Comparing hierarchical modeling with traditional logistic regression analysis among patients hospitalized with acute myocardial infarction: Should we be analyzing cardiovascular outcomes data differently?

2003 ◽  
Vol 145 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Peter C. Austi ◽  
Jack V. T ◽  
David A. Alte
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Hierarchical Modeling ◽  
Cardiovascular Outcomes

scholarly journals Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259979
Author(s):  
Ishmum Zia Chowdhury ◽  
Md. Nurul Amin ◽  
Mashhud Zia Chowdhury ◽  
Sharar Muhib Rahman ◽  
Mohsin Ahmed ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Chest Pain ◽  
Logistic Regression Analysis ◽  
Symptom Onset ◽  
Associated Factors ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression

Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.

scholarly journals Association of Serum Omentin-1, Chemerin, and Leptin with Acute Myocardial Infarction and its Risk Factors

2020 ◽  
Vol 36 (6) ◽  
Author(s):  
Mukhtiar Baig ◽  
Kamal Waheeb Alghalayini ◽  
Zohair Jamil Gazzaz ◽  
Hazem Atta
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Healthy Subjects ◽  
Multiple Logistic Regression Analysis ◽  
University Hospital ◽  
Serum Leptin

Objective: To determine the association of serum omentin-1, chemerin, and leptin with acute myocardial infarction (AMI) and its risk factors among individuals admitted with AMI to the coronary care unit (CCU). Methods: The current case-control study was conducted at the CCU of King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia (KSA), in 2016-2018. A total of 122 AMI patients admitted to CCU, and 52 BMI and age-matched healthy subjects, between 30 and 65 years of age, were included. Results: Chemerin and omentin-1 are independent predictors of the incidence of MI. Furthermore, serum omentin-1 was significantly lowered while chemerin and hsCRP levels were found to be significantly raised among the individuals with AMI compared to the healthy subjects, and no notable change was found in the serum leptin level. Serum omentin-1, chemerin, and leptin were significantly correlated with weight, BMI, waist circumference in patients, and control subjects. Binary logistic regression analysis displayed that the occurrence of MI is positively correlated with fasting plasma glucose (FPG), TC, TG, LDL-C, hsCRP, and chemerin and in a negative manner with HDL-C, and omentin. The chemerin and omentin-1 were also linked with the MI in multiple logistic regression analysis. Conclusions: The present results indicated that the serum omentin levels were significantly lowered while chemerin and hsCRP levels were found to be markedly raised among patients. No change was found in serum leptin levels. Serum chemerin and omentin-1 levels were independently associated with the MI. It appears that these parameters may be used to assess the risk spectrum of CAD. doi: https://doi.org/10.12669/pjms.36.6.2372 How to cite this:Baig M, Alghalayini KW, Gazzaz ZJ, Atta H. Association of Serum Omentin-1, Chemerin, and Leptin with Acute Myocardial Infarction and its Risk Factors. Pak J Med Sci. 2020;36(6):---------. doi: https://doi.org/10.12669/pjms.36.6.2372 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Predicting hospital mortality in patients with acute myocardial infarction

1994 ◽  
Vol 3 (3) ◽  
pp. 168-176 ◽  
Author(s):  
M Funk ◽  
RL Pooley-Richards
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Coronary Angiography ◽  
Hospital Mortality ◽  
Logistic Regression Analysis ◽  
Severity Of Illness ◽  
Left Ventricular ◽  
Left Ventricular Ejection

BACKGROUND Patients who have a myocardial infarction are a heterogeneous group. If those at risk for early mortality could be readily identified, it would provide a more solid basis for management decisions. Although past research has explored factors associated with mortality, findings are inconsistent. Variables have also been combined into prognostic indices, but these tools have yet to be evaluated adequately. OBJECTIVES To determine factors predictive of hospital mortality in patients with acute myocardial infarction, and to examine the usefulness of two severity-of-illness indices. METHODS The medical records of 392 patients diagnosed with acute myocardial infarction who had undergone coronary angiography during 1989 at a university medical center were reviewed. RESULTS Overall mortality was 9.4% (n = 37). Logistic regression analysis demonstrated that history of myocardial infarction, cardiogenic shock, age, left ventricular ejection fraction, and the number of occluded coronary vessels were significantly associated with hospital mortality in patients with acute myocardial infarction. The two severity-of-illness indices were significant predictors of mortality, although sensitivity, specificity, and predictive values varied. A formula for determining the probability of mortality, based on logistic regression analysis, is also presented. CONCLUSIONS Five factors were found to predict hospital mortality. The two severity-of-illness indices were moderately useful in predicting mortality. Unlike previous indices that did not incorporate currently available diagnostic data, the new formula included data from coronary angiography and nuclear scans. Although this formula requires validation on independent samples of patients with myocardial infarction, the findings of this study advance clinicians' ability to predict patient outcome.

scholarly journals Promoter polymorphisms in the lncRNA-MIAT gene associated with acute myocardial infarction in Chinese Han population: a case–control study

2020 ◽  
Vol 40 (2) ◽  
Author(s):  
Ruchao Ma ◽  
Xiaohui He ◽  
Xiaoyun Zhu ◽  
Shuchao Pang ◽  
Bo Yan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Chinese Han Population ◽  
Control Group ◽  
Promoter Polymorphisms ◽  
Chinese Han ◽  
Han Population

Abstract Background: Coronary atherosclerotic disease (CAD) is one of the greatest causes of death and disability around the world, and has emerged as a major public health problem. Acute myocardial infarction (AMI) is the most serious type of CAD. Myocardial infarction (MI) association transcript (MIAT) has demonstrated that it plays an important role in AMI. Purpose: To investigate the association between MIAT promoter polymorphisms and AMI in Chinese Han population. Methods: A total of 212 AMI patients and 218 healthy controls were recruited. The long non-coding RNA (lncRNA)-MIAT promoter polymorphisms (single nucleotide polymorphisms (SNPs)) were obtained using polymerase chain reaction (PCR) and sequencing techniques. Chi-square test was used to analyze the allele and genotype frequencies of each SNP in two groups. Logistic regression analysis was used to analyze the association of each SNP with AMI. Linkage disequilibrium (LD) and haplotype analysis were performed using SHEsis software. A JASPAR database search predicts transcription factors transition of linked polymorphism in MIAT promoter. Results: Ten SNPs were found, including rs56371714, rs55892869, rs151057042, rs2157598, rs150465374, rs5761664, rs8142890, rs5752375, rs9608515 and rs1055293700, whereas rs1055293700 was found only in the control group. Single and logistic regression analysis showed that there was a significant correlation between rs5752375 and rs9608515 polymorphisms and AMI, while other sites had no relationship with AMI. These MI association polymorphisms may change the binding sites with transcription factor. Conclusions: The polymorphisms of lncRNA-MIAT promoter rs5752375 and rs9608515 were significantly associated with AMI in Chinese Han population. This result would be of clinical importance for the early diagnosis of AMI.

scholarly journals Left ventricular blood flow energetics after acute ST-segment elevation myocardial infarction associate with left ventricular remodeling

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Demirkiran ◽  
P Garg ◽  
R J Geest ◽  
H J Berkhof ◽  
R Nijveldt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Blood Flow ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Infarct Size ◽  
Logistic Regression Analysis ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
St Segment ◽  
Lv Remodeling

Abstract Background Myocardial infarction (MI) leads to complex changes in left ventricular (LV) haemodynamics. It remains unknown how four-dimensional (4D) acute changes in LV blood flow kinetic energy (KE) affect LV remodeling. We hypothesized that LV blood flow energetics are independently associated with adverse LV-remodeling. Methods In total, 69 revascularised ST-segment elevation MI patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart 4D flow acquisitions. CMR analysis included: LV volumes, function, infarct size (indexed to body surface area), microvascular obstruction (MVO), two-dimensional, retrospective valve tracking derived mitral inflow metrics, and 4D blood flow KE components (Fig. 1). Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume: 10% (mild), 15% (moderate), and 20% (severe). Results Twenty-four patients (35%) developed mild, 17 patients (25%) moderate, 11 patients (16%) severe LV remodeling. Demographics and clinical history were comparable between patients with/without LV remodeling. In univariable logistic regression analysis, A-wave KE was associated with mild, moderate, and severe LV remodeling (p=0.03, p=0.02, p=0.02, respectively), whereas infarct size was associated with only mild LV remodeling (p=0.02). In multivariable logistic regression analysis, whilst the infarct size and A-wave KE were identified as independent markers for mild LV remodeling (p=0.03, p=0.09, respectively), A-wave KE was the only independent marker regarding moderate and severe LV remodeling (both, p<0.01). In ROC analysis for A-wave KE to be associated with the presence of adverse LV remodeling, the area under the curve was 0.67 for mild (p=0.02), 0.70 for moderate (p=0.01), 0.71 for severe (p=0.03) LV remodeling. Conclusion In patients with STEMI, LV hemodynamics assessment by LV blood flow KE demonstrated an incremental value to predict adverse LV-remodeling. A-wave KE early after acute MI had an independent effect on adverse LV remodeling. FUNDunding Acknowledgement Type of funding sources: Foundation. Main funding source(s): This work was supported by the British Heart Foundation [FS/10/62/28409 to S.P.] and Dutch Technology Foundation (STW), project number 11626 (JW, ME).

P6403Predictors of bleeding in elderly patients with myocardial infarction: data from the real world

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Alegria ◽  
A R Marques ◽  
A R Pereira ◽  
A Briosa ◽  
D Sebaiti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Elderly Patients ◽  
Logistic Regression Analysis ◽  
Major Bleeding ◽  
Previous History ◽  
Hospital Death ◽  
Hybrid Strategy ◽  
Younger Patients

Abstract Background The population of elderly patients with acute myocardial infarction (MI) is clearly underrepresented in contemporary clinical trials. This population presents a higher risk of both cardiovascular and bleeding events, making the decision of the antithrombotic strategy particularly challenging. Purpose To characterize the antithrombotic therapy used in patients with MI and age ≥75 years, and to identify predictors of major bleeding and cardiovascular events in this population. Methods Retrospective analysis of patients with a diagnosis of MI and age ≥75 years included in the Portuguese Registry of Acute Coronary Syndromes between October 2010 and January 2018. Logistic regression analysis was used to identify predictors of major bleeding and of the combined endpoint of in-hospital mortality and reinfarction. Results The analysis included 17.868 patients of which 30.1% with age ≥75 years. This population had a mean age of 82±5 years, 57% were male and 36% had a diagnosis of STEMI. On admission 10% presented with Killip-Kimball (KK) class III or IV, 14% were on atrial fibrillation (AF), and the mean Hb and creatinine levels were 13±2 g/dl and 1.6±1.2 mg/dl, respectively. In comparison with younger patients, this population had higher Grace and Crusade scores (178 vs 139, and 41 vs 24, respectively). Most elderly patients (74%) underwent coronary angiography (71% by radial artery access) and 75% were submitted to percutaneous revascularization, 9% to surgery, and 1% to an hybrid strategy. Aspirin was used in 96% of patients, clopidogrel in 82%, ticagrelor in 13% (vs 25% of younger patients; p<0.001), and glycoprotein IIb/IIIa inhibitors (GPI) in 11%. Most patients were anticoagulated with enoxaparin (68 vs 56% of younger patients; p<0.001), 22% with unfractionated heparin (vs 30%; p<0.001), and 13% with fondaparinux (vs 14%; p=0.018). Complications were more common in the elderly population, including mechanical complications (1 vs 0.5%), atrioventricular block (5 vs 3%), stroke (1 vs 0.6%), major bleeding (3 vs 1%), in-hospital death (8 vs 2%) and reinfarction (2 vs 1%) (p<0.001 for all). In multivariate logistic regression analysis, the predictors of major bleeding were diastolic blood pressure (BP) on admission <50 mmHg, maximum creatinine ≥2 mg/dl and the use of GPI. The predictors of the combined endpoint were a diagnosis of STEMI, previous history of cancer, chronic kidney disease or demencia, and the presence on admission of an heart rate <60 bpm, systolic BP <90 mmHg or ≥180 mmHg, KK class > I, AF, left bundle branch block, and left ventricle systolic dysfunction. Conclusions This study reflects the contemporary national reality of the management of elderly patients with MI. Overall, this population has a high risk of major bleeding, but several characteristics are associated with an even higher risk, such as the hemodynamic profile, renal function, and the use of GPI.

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