Participation in a research study related to acute myocardial infarction is not a guarantee to live more longer: results from the FAST-MI registries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Puymirat ◽  
F Schiele ◽  
F Roubille ◽  
V Tea ◽  
J Ferrieres ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Trial ◽  
Clinical Outcome ◽  
Clinical Characteristics ◽  
Research Study ◽  
St Elevation Myocardial Infarction ◽  
Lower Mortality ◽  
St Elevation ◽  
One Year

Abstract Background The main potential benefits of participating in a clinical trial is to have access to a treatment that is not available yet and to have a regular and careful attention from physicians. Several data have suggested that inclusion in a research study was associated with better clinical outcome. Aims The aim of this study is to describe the prevalence of inclusions in a research study (i.e., device or medication), clinical characteristics, management and clinical outcome in patients admitted for acute myocardial infarction (AMI) according to participation in a research study (versus not) using data from the French registries of Acute ST-or non-ST-elevation Myocardial infarction (FAST-MI) 2010 and 2015. Methods We used data from 2 one-month French registries, conducted 5 years apart, including 9,414 AMI admitted to coronary or intensive care units. We analyzed baseline characteristics, management and one-year survival according to participation in a research study. Results From 2010 to 2015, the prevalence of patients included in a research study decreased from 6.8% to 3.6% (P<0.001). Inclusions were performed mainly in university hospitals (8%). Clinical characteristics according to participation in a research study were strongly different. Overall, patients included in a research study were younger (61.2±12.7 vs 65.7±14.1; P<0.001) with less previous medical history and co-morbidities. Clinical presentation was preferentially a ST-elevation myocardial infarction (STEMI: 70% vs 52%; P<0.001) in these patients who had a lower GRACE score (133±32 vs. 141±35; P<0.001). The use of invasive strategies was more used in patients included in a research study (coronary angiogram: 99% vs 95%, P<0.001) as prescriptions of recommended medications (i.e., antiplatelet agents, beta-blockers, angiotensin-converting-enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB) and statins) at discharge (72% vs 63%; P<0.001). In a cox multivariate analysis, participation in a research study was not associated with lower mortality at one-year (HR= 0.68, 95% CI, 0.39–1.18, P=0.17). Similar results were observed in patients discharge alive (HR= 0.81, 95% CI, 0.44–1.48, P=0.49). Recommended medications were however more used in patients included in a clinical trial (OR=1.34; 95% CI, 1.09–1.65; P=0.007). Conclusions The number of inclusions in a research study related to AMI in France is low. Our data suggest that patients included in a research study are selected and received more recommended medications and invasive strategies. However, this management is not associated with a lower mortality at one-year. Funding Acknowledgement Type of funding source: None

Impact of cardiac rehabilitation referral on one-year outcome after discharge of patients with acute myocardial infarction

2018 ◽  
Vol 26 (2) ◽  
pp. 138-144 ◽  
Author(s):  
Matthias Hermann ◽  
Fabienne Witassek ◽  
Paul Erne ◽  
Hans Rickli ◽  
Dragana Radovanovic
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
St Elevation Myocardial Infarction ◽  
Multivariable Logistic Regression Analysis ◽  
St Elevation ◽  
One Year ◽  
Lost To Follow Up ◽  
The Impact

Background Cardiac rehabilitation after an acute myocardial infarction has a class I recommendation in the present guidelines. However, data about the impact on mortality in Switzerland are not available. Therefore, we analysed one-year outcome of acute myocardial infarction patients according to cardiac rehabilitation referral at discharge. Design and methods Data were extracted from the Swiss AMIS Plus registry and included patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction, who were asked to give their informed consent to a telephone follow-up one year after discharge. Results From 10,141 patients, 1956 refused to participate in follow-up and 302 were lost to follow-up. There were 4508 (57.2%) patients with cardiac rehabilitation referrals compared with 3375 (42.8%) without. Patients referred to cardiac rehabilitation were younger (62.4 years vs. 68.8 years), more often male (77% vs. 70%), presented more often with ST-elevation myocardial infarction (63.5% vs. 52.1%) and, apart from smoking (44.0% vs. 34.9%), they had fewer risk factors, such as dyslipidaemia (55.0% vs. 60.1%), hypertension (55.6% vs. 65.3%) and diabetes (16.7% vs. 21.5%). Patients referred to cardiac rehabilitation had a lower crude one-year all-cause mortality (1.7% vs. 5.8%; p < 0.001) and lower rates of re-infarction, rehospitalization for cardiovascular disease and intervention (all p < 0.005). In a multivariable logistic regression analysis, cardiac rehabilitation was an independent predictor for lower mortality rate (odds ratio 0.65; 95% confidence interval 0.48–0.89; p = 0.007). Conclusions Although the detailed data of cardiac rehabilitation programmes and patient participation were not available for this study, our data from 7883 acute myocardial infarction patients showed a better one-year outcome for patients with cardiac rehabilitation referrals than for those without.

The effect of preloading statins prior to primary reperfusion on in-hospital mortality risk in a contemporary large-scale cohort of patients with ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Fu ◽  
C.X Song ◽  
X.D Li ◽  
Y.J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Large Scale ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Control Group ◽  
Funding Source ◽  
St Elevation

Abstract Background The benefit of statins in secondary prevention of patients stabilized after acute coronary syndrome (ACS) has been well established. However, the benefit of preloading statins, i.e. high-intensity statins prior to reperfusion therapy remains unclear. Most previous studies included all types of ACS patients, and subgroup analysis indicated the benefit of preloading statins was only seen in ST-elevation myocardial infarction (STEMI) patients who underwent percutaneous coronary intervention (PCI). However, the sample size of subgroup population was relatively small and such benefit requires further validation. Objective To investigate the effect of loading dose of statins before primary reperfusion on 30-mortality in patients with STEMI. Methods We enrolled patients in China Acute Myocardial Infarction (CAMI) registry from January 2013 to September 2014. CAMI registry was a prospective multicenter registry of patients with acute acute myocardial infarction in China. Patients were divided into two groups according to statins usage: preloading group and control group. Patients in preloading group received loading does of statins before primary reperfusion and during hospitalization. Patients in control group did not receive statins during hospitalization or at discharge. Primary outcome was in-hospital mortality. Baseline characteristics, angiographic characteristics and outcome were compared between groups. Propensity score (PS) matching was used to mitigate baseline differences between groups and examine the association between preloading statins on in-hospital mortality risk. The following variables were used to establish PS matching score: age, sex, classification of hospitals, clinical presentation (heart failure at presentation, cardiac shock, cardiac arrest, Killip classification), hypertension, diabetes, prior angina, prior myocardial infarction history, prior stroke, initial treatment. Results A total of 1169 patients were enrolled in control group and 6795 in preloading group. A total of 833 patients (334 in control group and 499 in preloading group) died during hospitalization. Compared with control group, preloading group were younger, more likely to be male and present with Killip I classification. The proportion of hypertension and diabetes were higher in preloading group. After PS matching, all the variables used to generate PS score were well balanced. In the PS-matched cohort, 30-day mortality risk was 26.3% (292/1112) in the control group and 11.9% (132/1112) in the preloading group (p&lt;0.0001). Conclusions The current study found preloading statins treatment prior to reperfusion therapy reduced in-hospital mortality risk in a large-scale contemporary cohort of patients with STEMI. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Chinese Academy of Medical Sciences

scholarly journals DIFFERENTIAL CELL COUNT AS DIAGNOSTIC AND PROGNOSTIC MARKER OF ACUTE MYOCARDIAL INFARCTION

2018 ◽  
Vol 24 (2) ◽  
pp. 175
Author(s):  
Sri Anita ◽  
Liong Boy Kurniawan ◽  
Darwati Muhadi
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cell Count ◽  
Inflammatory Marker ◽  
St Elevation Myocardial Infarction ◽  
Chi Square ◽  
Cross Sectional ◽  
Differential Cell Count ◽  
Differential Cell ◽  
St Elevation

Myocardial infarction is a necrosis of myocardial cells due to lack of blood and oxygen supply caused by obstruction of coronary arteries, mostly due to atherosclerosis processes. Increased inflammatory marker level is associated with poor cardiovascular prognosis. This study was aimed to know whether leukocytes count, differential cell count and the Ratio of Neutrophils-Lymphocytes (RNL) could distinguish between types of Acute Myocardial Infarction (AMI) and to evaluate its correlation with mortality. This was a cross-sectional retrospective study using medical records patients which were diagnosed as AMI by clinicians in Cardiac Centre of the Dr. Wahidin Sudirohusodo Hospital during the period of April 1st, 2015 - May 31st, 2016. Statistical analysis used the Mann-Whitney and Chi-Square test, p<0.05 was considered as significant. The total subjects were 435 patients divided into 289 ST- Elevation Myocardial Infarction (STEMI) and 146 Non-ST-Elevation Myocardial Infarction (NSTEMI). There were significant differences in that mean of leukocytes, neutrophils, lymphocytes, monocytes, eosinophils counts and RNL between STEMI and NSTEMI (p <0.05). Significant differences were also found in leukocyte, neutrophils, lymphocytes, eosinophils, basophils and RNL mean between those who died and survived (p <0.05) and a significant correlation between increased leukocytes, neutrophils, basophils counts with mortality (p <0.05). In conclusion, the number of leukocytes and leukocyte count can be used as diagnostic markers of AMI between STEMI and NSTEMI, as well as prognostic markers among patients who died and survived. Routine blood sampling cohort studies in patients with AMI can avoid the bias of the results obtained. 

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