Treatment delay in STEMI is associated with heart failure and mortality. National data from the Norwegian myocardial infarction register

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Halle ◽  
R.E.S Govatsmark ◽  
K.H Bonaa
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Time Delay ◽  
Symptom Onset ◽  
Missing Values ◽  
Outcome Variable ◽  
P Value ◽  
Primary Pci ◽  
Increased Risk

Abstract Background European guidelines in ST-segment elevation acute myocardial infarction (STEMI) recommends a primary PCI (P-PCI) strategy if wire crossing of the occluded artery can be performed within 120 min of ECG diagnosis. A large proportion of the Norwegian population lives in remote geographical areas where P-PCI may not be performed expeditiously. Time delay from first medical contact to primary PCI is expected to be related to outcomes like heart failure and mortality. Norwegian hospitals are by law required to register clinical data for all patients treated for acute myocardial infarction in the Norwegian Myocardial Infarction. The register includes >90% of eligible patients. Purpose The aim of the study was to investigate the association of time from first medical contact (FMC) to P-PCI with heart failure (EF <50%) and mortality. Methods The study includes all patients registered during 2015–2018 in the Norwegian Myocardial Infarction Registry with STEMI who were <85 years of age and had <12 hours from symptom onset to FMC. For patients with missing values, FMC was calculated as time of prehospital ECG minus 10 minutes. The primary outcome variable was heart failure (defined as ejection fraction <50% during hospitalization) or all-cause mortality within 1 year after hospitalization. We calculated ORs (95% CI) adjusted for age, gender, and history of myocardial infarction, hypertension, diabetes, and heart failure. Results During 2015–2018 a total of 6398 STEMI patients <85 years of age were registered in the Norwegian Myocardial Infarction Registry with less than 12 hours from symptom onset to FMC. Time delay from FMC to P-PCI were <90 minutes, 90–119 minutes, and >120 minutes in 40%, 25%, and 35% of the patients, respectively. Compared to patients with P-PCI within 90 minutes after FMC, the multivariable adjusted OR (95% CI; p-value) for heart failure or 1 year mortality was 1.05 (1.02–1.08; p<0.01) for patients with P-PCI within 90–119 minutes after FMC, and 1.05 (1.02–1.08; p<0.001) for patients with P-PCI >120 minutes after FMC. The corresponding ORs for 1 year mortality were 1.01 (0.99–1.02) and 1.03 (1.02–1.04), respectively, and the corresponding ORs for EF<50% were 1.07 (1.04–1.11) and 1.07 (1.04–1.11). Conclusion In Norway, only 40% of STEMI patients undergo P-PCI within 90 minutes after FMC, and 35% of patients undergoes P-PCI >120 minutes after FMC. Time delays of more than 90 minutes after FMC are associated with increased risk of heart failure and mortality. A fibrinolysis strategy may be preferred over P-PCI for a substantial proportion of STEMI patients. Funding Acknowledgement Type of funding source: None

Abstract 569: NT-proBNP is an Important Independent Predictor of Clinical Events after Primary PCI for STEMI

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Justin A Ezekowitz ◽  
Jeffery A Bakal ◽  
Kurt Huber ◽  
Pierre Theroux ◽  
Stefan K James ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Symptom Onset ◽  
Public Health Issue ◽  
Primary Pci ◽  
Composite Outcome ◽  
Cart Model ◽  
Primary Composite Outcome

Acute myocardial infarction with ST-segment elevation (STEMI) remains a major global public health issue. Despite advances in therapy, patients remain at risk for death, repeat myocardial infarction (MI) shock and heart failure (HF). Novel markers that predict those at risk are needed. We studied 903 STEMI patients in The Assessment of Pexelizumab in Acute Myocardial Infarction trial (which enrolled STEMI patients presenting < 6 hrs of symptom onset who were to undergo primary PCI) in a case-control design (cases selected based on the trial’s primary composite outcome - death, shock or HF - and matched on age, gender and infarct location to controls). NT-proBNP (pg/ml) was measured at randomization and 24 hrs. Outcomes (individually and the composite) of death, shock, and HF at 90 days were examined by quartiles of NT-proBNP. A CART model was used to categorize adjusted risk. NT-proBNP was higher in patients who had events. Patients with higher NT-proBNP levels at baseline (median symptom onset to randomization 2.7 hrs) and 24 hrs had more events (composite p<0.001; death p<0.0001; HF p<0.0001; shock p=0.05) - See figure . Using the CART model (adjusted for age, gender and infarct location), baseline Killip class and NT-proBNP could further subcategorize patients into 90 day mortality categories 4%, 10%, 30%, and 53%. In fact, only 4 patients (1%) with a 24 hour NT-proBNP <999 pg/ml had any event in the next 90 days. Although the overall prognosis in STEMI patients undergoing primary PCI is good, NT-proBNP performed early and at 24 hrs provides important prognostic information for predicting negative outcomes i.e. shock, heart failure and death. Figure. Kaplan-Meier curve for the primary composite outcome stratified by baseline NT-proBNP (a), or 24 hour NT-proBNP (b).

Association of Stress hyperglycemia and adverse cardiac events in acute myocardial infarction – A cohort study

2021 ◽  
Vol 22 ◽  
Author(s):  
Annu Rajpurohit ◽  
Bharat Sejoo ◽  
Rajendra Bhati ◽  
Prakash Keswani ◽  
Shrikant Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Blood Glucose ◽  
Clinical Outcomes ◽  
P Value ◽  
Cardiac Events ◽  
Stress Hyperglycemia ◽  
Adverse Cardiac Events ◽  
Hba1c Levels

Background: Stress hyperglycemia is a common phenomenon in patients presenting with acute myocardial infarction (MI). We aim to evaluate the association of stress hyperglycemia at the time of hospital presentation and adverse cardiac events in myocardial infarction during the course of hospital stay. Methods: Subjects with age ≥18 years with acute MI were recruited on hospital admission and categorized based on admission blood glucose (<180 and ≥180 mg/dl, 50 patients in each group). Both groups were compared for clinical outcomes, adverse cardiac events and mortality. We also compared the adverse cardiac outcomes based on HbA1c levels (<6% and ≥6%). Results: Patients with high blood glucose on admission (stress hyperglycemia) had significant increased incidences of severe heart failure (Killip class 3 and 4), arrythmias, cardiogenic shock and mortality (p value = 0.001, 0.004, 0.044, and 0.008 respectively). There was no significant association between adverse cardiac events and HbA1c levels (heart failure 18.8% vs. 25%, p value = 0.609 and mortality 16.7% vs. 17.3%, p value = 0.856). Conclusions: Stress hyperglycemia is significantly associated with adverse clinical outcomes in patients with MI irrespective of previous diabetic history or glycemic control. Clinicians should be vigilant for admission blood glucose while treating MI patients.

D-dimer and the incidence of heart failure and mortality after acute myocardial infarction

Heart ◽  
2020 ◽  
pp. heartjnl-2020-316880 ◽  
Author(s):  
Xiaoyuan Zhang ◽  
Shanjie Wang ◽  
Jinxin Liu ◽  
Yini Wang ◽  
Hengxuan Cai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Plaque Rupture ◽  
Risk Of Death ◽  
Increased Risk ◽  
Clinical Covariates ◽  
All Cause Mortality ◽  
D Dimer

ObjectiveD-dimer might serve as a marker of thrombogenesis and a hypercoagulable state following plaque rupture. Few studies explore the association between baseline D-dimer levels and the incidence of heart failure (HF), all-cause mortality in an acute myocardial infarction (AMI) population. We aimed to explore this association.MethodsWe enrolled 4504 consecutive patients with AMI with complete data in a prospective cohort study and explored the association of plasma D-dimer levels on admission and the incidence of HF, all-cause mortality.ResultsOver a median follow-up of 1 year, 1112 (24.7%) patients developed in-hospital HF, 542 (16.7%) patients developed HF after hospitalisation and 233 (7.1%) patients died. After full adjustments for other relevant clinical covariates, patients with D-dimer values in quartile 3 (Q3) had 1.51 times (95% CI 1.12 to 2.04) and in Q4 had 1.49 times (95% CI 1.09 to 2.04) as high as the risk of HF after hospitalisation compared with patients in Q1. Patients with D-dimer values in Q4 had more than a twofold (HR 2.34; 95% CI 1.33 to 4.13) increased risk of death compared with patients in Q1 (p<0.001). But there was no association between D-dimer levels and in-hospital HF in the adjusted models.ConclusionsD-dimer was found to be associated with the incidence of HF after hospitalisation and all-cause mortality in patients with AMI.

scholarly journals Predictors of heart failure in patients treated with primary PCI for acute myocardial infarction: Short term 30-days follow-up

2011 ◽  
Vol 30 (4) ◽  
pp. 27-34
Author(s):  
Ivana Nedeljković ◽  
Miodrag Ostojić ◽  
Bosiljka Vujisić-Tešić ◽  
Branko Jakovljević ◽  
Milan Petrović ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Primary Pci ◽  
Short Term

scholarly journals Does sacubitril/valsartan work in acute myocardial infarction? The PARADISE-AMI study

2021 ◽  
Vol 23 (Supplement_E) ◽  
pp. E87-E90
Author(s):  
Laura Gatto
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Dysfunction ◽  
Clinical Studies ◽  
Ventricular Dysfunction ◽  
Left Ventricular ◽  
Laboratory Animals ◽  
Risk Of Death ◽  
Increased Risk

Abstract Patients with acute myocardial infarction (AMI) complicated by left ventricular dysfunction have an increased risk of death and heart failure. Numerous clinical studies have demonstrated the ability of ACE inhibitors in optimizing the outcome in this particular clinical setting. In recent years, the sacubitril/valsartan association has drastically improved the prognosis of patients with heart failure with reduced ejection fraction with a significant decrease in mortality from cardiovascular causes and hospitalizations due to acute heart failure. However, it has not yet been fully clarified whether this pharmacological association may play a role in patients with AMI. Pre-clinical studies have suggested the possibility that sacubitril/valsartan can reduce the size of the infarct scar and prevent the onset of ventricular arrhythmias in laboratory animals in which myocardial infarction was induced. On the other hand, small clinical experiences with patients after myocardial infarction have provided conflicting data. The results of the PARADISE-MI study were recently presented, which enrolled 5661 patients with AMI complicated by pulmonary congestion and left ventricular dysfunction randomized to therapy with ramipril or sacubitril/valsartan and followed up for ∼2 years. Although combination therapy was associated with an ∼10% reduction in the risk of death from cardiovascular causes or an episode of heart failure, this was not enough to achieve statistical significance. However, treatment with sacubitril/valsartan was shown to be more effective than ramipril in preventing recurrence of heart failure after the first one.

Abstract 572: Hyperglycemia and Poor Outcomes in Patients without Diabetes Mellitus in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS): A Propensity Matched Analysis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Prakash C Deedwania ◽  
Bertram Pitt ◽  
Enrique V Carbajal ◽  
Ali Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Propensity Scores ◽  
Cox Regression ◽  
Baseline Serum ◽  
Increased Risk

Background: The effect of hyperglycemia on outcomes in patients with acute MI (AMI) and low LVEF without diabetes mellitus is not well known. Methods: In the EPHESUS trial, of the 4411 non-DM patients, 554 had baseline hyperglycemia (≥140 mg/dL). Propensity scores for hyperglycemia were calculated for each of the 4411 patients based on 63 baseline covariates, and a greedy 1:8 matching protocol was used to match 400 and 2542 patients respectively with and without hyperglycemia. Matched Cox regression models were used to estimate associations between hyperglycemia and outcomes during 16 months of follow up. Results: Patients with hyperglycemia were more likely to be older, have higher heart rate, lower LVEF, and receive nitrates, statins, digoxin, loop diuretics, and PTCA during index admission. Unadjusted hazard ratios {HR} and 95% confidence intervals {CI} for hyperglycemia were: all-cause death (1.51; 1.22–1.87; P<0.001), cardiovascular (CV) death (1.52; 1.21–1.90; P<0.001), heart failure (HF) death (2.19, 1.46–3.29; P<0.001), all-cause hospitalization (1.23; 1.08–1.40; P=0.002), CV hospitalization (1.51, 1.24–1.84; P<0.001) and HF hospitalization (1.75; 1.37–2.25; P<0.001). In the matched cohort, hyperglycemia was significantly associated with CV death (HR=1.25, 95%CI=1.01–1.54; P=0.039), sudden cardiac death (HR=1.33; 95%CI=1.02–1.73, P=0.035) and fatal/nonfatal AMI (HR=1.53, 95%CI=1.07–2.19; P=0.04; Figure ). Conclusions: In non-diabetic post-AMI HF patients, hyperglycemia is a poor prognosticator and is associated with increased risk of fatal and non-fatal AMI, CV death, HF deaths, sudden cardiac death, and CV hospitalization. Figure Fatal or non fatal acute myocardial infarction (AMI) by baseline serum glucose in post-AMI patients with no known history of diabetes mellitus

scholarly journals Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade

EP Europace ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. 1547-1557
Author(s):  
Gesa von Olshausen ◽  
Tara Bourke ◽  
Jonas Schwieler ◽  
Nikola Drca ◽  
Hamid Bastani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Cardiovascular Events ◽  
Control Group ◽  
Risk Of Death ◽  
Increased Risk

Abstract Aims Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. Methods and results Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint — death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure — occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15–5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01–13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68–276.86); P = 0.001]. Conclusion Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.

scholarly journals Acute myocardial infarction in the Covid-19 era: incidence, clinical characteristics and in-hospital outcomes – a multicenter registry

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Fardman ◽  
D Zahger ◽  
K Orvin ◽  
N Kofman ◽  
J Mohsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Severe Disease ◽  
Admission Rate ◽  
P Value ◽  
Study Cohort ◽  
Hospital Outcomes ◽  
Ischemic Time ◽  
Coronary Syndrome ◽  
Increased Risk

Abstract Background A reduction in acute myocardial infarction (AMI) hospitalizations during the coronavirus pandemic has been previously documented. We aimed to describe the characteristics and in-hospital outcomes of AMI patients during the Covid-19 era compared to a recent previous registry. Methods We conducted a prospective, multicenter, observational study involving 13 intensive cardiac care units (ICCUs) to evaluate consecutive AMI patients admitted throughout an 8-week period during the Covid-19 outbreak. Data were compared to the corresponding period in 2018 using an acute coronary syndrome survey conducted in all ICCUs in Israel. The primary end-point was defined as a composite of sustained ventricular arrhythmia, pulmonary congestion, and/or in-hospital mortality. Results The study cohort comprised 1466 patients, of whom 774 (53%) were hospitalized during the Covid-19 outbreak. Overall, 841 patients were diagnosed with ST-elevation MI (STEMI): 424 (50.4%) during the Covid-19 era and 417 (49.6%) during the parallel period in 2018. No differences were detected in the admission rate of patients between the two study periods. STEMI patients admitted during the Covid-19 period tended to have fewer co-morbidities, but a higher Killip class (p value = 0.03). The median time from symptom onset to reperfusion was extended from 180 minutes (IQR 122–292) in 2018 to 290 minutes (IQR 161–1080, p&lt;0.001) in 2020. Hospitalization during the Covid-19 era was independently associated with an increased risk of the combined endpoint of heart failure, malignant arrhythmia, or death in the multivariable logistic regression model (OR 1.63, 95% CI 1.02–2.65, p value = 0.05). Conclusion While the admission rate of AMI and STEMI in Israel remained similar during both the Covid-19 era and the corresponding period in 2018, total ischemic time extended significantly during the Covid-19 period, which translated into a more severe disease status upon hospital admission, and a higher rate of in-hospital adverse events. FUNDunding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This work was supported by a grant from a Fefer foundation for medical research

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