Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Arroyo-Espliguero ◽  
M.C Viana-Llamas ◽  
A Silva-Obregon ◽  
A Estrella-Alonso ◽  
C Marian-Crespo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Primary Angioplasty ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
One Year ◽  
The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Ramos Nascimento ◽  
Marcos Roberto de Sousa ◽  
Fábio Nogueira Demarqui ◽  
Antonio Luiz Pinho Ribeiro
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Regression ◽  
Randomized Trials ◽  
Primary Angioplasty ◽  
Medline Search ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Risks And Benefits ◽  
St Segment ◽  
The Impact

Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r=-0.466, P=0.005) and MB (r=0.403, P=0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r=-0.380, P<0.001), MB (r=0.212, P=0.014), and AMI (r=-0.231, P=0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.

Abstract 17227: Atrial Fibrillation in the Presence of Post-ST Segment Elevation Myocardial Infarction Left Ventricular Thrombus is Associated With Worse Outcomes

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Aloysius Shen-Ting Leow ◽  
Ching-Hui Sia ◽  
Leonard Leong-Litt Yeo ◽  
Benjamin Yong-Qiang Tan ◽  
Rajinderdeep Kaur ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Thrombus Formation ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
The Impact ◽  
Repeat Imaging

Introduction: Left ventricular (LV) thrombus is a complication of ST-segment elevation myocardial infarction (STEMI) that leads to a higher risk of stroke. Atrial fibrillation (AF) is another independent risk factor for stroke, however there is a dearth of studies examining the outcomes of patients with concomitant AF and LV thrombus. Hypothesis: This study aims to investigate the impact of the presence of concomitant AF in post-STEMI patients with an LV thrombus on stroke and mortality outcomes. Methods: We screened 6007 transthoracic echocardiogram reports containing the “thrombus” keyword from July 2006 to September 2017. Relevant clinical data was collected from 196 post-STEMI patients positive for an LV thrombus, stratified into non-AF and AF groups. Results: AF patients (69.6 ± 11.8 years) were significantly older (p < 0.01) than non-AF patients (55.5 ± 12.2 years) and more were found to have chronic kidney disease (p = 0.02), hypertension (p = 0.04) and dyslipidaemia (p = 0.03), with significantly higher baseline HAS-BLED score (p < 0.01) and CHA2DS2-VASc score (p < 0.01). Fewer AF patients were treated with triple therapy (p = 0.04). Despite this, there was no difference observed in resolution of the LV thrombus on repeat imaging (p = 0.30). However, Kaplan-Meier analysis showed a higher incidence of stroke (p = 0.02) and all-cause mortality (p < 0.01) in AF patients. Conclusion: Post-STEMI patients with LV thrombus formation and AF have significant differences from non-AF patients and are associated with poorer outcomes. These findings should be validated in larger cohorts.

P6264Mitral regurgitation and prognosis after non-ST-segment elevation myocardial infarction in very old patients

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Vera Sainz ◽  
P Diez Villanueva ◽  
A Ariza Sole ◽  
F Formiga ◽  
R Lopez Palop ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mitral Regurgitation ◽  
Prognostic Impact ◽  
Lower Systolic Blood Pressure ◽  
Old Patients ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Impact

Abstract Background Mitral regurgitation (MR) after acute coronary syndromes is associated with adverse prognosis. However, the prognostic impact of MR in older patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI) has not been well addressed. Methods The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Echocardiography performed during admission quantified mitral valve parameters in 497 patients, who were classified according to mitral regurgitation (MR) status in two groups: significant (moderate or severe) or no significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6-months. Results Mean age was 84.3±4.1 years, 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with patients without significant MR these patients had lower systolic blood pressure (132±28 vs 141±27 mmHg), higher heart rate (82±21 vs 74±17 bpm), worse Killip class (≥II 49.5% vs 22.5%), lower ejection fraction (47±14% vs 55±11%), higher pulmonary pressure (42±15 vs 35±11 mmHg), as well as more frequent new onset atrial fibrillation (16.4% vs 7.2%) (all p values=0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs 1.3%, p=0.04) and longer hospital stay (median 8 [5–12] vs 6 [4–10] days, p=0.002),and higher mortality/readmission at 6 months (HR 1,54, 95% CI 1.09–2.18). However, after adjusting for potential confounders, this last association was not significant. Conclusions Significant MR is seen in about one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, which is mainly determined by their clinical characteristics.

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