scholarly journals REAL WORLD RELATIONSHIPS BETWEEN BASELINE Q WAVES, TIME FROM SYMPTOM ONSET AND CLINICAL OUTCOMES IN ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION PATIENTS: INSIGHT FROM THE VITAL HEART RESPONSE REGISTRY

2017 ◽  
Vol 69 (11) ◽  
pp. 170
Author(s):  
Yinggan Zheng ◽  
Kevin Bainey ◽  
Ben Tyrrell ◽  
Neil Brass ◽  
Paul Armstrong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Real World ◽  
Symptom Onset ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

P4629Long-term outcomes in patients with ST-segment elevation myocardial infarction according to modalities of reperfusion therapy: data from china acute myocardial infarction (CAMI) registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
X J Gao ◽  
J G Yang ◽  
Y J Yang ◽  
C Wu ◽  
S B Qiao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Real World ◽  
Symptom Onset ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Real World Setting ◽  
St Segment ◽  
The Impact

Abstract Background Although primary percutaneous coronary intervention (pPCI) is the optimal reperfusion method for ST-segment elevation myocardial infarction (STEMI), it remains difficult to implement in many areas. Some STEMI patients have to accept fibrinolytic therapy and no reperfusion therapy instead. Purpose The aim of this study was to describe the impact of reperfusion therapy on the long-term outcomes of STEMI patients in China. Methods Using data from the China Acute Myocardial Infarction (CAMI) registry, we analyzed the 2-year outcomes of 18,075 STEMI patients symptom onset within 7 days from January 2013 to September 2014 according to the type of reperfusion therapy. The primary endpoint was a composite of major adverse cardiovascular event (MACE), defined as all-cause mortality, myocardial infarction or stroke. Results 7798 (43%) were treated with pPCI and 1798 (10%) underwent fibrinolysis; 8479 (47%) did not receive any reperfusion. The 2-year MACE was 9.6% following pPCI, 15.7% following fibrinolysis, and 21.5% for patients without reperfusion therapy (P<0.0001). Adjusted hazard ratios for 2-year MACE were 0.71 (95% confidence interval [CI] 0.65–0.78, P<0.0001) for pPCI versus no reperfusion and 0.92 (95% CI 0.82–1.03, P=0.16) for fibrinolysis versus no reperfusion. Compared with patients without reperfusion, fibrinolysis only showed benefit in patients presented within 3 hours of symptom onset (HR 0.70, 95% CI 0.57–0.85, P=0.0005), whereas pPCI was associated with significantly decreased 2-year MACE rate in patients presented within 3 hours (HR 0.53, 95% CI 0.44–0.64, P<0.0001), 3–6 hours (HR 0.60, 95% CI 0.51–0.71, P<0.0001) and >6 hours (HR 0.86, 95% CI 0.76–0.97, P=0.01) of symptom onset. Adjusted cumulative MACE rate Conclusions In a real-world setting, early reperfusion is the optimal strategy for STEMI. Fibrinolysis was not associated with better outcome in STEMI patients admitted >3 hours of symptom onset in Chinese real world setting. Acknowledgement/Funding Ministry of Science and Technology of China (Grant No. 2011BAI11B02)

Abstract 169: Early Intravenous Beta-Blockers in Patients With ST-Segment Elevation Myocardial Infarction

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Abhishek Sharma ◽  
Samin Sharma ◽  
Debabrata Mukherjee ◽  
Akash Garg ◽  
Carl Lavie ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Final Analysis ◽  
Reperfusion Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Standard Medical Therapy ◽  
St Segment ◽  
Early Use

Background: It remains unclear if early use of intravenous (IV) beta-blockers (iBB) improves clinical outcomes patients with ST-segment elevation myocardial infarction (MI; STEMI), especially among those who received reperfusion therapy. Objective: To evaluate effect of early iBB use on clinical outcomes among patients with STEMI. Methods: A systematic review of randomized control trials in MEDLINE, EMBASE, CINAHL, and Cochrane databases comparing early use (administered within 12 hours of presentation) of iBB with standard medical therapy/placebo among patients who presented with STEMI. The effect of iBB was assessed by stratifying studies into pre-reperfusion and reperfusion trials and pooled treatment effects were estimated using relative risk with Mantel-Haenszel risk ratio, using a random-effects model Results: Twenty-one studies (N=74,801) were selected for final analysis. Clinical outcomes at 30 days and 1 year are summarized in table below. Conclusion: In the current reperfusion era, early use of iBB in patients with STEMI was associated with reduction in the risk of recurrent MI and ventricular tachyarrhythmias without any significant reduction in all-cause or CV mortality or increase in the risk of cardiogenic shock.

Abstract 13993: Impact of Prasugrel Pretreatment and Timing of Coronary Artery Bypass Grafting on Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction: From the Accoast Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dariusz Dudek ◽  
Petr Widimsky ◽  
Leonardo Bolognese ◽  
Patrick Goldstein ◽  
Christian Hamm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Cabg Patients ◽  
The Impact

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than those in the other 2 groups (p<0.045, p<0.002 respectively), but the patients in the higher 2 groups were not significantly different from each other. No difference was detected in all cause death among the 3 groups (p>0.39). A multivariate model evaluated 5 possible predictors of the composite endpoint of all cause death, MI, stroke and TIMI major bleeding. Time from randomization to CABG (HR 0.84 for each 1 hour of delay), left main disease presence (HR 1.76), and region of enrollment (Eastern Europe vs other, HR 3.83) were significant predictors but not prasugrel pretreatment or baseline troponin level ≥3xULN. Conclusions: In this group of high-risk patients presenting with NSTEMI, early surgical revascularization carried an increased risk of bleeding and ischemic complications, without impact on all-cause mortality. No impact of baseline troponin or prasugrel pretreatment (important factors influencing time of CABG) on clinical outcomes was confirmed.

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