scholarly journals Infarct-related artery and long-term mortality following recurrent ST-elevation myocardial infarction; insights from a Polish nationwide registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Wolny ◽  
P Desperak ◽  
J Kwiecinski ◽  
M Gasior ◽  
A Witkowski
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Infarct Related Artery ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Recurrent ST-elevation myocardial infarction (rSTEMI) occurs either as an acute thrombotic event in the same (target-vessel, TV-STEMI) or different vessel (non-target, nonTV-STEMI) compared with the first infarction. Little is known about the frequency of rSTEMI in the era of primary percutaneous coronary intervention (PCI) and about the impact of the infarct-related artery (IRA) on long-term prognosis. Purpose We hypothesized that long-term mortality after rSTEMI varies according to IRA (either same or different compared with first STEMI). Methods We retrospectively analysed data from the Polish Registry of Acute Coronary Syndromes (PL-ACS) and identified survivors of first STEMI treated with PCI who experienced rSTEMI and were discharged home. We divided rSTEMI into TV-STEMI and nonTV-STEMI group. We compared baseline clinical, angiographic and procedural characteristics and utilized propensity score matching to adjust for baseline differences. 1-, 3- and 5-year all-cause mortality was obtained from the Polish National Health Fund. Categorical variables were presented as counts and percentages and compared using Chi2 test. Continuous variables were presented as medians and interquartile ranges and compared using Mann-Whitney test. The registry was approved by local Ethics Committee and meets the conditions of the Declaration of Helsinki Results Between January 2003 and August 2019 a total of 3517 patients (mean age 62.9 years, 75% male) had rSTEMI, of whom 1941 (55%) had TV- and 1576 (45%) had nonTV-STEMI after 615 (77, 1683) days since first infarction (Figure 1). Patients with nonTV-STEMI had higher BMI (27.2 vs 26.8 kg/m2, p=0.03), more hypertension (76.9 vs. 73.5%, p=0.02) and atrial fibrillation (4.7 vs. 3.3%, p=0.04), but had lower left ventricular ejection fraction (43 [35,50] vs. 45 [38,50], p<0.001) compared with TV-STEMI. On coronary angiography nonTV-STEMI had more frequently TIMI flow ≥1 (44.9 vs. 28.0%, p<0.001), multivessel disease (51.8 vs. 41.1%, p=0.003), culprit lesion located in circumflex artery (15.2 vs. 4.8, p<0.001) and more frequently underwent stenting (88.4 vs. 76.1%, p<0.001) compared with TV-STEMI. There was no difference in unadjusted 1-, 3- and 5-year mortality between nonTV-STEMI and TV-STEMI group (14.9 vs. 14.7%, p=0.9; 23.4 vs. 24.2%, p=0.64 and 29.6 vs. 32.9%, p=0.1 respectively). The propensity-score matching of 825 patients with TV- and 826 patients with nonTV STEMI suppressed all baseline differences, but adjusted mortality remained similar between study groups (Figure 1). Conclusion While patients with recurrent nonTV-STEMI have different clinical and angiographic characteristics compared with TV-STEMI, the long-term mortality in these groups is similar. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 13193: Impact of “Off-Peak” Versus “Peak” Hour Coronary Interventions for ST-Elevation Myocardial Infarction on Adverse Outcomes

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Jae S Lee ◽  
Gabriel Redel-Traub ◽  
Michael Kim ◽  
Perwaiz Meraj ◽  
Christina Brennan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Adverse Outcomes ◽  
St Elevation Myocardial Infarction ◽  
Coronary Interventions ◽  
St Elevation ◽  
Peak Versus ◽  
Versus Peak ◽  
Long Term Mortality

Background: In addition to patient-dependent factors, whether the time of arrival of the patient to the hospital with ST-elevation myocardial infarction (STEMI) might play a role in subsequent adverse outcomes following primary percutaneous coronary interventions (PCI) is not well studied. Method: 856 PCI procedures for patients presenting with STEMI from two large hospitals in the health system were analyzed. Peak hours were defined as procedures performed between 7 AM and 7 PM on weekdays. Off-peak hours were defined as procedures performed between 7 PM and 7 PM on weekdays and weekends. Unadjusted and propensity score-adjusted analyses were performed to analyze the following inpatient outcomes: composite of death/MI/stroke, composite of bleeding events, composite of death/MI/stroke/bleeding endpoints, and long-term mortality. Results: Of 856 PCIs, 407 (47.5%) were performed during the peak hours. In both unadjusted and propensity score-adjusted analyses, no significant differences in adverse outcomes and long-term mortality were observed in patients who had PCIs during off-peak and peak hours (see Table). In addition, a separate analysis performed on patients who underwent primary PCIs between 7 AM-7 PM (“Morning”) versus 7 PM-7 AM (“Evening”) on all days showed no difference in the inpatient adverse outcomes and long-term mortality (Adjusted long term mortality: HR 0.79 (95% CI 0.40-1.56), p=0.49). Conclusion: Primary PCIs performed on patients presenting with STEMI during off-peak versus peak hours results in similar inpatient adverse outcomes and long-term mortality.

scholarly journals The impact of the location of a chronic total occlusion in a non-infarct-related artery on long-term mortality in ST-elevation myocardial infarction patients

2016 ◽  
Vol 12 (4) ◽  
pp. 423-430 ◽  
Author(s):  
Loes P.C. Hoebers ◽  
Joëlle Elias ◽  
Ivo M. van Dongen ◽  
Dagmar M. Ouweneel ◽  
Bimmer E.P.M. Claessen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Total Occlusion ◽  
St Elevation Myocardial Infarction ◽  
Total Occlusion ◽  
Infarct Related Artery ◽  
St Elevation ◽  
The Impact ◽  
Long Term Mortality

scholarly journals Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ana Lopez-de-Andres ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernández-Barrera ◽  
Jose M. de Miguel-Yanes ◽  
Romana Albaladejo-Vicente ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Sex Differences ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Discharge ◽  
St Elevation Myocardial Infarction ◽  
Men And Women ◽  
St Elevation

Abstract Background To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences. Methods Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM. Results MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI. Conclusions T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

scholarly journals Characteristics and long-term mortality of patients with ST-elevation or non-ST-elevation myocardial infarction after orthopaedic surgery

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199299
Author(s):  
Wenlan Hu ◽  
Kaiping Zhao ◽  
Youzhou Chen ◽  
Jihong Wang ◽  
Mei Zheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Orthopaedic Surgery ◽  
Troponin I ◽  
Cox Regression ◽  
St Elevation Myocardial Infarction ◽  
Entire Cohort ◽  
St Elevation ◽  
Universal Definition ◽  
Long Term Mortality

Objective To investigate the clinical characteristics and long-term mortality of patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) after orthopaedic surgery. Methods This retrospective, single-centre study enrolled patients that underwent inpatient orthopaedic surgery from 2009 to 2017 in Beijing Jishuitan Hospital. The patients were screened for a cardiac troponin I elevation and fulfilled the Fourth Universal Definition of Myocardial Infarction within 30 days of surgery. Results A total of 180 patients that developed perioperative myocardial infarction (MI) were included in the study. Among them, 14 patients (7.8%) were classified as STEMI, and 166 (92.2%) had NSTEMI. Compared with those with NSTEMI, STEMI patients had significantly higher 30-day and long-term mortality rates (50.0% versus 5.4%; 71.4% versus 22.3%; respectively). Multivariate Cox regression model analysis among the entire cohort demonstrated that STEMI (hazard ratio [HR] 5.78, 95% confidence interval [CI] 2.50, 13.38) and prior MI (HR 2.35, 95% CI 1.02, 5.38) were the most significant independent predictors of long-term mortality. Conclusion Perioperative MI after orthopaedic surgery was associated with a high mortality rate. STEMI was independently associated with a significant increase in short- and long-term mortality.

Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network

2017 ◽  
Vol 130 (5-6) ◽  
pp. 172-181 ◽  
Author(s):  
Paul Michael Haller ◽  
Bernhard Jäger ◽  
Serdar Farhan ◽  
Günter Christ ◽  
Wolfgang Schreiber ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Short And Long Term ◽  
St Elevation ◽  
Long Term Mortality

scholarly journals Temporal Course of Plasma Trimethylamine N-Oxide (TMAO) Levels in ST-Elevation Myocardial Infarction

2021 ◽  
Vol 10 (23) ◽  
pp. 5677
Author(s):  
Mohammad A. Almesned ◽  
Femke M. Prins ◽  
Erik Lipšic ◽  
Margery A. Connelly ◽  
Erwin Garcia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Function ◽  
Infarct Size ◽  
Impaired Renal Function ◽  
Left Ventricular ◽  
St Elevation Myocardial Infarction ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Temporal Course ◽  
St Elevation

The gut metabolite trimethylamine N-oxide (TMAO) at admission has a prognostic value in ST-elevation myocardial infarction (STEMI) patients. However, its sequential changes and relationship with long-term infarct-related outcomes after primary percutaneous coronary intervention (PCI) remain elusive. We delineated the temporal course of TMAO and its relationship with infarct size and left ventricular ejection fraction (LVEF) post-PCI, adjusting for the estimated glomerular filtration rate (eGFR). We measured TMAO levels at admission, 24 h and 4 months post-PCI in 379 STEMI patients. Infarct size and LVEF were determined by cardiac magnetic resonance 4 months after PCI. TMAO levels decreased from admission (4.13 ± 4.37 μM) to 24 h (3.41 ± 5.84 μM, p = 0.001) and increased from 24 h to 4 months (3.70 ± 3.86 μM, p = 0.026). Higher TMAO values at 24 h were correlated to smaller infarct sizes (rho = −0.16, p = 0.024). Larger declines between admission and 4 months suggestively correlated with smaller infarct size, and larger TMAO increases between 24 h and 4 months were associated with larger infarct size (rho = −0.19, p = 0.008 and rho = −0.18, p = 0.019, respectively). Upon eGFR stratification using 90 mL/min/1.73 m2 as a cut-off, significant associations between TMAO and infarct size were only noted in subjects with impaired renal function. In conclusion, TMAO levels in post-PCI STEMI patients are prone to fluctuations, and these fluctuations could be prognostic for infarct size, particularly in patients with impaired renal function.

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