Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the myocardial infarction triage and intervention project)

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p<0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

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Accessibility to Reperfusion Therapy Among Women with Acute Myocardial Infarction: Impact on Hospital Mortality

Journal of Women s Health ◽

10.1089/jwh.2014.5011 ◽

2015 ◽

Vol 24 (11) ◽

pp. 882-888 ◽

Cited By ~ 7

Author(s):

Eva de-Miguel-Balsa ◽

Jaime Latour-Pérez ◽

Anna Baeza-Román ◽

Ana Llamas-Álvarez ◽

Javier Ruiz-Ruiz ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Reperfusion Therapy

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Shifting from pharmacological to systematic mechanical reperfusion therapy for acute myocardial infarction via a cooperating network: impact on reperfusion rate and in-hospital mortality

Journal of Cardiovascular Medicine ◽

10.2459/jcm.0b013e328224b959 ◽

2008 ◽

Vol 9 (3) ◽

pp. 245-250 ◽

Cited By ~ 1

Author(s):

Giovanni Falsini ◽

Francesco Liistro ◽

Kenneth Ducci ◽

Paolo Angioli ◽

Silvia Baldassarre ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Reperfusion Therapy ◽

Reperfusion Rate

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Abstract 17020: Nationwide Analysis to Determine Mechanical Circulatory Support Device Use in Mechanical Complications of Acute Myocardial Infarction

Circulation ◽

10.1161/circ.142.suppl_3.17020 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

ayesha shaik ◽

Karthik Gonuguntla ◽

Nikola Perosevic

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiogenic Shock ◽

Mechanical Circulatory Support ◽

Reperfusion Therapy ◽

Circulatory Support ◽

Cardiac Transplant ◽

Papillary Muscle Rupture ◽

Mechanical Complications

Introduction: Without timely reperfusion therapy, acute myocardial infarction (AMI) can lead to mechanical complications (MC) such as papillary muscle rupture (PMR), ventricular septal rupture (VSR), free wall rupture (FWR). Mechanical circulatory support (MCS) devices such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) are used in cardiogenic shock associated with AMI-MC. Hypothesis: As per the SHOCK-II trial use of MCS in MI complicated cardiogenic shock showed no difference in mortality. We sought to determine the rates of AMI-MC, MCS device placements and outcomes associated with them. Methods: The Nationwide Inpatient Sample was queried from 2010 to 2014 using ICD-9 codes with a primary diagnosis of AMI. We also used diagnosis and procedure codes for MC and MCS devices. We excluded patients with NSTEMI. Results: From 2010 to 2014, we identified 3158 hospitalizations related to AMI-MC with a mean age of 64±13.4 years. Majority were men 69% with 75% Caucasian with an in-hospital mortality rate of 37%. Use of MCS was most common in males (67%), Caucasians (77%), and with an age group of 50-70 years (54%). Of these patients, PMR was noted in 13%, VSR in 31% and FWR in 56%. Rates of MCS devices were 38% (IABP 35%, Impella 3% and ECMO 4%). Overall use of MCS for FWR, VSR, PMR were 15%, 61%, 80%. Percentage of MC requiring IABP, Impella, ECMO were as follows; FWR (15%, 0.6%, 0.3%), VSR (58%, 7%, 6%), PMR (70%, 5%, 12%). Patients that received cardiac transplant was 0.2%. In-hospital mortality among patients who received MCS to those who did not receive MCS were 59% vs 24%; p<0.001, among patients who received IABP to those who did not receive any MCS were 54% vs 24%; p<0.001 and among patients who received Impella to no MCS were 86% vs 24%; p<0.001. Conclusions: Based on the results, FWR was the most common MC. MCS were most commonly used in PMR followed by VSR, with IABP being the most common type. Patients on MCS had increased in-hospital mortality compared to those without MCS. Large randomized trials are needed to determine the effectiveness of these devices in predicting outcomes associated with AMI-MC

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Impact of Left and Right Bundle Branch Block on In-hospital Mortality in Acute Myocardial Infarction

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(97)85325-9 ◽

1998 ◽

Vol 31 (2) ◽

pp. 372A

Author(s):

A Go

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Right Bundle Branch Block ◽

Bundle Branch Block ◽

Left And Right

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Increasing the Penetration of Primary Angioplasty in Europe

European Cardiology Review ◽

10.15420/ecr.2012.8.1.60 ◽

2012 ◽

Vol 8 (1) ◽

pp. 60 ◽

Cited By ~ 2

Author(s):

Zuzana Kaifoszova ◽

Petr Widimsky ◽

◽

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Treatment Guidelines ◽

Coronary Intervention ◽

Reperfusion Therapy ◽

Success Factor ◽

The Balkans ◽

Life Saving ◽

Percutaneous Coronary

Primary percutaneous coronary intervention (PPCI) is recommended by the European Society of Cardiology (ESC) treatment guidelines as the preferred treatment for ST-elevation acute myocardial infarction (STEMI) whenever it is available within 90–120 minutes of the first medical contact. A survey conducted in 2008 in 51 ESC countries found that the annual incidence of hospital admissions for acute myocardial infarction is around 1,900 patients per million population, with an incidence of STEMI of about 800 per million. It showed that STEMI patients’ access to reperfusion therapy and the use of PPCI or thrombolysis (TL) vary considerably between countries. Northern, western and central Europe already have well-developed PPCI services, offering PPCI to 60–90 % of all STEMI patients. Southern Europe and the Balkans are still predominantly using TL. Where this is the case, a higher proportion of patients are left without any reperfusion treatment. The survey concluded that a nationwide PPCI strategy results in more patients being offered reperfusion therapy. To address the inequalities in STEMI patients’ access to life-saving PPCI, and to support the implementation of the ESC STEMI treatment guidelines in Europe, the Stent for Life (SFL) Initiative was launched jointly by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and EuroPCR in 2008. National cardiac societies from Bulgaria, France, Greece, Serbia, Spain and Turkey signed the SFL Declaration at the ESC Congress in Barcelona in 2009. The aim of the SFL Initiative is to improve the delivery of, and STEMI patients’ access to, life-saving PPCI and thereby reduce mortality and morbidity. Currently, 10 national cardiac societies support the SFL Initiative in their respective countries. SFL national action programmes have been developed and are being implemented in several countries. The formation of regional PPCI networks involving emergency medical services, non-percutaneous coronary intervention hospitals and PPCI centres is considered to be a critical success factor in implementing PPCI services effectively. This article describes examples of how SFL countries are progressing in implementing their national programmes, thus increasing PPCI penetration in Europe.

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