alla
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Andrew M. Goldsweig
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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Mueed A, Khatti S, Ashraf J, Aarij KM, Waqas M, Khan TM. Arrhythmia in Acute Myocardial Infarction: A Six-Month Retrospective Analysis From the National Institute of Cardiovascular Diseases. Cureus 2020; 12:e11322. [PMID: 33304665 PMCID: PMC7720432 DOI: 10.7759/cureus.11322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Acute myocardial infarction (AMI) is a devastating medical emergency that requires immediate pharmacological and radiological intervention. With the advent of techniques such as percutaneous coronary intervention (PCI), pacemakers, and percussion pacing, survival rates have improved significantly. However, there are certain factors and complications associated with AMI that still lead to a high mortality rate, such as old age, advanced heart disease, diabetes mellitus (DM), and arrhythmias. Factors such as the type of arrhythmia, the heart rate, and the level at which dissociation occurs between atrial and ventricular rhythm all influence mortality and morbidity rates. Outcomes are further influenced by the sex of the patient, the type of AMI [ST-elevation myocardial infarction (STEMI) or non-ST-elevation myocardial infarction (NSTEMI)], history of smoking, arrival times at the hospital, presence of hyperglycemia, previous history of cardiac surgery, and the need for a temporary pacemaker or a permanent pacemaker. As with most scientific studies, local data from Pakistan is hard to find on this topic as well. With this study, we hope to contribute valuable information and updates to the study of a developing problem from the developing world. Objective We aimed to analyze the frequency and outcomes of different types of arrhythmia in AMI. Methods This study involved a retrospective observational cohort. It was conducted at the National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2019 to July 2019 (six months). All data were retrieved from the online database at the NICVD. Written consent was obtained from all patients. Patient confidentiality was ensured at all times. Results A total of 500 patients were included in the study. The mean age of our cohort was 56.17 ±14.01 years. NSTEMI was more prevalent than STEMI. Sinus arrhythmia (SA) was the most frequently recorded arrhythmia and had the best survival rates. Atrioventricular (AV) nodal blocks and ventricular tachycardia (VT) had the worst outcomes. The overall mortality rate was 11.4%, and the mean in-hospital length of stay was 2.07 ±1.54 days. Smoking increased mortality in all cases. Conclusions AMI is complicated by several types of arrhythmia. SA is the most common arrhythmia in AMI. Mortality in AMI is largely due to AV nodal blocks and VT. Smoking increases mortality in all cases.
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Affiliation(s)
- Abdul Mueed
- Cardiac Electrocardiography, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Shahzad Khatti
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Jibran Ashraf
- Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Khawaja M Aarij
- Noninvasive Imaging, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Muhammad Waqas
- Interventional Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK
| | - Tariq M Khan
- Cardiac Surgery, College of Physicians and Surgeons Pakistan, Karachi, PAK
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Mboera LEG, Rumisha SF, Lyimo EP, Chiduo MG, Mangu CD, Mremi IR, Kumalija CJ, Joachim C, Kishamawe C, Massawe IS, Matemba LE, Kimario E, Bwana VM, Mkwashapi DM. Cause-specific mortality patterns among hospital deaths in Tanzania, 2006-2015. PLoS One 2018; 13:e0205833. [PMID: 30379899 PMCID: PMC6209209 DOI: 10.1371/journal.pone.0205833] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 10/02/2018] [Indexed: 01/03/2023] Open
Abstract
Background Understanding the causes of inpatient mortality in hospitals is important for monitoring the population health and evidence-based planning for curative and public health care. Dearth of information on causes and trends of hospital mortality in most countries of Sub-Saharan Africa has resulted to wide use of model-based estimation methods which are characterized by estimation errors. This retrospective analysis used primary data to determine the cause-specific mortality patterns among inpatient hospital deaths in Tanzania from 2006–2015. Materials and methods The analysis was carried out from July to December 2016 and involved 39 hospitals in Tanzania. A review of hospital in-patient death registers and report forms was done to cover a period of 10 years. Information collected included demographic characteristics of the deceased and immediate underlying cause of death. Causes of death were coded using international classification of diseases (ICD)-10. Data were analysed to provide information on cause-specific, trends and distribution of death by demographic and geographical characteristics. Principal findings A total of 247,976 deaths were captured over a 10-year period. The median age at death was 30 years, interquartile range (IQR) 1, 50. The five leading causes of death were malaria (12.75%), respiratory diseases (10.08%), HIV/AIDS (8.04%), anaemia (7.78%) and cardio-circulatory diseases (6.31%). From 2006 to 2015, there was a noted decline in the number of deaths due to malaria (by 47%), HIV/AIDS (28%) and tuberculosis (26%). However, there was an increase in number of deaths due to neonatal disorders by 128%. Malaria and anaemia killed more infants and children under 5 years while HIV/AIDS and Tuberculosis accounted for most of the deaths among adults. Conclusion The leading causes of inpatient hospital death were malaria, respiratory diseases, HIV/AIDS, anaemia and cardio-circulatory diseases. Death among children under 5 years has shown an increasing trend. The observed trends in mortality indicates that the country is lagging behind towards attaining the global and national goals for sustainable development. The increasing pattern of respiratory diseases, cancers and septicaemia requires immediate attention of the health system.
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Affiliation(s)
- Leonard E. G. Mboera
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- Sokoine University of Agriculture, College of Veterinary Medicine and Biomedical Sciences, Africa Centre of Excellence for Infectious Diseases of Humans and Animals in Eastern and Southern Africa, Morogoro, Tanzania
- * E-mail:
| | - Susan F. Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Emanuel P. Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Mercy G. Chiduo
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Chacha D. Mangu
- National Institute for Medical Research, Mbeya Research Centre, Mbeya, Tanzania
| | - Irene R. Mremi
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
- Sokoine University of Agriculture, College of Veterinary Medicine and Biomedical Sciences, Africa Centre of Excellence for Infectious Diseases of Humans and Animals in Eastern and Southern Africa, Morogoro, Tanzania
| | - Claud J. Kumalija
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Catherine Joachim
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Coleman Kishamawe
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
| | - Isolide S. Massawe
- National Institute for Medical Research, Tanga Research Centre, Tanga, Tanzania
| | - Lucas E. Matemba
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Evord Kimario
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Veneranda M. Bwana
- National Institute for Medical Research, Amani Research Centre, Muheza, Tanzania
| | - Denna M. Mkwashapi
- National Institute for Medical Research, Mwanza Research Centre, Mwanza, Tanzania
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Juhan N, Zubairi YZ, Zuhdi AS, Khalid ZM, Wan WA. Gender differences in mortality among ST elevation myocardial infarction patients in Malaysia from 2006 to 2013. Ann Saudi Med 2018; 38:1-7. [PMID: 29419522 PMCID: PMC6074185 DOI: 10.5144/0256-4947.2018.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is one of the leading causes of death in Malaysia. However, the prevalence of CAD in males is higher than in females and mortality rates are also different between the two genders. This suggest that risk factors associated with mortality between males and females are different, so we compared the clinical characteristics and outcome between male and female STEMI patients. OBJECTIVES To identify the risk factors associated with mortality for each gender and compare differences, if any, among ST-elevation myocardial infarction (STEMI) patients. DESIGN Retrospective analysis. SETTINGS Hospitals across Malaysia. PATIENTS AND METHODS We analyzed data on all STEMI patients in the National Cardiovascular Database-Acute coronary syndrome (NCVD-ACS) registry for the years 2006 to 2013 (8 years). We collected demographic and risk factor data (diabetes mellitus, hypertension, smoking status, dyslipidaemia and family history of CAD). Significant variables from the univariate analysis were further analysed by a multivariate logistic analysis to identify risk factors and compare by gender. MAIN OUTCOME MEASURES Differential risk factors for each gender. RESULTS For the 19484 patients included in the analysis, the mortality rate over the 8 years was significantly higher in females (15.4%) than males (7.5%) (P < .001). The univariate analysis showed that the majority of male patients < 65 years while females were >=65 years. The most prevalent risk factors for male patients were smoking (79.3%), followed by hypertension (54.9%) and diabetes mellitus (40.4%), while the most prevalent risk factors for female patients were hypertension (76.8%), followed by diabetes mellitus (60%) and dyslipidaemia (38.1%). The final model for male STEMI patients had seven significant variables: Killip class, age group, hypertension, renal disease, percutaneous coronary intervention and family history of CVD. For female STEMI patients, the significant variables were renal disease, smoking status, Killip class and age group. CONCLUSION Gender differences existed in the baseline characteristics, associated risk factors, clinical presentation and outcomes among STEMI patients. For STEMI females, the rate of mortality was twice that of males. Once they reach menopausal age, when there is less protection from the estrogen hormone and there are other risk factors, menopausal females are at increased risk for STEMI. LIMITATION Retrospective registry data with inter-hospital variation.
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Affiliation(s)
| | - Yong Z Zubairi
- Yong Z. Zubairi, Foundation Studies in Science,, University of Malaya,, Wilayah Persekutan 50603, Kuala Lumpur, Malaysia T: +60379673273, , ORCID: http://orcid.org/0000-0002-6174-7285
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El-Menyar AA, Al Suwaidi J. Impact of gender in patients with acute coronary syndrome. Expert Rev Cardiovasc Ther 2014; 7:411-21. [DOI: 10.1586/erc.09.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Shah MJ, Bhatt NR, Dabhi A, Thorat P, Chudasama K, Patel J. A Study of 100 Cases of Arrhythmias in First Week of Acute Myocardial Infarction (AMI) in Gujarat: A High Risk and Previously Undocumented Population. J Clin Diagn Res 2014; 8:58-61. [PMID: 24596724 PMCID: PMC3939588 DOI: 10.7860/jcdr/2014/6658.3769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Accepted: 10/19/2013] [Indexed: 11/24/2022]
Abstract
AIM To study the incidence of arrhythmias in the first week of Acute Myocardial Infarction (AMI) with respect to type of arrhythmia, age distribution, sex and location of infarctin a patient population from western India and to evaluate its prognostic value and assessment of effect of pharmacotherapy. STUDY DESIGN A prospective clinical study consisting of 100 patients was undertaken to investigate the relationship of arrhythmia with site of AMI, timing, complications and outcome in terms of mortality and morbidity. MATERIALS AND METHODS Hundred consecutive cases of AMI with arrhythmia admitted in ICCU of Sir Sayaji General Hospital, Vadodara were taken in the study. RESULTS Among 100 cases, maximum incidence (41%) was found after 6th decade. Incidence of arrhythmias was higher in males (70%) than females (30%). Anterior wall infarcts (69%) were more common than inferior wall (26%). Ventricular Premature Contraction (VPC) (36.23%) was the commonest arrhythmia is anterior wall MI while Complete Heart Block (CHB) (26.92%) was most frequent in inferior wall MI. A large number of arrhythmias were terminated pharmacologically (39%) whereas 13 % of the arrhythmias persisted in spite of treatment. CONCLUSION Hence, in one of the largest study of this kind in a patient population of Western India, we established VPC's as the most common arrhythmia in AMI patients. Older patients (sixth decade) and males are affected more commonly. Ventricular tachycardia is more fatal in acute inferior wall MI. Pharmacotherapy was successful in a large number of cases.
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Affiliation(s)
- Mohit J Shah
- Resident, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
| | - Nikita R. Bhatt
- Intern, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
| | - Ajay Dabhi
- Associate Professor, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
| | - P.B. Thorat
- Associate Professor, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
| | - Ketan Chudasama
- Resident, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
| | - Jigar Patel
- Resident, Department of Medicine, Baroda Medical College, Sir Sayaji General Hospital, Vadodara, India
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Abstract
Cardiogenic shock (CS) describes the physiologic state in which reduced cardiac output and resultant tissue hypoxia occur in the presence of adequate intravascular volume. Among patients hospitalized with myocardial infarction (MI), CS is the foremost cause of death. Women are more susceptible to CS than men in the setting of ST segment increase MI. Introduction of early revascularization strategies and mechanical ventricular support have seen a decrease in short-term mortality from CS. However, the prognosis following CS remains poor. This article examines the prevalence, causes, pathophysiology, and therapeutic options for CS among women.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK.
| | - Louise Coats
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals, NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Annapoorna S Kini
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Roxana Mehran
- Mount Sinai School of Medicine, One Gustave L. Levy Place, New York, NY 10029, USA
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Claassen M, Sybrandy KC, Appelman YE, Asselbergs FW. Gender gap in acute coronary heart disease: Myth or reality? World J Cardiol 2012; 4:36-47. [PMID: 22379536 PMCID: PMC3289892 DOI: 10.4330/wjc.v4.i2.36] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 12/09/2011] [Accepted: 12/16/2011] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate potential gender differences in the prevalence of cardiovascular risk factors, cardiovascular disease (CVD) management, and prognosis in acute coronary syndrome (ACS). METHODS A systematic literature search was performed through Medline using pre-specified keywords. An additional search was performed, focusing specifically on randomized controlled clinical trials in relation to therapeutic intervention and prognosis. In total, 92 relevant articles were found. RESULTS Women with CVD tended to have more hypertension and diabetes at the time of presentation, whereas men were more likely to smoke. Coronary angiography and revascularization by percutaneous coronary intervention were performed more often in men. Women were at a greater risk of short-term mortality and complications after revascularization. Interestingly, women under 40 years presenting with ACS were at highest risk of cardiovascular death compared with men of the same age, irrespective of risk factors. This disadvantage disappeared in older age. The long-term mortality risk of ACS was similar in men and women, and even in favor of women. CONCLUSION Mortality rates are higher among young women with ACS, but this difference tends to disappear with age, and long-term prognosis is even better among older women.
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Affiliation(s)
- Mette Claassen
- Mette Claassen, Kirsten C Sybrandy, Folkert W Asselbergs, Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, 3508 GA Utrecht, The Netherlands
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Al-Aqeedi RF, Al Suwaidi J, Singh R, Al Binali HA. Does prior coronary artery bypass surgery alter the gender gap in patients presenting with acute coronary syndrome? A 20-year retrospective cohort study. BMJ Open 2012; 2:e001969. [PMID: 23194954 PMCID: PMC3533054 DOI: 10.1136/bmjopen-2012-001969] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Previous studies demonstrated women presenting with acute coronary syndrome (ACS) have poor outcomes when compared with men 'the gender gap phenomenon'. The impact of prior coronary artery bypass graft (CABG) on women presenting with ACS is unknown. We hypothesised that the gender gap is altered in ACS patients with prior CABG. The aim of this study was to evaluate patients presenting with ACS according to their gender and history of prior CABG. DESIGN Retrospective, observational (cohort) study. SETTING Data were collected from hospital-based registry of patients hospitalised with ACS in Doha, Qatar, from 1991 through 2010. The data were analysed according to their gender and history of prior CABG. PARTICIPANTS A total of 16 750 consecutive patients with ACS were studied. In total, 693 (4.3%) patients had prior CABG; among them 125 (18%) patients were women. PRIMARY AND SECONDARY OUTCOME MEASURES Comparisons of clinical characteristics, inhospital treatment, and outcomes, including inhospital mortality and stroke were made. RESULTS Women with or without prior CABG were older, less likely to be smokers, but more likely to have diabetes mellitus (DM), hypertension and renal impairment than men (p=0.001). Women were less likely to receive reperfusion and early invasive therapies. When compared with men, women without prior CABG carried higher inhospital mortality (11% vs 4.9%; p=0.001) and stroke rates (0.9% vs 0.3%; p=0.001). Female gender was independent predictor of poor outcome. Among prior CABG patients, despite the fact that women had worse baseline characteristics and were less likely to receive evidence-based therapy, there were no significant differences in mortality or stroke rates between the two groups. CONCLUSIONS Consistent with the world literature, women presenting with ACS and without prior CABG had higher death rates compared with men. Patients with prior CABG had comparable death rates regardless of the gender status.
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Affiliation(s)
| | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A Al Binali
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Free wall rupture (FWR) in patients with acute ST-elevation myocardial infarction (STEMI) receiving fibrinolytic therapy (FT): A 7-year prospective study. Arch Gerontol Geriatr 2012; 54:266-70. [DOI: 10.1016/j.archger.2011.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 03/06/2011] [Accepted: 03/15/2011] [Indexed: 11/22/2022]
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Shao YH, Croitor SK, Moreyra AE, Wilson AC, Kostis WJ, Cosgrove NM, Kostis JB. Comparison of hospital versus out of hospital coronary death rates in women and men. Am J Cardiol 2010; 106:26-30. [PMID: 20609642 DOI: 10.1016/j.amjcard.2010.02.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 02/15/2010] [Accepted: 02/15/2010] [Indexed: 11/27/2022]
Abstract
Young women hospitalized with acute myocardial infarction (MI) have greater in-hospital mortality than young men. However, the reasons for this difference have not been well characterized. We analyzed the data from 423,067 patients (247,701 men and 175,366 women) who were discharged with the diagnosis of MI from nonfederal hospitals in New Jersey and 355,569 coronary heart disease (CHD) deaths in New Jersey from 1990 to 2004 in 4 age strata: 35 to 54, 55 to 64, 65 to 74 and > or =75 years. Of the patients hospitalized for MI, young (35 to 54 years) women had greater in-hospital mortality than young men (5.2% vs 2.5%, adjusted odds ratio 1.64, 95% confidence interval 1.48 to 1.81, p <0.0001). However, in a community-wide analysis, when the total out-of-hospital CHD deaths in New Jersey were examined, young women had a lower out-of-hospital death rate than young men (11 vs 55/100,000). Statewide, young women were 4 times less likely to be hospitalized for MI (78 vs 297/100,000, relative risk 0.26), but they were only 1/2 as likely to die from MI in the hospital (7 vs 17/100,000, relative risk 0.41). Thus, women had a greater odds ratio for in-hospital mortality but a lower odds ratio for out-of-hospital CHD death than men. In conclusion, the greater in-hospital mortality of young women hospitalized for MI compared to young men could be explained in part by the finding that young men were more likely to have out-of-hospital CHD death.
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Bajraktari G, Thaqi K, Pacolli S, Gjoka S, Rexhepaj N, Daullxhiu I, Sylejmani X, Elezi S. In-hospital mortality following acute myocardial infarction in Kosovo: a single center study. Ann Saudi Med 2008; 28:430-4. [PMID: 19011318 PMCID: PMC6074258 DOI: 10.5144/0256-4947.2008.430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Randomized trials have demonstrated that primary angioplasty is more effective than intravenous thrombolysis in reducing mortality and morbidity in patients with acute myocardial infarction (AMI). The aim of this study was to assess the in-hospital mortality of patients with AMI admitted to the only tertiary care center in Kosovo, where coronary percutaneous intervention procedures are unavailable. We also assessed the impact of age and gender on in-hospital mortality. PATIENTS AND METHODS Consecutive patients with the diagnosis of AMI, admitted in our institution between 1999 and 2007, were included in this retrospective study. RESULTS Of 2848 patients (mean age 61+/-11.3 years, 73.4% males) admitted with AMI, 292 (10.25%) patients died during in-hospital stay. The overall in-hospital mortality was 12.3% for women and 9.5% for men (P<.05). Women were significantly older than men (64.2+/-11 years vs 59.7+/-11.8 years, P<.05). Mean length of stay was 12.0+/-94 for women and 10.7+/-7.6 for men. From 1999 to 2007 there was an increase in the age of patients with AMI but the mortality rate remained stable. CONCLUSIONS Compared to developed countries, patients with AMI in Kosovo present at an earlier age but have a higher mortality rate. Women with AMI had a significantly higher in-hospital mortality rate than men. The lack of percutaneous coronary intervention procedures in AMI patients may have contributed to the high in-hospital mortality in our population.
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Affiliation(s)
- Gani Bajraktari
- Second Division of Cardiology, Internal Medicine Clinic, University Cinical Centre of Kosova and the Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo.
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Seeman MV. Prevention inherent in services for women with schizophrenia. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:332-41. [PMID: 18551854 DOI: 10.1177/070674370805300508] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Effective care to women with serious mental illness provides an opportunity for prevention of mental health problems in their offspring. The objective of this study is to outline the preventive possibilities of a service targeted to women with schizophrenia. METHOD An analysis of recently published literature on women suffering from schizophrenia, focusing on intervention. RESULTS Genetic counselling, prenatal care, prevention of obstetrical complications, substance abuse reduction, appropriate antipsychotic treatment, parenting support, safety issues, quality of life, ethics, cultural competence, and advocacy are components of a comprehensive service to women with schizophrenia. CONCLUSIONS These components improve maternal health and, by also ensuring fetal and neonatal health, are potentially preventive against schizophrenia in the second generation.
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Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario.
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