scholarly journals Gender disparities in management and treatment in acute myocardial infarction – a German nationwide real-life analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Kuehnemund ◽  
J Koeppe ◽  
J Feld ◽  
A Wiederhold ◽  
J Illner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Bypass Surgery ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Funding Source ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background/Introduction Acute myocardial infarction (AMI) continues to be one of the most frequent diseases worldwide, remaining among the most common causes of mortality in both women and men of industrialised nations. Female sex has been reported to be associated with an unfavourable outcome in AMI. Differences related to patients' sex have been reported for incidence, symptom presentation, pathophysiological characteristics as well as treatment strategies and outcome. Purpose Objective of this routine-data based analysis was to explore sex differences of recent nationwide trends in in-patient healthcare and acute outcome of AMI. Methods The data base provided by the Federal Statistical Offices comprises all in-patient treated patients on a case base per year. We identified all cases with a main diagnosis of ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) between 01.01.2014 and 31.12.2017. Further, data on concomitant diseases, risk constellations and selected cardiovascular procedures were acquired for sex-specific analysis. Results In total, we identified 280,515 STEMI and 595,220 NSTEMI cases over the four-year period. STEMI cases decreased from 72,894 in 2014, to 70,230 in 2015, to 69,178 in 2016, and to 68,213 in 2017 with 70% of STEMI cases assignable to men. Female sex was associated with older age (74 vs. 62 yrs), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.21% vs. 12.5%), diabetes (26.4% vs. 21.7%), left ventricular heart failure (36% vs. 32.1%), or atrial fibrillation (17.6% vs. 13%). However, dyslipidemia (43.9% vs. 49.3%) and smoking (7.4% vs. 12.1%) were more frequent in male STEMI cases than in female STEMI cases. Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI; p<0.0001; s. Figure); coronary bypass surgery was performed in 2.7% of female vs. 4.2% of male cases (p<0.0001). There were 5,125 female and 2,015 male STEMI patients aged 90 years and older. These received less frequent percutaneous coronary intervention (42.5% female vs. 52.8% male; p<0.0001) and coronary bypass surgery (0.1% female vs. 0.4% male; p=0.0063) compared to younger age groups. Observed in-hospital mortality was significantly increased in female patients with STEMI (15% female vs. 9.6% male; p<0.0001) and NSTEMI (8.4% vs. 6.3%; p<0.0001). Conclusion In a nationwide real-world setting, in-patient STEMI cases continue to decrease over the recent past in both, male and female patients. Women with AMI are older and continue to be less likely to receive revascularization therapies than men. In addition, women present with significantly higher observed in-hospital mortality compared to men. It is important to draw attention to the peculiarities of women with AMI and to supply revascularization therapy equally in high risk clientele. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Innovationsfonds des gemeinsame Bundesausschusses

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

scholarly journals A kórelőzményben szereplő revascularisatiós műtét rövid és hosszú távú prognosztikai jelentősége szívinfarktus miatt kezelt betegekben

2021 ◽  
Vol 162 (5) ◽  
pp. 177-184
Author(s):  
András Jánosi ◽  
Tamás Ferenci ◽  
András Komócsi ◽  
Péter Andréka
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation

Összefoglaló. Bevezetés: A szívinfarktust megelőző revascularisatiós beavatkozások prognosztikai jelentőségével kapcsolatban kevés elemzés ismeretes, hazai adatokat eddig nem közöltek. Célkitűzés: A szerzők a Nemzeti Szívinfarktus Regiszter adatait felhasználva elemezték a koszorúér-revascularisatiós szívműtétet (CABG) túlélt betegek prognózisát heveny szívinfarktusban. Módszer: Az adatbázisban 2014. 01. 01. és 2017. 12. 31. között 55 599 beteg klinikai és kezelési adatait rögzítették: 23 437 betegnél (42,2%) ST-elevációval járó infarktus (STEMI), 32 162 betegnél (57,8%) ST-elevációval nem járó infarktus (NSTEMI) miatt került sor a kórházi kezelésre. Vizsgáltuk a CABG után fellépő infarktus miatt kezelt betegek klinikai adatait és prognózisát, amelyeket azon betegek adataival hasonlítottunk össze, akiknél nem szerepelt szívműtét a kórelőzményben (kontrollcsoport). Eredmények: A betegek többsége mindkét infarktustípusban férfi volt (62%, illetve 59%). Az indexinfarktust megelőzően a betegek 5,33%-ánál (n = 2965) történt CABG, amely az NSTEMI-betegeknél volt gyakoribb (n = 2357; 7,3%). A CABG-csoportba tartozó betegek idősebbek voltak, esetükben több társbetegséget (magas vérnyomás, diabetes mellitus, perifériás érbetegség) rögzítettek. Az indexinfarktus esetén a katéteres koszorúér-intervenció a kontrollcsoport STEMI-betegeiben gyakoribb volt a CABG-csoporthoz viszonyítva (84% vs. 71%). Az utánkövetés 12 hónapja során a betegek 4,7–12,2%-ában újabb infarktus, 13,7–17,3%-ában újabb katéteres koszorúér-intervenció történt. Az utánkövetés alatt a CABG-csoportban magasabbnak találtuk a halálozást. A halálozást befolyásoló tényezők hatásának korrigálására Cox-féle regressziós analízist, illetve ’propensity score matching’ módszert alkalmaztunk. Mindkét módszerrel történt elemzés azt mutatta, hogy a kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a túlélést. Amennyiben a beteg kórelőzményében szerepelt a koszorúérműtét, az indexinfarktus nagyobb eséllyel volt NSTEMI, mint STEMI (HR: 1,612; CI 1,464–1,774; p<0,001). Következtetés: A kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a szívinfarktus miatt kezelt betegek életkilátásait. Orv Hetil. 2021; 162(5): 177–184. Summary. Introduction: Little analysis is known about the prognostic significance of revascularization interventions before myocardial infarction; no domestic data have been reported so far. Method: The authors use data from the Hungarian Myocardial Infarction Registry to analyze the prognosis of patients with acute myocardial infarction who had previous coronary artery bypass grafting (CABG). Between 01. 01. 2014. and 31. 12. 2017, 55 599 patients were recorded in the Registry: 23 437 patients (42.2%) had ST-elevation infarction (STEMI) and 31 162 patients (57.8%) had non-ST-elevation infarction (NSTEMI). The clinical data and prognosis of patients treated for infarction after CABG were compared with those of patients without a CABG history. Results: The majority of patients were male (59% and 60%, respectively). Prior to index infarction, CABG occurred in 5.33% of patients (n = 2965), which was more common in NSTEMI (n = 2357; 7.3%). The CABG patients were older and had more comorbidities (hypertension, diabetes mellitus, peripheral vascular disease). For index infarction, percutaneous coronary intervention was more common in STEMI patients in the control group compared to CABG (84% vs. 71%). At 12 months of follow-up, 4.7–12.2% of patients had reinfarction, and 13.7–17.3% had another percutaneous coronary intervention. During the full follow-up, the CABG group had higher mortality. Cox regression analysis and propensity score matching were used to correct for the effect of other factors influencing mortality. Both analyses showed CABG did not affect survival. In the CABG group, the index infarction was more likely to be NSTEMI than STEMI (HR: 1.612; CI 1.464–1.774; p<0.001). Conclusion: The history of CABG does not affect the life expectancy of patients treated for an acute myocardial infarction. Orv Hetil. 2021; 162(5): 177–184.

scholarly journals Transradial Percutaneous Coronary Intervention in Patients with ST-Elevation Acute Myocardial Infarction

2012 ◽  
Vol 20 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Clarissa Campo Dall’Orto ◽  
Rubens Pierry Ferreira Lopes ◽  
Luiz Daniel Silva de Oliveira ◽  
Giovanni Cisari ◽  
Alexandre de Souza Marques ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Elevation Acute Myocardial Infarction

scholarly journals Syphilitic Coronary Artery Ostial Stenosis Resulting in Acute Myocardial Infarction Treated by Percutaneous Coronary Intervention

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Marcelo A. Nakazone ◽  
Maurício N. Machado ◽  
Raphael B. Barbosa ◽  
Márcio A. Santos ◽  
Lilia N. Maia
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Case Reports ◽  
Coronary Intervention ◽  
Wall Thickening ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Ostial Lesion

Cardiovascular abnormalities are well-known manifestations of tertiary syphilis infections which although not frequent, are still causes of morbidity and mortality. A less common manifestation of syphilitic aortitis is coronary artery ostial narrowing related to aortic wall thickening. We report a case of a 46-year-old male admitted due to acute anterior ST elevation myocardial infarction submitted to primary percutaneous coronary intervention successfully. Coronary angiography showed a suboccluded ostial lesion of left main coronary artery. VDRL was titrated to 1/512. The patient was discharged with treatment including benzathine penicillin. Previous case reports of acute myocardial infarction in association with syphilitic coronary artery ostial stenosis have been reported, but the fact that the patient was treated by percutaneous coronary intervention is unique in this case.

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