Prognostic impact of gender and young age in patients with acute myocardial infarction undergoing primary PCI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Radomirovic ◽  
D Milasinovic ◽  
Z Mehmedbegovic ◽  
A Pavlovic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rates ◽  
Primary Pci ◽  
Female Patients ◽  
Crude Mortality ◽  
Short And Long Term ◽  
Male Patients ◽  
Baseline Characteristics ◽  
Long Term Mortality

Abstract Background Previous studies showed higher unadjusted mortality rates in female patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, after adjusting for differences in baseline characteristics, including age, female gender was not consistently associated with higher mortality. Purpose Our aim was to investigate the impact of gender on short- and long-term mortality in patients aged 18 to 55 years with AMI undergoing primary PCI. Methods We included 11 288 patients admitted for primary PCI during 2009–2019, from a prospectively kept, electronic registry of a high-volume tertiary center. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard. Median follow up was 1 507 days. Results 3 505 patients were younger than 55 years (31%). In this age group, 18.9% were female patients (n=661). Baseline characteristics were similar for females vs. males below the age of 55 years, including similar reperfusion times (338 min. vs. 341 min., p=0.8), with only exceptions being a higher rate of previous hypertension (64% vs. 58%, p=0.002) and stroke (3.6% vs. 2.2%, p=0.049), as well as lower ejection fraction (48% vs. 51%, p<0.001), in female patients. MINOCA (Myocardial Infarction with Nonobstructive Coronary Arteries) was more frequently present in female vs. male patients aged ≤55 years (10.1% vs. 5.0%, p<0.001). In the overall population, crude mortality was higher in female patients at 30 days (9.8% vs. 6.0%, p<0.001) and 5 years (38.4% vs. 30.2%, p<0.001). In younger patients (≤55 years), mortality rates were low and similar between the sexes at both 30 days (3.6% in females vs. 2.5% in males, p=0.136) and 5 years (14.5% vs. 13.4%, p=0.58). On the contrary, in patients aged >55 years, crude mortality was higher in female patients at both 30 days (11.3% vs. 7.9%, p<0.001) and 5 years (43.9% vs. 39.4%, p=0.02), albeit mainly driven by the differences in baseline characteristics between the sexes in this older age group (adjusted HR for female sex 1.220, CI95% 0.920–0.617, p=0.17, at 30 days; and adjusted HR 1.033, CI95% 0.908–0.175, p=0.62, at 5 years). Conclusion Differences in crude mortality rates between sexes in patients with AMI admitted for primary PCI appear to be mainly dependent on age, with similar rates of both short- and long-term mortality in younger patients (≤55 years). The observed excess in mortality in older (>55 years) female vs. male patients could be explained by the differences in baseline clinical characteristics. Funding Acknowledgement Type of funding source: None

scholarly journals Sex differences in short-and long-term survival among critically ill patients with sepsis: a real-world study using propensity scoring methods

2020 ◽  
Author(s):  
Shan Lin ◽  
Shanhui Ge ◽  
Wanmei He ◽  
Lihong Bai ◽  
Mian Zeng
Keyword(s):  
Sex Differences ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Mortality Rates ◽  
Term Survival ◽  
Long Term Survival ◽  
Female Patients ◽  
Short And Long Term ◽  
Male Patients

Abstract Background At present, there have been studies showing a correlation between sex differences and prognosis. Nevertheless, the evidence of short- and long-term survival of sex-based differences among critically ill patients with sepsis is still limited and controversial. The purpose of this study was to evaluate the effect of sex on the short- and long-term survival of critically ill patients with sepsis. Methods We used the Medical Information Mart for Intensive Care III database. Cox proportional hazards models were conducted to determine the relationship of 28-day and 1-year mortality rates with a different sex. Interaction and stratified analyses were conducted to test whether the effect of sex differed across various subgroups. Results A total of 12,321 patients were enrolled in this study. After adjustments, the 28-day and 1-year mortality rates for female patients were reduced by 12% and 10%, respectively (HR = 0.88, 95% CI 0.81–0.96 and HR = 0.90, 95% CI 0.85–0.95) when compared to male patients. The effects of the association between sex and 28-day and 1-year mortality were broadly consistent for all subgroup variables. Only a significant interaction of age was observed in 1-year mortality (P = 0.0091). Compared with male patients, female patients (< 50 years) had better long-term survival advantages (HR 0.76 95% CI 0.62–0.94, P = 0.0124); on the contrary, for older patients (≥ 50 years), we did not find sex-based differences in long-term survival (HR 1.03, 95% CI 0.97–1.09, P = 0.3678). Conclusions In the current retrospective large database review, female patients had a significantly lower 28-day and 1-year mortality rates than did males among critically ill patients with sepsis. Of concern, there was an interaction between age and sex, and whether to suggest that female-associated hormones affect clinical outcomes needs to be further researched.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (&gt;50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF&lt;40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF&lt;40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p&lt;0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p&lt;0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p&lt;0.001) and median age (61 vs. 59 vs. 64 years, p&lt;0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p&lt;0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p&lt;0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p&lt;0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (&lt;40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

scholarly journals Short- and long-term mortality for patients undergoing primary angioplasty for acute myocardial infarction

2000 ◽  
Vol 36 (4) ◽  
pp. 1194-1201 ◽  
Author(s):  
Edward L Hannan ◽  
Michael J Racz ◽  
Djavad T Arani ◽  
Thomas J Ryan ◽  
Gary Walford ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Primary Angioplasty ◽  
Short And Long Term ◽  
Long Term Mortality

Effects of Bailout Tirofiban on In-Hospital Outcomes and Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Intervention

Angiology ◽  
2018 ◽  
Vol 70 (5) ◽  
pp. 431-439 ◽  
Author(s):  
Yalcin Velibey ◽  
Tolga Sinan Guvenc ◽  
Koray Demir ◽  
Ahmet Oz ◽  
Evliya Akdeniz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Intervention ◽  
St Segment Elevation ◽  
Cerebrovascular Events ◽  
St Segment ◽  
Short And Long Term ◽  
Acute Stent Thrombosis ◽  
Primary Percutaneous Intervention ◽  
Long Term Mortality

We retrospectively analyzed short- and long-term outcomes of patients who received bailout tirofiban during primary percutaneous intervention (pPCI). A total of 2681patients who underwent pPCI between 2009 and 2014 were analyzed; 1331 (49.6%) out of 2681 patients received bailout tirofiban. Using propensity score matching, 2100 patients (1050 patient received bail-out tirofiban) with similar preprocedural characteristics were identified. Patients who received bailout tirofiban had a significantly higher incidence of acute stent thrombosis, myocardial infarction, and major cardiac or cerebrovascular events during the in-hospital period. There were numerically fewer deaths in the bailout tirofiban group in the unmatched cohort (1.7% vs 2.5%, P = .118). In the matched cohort, in-hospital mortality was significantly lower (1.1% vs 2.4%, P = .03), and survival at 12 and 60 months were higher (96.9% vs 95.2%, P = .056 for 12 months and 95.1% vs 92.0%, P = .01 for 60 months) in the bailout tirofiban group. After multivariate adjustment, bailout tirofiban was associated with a lower mortality at 12 months (odds ratio [OR]: 0.554, 95% confidence interval [CI], 0.349-0.880, P = .012) and 60 months (OR: 0.595, 95% CI, 0.413-0.859, P = .006). In conclusion, bailout tirofiban strategy during pPCI is associated with a lower short- and long-term mortality, although in-hospital complications were more frequent.

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 Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus

2007 ◽  
Vol 22 (12) ◽  
pp. 883-888 ◽  
Author(s):  
H. L. Koek ◽  
S. S. Soedamah-Muthu ◽  
J. W. P. F. Kardaun ◽  
E. Gevers ◽  
A. de Bruin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Short And Long Term ◽  
Long Term Mortality

scholarly journals Epidemiology of Major Lower Extremity Amputations in Individuals With Diabetes in Austria, 2014-2017: A Retrospective Analysis of Health Insurance Database

2020 ◽  
Author(s):  
Faisal Aziz ◽  
Berthold Reichardt ◽  
Caren Sourij ◽  
Hans-Peter Dimai ◽  
Daniela Reichart ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Health Insurance ◽  
Lower Extremity ◽  
Renal Disease ◽  
Mortality Rates ◽  
Short And Long Term ◽  
Male Sex ◽  
Long Term Mortality

Abstract Background: Previous data show a high incidence of major lower extremity amputations (LEA) in Austria. Moreover, recent data on the epidemiology of major LEA are sparse in the Country. This study estimated the incidence and mortality rates of major LEA and assessed risk factors of post major LEA mortality in individuals with diabetes.Methods: A retrospective cohort analysis of 507,180 individuals with diabetes enrolled in the Austrian Health Insurance between 2014 and 2017 was performed. Crude and age-standardized rates of major LEA (hip, femur, knee, lower leg) were estimated by extracting their procedure codes from the database. Short- (30-day, 90-day) and long-term (1-year, 5-year) all-cause cumulative mortality after major LEA was estimated from the date of amputation till the date of death. Poisson regression was performed to compare rates by characteristics and assess the annual trend. The Cox-regression was performed to identify significant risk factors of all-cause mortality after major LEA.Results: A total of 2,165 individuals with diabetes underwent major LEA between 2014 and 2017. The mean age was amputees was 73.0 ±11.3 years, 62.7% were males, and 87.3% had a peripheral vascular disease (PVD). The overall age-standardized rate was 6.44 per 100,000 population. The rate increased with age (p<0.001) and was higher (p<0.001) in males (9.38) than females (5.66). The rate was 5.71 in 2014, 6.86 in 2015, 6.71 in 2016, and 6.66 in 2017, with an insignificant annual change of 3% (p=0.825). The cumulative 30-day mortality was 13.5%, 90-day was 22.0%, 1-year was 34.4%, and 5-year was 66.7%. Age, male sex, above-knee amputation, Charlson index, and heart failure were significantly associated with both short- and long-term mortality. Cancer, dementia, heart failure, PVD, and renal disease were only associated with long-term mortality.Conclusions: The rate of major LEA remained stable between 2014 and 2017 in Austria. Short and long-term mortality rates were considerably high after major LEA. Old age, male sex, above-knee amputations, heart failure, and Charlson Index were significant predictors of both short- and long-term mortality, whereas, comorbidities such as cancer, dementia, PVD, and renal disease were significant predictors of long-term mortality only.

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