scholarly journals Risk-associated management disparities in acute myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kai M. Eggers ◽  
T. Jernberg ◽  
B. Lindahl
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Coronary Revascularization ◽  
Temporal Trends ◽  
Medical Interventions ◽  
High Risk Patients ◽  
Continuous Quality ◽  
Risk Patients ◽  
Coronary Procedures

AbstractDespite improvements in the treatment of myocardial infarction (MI), risk-associated management disparities may exist. We investigated this issue including temporal trends in a large MI cohort (n = 179,291) registered 2005–2017 in SWEDEHEART. Multivariable models were used to study the associations between risk categories according to the GRACE 2.0 score and coronary procedures (timely reperfusion, invasive assessment ≤ 3 days, in-hospital coronary revascularization), pharmacological treatments (P2Y12-blockers, betablockers, renin–angiotensin–aldosterone-system [RAAS]-inhibitors, statins), structured follow-up and secondary prevention (smoking cessation, physical exercise training). High-risk patients (n = 76,295 [42.6%]) experienced less frequent medical interventions compared to low/intermediate-risk patients apart from betablocker treatment. Overall, intervention rates increased over time with more pronounced increases seen in high-risk patients compared to lower-risk patients for in-hospital coronary revascularization (+ 23.6% vs. + 12.5% in patients < 80 years) and medication with P2Y12-blockers (+ 22.2% vs. + 7.8%). However, less pronounced temporal increases were noted in high-risk patients for medication with RAAS-blockers (+ 8.5% vs. + 13.0%) and structured follow-up (+ 31.6% vs. + 36.3%); pinteraction < 0.001 for all. In conclusion, management of high-risk patients with MI is improving. However, the lower rates of follow-up and of RAAS-inhibitor prescription are a concern. Our data emphasize the need of continuous quality improvement initiatives.

P3609Temporal trends of the management and outcomes of patients after myocardial infarction according to the risk for recurrent cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Grinberg ◽  
T Bental ◽  
Y Hammer ◽  
A R Assali ◽  
H Vaknin-Assa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Cardiovascular Events ◽  
Risk Group ◽  
Temporal Trends ◽  
High Risk Group ◽  
Low Risk ◽  
Intermediate Risk ◽  
High Risk Patients ◽  
Risk Patients

Abstract Background Following Myocardial Infarction (MI), patients are at increased risk for recurrent cardiovascular events, particularly during the immediate period. Yet some patients are at higher risk than others, owing to their clinical characteristics and comorbidities, these high-risk patients are less often treated with guideline-recommended therapies. Aim To examine temporal trends in treatment and outcomes of patients with MI according to the TIMI risk score for secondary prevention (TRS2°P), a recently validated risk stratification tool. Methods A retrospective cohort study of patients with an acute MI, who underwent percutaneous coronary intervention and were discharged alive between 2004–2016. Temporal trends were examined in the early (2004–2010) and late (2011–2016) time-periods. Patients were stratified by the TRS2°P to a low (≤1), intermediate (2) or high-risk group (≥3). Clinical outcomes included 30-day MACE (death, MI, target vessel revascularization, coronary artery bypass grafting, unstable angina or stroke) and 1-year mortality. Results Among 4921 patients, 31% were low-risk, 27% intermediate-risk and 42% high-risk. Compared to low and intermediate-risk patients, high-risk patients were older, more commonly female, and had more comorbidities such as hypertension, diabetes, peripheral vascular disease, and chronic kidney disease. They presented more often with non ST elevation MI and 3-vessel disease. High-risk patients were less likely to receive drug eluting stents and potent anti-platelet drugs, among other guideline-recommended therapies. Evidently, they experienced higher 30-day MACE (8.1% vs. 3.9% and 2.1% in intermediate and low-risk, respectively, P<0.001) and 1-year mortality (10.4% vs. 3.9% and 1.1% in intermediate and low-risk, respectively, P<0.001). During time, comparing the early to the late-period, the use of potent antiplatelets and statins increased among the entire cohort (P<0.001). However, only the high-risk group demonstrated a significantly lower 30-day MACE (P=0.001). During time, there were no differences in 1-year mortality rate among all risk categories. Temporal trends in 30-day MACE by TRS2°P Conclusion Despite a better application of guideline-recommended therapies, high-risk patients after MI are still relatively undertreated. Nevertheless, they demonstrated the most notable improvement in outcomes over time.

scholarly journals TEMPORAL TRENDS IN THE MANAGEMENT AND OUTCOME ACROSS THE SPECTRUM OF HIGH-RISK PATIENTS WITH MYOCARDIAL INFARCTION

2021 ◽  
Vol 77 (18) ◽  
pp. 119
Author(s):  
Tzlil Grinberg ◽  
Tamir Bental ◽  
Yoav Hammer ◽  
Abid Assali ◽  
Hana Vaknin Assa ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Temporal Trends ◽  
High Risk Patients ◽  
Risk Patients

Safety and Efficacy of Carotid Angioplasty and Stenting in High-Risk Patients

2006 ◽  
Vol 72 (8) ◽  
pp. 694-699 ◽  
Author(s):  
Rabih A. Chaer ◽  
Brian G. Derubertis ◽  
Susan M. Trocciola ◽  
Stephanie C. Lin ◽  
Robert Hynecek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Confidence Interval ◽  
Carotid Angioplasty ◽  
Safety And Efficacy ◽  
High Risk Patients ◽  
Risk Patients ◽  
Angioplasty And Stenting ◽  
Carotid Angioplasty And Stenting

Performance of carotid endarterectomy (CEA) may be associated with an increased risk in patients with significant comorbid medical conditions, neck irradiation, or previous CEA. This study compared the results of CEA with carotid angioplasty and stenting (CAS) in high-risk patients treated for carotid stenosis. Five hundred forty-five patients who underwent CEA and 148 patients who underwent CAS were evaluated. For patients undergoing CEA, general anesthesia was used in 91 per cent, electroencephalographic monitoring was used in 63 per cent, and shunting was performed in 19.8 per cent. Cerebral protection devices were used in 145/148 of CAS cases, and self-expanding stents were used in all cases. Evaluated end points included major cardiovascular events, and a composite of death, stroke, or myocardial infarction for the duration of the follow-up. Mean follow-up was 18 months for CAS and 23 months for CEA. Significant differences were present in patient age (CAS, 75 ± 11.0 years vs CEA, 71 ± 9 years, P = 0.012), however, there were no significant differences ( P = NS) in gender or smoking history. The mean modified Goldman Score was significantly higher for CAS (21.1 ± 14.8 [95% confidence interval = 18, 24]) than for CEA (6.3 ± 6.8 [95% confidence interval = 5.7, 6.9]; P = 0.0001) patients. The incidence of periprocedural complications did not vary significantly between patients treated with CAS (CVA, 1.4%; myocardial infarction [MI], 1.4%; death, 0.7%; CVA/MI/death, 3.4%) compared with CEA (CVA, 1.8%; MI, 1.1%; death, 0.4%; CVA/MI/death, 4.0%). CAS is equivalent to CEA in safety and efficacy, even when performed in patients who may be at increased surgical risk.

Abstract 334: Potential Risk Factors for Recurrent Coronary Revascularization and Hospitalization for Unstable Angina Following Acute Myocardial Infarction

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Kim Smolderen ◽  
Yan Li ◽  
David Cohen ◽  
Suzanne V Arnold ◽  
Phil G Jones ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Unstable Angina ◽  
Risk Score ◽  
Coronary Revascularization ◽  
High Risk Patients ◽  
Grace Risk Score ◽  
Increased Risk ◽  
Risk Patients

Background: Subsequent hospitalizations after acute myocardial infarction (AMI) for unstable angina (UA) and coronary revascularization represent common and important clinical events. While numerous studies sought to predict survival, AMI, and all-cause rehospitalization after AMI, there are limited data about how to best risk-stratify patients for UA and subsequent revascularization. Understanding these factors can support the development of more efficient AMI care. Methods: In the multi-center TRIUMPH registry, we used 3,283 patients with detailed baseline and 1-year follow-up information, including adjudicated hospitalizations, following initial AMI admission. An initial prediction model was derived after examining > 60 demographic, socio-economic, comorbidity, AMI severity, treatment, psychosocial and health status characteristics using hierarchical Cox Proportional Hazards for UA or revascularization. Staged PCIs and elective CABGs performed ≤1 month were excluded. Results: A total of 140 (4.3%) patients were readmitted ≤1 year for UA and 158 (4.8%) for revascularization. Independent predictors of UA were female sex (HR=1.88; 95%CI: 1.33, 2.65), prior PCI (HR=1.64; 95%CI: 1.12, 2.39), prior CABG (HR=2.06; 95%CI: 1.28, 3.32), and GRACE risk score (HR per 1 point increase=0.99; 95%CI: 0.98, 0.99). Independent predictors of revascularization were diseased vessels >1 (HR=2.50; 95%CI: 1.74, 3.60), and GRACE risk score (HR=0.99; 95%CI: 0.99, 1.00). While high-risk patients (those with diabetes, peripheral artery and cerebrovascular disease) were at increased risk of being readmitted for UA (HR=1.48; 95%CI 1.04, 2.10) or revascularization (HR=1.35; 95%CI: 0.97, 1.88), there was no interaction between these associations and risk status, suggesting equal prognostic significance in those with and without high-risk characteristics. Conclusion: Unique characteristics are associated with admissions for UA and revascularization. Creating multivariable models, risk scores and prospective risk stratification can support tailoring treatment to those at highest risk, although prospective studies are needed to establish the best management for high-risk patients.

Outcome of carotid endarterectomy under local anaesthesia with respect to the patients’ risk profile

VASA ◽  
2009 ◽  
Vol 38 (3) ◽  
pp. 225-233 ◽  
Author(s):  
Aleksic ◽  
Luebke ◽  
Brunkwall
Keyword(s):  
Myocardial Infarction ◽  
High Risk ◽  
Carotid Endarterectomy ◽  
Complication Rate ◽  
Local Anaesthesia ◽  
High Risk Group ◽  
High Risk Patients ◽  
Hostile Neck ◽  
Risk Patients ◽  
Angioplasty And Stenting

Background: In the present study the perioperative complication rate is compared between high- and low-risk patients when carotid endarterectomy (CEA) is routinely performed under local anaesthesia (LA). Patients and methods: From January 2000 through June 2008 1220 consecutive patients underwent CEA under LA. High-risk patients fulfilled at least one of the following characteristics: ASA 4 classification, “hostile neck”, recurrent ICA stenosis, contralateral ICA occlusion, age ≥ 80 years. The combined complication rate comprised any new neurological deficit (TIA or stroke), myocardial infarction or death within 30 days after CEA, which was compared between patient groups. Results: Overall 309 patients (25%) were attributed to the high-risk group, which differed significantly regarding sex distribution (more males: 70% vs. 63%, p = 0,011), neurological presentation (more asymptomatic: 72% vs. 62%, p = 0,001) and shunt necessity (33% vs. 14%, p < 0,001). In 32 patients 17 TIAs and 15 strokes were observed. In 3 patients a myocardial infarction occurred. Death occurred in one patient following a stroke and in another patient following myocardial infarction, leading to a combined complication rate of 2,9% (35/1220). In the multivariate analysis only previous neurological symptomatology (OR 2,85, 95% CI 1,38-5,91) and intraoperative shunting (OR 5,57, 95% CI 2,69-11,55) were identified as independent risk factors for an increased combined complication rate. Conclusions: With the routine use of LA, CEA was not associated with worse outcome in high-risk patients. Considering the data reported in the literature, it does not appear justified to refer high-risk patients principally to carotid angioplasty and stenting (CAS) when LA can be chosen to perform CEA.

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