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Wita K, Wilkosz K, Wita M, Kulach A, Wybraniec M, Polak M, Matla M, Maciejewski L, Skowerski T, Fluder J, Kalanska-Lukasik B, Gomulka S, Turski M, Szydlo K. P6211Efficacy of comprehensive Managed Care after Acute Myocardial Infarction (MC-AMI) in a long-term follow-up - preliminary experience of a single high-volume center. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Despite substantial progress in the medical and interventional treatment of acute myocardial infarction (AMI), a long-term prognosis in MI survivors remains unsatisfactory. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is the first program of a comprehensive, supervised care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD.
Purpose
To assess the effect of MC-AMI on major adverse cardiovascular and cerebrovascular events (MACCE) in 12 months follow-up.
Methods
In this single-center, retrospective observational study we enrolled 1211 patients, out of which 719 consented for participation in MC-AMI and compared them to 1130 subjects in the control group. After propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI on clinical endpoints.
Results
Primarily, MC-AMI has been proved to reduce MACCE rate by 40% in a 12-month observation. Participants of MC-AMI had a higher adherence to cardiac rehabilitation (98 vs. 14%) higher rate of scheduled revascularisation (coronary artery bypass grafting: 9.8% vs. 4.9%, p<0.001; elective percutaneous coronary intervention: 3.0% vs 2.1%, p<0.05) and ICD implantation (2.8% vs. 0.6%, p<0.05) compared to control.
Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACCE at 12 months (HR=0.500, 95%Cl 0.349–0.718, p<0.001). Besides, older age, diabetes mellitus, hyperlipidemia, prior PAD, previous UA, and lower LVEF were significantly associated with the primary endpoint.
12-month FU - freedom from MACCE
Conclusions
MC-AMI is the first program of a comprehensive in-hospital and post-discharge care for AMI patients. MC-AMI improves prognosis by increasing the rate of patients undergoing CR, complete revascularization and ICD implantation, thus reducing MACCE rate by 40% in 12 months. Participation in MC-AMI is inversely related to mortality rate, recurrent MI and heart failure related hospitalization during 12 months.
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Affiliation(s)
- K Wita
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - K Wilkosz
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Wita
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - A Kulach
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - M Wybraniec
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Polak
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Matla
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - L Maciejewski
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - T Skowerski
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - J Fluder
- Medical University of Silesia, 3rd Department of Cardiology, Katowice, Poland
| | - B Kalanska-Lukasik
- Medical University of Silesia, 3rd Department of Cardiology, Katowice, Poland
| | - S Gomulka
- Upper Silesian Medical Center, Daily Cardiology Rehabilitation Department, Katowice, Poland
| | - M Turski
- Upper Silesian Medical Center, Daily Cardiology Rehabilitation Department, Katowice, Poland
| | - K Szydlo
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
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Kulach A, Wita K, Wita M, Wybraniec M, Wilkosz K, Polak M, Matla M, Maciejewski Ł, Skowerski T, Fluder J, Kalanska-Lukasik B, Gomulka S, Szydlo K. P6217Managed Care after Acute Myocardial Infarction (MC-AMI) reduces MACE by 45% in 3-month follow-up - results form Poland's National Health Fund program of post-MI care. A single center analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Despite progress in the medical and interventional treatment of acute myocardial infarction (AMI) and low in-hospital mortality related to AMI, a post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD.
Aims
To assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in a 3-month follow-up.
Methods
In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1:1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE.
Results
MC-AMI has been proved to reduce MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR 0.476, 95% CI 0.283–0.799, p<0.005). Besides, older age, male sex (HR 2.0), history of unstable angina (HR 3.15), peripheral artery disease (HR 2.17), peri-MI atrial fibrillation (HR 1.87) and diabetes (HR 1.5), were significantly associated with the primary endpoint.
Comparison of study endpoints between KO Total, n (%) MC-AMI group, n (%) Control Group, n (%) RR 95% CI NNT P n=1058 n=529 n=529 All-cause mortality 19 (1.8%) 7 (1.3%) 12 (2.3%) 0.583 0.232–1.470 105.8 0.247 Hospitalization for HF 31 (2.9%) 12 (2.3%) 19 (3.6%) 0.632 0.310–1.288 75.6 0.202 Myocardial infarction 25 (2.4%) 9 (1.7%) 16 (3.0%) 0.563 0.251–1.262 75.6 0.157 MACE 73 (6.9%) 26 (4.9%)# 47 (8.9%) 0.553 0.348–0.879 25.2 0.012 *Two-tailed Pearson's Chi-square test; MACE, Major Adverse Cardiovascular Events. #Number of patients with at least one MACE; in 2 patients 2 endpoints occurred. This explains why the total number of MACE is lower than the sum of all endpoints.
MC-AMI vs. control - MACE in 3 months up
Conclusions
MC-AMI is the first program of a comprehensive. Participation in MC-AMI – a first comprehensive in-hospital and post-discharge care for AMI patients for AMI patients improves prognosis and reduces MACE rate by 45% as soon as in 3 months.
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Affiliation(s)
- A Kulach
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - K Wita
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Wita
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Wybraniec
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - K Wilkosz
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Polak
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
| | - M Matla
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - Ł Maciejewski
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - T Skowerski
- Medical University of Silesia, 2nd Department of Cardiology, Katowice, Poland
| | - J Fluder
- Medical University of Silesia, 3rd Department of Cardiology, Katowice, Poland
| | - B Kalanska-Lukasik
- Medical University of Silesia, 3rd Department of Cardiology, Katowice, Poland
| | - S Gomulka
- Upper Silesian Medical Center, Daily Cardiology Rehabilitation Department, Katowice, Poland
| | - K Szydlo
- Medical University of Silesia, 1st Department of Cardiology, Katowice, Poland
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Skowerski M, Wozniak-Skowerska I, Hoffmann A, Nowak S, Skowerski T, Sosnowski M, Wnuk-Wojnar AM, Mizia-Stec K. Pulmonary vein anatomy variants as a biomarker of atrial fibrillation - CT angiography evaluation. BMC Cardiovasc Disord 2018; 18:146. [PMID: 30005637 PMCID: PMC6045862 DOI: 10.1186/s12872-018-0884-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 07/05/2018] [Indexed: 12/19/2022] Open
Abstract
Background It has been suggested that changes in pulmonary veins (PV) and left atrium (LA) anatomy may have an influence on initiating atrial fibrillation (AF) and the effectiveness of pulmonary vein isolation (PVI) in patients (pts) with atrial fibrillation. The aim of the study was to assess anatomy abnormalities of the PV and LA in the patients with the history of AF and compare it with the control group(CG). Methods The multi-slice tomography (MSCT) scans were performed in 224 AF pts. before PVI (129 males, mean age 59 ± 9 yrs). The CG consisted of 40 pts. without AF (26 males, age 45 ± 9 yrs). LA and PV anatomy were evaluated. Diameters of PV ostia were measured in two directions: anterior-posterior (AP) and superior-inferior (SI) automatically using Vitrea 4.0. Results Pulmonary veins anatomy variants were observed more frequently in the atrial fibrillation group - 83 pts. (37%) vs 6 pts. (15%) in CG; 9% (21 pts) left common ostia (CO), 2% (5 pts) right CO, 19% (42 pts) additional right PV (APV), (1.8%) 4 pts. APV left, 8% right early branching (EB) and 3.5% left EB. The LA diameter differed significantly in AF vs CG group (41.2 ± 6 mm vs 35 ± 4.2 mm, p < 0.0001) respectively. Conclusions The anomalies of pulmonary vein anatomy occurred more often in pts. with AF. They can be defined as an image biomarkers of atrial fibrillation. Right additional (middle) pulmonary vein was the most important anomaly detected in AF patients as well as enlargered diameters of the LA and PV ostia.
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Affiliation(s)
- M Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland
| | - I Wozniak-Skowerska
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - A Hoffmann
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - S Nowak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - T Skowerski
- Department of Cardiology, School of Health Sciences, Medical University of Silesia, Katowice, Poland.
| | - M Sosnowski
- Unit of Noninvasive Cardiovascular Diagnostics, Medical University of Silesia, Katowice, Poland
| | - A M Wnuk-Wojnar
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - K Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
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Setiawan S, Castineira Busto M, Wozniak-Skowerska I, Alskaf E, Boiten HJ, Ahmed A, Karolyi M, Benedek T, Ewe SH, Allen JC, Chao V, Lee CY, Tan F, Lim ST, Ho KW, Soon JL, Tan SY, Martinez Monzonis MA, Pubul Nunez V, Martinez De La Alegria Alonso A, Pena Gil C, Alvarez Barredo M, Bandin Dieguez MA, Gonzalez Juanatey JR, Skowerski M, Hoffmann A, Nowak S, Faryan M, Kolasa J, Skowerski T, Sosnowski M, Wnuk-Wojnar A, Mizia-Stec K, Kardos A, Valkema R, Van Den Berge JC, Van Domburg RT, Zijlstra F, Schinkel AFL, Suleiman A, Almohdar S, Aljizeeri A, Smete O, Abazid R, Alsaileek A, Alharthi M, Al-Mallah M, Bartykowszki A, Kolossvary M, Kocsmar I, Szilveszter B, Jermendy A, Karady J, Sax B, Balogh O, Merkely B, Maurovich-Horvat P, Rat N, Morariu M, Suciu ZS, Stanescu A, Dobra M, Opincariu D, Benedek I. Rapid Fire Abstract: Cardiac imaging with computed tomography and radionuclide techniques: usefulness in miscellaneous patient subsets347A novel CT calcium-based approach for predicting mitral stenosis348Value of 18-fluoro-2-deoxyglucose positron emission tomography-computed tomography in the diagnosis of native, prosthetic and device related infective endocarditis349Pulmonary veins anatomy variants assessment using CT in patients with atrial fibrillation350Aortic valve area using cardiac CT to improve the validity of LVOT measurement (ACTIV-LVOT study)351Impact of early coronary revascularization on long-term outcomes in patients with myocardial ischemia on myocardial perfusion single-photon emission computed tomorgraphy352Is there a correlation between coronary calcium score and high sensitivity c-reactive protein in patients with suspected coronary artery disease?353Coronary CT angiography for the assessment of cardiac allograft vasculopathy after heart transplantation354Correlation between the epicardial fat volume, assessed by coronary computed tomography, and coronary plaque vulnerability in acute coronary syndromes. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jung H, Kim M, Youn H, Wozniak-Skowerska I, Skowerski M, Skowerski M, Hoffmann A, Hoffmann A, Kolasa J, Kolasa J, Skowerski T, Skowerski T, Sosnowski M, Sosnowski M, Wnuk-Wojnar A, Wnuk-Wojnar A, Gasior Z, Gasior Z, Mizia-Stec K, Mizia-Stec K, Schirmer H, Forsdahl S, Sildnes T, Trovik T, Iqbal A, Astrom Aneq M, Engvall J, Abreu A, Oliveira L, Portugal G, Goncalves M, Mota Carmo M, Santa Clara H, Pereiro T, Oliveira M, Branco L, Ferreira R, Moody W, Sze Lin L, Bloxham N, Fraser H, Taylor R, Holloway B, Edwards N, Ferro C, Townend J, Steeds R, Perea G, Corneli M, Meretta A, Aguirre M, Rosa D, Henquin R, Ronderos R, Perez Balino N, Sunman H, Yorgun H, Sahiner L, Kaya B, Hazirolan T, Ozer N, Aytemir K, Tokgozoglu L, Kabakci G, Oto A, Peovska I, Srbinovska E, Hristova E, Otljanska M, Bosevski M, Arnaudova F, Andova V, Iwaki T. Moderated Posters session * Cardiovascular computed tomography, magnetic resonance and nuclear imaging: 13/12/2013, 08:30-12:30 * Location: Moderated Poster area. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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