scholarly journals Long-Term Use of Antiplatelet Therapy in Real-World Patients with Acute Myocardial Infarction: Insights from the PIPER Study

TH Open ◽  
2018 ◽  
Vol 02 (04) ◽  
pp. e437-e444
Author(s):  
Luca Degli Esposti ◽  
Valentina Perrone ◽  
Chiara Veronesi ◽  
Stefano Buda ◽  
Roberta Rossini ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Antiplatelet Therapy ◽  
Real World ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Local Health ◽  
Number Of Patients ◽  
All Cause Mortality

AbstractThe aim of this study was to assess long-term drug adherence and prognosis in real-world patients discharged on dual-antiplatelet therapy (DAPT) after acute myocardial infarction (AMI). A retrospective cohort analysis using administrative databases kept by eight local health units was performed. DAPT exposure (defined as ≥ 2 prescriptions), adherence, and the occurrence of major adverse events (MACE) were analyzed during a 36-month follow-up. The analysis included 11,101 patients who were discharged alive with a primary diagnosis of AMI. Of these, 5,919 patients (53.31%) were discharged on DAPT without a diagnosis of cancer or anemia, without transient DAPT discontinuation, and represented the study population. DAPT discontinuation occurred in 2,200 patients (37.2%) and in 1,995 (33.7%) after the first 6 and 12 months, respectively, whereas 423 patients (7.1%) were still on DAPT after 36 months. Patients who maintained DAPT up to 12 months had a significantly lower overall mortality, compared with patients who discontinued DAPT after 6 months. Exposure to DAPT at 3 years was associated with reduced all-cause mortality (hazard ratio [HR]: 0.067, 95% confidence interval [CI]: 0.027–0.162, p < 0.001) and reduced recurrent AMI (HR: 0.02, 95% CI: 0.003–0.173, p < 0.001). In conclusion, this study shows that prolonged DAPT over 12 months is maintained in a relevant number of patients after AMI. However, adherence to antiplatelet therapy in first 12 months after AMI is still unsatisfactory and efforts to enhance patients' compliance are warranted. Exposure to prolonged DAPT at 3 years seems to be associated with a significant reduction in all-cause mortality and AMI.

scholarly journals Association of Hypertriglyceridemia with All‐Cause Mortality and Atherosclerotic Cardiovascular Events in a Low‐Risk Italian Population: The TG‐REAL Retrospective Cohort Analysis

2020 ◽  
Vol 9 (19) ◽  
Author(s):  
Marcello Arca ◽  
Chiara Veronesi ◽  
Laura D’Erasmo ◽  
Claudio Borghi ◽  
Furio Colivicchi ◽  
...  
Keyword(s):  
Real World ◽  
Clinical Setting ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Local Health ◽  
Atherosclerotic Cardiovascular Disease ◽  
Italian Population ◽  
Increased Risk ◽  
All Cause Mortality ◽  
Very High

Background Evidence regarding the relationships among high plasma triglycerides (TG), all‐cause mortality, and atherosclerotic cardiovascular disease (ASCVD) events in low‐to‐moderate risk individuals is limited. The aim of this study was to determine whether the presence of high TG levels influences the risk of all‐cause mortality and ASCVD events in a population cohort followed in the real‐world clinical setting. Methods and Results A retrospective longitudinal cohort analysis using administrative databases of 3 Italian Local Health Units was performed. All individuals with at least one TG measurement between January 1, 2010 and December 31, 2015 were followed through December 2016. Outcome measures included incident ASCVD events and all‐cause mortality. Individuals with normal TG levels (<150 mg/dL) were compared with those with high (150–500 mg/dL) and very high TG (>500 mg/dL). 158 042 individuals (142 289 with normal, 15 558 with high, and 195 with very high TG) were considered. In the whole cohort, the overall incidence rates of ASCVD and all‐cause mortality were 7.2 and 17.1 per 1000 person‐years, respectively. After multivariate adjustment for potential confounders, individuals with high and very high TG showed a significantly increased risk of all‐cause mortality (hazard ratio [HR]=1.49 [95% confidence interval (CI) 1.36–1.63], P <0.001, and HR=3.08 [95% CI 1.46–6.50], P <0.01, respectively) and incident ASCVD events (HR=1.61 [95% CI 1.43–1.82], P <0.001, and HR=2.30 [95% CI 1.02–5.18], P <0.05, respectively) as compared to those with normal TG. Conclusions Moderate‐to‐severe elevation of TG is associated with a significantly increased risk of all‐cause mortality and ASCVD events in a large cohort of low‐to‐moderate cardiovascular risk individuals in a real‐world clinical setting.

scholarly journals Sociodemographic, labour market marginalisation and medical characteristics as risk factors for reinfarction and mortality within 1 year after a first acute myocardial infarction: a register-based cohort study of a working age population in Sweden

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033616
Author(s):  
Mo Wang ◽  
Marjan Vaez ◽  
Thomas Ernst Dorner ◽  
Syed Ghulam Rahman ◽  
Magnus Helgesson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Labour Market ◽  
Work Disability ◽  
First Year ◽  
Risk Of Mortality ◽  
All Cause Mortality

ObjectivesResearch covering a wide range of risk factors related to the prognosis during the first year after an acute myocardial infarction (AMI) is insufficient. This study aimed to investigate whether sociodemographic, labour market marginalisation and medical characteristics before/at AMI were associated with subsequent reinfarction and all-cause mortality.DesignPopulation-based cohort study.ParticipantsThe cohort included 15 069 individuals aged 25–64 years who had a first AMI during 2008–2010.Primary and secondary outcome measuresThe outcome measures consisted of reinfarction and all-cause mortality within 1 year following an AMI, which were estimated by univariate and multivariable HRs and 95% CIs by Cox regression.ResultsSociodemographic characteristics such as lower education showed a 1.1-fold and 1.3-fold higher risk for reinfarction and mortality, respectively. Older age was associated with a higher risk of mortality while being born in non-European countries showed a lower risk of mortality. Labour market marginalisation such as previous long-term work disability was associated with a twofold higher risk of mortality. Regarding medical characteristics, ST-elevation myocardial infarction was predictive for reinfarction (HR: 1.14, 95% CI: 1.07 to 1.21) and all-cause mortality (HR: 3.80, 95% CI: 3.08 to 4.68). Moreover, diabetes mellitus, renal insufficiency, stroke, cancer and mental disorders were associated with a higher risk of mortality (range of HRs: 1.24–2.59).ConclusionsSociodemographic and medical risk factors were identified as risk factors for mortality and reinfarction after AMI, including older age, immigration status, somatic and mental comorbidities. Previous long-term work disability and infarction type provide useful information for predicting adverse outcomes after AMI during the first year, particularly for mortality.

scholarly journals More is not better in the early care of acute myocardial infarction: a prospective cohort analysis on administrative databases

2006 ◽  
Vol 27 (22) ◽  
pp. 2649-2654 ◽  
Author(s):  
H. Van Brabandt ◽  
C. Camberlin ◽  
F. Vrijens ◽  
Y. Parmentier ◽  
D. Ramaekers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Prospective Cohort ◽  
Cohort Analysis ◽  
Administrative Databases ◽  
Early Care

Efficacy and Safety of Adjunctive Trimetazidine Therapy for Acute Myocardial Infarction: A Systematic Review and Meta-Analysis

Cardiology ◽  
2016 ◽  
Vol 135 (3) ◽  
pp. 188-195 ◽  
Author(s):  
Yongyong Li ◽  
Dewei Wang ◽  
Chunxiao Hu ◽  
Peng Zhang ◽  
Dongying Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Adverse Events ◽  
Meta Analysis ◽  
Efficacy And Safety ◽  
Short Term ◽  
All Cause Mortality ◽  
Acute Mi

Background: Several lines of evidence support the clinical use of trimetazidine as an adjunctive therapy in cardioischemic patients. Therefore, we assessed here the efficacy and safety of adjunctive trimetazidine therapy in acute myocardial infarction (MI) patients by a systematic review and meta-analysis of the current literature. Methods: PubMed, the Cochrane Library, and the China National Knowledge Infrastructure databases were searched for clinical studies comparing adjunctive trimetazidine therapy against placebo in adult acute MI patients. Several clinical outcomes [early/short-term all-cause mortality, long-term all-cause mortality, total major adverse cardiac events (MACE), recurrent nonfatal MI, in-hospital adverse events, target vessel revascularization (TVR), and coronary artery bypass graft (CABG)] were analyzed by the intention-to-treat principle. Odds ratios (OR) and their 95% confidence intervals (CI) were derived from the number of outcome events in each study arm to estimate the association between adjuvant trimetazidine administration and the various clinical outcomes. A random-effects model was applied for all meta-analyses. Results: We found that adjunctive trimetazidine therapy showed a significant effect upon total MACE (OR = 0.33, 95% CI = 0.15-0.74; p = 0.007) but showed no significant effect upon early/short-term all-cause mortality, long-term all-cause mortality, recurrent nonfatal MI, in-hospital adverse events, TVR, or CABG (p > 0.05). Conclusions: This is the first meta-analysis to report that adjunctive trimetazidine therapy has a beneficial effect upon total MACE in acute MI patients. Clinical investigators should consider further trials on adjunctive trimetazidine therapy in order to better define its risks and benefits in acute MI patients.

scholarly journals Association Between Fasting Hyperglycemia and New-Onset Atrial Fibrillation in Patients With Acute Myocardial Infarction and the Impact on Short- and Long-Term Prognosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Mingxing Li ◽  
Yingying Gao ◽  
Kai Guo ◽  
Zidi Wu ◽  
Yi Lao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
All Cause Mortality ◽  
Long Term Prognosis ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: The relationship between fasting hyperglycemia (FHG) and new-onset atrial fibrillation (AF) in patients with acute myocardial infarction (AMI) is unclear, and whether their co-occurrence is associated with a worse in-hospital and long-term prognosis than FHG or AF alone is unknown.Objective: To explore the correlation between FHG and new-onset AF in patients with AMI, and their impact on in-hospital and long-term all-cause mortality.Methods: We performed a retrospective cohort study comprising 563 AMI patients. The patients were divided into the FHG group and the NFHG group. The incidence of new-onset AF during hospitalization was compared between the two groups and sub-groups under different Killip grades. Logistic regression was used to assess the association between FHG and new-onset AF. In-hospital mortality and long-term all-cause mortality were compared among patients with FHG, AF, and with both FHG and AF according to 10 years of follow-up information.Results: New-onset AF occurred more frequently in the FHG group than in the NFHG group (21.6 vs. 9.2%, p &lt; 0.001). This trend was observed for Killip grade I (16.6 vs. 6.5%, p = 0.002) and Grade II (17.1 vs. 6.9%, p = 0.005), but not for Killip grade III–IV (40 vs. 33.3%, p = 0.761). Logistic regression showed FHG independently correlated with new-onset AF (OR, 2.56; 95% CI, 1.53–4.30; P &lt; 0.001), and 1 mmol/L increased in fasting glucose was associated with a 5% higher rate of new-onset AF, after adjustment for traditional AF risk factors. AMI patients complicated with both fasting hyperglycemia and AF showed the highest in-hospital mortality and long-term all-cause mortality during an average of 11.2 years of follow-up. Multivariate Cox regression showed FHG combined with AF independently correlated with long-term all-cause mortality after adjustment for other traditional risk factors (OR = 3.13, 95% CI 1.64–5.96, p = 0.001), compared with the group with neither FHG nor new-onset AF.Conclusion: FHG was an independent risk factor for new-onset AF in patients with AMI. AMI patients complicated with both FHG and new-onset AF showed worse in-hospital and long-term all-cause mortality than with FHG or AF alone.

scholarly journals Prognostic Impact of the Symptom of New-Onset Atrial Fibrillation in Acute Myocardial Infarction: Insights From the NOAFCAMI-SH Registry

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiachen Luo ◽  
Baoxin Liu ◽  
Hongqiang Li ◽  
Siling Xu ◽  
Mengmeng Gong ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Prognostic Impact ◽  
Term Survival ◽  
All Cause Mortality ◽  
Onset Atrial Fibrillation ◽  
New Onset

Background: New-onset atrial fibrillation (NOAF) is a common complication during acute myocardial infarction (AMI) and sometimes can be completely asymptomatic, but the clinical implications of these asymptomatic episodes require further characterization. The objective of this study was to investigate the short- and long-term prognostic impact of post-MI NOAF based on the presence of AF-related symptoms.Methods: The New-Onset Atrial Fibrillation Complicating Acute Myocardial Infarction in ShangHai (NOAFCAMI-SH) registry was a retrospective cohort including participants with AMI without a documented history of AF. Patients with NOAF were divided into two groups according to the AF-related symptoms. The primary endpoint was all-cause mortality.Results: Of 2,399 patients included, 278 (11.6%) developed NOAF of whom 145 (6.0%) with asymptomatic episodes and 133 (5.5%) with symptomatic ones. During hospitalization, 148 patients died [106, 10, and 32 in the sinus rhythm (SR), asymptomatic, and symptomatic NOAF groups, respectively]. After multivariable adjustment, only symptomatic NOAF was associated with in-hospital mortality [odds ratio (OR): 2.32, 95% confidence interval (CI): 1.36–3.94] compared with SR. Over a median follow-up of 2.7 years, all-cause mortality was 3.2, 12.4, and 11.8% per year in the SR, asymptomatic, and symptomatic NOAF groups, respectively. After adjustment for confounders, it was the asymptomatic NOAF [hazard ratio (HR): 1.61, 95% CI: 1.09–2.37) rather than the symptomatic one (HR: 1.37, 95% CI: 0.88–2.12) that was significantly related to mortality. Similar results were also observed for cardiovascular mortality [HRs and 95% CI were 1.71 (1.10–2.67) and 1.25 (0.74–2.11) for asymptomatic and symptomatic NOAF, respectively]. Both asymptomatic and symptomatic NOAF episodes were associated with heart failure, whereas only those with symptomatic NOAF were at heightened risk of ischemic stroke. Our exploratory analysis further identified patients with asymptomatic high-burden NOAF as the highest-risk population (mortality: 19.6% per year).Conclusion: Among patients with AMI, symptomatic NOAF is related to in-hospital mortality and asymptomatic NOAF is associated with poor long-term survival.Registration: URL: https://clinicaltrials.gov/; Unique identifier: NCT03533543.

scholarly journals Impact of Pre-Revascularization and Post-Revascularization Cardiac Arrest on Survival Prognosis in Patients With Acute Myocardial Infarction and Following Emergency Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Changzuan Zhou ◽  
Qingcheng Lin ◽  
Guangze Xiang ◽  
Mengmeng Chen ◽  
Mengxing Cai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Coronary Intervention ◽  
Killip Class ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Emergency Percutaneous Coronary Intervention

Objectives: To evaluate the effects of occurrence and timing of sudden cardiac arrest (SCA) on survival in patients with acute myocardial infarction (AMI) who underwent emergency percutaneous coronary intervention (PCI).Methods: We analyzed 1,956 consecutive patients with AMI with emergency PCI from 2014 to 2018. Patients with cardiac arrest events were identified, and their medical records were reviewed.Results: Patients were divided into non-cardiac arrest group (NCA group, n = 1,724), pre-revascularization cardiac arrest (PRCA group, n = 175), and post-revascularization SCA (POCA group, n = 57) according to SCA timing. Compared to NCA group, PRCA group and POCA group presented with higher brain natriuretic polypeptide (BNP), more often Killip class 3/4, atrial fibrillation, and less often completed recovery of coronary artery perfusion (all p &lt; 0.05). Both patients with PRCA and POCA showed increased 30-day all-cause mortality when compared to patients with NCA (8.0 and 70.2% vs. 2.9%, both p &lt; 0.001). However, when compared to patients with NCA, patients with PRCA did not lead to higher mortality during long-term follow-up (median time 917 days) (16.3 vs. 18.6%, p = 0.441), whereas patients with POCA were associated with increased all-cause mortality (36.3 vs. 18.6%, p &lt; 0.001). Multivariate analysis identified Killip class 3/4, atrial fibrillation, high maximum MB isoenzyme of creatine kianse, and high creatinine as predictive factors for POCA. In Cox regression analysis, POCA was found as a strong mortality-increase predictor (HR, 8.87; 95% CI, 2.26–34.72; p = 0.002) for long-term all-cause death.Conclusions: POCA appeared to be a strong life-threatening factor for 30-day and long-term all-cause mortality among patients with AMI who admitted alive and underwent emergency PCI. However, PRCA experience did not lead to a poorer long-term survival in patients with AMI surviving the first 30 days.

Abstract 19275: Gender Differences in Cardiovascular- and Cancer Mortality During Long-term Follow-up After Acute Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Kristin M Kvakkestad ◽  
Morten W Fagerland ◽  
Jan Eritsland ◽  
Sigrun Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Gender Differences ◽  
Cause Of Death ◽  
Cancer Mortality ◽  
All Cause Mortality ◽  
Specific Mortality ◽  
Long Term Follow Up

Background: The existence of gender differences in cause-specific mortality after acute myocardial infarction (AMI) is unknown. Aim: To study gender differences in all-cause and cause-specific mortality in women and men with AMI. Methods: Consecutive AMI patients were enrolled in a prospective cohort study during 2005-2011. Cardiovascular (CV) risk factors, treatment and in-hospital complications were registered. Date and cause of death were obtained from the Norwegian cause of death registry, with censoring date set to Dec 31, 2012. Patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) were analysed separately. We used Kaplan Meier- and cumulative incidence function-plots to assess gender differences in CV, cancer and all-cause mortality. Cox- and Fine-Gray regression models, adjusted for age, estimated the effect of female gender. Results: We included 5159 NSTEMI (34% women) and 4899 STEMI (25% women) patients. Women were older and had more complications compared to men. After a median follow-up time of 1043 and 1262 days for NSTEMI and STEMI, respectively, 1461 NSTEMI (28%) and 886 STEMI (18%) patients had died. After adjustment for age, NSTEMI women had lower (HR 0.89 [95% CI: 0.80-0.99]) and STEMI women similar (HR 1.05 [95% CI: 0.91-1.22]) risk of all-cause mortality compared to men. There were no gender differences in CV mortality. We observed a non-significant trend toward lower cancer mortality in women than men with NSTEMI (adjusted subhazard ratio 0.76 [95% CI:0.56-1.03]). In both genders, CV death was more prevalent (Figure) and occurred earlier than cancer death. Conclusion: After adjustment for age, there were no excess risks of all-cause or CV mortality in women versus men with AMI during long-term follow-up. Possible gender differences in risk of cancer mortality needs further investigation.

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