scholarly journals Women and elderly: do we delay treatment even after identifying ST-segment elevation?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
P Araujo Leite Medeiros ◽  
J Martins ◽  
I Campos ◽  
C Oliveira ◽  
C Pires ◽  
...  
Keyword(s):  
Older Patients ◽  
Statistical Significance ◽  
Coronary Intervention ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Delay In Diagnosis ◽  
Atypical Symptoms ◽  
Funding Sources ◽  
St Segment ◽  
Gender And Age

Abstract Funding Acknowledgements Type of funding sources: None. Introduction It is known that some subgroups (e.g. women or elderly) may experience a delay in diagnosis of acute myocardial infarction (AMI). This may be due to atypical symptoms that don’t trigger further evaluation as promptly as typical symptoms or due to underestimation of patient’s complaints. However, we don’t know if there is any delay in treatment after the diagnostic electrocardiogram (ECG). Aim To evaluate the association between patients’ gender and age and reperfusion (by percutaneous coronary intervention - PCI) time after ECG. Methods Single-center retrospective study of individuals that underwent primary PCI between June 2011 and December 2017. We included patients aged ≥ 18, with time registry of the first ECG with ST segment elevation (or equivalent) and time of PCI. No patients were excluded. We defined the time between the first ECG and reperfusion as the ECG-PCI time. Results A total of 1679 patients were included; 78% male (n = 1317) and 22% female (n = 362); 59% were younger than 65 (n = 985) and 41% were 65 or older (n = 694). Median ECG-PCI time was higher in females [104 minutes (IQR = 68)] than in males [94 minutes (IQR = 61)]; this association was statistically significant (U = 269124, p < 0.001). Median ECG-PCI time was also higher in older (≥ 65 years) patients [101 minutes (IQR = 68)] than in younger patients [93 minutes (IQR = 55)], with statistical significance (U = 381141, p < 0.001). After stratifying patients’ gender by age, we observed that, in male patients, median ECG-PCI time was lower in younger patients [91 minutes (IQR = 55)] than in older patients [100 minutes (IQR = 69)]; this association was also significant (U = 220025, p < 0.001). On the other hand, the same analysis in female patients found no significant association between younger and older patients (U = 13799, p = 0.522). Conclusion Despite a median ECG-PCI time difference of only 9 minutes between males and females, this difference was found to be significant. Factors delaying evaluation after onset of symptoms in women may also delay PCI after diagnostic ECG; borderline ECG criteria may be devalued in women. Older patients may take longer to PCI due to the higher incidence of comorbidities, specially diabetes mellitus, which can mask typical AMI symptoms. Survival impact of these differences should be further studied. Abstract Figure. ECG-PCI time according to gender and age

scholarly journals Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: retrospective analysis in a multiethnic Asian population

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001437
Author(s):  
Benjamin WL Tung ◽  
Zhe Yan Ng ◽  
William Kristanto ◽  
Kalyar Win Saw ◽  
Siew-Pang Chan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Patients ◽  
Young Patients ◽  
Coronary Intervention ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
History Of

ObjectiveST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention.MethodsData from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups.ResultsOf the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups.ConclusionYoung patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.

Abstract 14178: Characteristics and Outcomes of Young ST Segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Intervention

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Benjamin W Tung ◽  
Zhe Yan Ng ◽  
William Kristanto ◽  
Kalyar W Saw ◽  
winnie C sia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Patients ◽  
Young Patients ◽  
Percutaneous Intervention ◽  
Old Patients ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Primary Percutaneous Intervention

Introduction: ST-segment elevation myocardial infarction (STEMI) is associated with significant morbidity and mortality leading to loss of productivity and productive life years, especially in younger patients. Understanding the characteristics of younger patients with STEMI and their outcomes could help focus public health efforts in STEMI prevention within a population. Aim: This study aims to compare the characteristics and outcomes of younger versus older patients with STEMI undergoing primary percutaneous intervention (PPCI). Methods: Data from the Coronary Care Unit database of the National University Hospital between July 2015 to June 2019 was reviewed. Patients were divided into Young (<50 years old) or Old (≥50 years old) groups. Results: Of the 1818 consecutive patients with STEMI and underwent PPCI, 465 (25.6%) were Young patients with mean age 43±4.9 years old as compared to Old patients with mean age 63.2±9.4 years old. Young patients were more likely to be male (94% vs. 85%, p<0.0001), current smokers (61.1% vs. 42.6%, p<0.0001), of Indian ethnicity (32% vs. 16.3%, p<0.0001), and had family history of myocardial infarction (MI) (18.1% vs. 9.5%, p<0.0001). Compared to Old patients, Young patients had better post-MI left ventricular ejection fraction (49.5±10.7 vs. 47.8±11.6, p=0.007) with fewer of them suffered from cardiogenic shock (7.1% vs. 13.2%, p<0.0001), and had lower mortality at one year (3.4% vs. 10.4%, p<0.0001). Although diabetes, hypertension and hyperlipidemia was less common among the Young patients when compared to the Old, the prevalence was high in the range of 28 to 38% (Table 1). Conclusions: A sizable proportion of STEMI patients are younger than 50 years old. The risk profile of these younger patients can be attributed to constitutional factors and smoking but other cardiovascular risk factors are also prevalent among them. Although mortality is lower among the younger than the older patients, it is not negligible.

scholarly journals Age and Phenotype of Patients With Plaque Erosion

2021 ◽  
Vol 10 (19) ◽  
Author(s):  
Makoto Araki ◽  
Taishi Yonetsu ◽  
Osamu Kurihara ◽  
Akihiro Nakajima ◽  
Hang Lee ◽  
...  
Keyword(s):  
Older Patients ◽  
Age Groups ◽  
Data Sets ◽  
Current Smoking ◽  
Younger Patients ◽  
St Segment Elevation ◽  
Plaque Erosion ◽  
St Segment ◽  
Lipid Rich Plaque ◽  
Coronary Syndromes

Background A recent study reported that the outcome of patients with plaque erosion treated with stenting is poor when the underlying plaque is lipid rich. However, the detailed phenotype of patients with plaque erosion, particularly as related to different age groups, has not been systematically studied. Methods and Results Patients with acute coronary syndromes caused by plaque erosion were selected from 2 data sets. Demographic, clinical, angiographic, and optical coherence tomography findings of the culprit lesion were compared between 5 age groups. Among 579 erosion patients, male sex and current smoking were less frequent, and hypertension, diabetes, and chronic kidney disease were more frequent in older patients. ST‐segment–elevation myocardial infarction was more frequent in younger patients. Percentage of diameter stenosis on angiogram was greater in older patients. The prevalence of lipid‐rich plaque (27.3% in age <45 years and 49.4% in age ≥75 years, P <0.001), cholesterol crystal (3.9% in age <45 years and 21.8% in age ≥75 years, P =0.027), and calcification (5.5% in age <45 years and 54.0% in age ≥75 years, P <0.001) increased with age. After adjusting risk factors, younger patients were associated with the presence of thrombus, and older patients were associated with greater percentage of diameter stenosis and the presence of lipid‐rich plaque and calcification. Conclusions The demographic, clinical, angiographic, and plaque phenotypes of patients with plaque erosion distinctly vary depending on age. This may affect the clinical outcome in these patients. Registration URL: https://www.clinicaltrials.gov . Unique identifiers: NCT03479723, NCT02041650.

scholarly journals Efficacy and safety of bivalirudin application during primary percutaneous coronary intervention in older patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 48 (9) ◽  
pp. 030006052094794
Author(s):  
Hongwu Chen ◽  
Xiaofan Yu ◽  
Xiangyong Kong ◽  
Longwei Li ◽  
Jiawei Wu ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Older Patients ◽  
Coronary Intervention ◽  
Efficacy And Safety ◽  
Bleeding Events ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary

Objective ST-segment elevation myocardial infarction (STEMI) is the most serious type of acute coronary syndrome. This study aimed to investigate the efficacy and safety of bivalirudin application during primary percutaneous coronary intervention (PPCI) in older patients with acute STEMI. Methods A total of 672 older patients with STEMI (>75 years) who underwent PPCI were studied. The primary endpoints were 30-day net adverse clinical events (NACEs) post-emergency percutaneous coronary intervention, including major adverse cardiac and cerebrovascular events (MACCEs) and Bleeding Academic Research Consortium grades 2 to 5 (BARC 2–5) bleeding events. Results The incidence of NACEs and BARC 2–5 bleeding events in the bivalirudin group was significantly lower than that in the unfractionated heparin group. Multivariate Cox regression analysis showed that bivalirudin significantly reduced 30-day NACEs (odds ratio: 0.700, 95% confidence interval: 0.492–0.995) and BARC 2–5 bleeding events (odds ratio: 0.561, 95% confidence interval: 0.343–0.918). At 1-year follow-up, these results were similar. Conclusions Bivalirudin can be safely and effectively used during PPCI in older patients with STEMI. Bivalirudin reduces the risks of NACEs and bleeding within 30 days after PPCI, without increasing the risks of MACCEs and stent thrombosis compared with heparin.

scholarly journals Acute coronary syndrome in nonagenarians: gender gap?

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
JULIO Echarte-Morales ◽  
E Martinez Gomez ◽  
PEDRO Cepas-Guillen ◽  
M Llagostera ◽  
ELENA Tundidor Sanz ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Gender Gap ◽  
Coronary Intervention ◽  
The Elderly ◽  
Conservative Strategy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Funding Sources ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Funding Acknowledgements Type of funding sources: None. Background Ischemic heart disease in the elderly people has increased accordingly with rising hope of life. In patients with acute coronary syndrome (ACS) women have a higher mortality than men. However, it is unknown if these differences remain in nonagenarians. Purpose The aim of the study was to evaluate the therapeutic strategies and mortality at 1 year according to gender. Methods We retrospectively included in a multicenter study  all consecutive patients &gt; 90 yo admitted with non-ST segment elevation (NSTEMI) or ST segment elevation MI (STEMI) between 2005 and 2018. Strategies treatment and mortality at 1 year by gender were evaluated. Results 680 patients were included (92.6 ± 2.4 years, 59% women) (Table 1). Women presented a greater prevalence of hypertension arterial. Conservative treatment was more frequent in women (73.5% vs 66.2%, p = 0.04) (Image 1), in particular in STEMI subgroup (p = 0.01). They had less capacity functional evaluated by Barthel index (p &lt;0.01) and higher number of infections during admission than men (17.45% vs. 11.7%, p &lt;0.01). The mortality evaluated at 12 months was similar in both groups (p = 0.38), with a trend of better prognosis in women who underwent percutaneous coronary intervention (PCI) (p = 0.08). Conclusions Women had lower functional capacity than men, which could explain that they were more likely to be treated with conservative strategy. Mortality was similar in both genders, however, in the subgroup of patients undergoing PCI, was achieved a trend of lower mortality in women. WomenMenPPatients402.0 (59,1%)278.0 (40,9%)Age92.5 ± 2,292.6 ± 2,50.82STEMI189.0 (47%)120.0 (43%)0.32Hypertension331.0 (82,6%)208.0 (74,8%)0.01CKD84.0 (20,9%)59.0 (21,2%)0.91COPD17.0 (4,2%)54.0 (19,4%)&lt;0.01Barthel index75.084.0&lt;0.01Atypical symptoms82.0 (20,4%)42 (15,1%)0.08GRACE175.0171.00.02LDL97.086.0&lt;0.07PCI44,8%54,3%0.04All cause mortality150.0 (37,3%)113.0 (40,6%)0.38Cardiovascular mortality97.0 (67,8%)63.0 (58,3%)0.12

scholarly journals Detección de barreras e implementación de procedimientos para reducir la demora en el tratamiento del síndrome coronario agudo con elevación del segmento ST mediante angioplastia primaria. Experiencia de 20 años de un centro de referencia en una ciudad de alta densidad demográfica

2021 ◽  
Vol 89 (2) ◽  
pp. 107-114
Author(s):  
Federico Blanco ◽  
Jorge Szarfer ◽  
Alejandro García Escudero ◽  
Federico Albornoz ◽  
Analía Alonso ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Demographic Differences ◽  
St Segment Elevation ◽  
Delay In Diagnosis ◽  
Coronary Syndrome ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Key Factor

Background: The delay to reperfusion of ST-segment elevation acute coronary syndrome (STEACS) is a key factor in its prognosis, and its reduction could reduce morbidity and mortality. Objective: The aim of this study was to identify and modify the barriers detected in 20 years of STEACS treatment in a tertiary care center of a densely populated city to evaluate their effect on the outcome of the procedure. Methods: A total of 3007 patients with STEACS within 12 hours of symptoms onset were prospectively and consecutively included to undergo primary percutaneous coronary intervention (PCI) from January 1, 2000 to December 31, 2019. Time from symptoms onset to balloon inflation was divided into intervals. After barriers were identified (2000-2009), the procedure was changed. The population was divided into two groups (G) G1: pre-implementation (2000-2009) and G2: post-implementation (2010-2019) of changes. Results: G1 included 1409 and G2 1598 patients with no demographic differences except for the type of PCI. Delays were identified in diagnosis, communication between physicians, transfer and admission of the patient to the hemodynamics lab. Procedural changes decreased first medical contact-hemodynamic team contact interval [G1: 90 min (36-168) vs. G2: 77 min (36-144) p –0.01] and hemodynamic team contact-hemodynamics lab admission interval [G1: 75 min (55-100) vs. G2: 51 min (34-70) p –0.01] and reduced in-hospital (G1: 9,2% vs. G2: 6,7% p –0,01) and 6-month (G1: 13.1% vs. G2: 7.5% p –0. 01) mortality. Conclusions: Delay in diagnosis, difficulty in communication and type of transfer were the most important causes of delay. Implementing a procedural protocol reduced delays. Continuous evaluation of results and permanent education constitute the fundamental cornerstones for optimizing network care programs

scholarly journals On- vs off-hours primary percutaneous coronary intervention: a single-centre experience

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
F G Mane ◽  
R Flores ◽  
R Silva ◽  
I Conde ◽  
C Rodrigues ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
Admission Time ◽  
Funding Sources ◽  
Kaplan Meier ◽  
St Segment ◽  
Percutaneous Coronary ◽  
One Year

Abstract Introduction In ST-segment elevation myocardial infarction (STEMI) patients, emergency medical system delays importantly affect outcomes. The effect of admission time in STEMI patients is dubious when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. Aims The authors aimed to retrospectively describe the association between admission time and STEMI patient's care standards and outcomes. Methods Characteristics and outcomes of 1222 consecutive STEMI patients treated in a PCI-centre were collected. On-hours were defined as admission on non-national-holidays from Monday to Friday from 8 AM to 6 PM. Time delays, in-hospital and one-year all-cause mortality were assessed. Results A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between groups, including the percentage of patients admitted in cardiogenic shock (on-hours: 4.6% vs off-hours 4%; p=0.62). Median emergency system dependent time to reperfusion (i.e. first-medical contact to reperfusion) did not differ between the two groups (on-hours: 120 min vs. off-hours 123 min, p=0.54). The authors observed no association between admission time and in-hospital mortality (on-hours: 5% vs. off-hours 4.9%, p=0.90) or 1-year mortality (on-hours: 10% vs. off-hours 10%, p=0.97). In patients admitted directly in the PCI-centre, median time from first-medical contact to reperfusion (on-hours: 87 min vs off-hours: 88 min, p=0.54), in-hospital mortality (on-hours: 4% vs off-hours: 7%, p=0.30) and 1 year mortality (on-hours: 9% vs off-hours: 13%, p=0.27) did not differ between the two groups. Survival analysis showed no survival benefit of on-hours PCI over off-hours PCI (HR 1.01; 95% CI [0.77–1.46], p=0.95). Conclusion In a contemporary well-organized emergency network, STEMI patients admission time in the PCI-centre was not associated with reperfusion delays or increased mortality. FUNDunding Acknowledgement Type of funding sources: None. Kaplan-Meier curve

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