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Tung BW, Ng ZY, Kristanto W, Saw KW, Chan SP, Sia W, Chan KH, Chan M, Kong W, Lee R, Loh JP, Low AF, Poh KK, Tay E, Tan HC, Yeo TC, Loh PH. Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population. Open Heart 2021; 8:openhrt-2020-001437. [PMID: 33441469 PMCID: PMC7812097 DOI: 10.1136/openhrt-2020-001437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 12/06/2020] [Accepted: 12/23/2020] [Indexed: 11/26/2022] Open
Abstract
Objective ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention. Methods Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups. Results Of the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups. Conclusion Young patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.
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Affiliation(s)
- Benjamin Wl Tung
- Cardiology, National University Heart Centre, Singapore .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Zhe Yan Ng
- Cardiology, National University Heart Centre, Singapore
| | - William Kristanto
- Cardiology, National University Heart Centre, Singapore.,Cardiology, Ng Teng Fong General Hospital, Singapore
| | | | - Siew-Pang Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Winnie Sia
- Cardiology, National University Heart Centre, Singapore
| | - Koo Hui Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Mark Chan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore
| | - William Kong
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ronald Lee
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Cardiovascular Research Institute, National University Health System, Singapore
| | - Joshua P Loh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Adrian F Low
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian Keong Poh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Edgar Tay
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Huay Cheem Tan
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tiong-Cheng Yeo
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Poay Huan Loh
- Cardiology, National University Heart Centre, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Chew NW, Sia CH, Wee HL, Benedict LJD, Rastogi S, Kojodjojo P, Chor WPD, Leong BSH, Koh BCP, Tam H, Quek LS, Sia WC, Saw KW, Tung BWL, Ng ZZY, Ambhore A, Tay ELW, Chan KH, Lee CH, Loh JPY, Low AFH, Chan MYY, Yeo TC, Tan HC, Loh PH. Impact of the COVID-19 Pandemic on Door-to-Balloon Time for Primary Percutaneous Coronary Intervention - Results From the Singapore Western STEMI Network. Circ J 2020; 85:139-149. [PMID: 33162491 DOI: 10.1253/circj.cj-20-0800] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Little is known about the effect of the coronavirus disease 2019 (COVID-19) pandemic and the outbreak response measures on door-to-balloon time (D2B). This study examined both D2B and clinical outcomes of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).Methods and Results:This was a retrospective study of 303 STEMI patients who presented directly or were transferred to a tertiary hospital in Singapore for PPCI from October 2019 to March 2020. We compared the clinical outcomes of patients admitted before (BOR) and during (DOR) the COVID-19 outbreak response. The study outcomes were in-hospital death, D2B, cardiogenic shock and 30-day readmission. For direct presentations, fewer patients in the DOR group achieved D2B time <90 min compared with the BOR group (71.4% vs. 80.9%, P=0.042). This was more apparent after exclusion of non-system delay cases (DOR 81.6% vs. BOR 95.9%, P=0.006). Prevalence of both out-of-hospital cardiac arrest (9.5% vs. 1.9%, P=0.003) and acute mitral regurgitation (31.6% vs. 17.5%, P=0.006) was higher in the DOR group. Mortality was similar between groups. Multivariable regression showed that longer D2B time was an independent predictor of death (odds ratio 1.005, 95% confidence interval 1.000-1.011, P=0.029). CONCLUSIONS The COVID-19 pandemic and the outbreak response have had an adverse effect on PPCI service efficiency. The study reinforces the need to focus efforts on shortening D2B time, while maintaining infection control measures.
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Affiliation(s)
- Nicholas Ws Chew
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Hwee-Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore
| | | | | | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore.,Department of Cardiology, Ng Teng Fong General Hospital
| | | | | | | | - Howen Tam
- Emergency Medicine Department, Ng Teng Fong General Hospital
| | - Lit-Sin Quek
- Emergency Medicine Department, Ng Teng Fong General Hospital
| | - Winnie Ch Sia
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Kalyar Win Saw
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Benjamin Wei-Liang Tung
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Zan Zhe-Yan Ng
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Anand Ambhore
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Edgar Lik-Wui Tay
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Koo-Hui Chan
- Department of Cardiology, National University Heart Centre, National University Health System
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Joshua Ping-Yun Loh
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Adrian Fatt-Hoe Low
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Mark Yan-Yee Chan
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Huay-Cheem Tan
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
| | - Poay-Huan Loh
- Department of Cardiology, National University Heart Centre, National University Health System.,Yong Loo Lin School of Medicine, National University of Singapore
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