scholarly journals Post-Discharge Bleeding and Mortality Following Acute Coronary Syndromes With or Without PCI

2020 ◽  
Vol 76 (2) ◽  
pp. 162-171 ◽  
Author(s):  
Guillaume Marquis-Gravel ◽  
Frederik Dalgaard ◽  
Aaron D. Jones ◽  
Yuliya Lokhnygina ◽  
Stefan K. James ◽  
...  
Keyword(s):  
Acute Coronary Syndromes ◽  
Post Discharge ◽  
Coronary Syndromes

Abstract 15408: Long-term Antithrombotic Management Patterns After Acute Coronary Syndromes: 2-[[Unsupported Character - Codename ­]]years Follow-up in the EPICOR Asia Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yong Huo ◽  
Stephen W Lee ◽  
Jitendra P Sawhney ◽  
Hyo-Soo Kim ◽  
Rungroj Krittayaphong ◽  
...  
Keyword(s):  
Antiplatelet Therapy ◽  
Hospital Discharge ◽  
Acute Coronary Syndromes ◽  
Single Agent ◽  
Real Life ◽  
Post Discharge ◽  
Index Event ◽  
Coronary Syndromes ◽  
Antithrombotic Management

Introduction: Guidelines recommend dual-antiplatelet therapy (DAPT) for 12 months in patients with acute coronary syndromes (ACS). Information on patterns and duration of DAPT use after hospital discharge in ACS patients in Asia is sparse. Objective: We describe changes in real-life antithrombotic management patterns (AMPs) up to 2-y post discharge based on data from the EPICOR Asia study (NCT01361386). Methods: This observational study enrolled 12 922 hospital survivors post ACS from 218 hospitals in 8 countries/regions in Asia. Data were collected from symptom onset for the index event (ST-segment elevation myocardial infarction [STEMI] 51.2%, non-STEMI (NSTEMI) 19.9%, or unstable angina [UA] 28.9%), during hospitalization, at discharge and over 2 y follow-up. Results: Overall, 90.6% of patients were on DAPT at hospital discharge which declined to 79.6%, 71.8%, 53.7%, and 45.6% at 6, 12, 18, and 23 months post discharge (Fig). At discharge, most patients (87.6%) received aspirin + clopidogrel, with 79.5%, 71.8%, 53.6%, and 45.4% on this combination at 6, 12, 18, and 23 months. At discharge only 3.0% of patients received aspirin + prasugrel and 1.7% of patients received aspirin + cilostazol. Only 8.3% of patients were on single antiplatelet therapy (SAPT) at discharge with 12.2%, 15.6%, 28.1%, and 30.3% on SAPT at 6, 12, 18, and 23 months post discharge; aspirin being the most commonly used single agent. No notable differences were seen among index event groups. Of the patients on DAPT at discharge, STEMI 93.4%; NSTEMI 90.2%; UA 85.9%, comparable proportions across groups remained on DAPT at 23 months follow up; STEMI 51.0%; NSTEMI 51.9%; UA 47.6%. Conclusions: Most ACS patients remain on DAPT at 12 months and around half remain at 23 months post-discharge. Further study should assess between-country differences, the benefit/risk balance from prolonged DAPT, why DAPT is discontinued before 12 months, and impact on clinical outcomes.

Cardiogenic shock in patients with acute coronary syndromes

2015 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Towards a Post-Discharge Bleeding Risk Equation for Acute Coronary Syndromes

2013 ◽  
Vol 22 (7) ◽  
pp. 581-582
Author(s):  
T. Suk ◽  
M. Lee ◽  
I. Ternouth ◽  
G. Devlin ◽  
A.J. Kerr
Keyword(s):  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Post Discharge ◽  
Risk Equation ◽  
Coronary Syndromes

Cardiogenic shock in patients with acute coronary syndromes

2018 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

scholarly journals Non-specific pain and 30-day readmission in acute coronary syndromes: findings from the TRACE-CORE prospective cohort

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jinying Chen ◽  
Catarina I. Kiefe ◽  
Marc Gagnier ◽  
Darleen Lessard ◽  
David McManus ◽  
...  
Keyword(s):  
Chest Pain ◽  
Language Processing ◽  
Prospective Cohort ◽  
Acute Coronary Syndromes ◽  
Healthcare Providers ◽  
Moderate Pain ◽  
Post Discharge ◽  
Patient Reported ◽  
Coronary Syndromes ◽  
The Impact

Abstract Background Patients with acute coronary syndromes often experience non-specific (generic) pain after hospital discharge. However, evidence about the association between post-discharge non-specific pain and rehospitalization remains limited. Methods We analyzed data from the Transitions, Risks, and Actions in Coronary Events Center for Outcomes Research and Education (TRACE-CORE) prospective cohort. TRACE-CORE followed patients with acute coronary syndromes for 24 months post-discharge from the index hospitalization, collected patient-reported generic pain (using SF-36) and chest pain (using the Seattle Angina Questionnaire) and rehospitalization events. We assessed the association between generic pain and 30-day rehospitalization using multivariable logistic regression (N = 787). We also examined the associations among patient-reported pain, pain documentation identified by natural language processing (NLP) from electronic health record (EHR) notes, and the outcome. Results Patients were 62 years old (SD = 11.4), with 5.1% Black or Hispanic individuals and 29.9% women. Within 30 days post-discharge, 87 (11.1%) patients were re-hospitalized. Patient-reported mild-to-moderate pain, without EHR documentation, was associated with 30-day rehospitalization (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.14–3.62, reference: no pain) after adjusting for baseline characteristics; while patient-reported mild-to-moderate pain with EHR documentation (presumably addressed) was not (OR: 1.23, 95% CI: 0.52–2.90). Severe pain was also associated with 30-day rehospitalization (OR: 3.16, 95% CI: 1.32–7.54), even after further adjusting for chest pain (OR: 2.59, 95% CI: 1.06–6.35). Conclusions Patient-reported post-discharge generic pain was positively associated with 30-day rehospitalization. Future studies should further disentangle the impact of cardiac and non-cardiac pain on rehospitalization and develop strategies to support the timely management of post-discharge pain by healthcare providers.

Cardiogenic shock in patients with acute coronary syndromes

2017 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

Cardiogenic shock in patients with acute coronary syndromes

2016 ◽  
Author(s):  
Holger Thiele ◽  
Uwe Zeymer
Keyword(s):  
Intensive Care ◽  
Cardiogenic Shock ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Intensive Care Treatment ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Coronary Syndromes

Cardiogenic shock complicating an acute coronary syndrome is observed in up to 10% of patients and is associated with high mortality still approaching 50%. The extent of ischaemic myocardium has a profound impact on the initial, in-hospital, and post-discharge management and prognosis of the cardiogenic shock patient. Careful risk assessment for each patient, based on clinical criteria, is mandatory, to decide appropriately regarding revascularization by primary percutaneous coronary intervention or coronary artery bypass grafting, drug treatment by inotropes and vasopressors, mechanical left ventricular support, additional intensive care treatment, triage among alternative hospital care levels, and allocation of clinical resources. This chapter will outline the underlying causes and diagnostic criteria, pathophysiology, and treatment of cardiogenic shock complicating acute coronary syndromes, including mechanical complications and shock from right heart failure. There will be a major focus on potential therapeutic issues from an interventional cardiologist’s and an intensive care physician’s perspective on the advancement of new therapeutical arsenals, both mechanical percutaneous circulatory support and pharmacological support. Since studying the cardiogenic shock population in randomized trials remains challenging, this chapter will also touch upon the specific challenges encountered in previous clinical trials and the implications for future perspectives in cardiogenic shock.

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