Five Years of a Comprehensive ST Elevation Myocardial Infarction Protocol and its Association with Sex Disparities

Abstract Aims To determine whether a comprehensive STEMI protocol is associated with reduced sex disparities over 5 years. Methods and Results This was an observational cohort study of 1833 consecutive STEMI patients treated with percutaneous coronary intervention (PCI) before (1/1/2011-7/14/2014, control group) and after (7/15/2014-7/15/2019, protocol group) implementation of a protocol for early guideline-directed medical therapy (GDMT), rapid door to balloon time (D2BT), and use of trans-radial PCI. In the control group females had less GDMT (77.1% vs. 68.1%, p = 0.03), similarly low trans-radial PCI (19.0% vs. 17.6%, p = 0.73), and longer D2BT(104 min [79, 133] vs. 112 min [85, 147], p = 0.02) corresponding to higher in-hospital mortality (4.5% vs. 10.3%, OR 2.44 [1.34-4.46], p = 0.004), major adverse cardiac and cerebrovascular events (MACCE, 9.8% vs. 16.3%, OR 1.79 [1.14-2.84], p = 0.01), and net adverse clinical events (NACE, 16.1% vs. 28.3%, OR 2.06 [1.42-2.99], p < 0.001). In the protocol group, no significant sex differences were observed in GDMT (87.2% vs. 86.4%, p = 0.81) or D2BT (85 min [64, 106] vs. 89 min [65, 111], p = 0.06) but trans-radial PCI was used less in females (77.6% vs. 71.2%, p = 0.03). In-hospital mortality (2.5% vs. 4.4%, OR 1.78 [0.91-3.51], p = 0.09) and MACCE (9.0% vs. 11.0%, OR 1.27 [0.83-1.92], p = 0.26) were similar between sexes, but higher NACE in females approached significance (14.8% vs. 19.4%, OR 1.38 [0.99-1.92], p = 0.05) due to higher bleeding risk (7.2% vs. 11.1%, OR 1.60 [1.04-2.46], p = 0.03). Conclusions A comprehensive STEMI protocol was associated with sustained reductions for in-hospital ischemic outcomes over 5 years, but higher bleeding rates in females persisted.

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Abstract P75: Cerebrovascular Events and Outcomes in Hospitalized Patients With Covid-19: The Society of Vascular and Interventional Neurology Multinational Registry

Stroke ◽

10.1161/str.52.suppl_1.p75 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

James E Siegler ◽

Pere Portela ◽

Juan F Arenillas ◽

Alba Chavarria-Miranda ◽

Ana Guillen ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Significant Risk ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Cerebrovascular Events ◽

Observational Cohort

Background: Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aims: To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods: Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in 4 countries (2/1/2020 - 06/16/2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results: Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970-1320/100,000), 68/171 (40.5%) of whom were female and 96/172 (55.8%) were between the ages 60-79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920-1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130 - 280/100,000) and 3 with CVST (0.02%; 20/100,000, 95%CI 4-60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p<0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63-15.44, p<0.01), older age (aOR 1.78, 95%CI 1.07-2.94, p=0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34-0.98 p=0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions: COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19 associated cerebrovascular complications, therefore aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

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Genotype-Phenotype Association and Impact on Outcomes following Guided De-Escalation of Anti-Platelet Treatment in Acute Coronary Syndrome Patients: The TROPICAL-ACS Genotyping Substudy

Thrombosis and Haemostasis ◽

10.1055/s-0038-1667337 ◽

2018 ◽

Vol 118 (09) ◽

pp. 1656-1667 ◽

Cited By ~ 6

Author(s):

Lisa Gross ◽

Dietmar Trenk ◽

Claudius Jacobshagen ◽

Anne Krieg ◽

Meinrad Gawaz ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Platelet Reactivity ◽

Bleeding Risk ◽

Coronary Intervention ◽

Control Group ◽

Carrier Status ◽

Unique Identifier ◽

Clinical Trial Registration ◽

Coronary Syndrome ◽

Alternative Treatment Strategy

Background Phenotype-guided de-escalation (PGDE) of P2Y12-inhibitor treatment with an early switch from prasugrel to clopidogrel was identified as an effective alternative treatment strategy in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). The Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment for Acute Coronary Syndromes (TROPICAL-ACS) Genotyping Substudy aimed to investigate whether CYP2C19 genotypes correlate with on-treatment platelet reactivity (PR) in ACS patients treated with clopidogrel or prasugrel and thus might be useful for guidance of early de-escalation of anti-platelet treatment. Methods and Results A total of 603 ACS consecutive patients were enrolled in four centres (23.1% of the overall TROPICAL-ACS population). Rapid genotyping (Spartan RX) for CYP2C19*2, *3 and *17 alleles was performed. Associations between PR and the primary and secondary endpoints of the TROPICAL-ACS trial and CYP2C19*2 and CYP2C19*17 carrier status were evaluated.For the PGDE group, the on-clopidogrel PR significantly differed across CYP2C19*2 (p < 0.001) and CYP2C19*17 genotypes (p = 0.05). Control group patients were not related (p = 0.90, p = 0.74) to on-prasugrel PR. For high PR versus non-high PR patients within the PGDE group, significant differences were observed for the rate of CYP2C19*2 allele carriers (43% vs. 28%, p = 0.007). Conclusion CYP2C19*2 and CYP2C19*17 carrier status correlates with PR in ACS patients treated with clopidogrel and thus might be useful for pre-selecting patients who will and who may not be suitable for PGDE of anti-platelet treatment. Regarding phenotype-guided treatment, we did not observe added benefit of genotyping to predict ischaemic and bleeding risk in patients who underwent a PGDE approach. Clinical Trial Registration URL: https//www.clinicaltrials.gov. Unique Identifier: NCT: 01959451.

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60. Evaluation of Outcomes Associated with Intermittent Versus Extended Infusion of Piperacillin/tazobactam in Acutely Ill Veterans

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.105 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S50-S51

Author(s):

Marianne Angeli Encarnacion ◽

Ariel Ma ◽

Scott T Johns

Keyword(s):

Mortality Rate ◽

Hospital Mortality ◽

Clinical Outcomes ◽

Final Analysis ◽

Hospital Length Of Stay ◽

Control Group ◽

Protocol Group ◽

Elevated Liver Enzymes ◽

The Impact ◽

Extended Infusion

Abstract Background Antibiotic dosing optimization is a key principle of antimicrobial stewardship. This study evaluated the impact of an extended infusion piperacillin/tazobactam dosing protocol on clinical outcomes in acutely ill veterans treated for infections at VA San Diego. Methods This retrospective cohort study looked at veterans admitted to the medical-surgical unit who were treated with piperacillin/tazobactam for at least 48 hours. The control group included patients who received treatment between 12/14/2017 to 7/22/2018, and the “protocol” or after protocol implementation group included patients who received treatment between 7/23/2018 to 2/28/2019. Excluded from the study were veterans with microbiological cultures showing intermediate sensitivity or resistance to piperacillin/tazobactam, those who experienced interruption in therapy, or those who required dialysis. Primary clinical outcomes included in-hospital mortality rate, 30-day mortality rate, hospital length of stay (LOS), and 30-day readmission rates. Rates of adverse effects such as elevated liver enzymes, thrombocytopenia, acute kidney impairment (AKI), and Clostridium difficile infection were also collected. χ 2, Fisher’s exact, and Mann-Whitney U tests were used for statistical analysis. Results 260 veterans were included in the final analysis: 96% male, mean age 65 years, mean BMI 29, 84 met SIRS criteria for sepsis, and 55% received at least 48 hours of concomitant vancomycin. Groups had similar outcomes for median LOS, in-hospital mortality, and 30-day mortality. The incidence of AKI was significantly lower in the protocol group (39.2% vs. 56.9%, p=0.004), in veterans on concomitant vancomycin (42.3% vs. 63.2%, p=0.011), and in veterans with obesity (36.4% vs. 70.8%, p=0.001). Rates of liver enzyme elevation, thrombocytopenia, and C. difficile infection were lower in the protocol group though these were not significant. Conclusion There was a significantly lower rate of AKI with EI dosing which supports enhanced patient safety. This may be the preferred method of administration for obese patients and/or those receiving vancomycin concurrently. This is the first study to demonstrate that EI piperacillin/tazobactam dosing significantly reduces rates of AKI in patients on concomitant vancomycin. Disclosures All Authors: No reported disclosures

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Abstract 360: Association Between Door-To-Balloon Time on Mortality in Patients With ST-Elevation Myocardial Infarction and Cardiac Arrest

Circulation ◽

10.1161/circ.138.suppl_2.360 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Anirudh Kumar ◽

Chetan P Huded ◽

Michael J Johnson ◽

Venu Menon ◽

Stephen G Ellis ◽

...

Keyword(s):

Myocardial Infarction ◽

Cardiac Arrest ◽

Hospital Mortality ◽

Systems Of Care ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Caucasian Race ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Background: Door-to-balloon-time (D2BT) is a national hospital metric for quality of care among patients with ST-elevation myocardial infarction (STEMI) but STEMI patients with cardiac arrest (CA) are excluded from D2BT public reporting metrics. The association of D2BT with mortality in STEMI patients with cardiac arrest (CA) in the contemporary era of rapid primary PCI is unknown. We assessed the association of D2BT and outcomes in patients with STEMI+CA. Methods: We reviewed consecutive cases of STEMI and CA, defined as loss of pulse requiring cardiopulmonary resuscitation and/or defibrillation, treated with percutaneous coronary intervention (PCI) at our center from 1/1/11-12/31/16.We assessed characteristics and outcomes among these patients by quartile of D2BT (Q1: 21-82 minutes, Q2: 83-106 minutes, Q3: 109-139 minutes, Q4: 141-489 minutes). Results: We identified 145 patients with STEMI+CA. Increasing quartiles of D2BT were associated with higher proportion of female sex (p=0.040), Caucasian race (p=0.001), and dyslipidemia (p=0.008). The use of guideline-directed medical therapy prior to PCI (aspirin, P2Y12 inhibitor, and anticoagulant) and the occurrence of in-hospital post-PCI adverse events were similar between groups. We observed a trend toward increased in-hospital mortality associated with increasing D2BT (Q1: 8.3%, Q2: 10.8%, Q3: 19.4%, Q4: 22.2%, p=0.059, Figure). Conclusion: D2BT is associated with in-hospital mortality among patients with STEMI+CA. Efforts should be made to implement systems of care to reduce disparities in D2BT among appropriate patients within this population.

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The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

Journal of Clinical Medicine ◽

10.3390/jcm10020278 ◽

2021 ◽

Vol 10 (2) ◽

pp. 278

Author(s):

Sherif Ayad ◽

Rafik Shenouda ◽

Michael Henein

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Hospital Stay ◽

Coronary Intervention ◽

Control Group ◽

St Segment Elevation ◽

Clinical Procedures ◽

St Segment ◽

Percutaneous Coronary ◽

The Impact

Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on in-hospital clinical outcome of ST elevation myocardial infarction (STEMI) patients managed with PPCI. This observational retrospective study was conducted on consecutive STEMI patients who presented to the International Cardiac Center (ICC) hospital, Alexandria, Egypt between 1 February and 31 October 2020. A group of STEMI patients presented during the same period in 2019 was also assessed (control group) and data was used for comparison. The inclusion criteria were established diagnosis of STEMI requiring PPCI.A total of 634 patients were included in the study. During the COVID-19 period, the number of PPCI procedures was reduced by 25.7% compared with previous year (mean 30.0 ± 4.01 vs. 40.4 ± 5.3 case/month) and the time from first medical contact to Needle (FMC-to-N) was longer (125.0 ± 53.6 vs. 52.6 ± 22.8 min, p = 0.001). Also, during COVID-19, the in-hospital mortality was higher (7.4 vs. 4.6%, p = 0.036) as was the incidence of re-infarction (12.2 vs. 7.7%, p = 0.041) and the need for revascularization (15.9 vs. 10.7%, p = 0.046). The incidence of heart failure, stroke, and bleeding was not different between groups, but hospital stay was longer during COVID-19 (6.85 ± 4.22 vs. 3.5 ± 2.3 day, p = 0.0025). Conclusion: At the ICC, COVID-19 pandemic contributed significantly to the PPCI management of STEMI patients with decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

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Cerebrovascular events and outcomes in hospitalized patients with COVID-19: The SVIN COVID-19 Multinational Registry

International Journal of Stroke ◽

10.1177/1747493020959216 ◽

2020 ◽

pp. 174749302095921 ◽

Cited By ~ 6

Author(s):

James E Siegler ◽

Pere Cardona ◽

Juan F Arenillas ◽

Blanca Talavera ◽

Ana N Guillen ◽

...

Keyword(s):

Ischemic Stroke ◽

Mortality Rate ◽

Hospital Mortality ◽

Acute Ischemic Stroke ◽

Cryptogenic Stroke ◽

Significant Risk ◽

Stroke Severity ◽

Cerebrovascular Event ◽

Cerebrovascular Events ◽

Observational Cohort

Background Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been associated with a significant risk of thrombotic events in critically ill patients. Aim To summarize the findings of a multinational observational cohort of patients with SARS-CoV-2 and cerebrovascular disease. Methods Retrospective observational cohort of consecutive adults evaluated in the emergency department and/or admitted with coronavirus disease 2019 (COVID-19) across 31 hospitals in four countries (1 February 2020–16 June 2020). The primary outcome was the incidence rate of cerebrovascular events, inclusive of acute ischemic stroke, intracranial hemorrhages (ICH), and cortical vein and/or sinus thrombosis (CVST). Results Of the 14,483 patients with laboratory-confirmed SARS-CoV-2, 172 were diagnosed with an acute cerebrovascular event (1.13% of cohort; 1130/100,000 patients, 95%CI 970–1320/100,000), 68/171 (40.5%) were female and 96/172 (55.8%) were between the ages 60 and 79 years. Of these, 156 had acute ischemic stroke (1.08%; 1080/100,000 95%CI 920–1260/100,000), 28 ICH (0.19%; 190/100,000 95%CI 130–280/100,000), and 3 with CVST (0.02%; 20/100,000, 95%CI 4–60/100,000). The in-hospital mortality rate for SARS-CoV-2-associated stroke was 38.1% and for ICH 58.3%. After adjusting for clustering by site and age, baseline stroke severity, and all predictors of in-hospital mortality found in univariate regression (p < 0.1: male sex, tobacco use, arrival by emergency medical services, lower platelet and lymphocyte counts, and intracranial occlusion), cryptogenic stroke mechanism (aOR 5.01, 95%CI 1.63–15.44, p < 0.01), older age (aOR 1.78, 95%CI 1.07–2.94, p = 0.03), and lower lymphocyte count on admission (aOR 0.58, 95%CI 0.34–0.98, p = 0.04) were the only independent predictors of mortality among patients with stroke and COVID-19. Conclusions COVID-19 is associated with a small but significant risk of clinically relevant cerebrovascular events, particularly ischemic stroke. The mortality rate is high for COVID-19-associated cerebrovascular complications; therefore, aggressive monitoring and early intervention should be pursued to mitigate poor outcomes.

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The effects of prearrival direct notification call to interventional cardiologist on door-to-balloon time in patients who required secondary diversion with ST-elevation myocardial infarction for primary percutaneous coronary intervention

Hong Kong Journal of Emergency Medicine ◽

10.1177/1024907918794782 ◽

2018 ◽

Vol 26 (3) ◽

pp. 165-173

Author(s):

Jeong Cheon Choe ◽

Kwang Soo Cha ◽

Jin Hee Choi ◽

Jinhee Ahn ◽

Jin Hee Kim ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Hospital Mortality ◽

Primary Percutaneous Coronary Intervention ◽

Coronary Intervention ◽

St Elevation Myocardial Infarction ◽

Catheterization Laboratory ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Background: Rapid door-to-balloon times in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention are associated with favorable outcomes. Objectives: We evaluated the effects of prearrival direct notification calls to interventional cardiologists on door-to-balloon time for ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Methods: A 24-h hotline was created to allow prearrival direct notification calls to interventional cardiologists when transferring ST-elevation myocardial infarction patients. In an urban, tertiary referral center, patients who visited via inter-facility or the emergency department directly were included. Clinical parameters, time to reperfusion therapy, and in-hospital mortality were compared between patients with and without prearrival notifications. Results: Of 228 ST-elevation myocardial infarction patients, 95 (41.7%) were transferred with prearrival notifications. In these patients, door-to-balloon time was shorter (50.0 vs 60.0 min, p = 0.010) and the proportion of patients with door-to-balloon time < 90 min was higher (89.5% vs 75.9%, p = 0.034) than patients without notifications. These improvements were more pronounced during “off-duty” hours (52.0 vs 78.0 min, p = 0.001; 88.3% vs 72.3%, p = 0.047, respectively) than during “on-duty” hours (37.5 vs 43.5 min, p = 0.164; 94.4% vs 79.4%, p = 0.274, respectively). In addition, door-to-activation time (–39 vs 11 min, p < 0.001) and door-to-catheterization laboratory arrival time (33 vs 42 min, p = 0.007) were shorter in patients with prearrival notifications than those without. However, in-hospital mortality was similar between the two groups (6.3% vs 6.8%, p = 0.892). Conclusion: Prearrival direct notification calls to interventional cardiologists significantly improved the door-to-balloon time and the proportion of patients with door-to-balloon time < 90 min through rapid patient transport in primary percutaneous coronary intervention scheduled hospital and readiness of the catheterization laboratory.

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Exploring the Delay in the Informed Consent Procedures of Patients with ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Is It Worth the Wait?

10.21203/rs.3.rs-813890/v1 ◽

2021 ◽

Author(s):

Mailikezhati Maimaitiming ◽

Junxiong Ma ◽

Xuejie Dong ◽

Shuduo Zhou ◽

Na Li ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Chest Pain ◽

Informed Consent ◽

Hospital Mortality ◽

Delay Time ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

St Elevation ◽

Door To Balloon

Abstract Background Failure to achieve timely informed consent is the most important predictors of prolonged in-hospital delay in China. It is critically serious among patients with ST-elevation myocardial infarction (STEMI), which is the deadliest and most time-sensitive acute cardiac event. Informed consent procedure always begins on ambulance before door still does not complete yet after the catheterization laboratory is ready for percutaneous coronary intervention (PCI), which results in delayed treatment and poor clinical outcomes. This study aimed to investigate the factors associated with informed consent delay in patients with STEMI undergoing PCI, and its influence on in-hospital mortality. Methods We conducted a national-representative retrospective cohort study, drawing patient data reported by hospital-based chest pain centers, of admission between January 2016 and June 2019. Using generalized linear mixed models and negative binomial regression, we estimated factors independently predicting informed consent delay time. The associations of informed consent delay time, door-to-balloon (D2B) time and in-hospital mortality were analyzed by logistic regression, adjusted for patient characteristics. Results A total of 263,219 patients were enrolled in the analysis. Informed consent delay occurred in 44.7% (117,672) patients, of whom the median delayed time was 18.6 minutes (SD = 22.2). Patients with sustainable chest pain (RR: 1.032, p = 0.010), intermittent chest pain (RR: 1.083, p < 0.001), and dyspnea (RR: 1.096, p = 0.001) were more likely to delay informed consent. Among transfer modes, walk-in (RR: 1.165, p < 0.001), transfer-in (RR: 1.122, p < 0.001), in-hospital onset (RR: 1.248, p < 0.001) significantly correlated with extended informed consent delay time. The age of 35–64 years (RR: 0.941, p = 0.010) had a negative association with informed consent delay time. Informed consent delay was significantly associated with prolonged D2B time (OR: 1.148, p < 0.001), whereas there was no significant association between informed consent delay and in-hospital mortality. Conclusion Informed consent delay provokes prolongation of door-to-balloon time, which contributes to in-hospital delay that endangers STEMI patients. For better management of STEMI patients in emergent situations, it is essential to reduce the time of informed consent obtaining through effective patient-physician communication, and care coordination within and between hospitals. Trial registration: Retrospectively registered.

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Analysis of the Value of Elojumab in Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v4i4.1333 ◽

2020 ◽

Vol 4 (4) ◽

Author(s):

Baojun Fu ◽

Daqing Song ◽

Shuyin Sun

Keyword(s):

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Adverse Reactions ◽

Coronary Intervention ◽

Control Group ◽

Study Group ◽

Coronary Syndrome ◽

Cerebrovascular Events ◽

Percutaneous Coronary ◽

Significant Difference

Objective: To analyze the application value of Elouzumab in patients with acute coronary syndrome (ACS) after percutaneous coronary intervention (PCI), so as to lay a foundation for the follow-up treatment. Methods: 84 ACS patients who underwent PCI in our hospital from December 1, 2018 to December 1, 2019 were selected and divided into control group (n = 42) and study group (n = 42) according to the random number table. The control group was treated with statins, and the study group was treated with alloxan combined therapy. The changes of blood lipid index, quality of life score, adverse cardiovascular and cerebrovascular events and adverse reactions were compared before and after treatment. Results: There was no significant difference in TCHO, TG, HDL-C and LDL-C between the two groups before treatment (P>0.05);After treatment, the levels of TCHO, TG, HDL-C and LDL-C in the study group were significantly lower than those in the control group (P<0.05);There was no significant difference in the scores of WHOQOL-BREF before treatment (P>0.05);After treatment, the WHOQOL-BREF scores of the two groups were improved, and the study group was significantly higher than the control group (P<0.05);The incidence of adverse cardiovascular and cerebrovascular events and adverse reactions in the study group was lower than that in the control group, but the difference was not statistically significant (P>0.05). Conclusion: After percutaneous coronary intervention in patients with acute coronary syndrome, the use of Elojumab can effectively reduce the blood lipid index, improve the quality of patients and reduce the incidence of adverse cardiovascular and cerebrovascular events and adverse reactions, which can be effectively promoted in clinical practice.

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Relationship of Neighborhood Deprivation and Outcomes of a Comprehensive ST Elevation Myocardial Infarction Protocol

Journal of the American Heart Association ◽

10.1161/jaha.121.024540 ◽

2021 ◽

Author(s):

Chetan P. Huded ◽

Jarrod E. Dalton ◽

Anirudh Kumar ◽

Nikolas I. Krieger ◽

Nicholas Kassis ◽

...

Keyword(s):

Coronary Intervention ◽

Area Deprivation ◽

Neighborhood Deprivation ◽

High Deprivation ◽

Percutaneous Coronary ◽

Hospital Patients ◽

Observational Cohort ◽

St Elevation ◽

Door To Balloon ◽

Relationship Of

ABSTRACT Background We evaluated whether a comprehensive STEMI protocol (CSP) focusing on guideline‐directed medical therapy, trans‐radial percutaneous coronary intervention (PCI), and rapid door to balloon time (D2BT) improves process and outcome metrics in patients with moderate or high socioeconomic deprivation. Methods and Results A total of 1761 patients with STEMI treated with PCI at a single hospital before (1/1/2011‐7/14/2014) and after (7/15/2014‐7/15/2019) CSP implementation were included in an observational cohort study. Neighborhood deprivation was assessed by the Area Deprivation Index and was categorized as low (≤ 50 th percentile; 29.0%), moderate (51‐90 th percentile; 40.8%), and high (>90 th percentile; 30.2%). The primary process outcome was D2BT. Achievement of guideline‐recommend D2BT goals improved in all deprivation groups pre‐ vs. post‐CSP (low: 67.8% vs. 88.5%; moderate: 50.7% vs. 77.6%; high: 65.5% vs. 85.6%; all p<0.001). Median D2BT among ED/in‐hospital patients was significantly non‐inferior in higher vs. lower deprivation groups post‐CSP (non‐inferiority limit = 5 minutes, p non‐inferiority high vs. moderate 0.002, high vs. low <0.001, moderate vs. low 0.02). In‐hospital mortality, the primary clinical outcome, was significantly lower post‐CSP in patients with moderate / high deprivation in unadjusted (pre‐CSP 7.0% vs. post‐CSP 3.1%, OR 0.42 [95% CI 0.25, 0.72], p=0.002) and risk‐adjusted (OR 0.42 [0.23, 0.77], p=0.005) models. Conclusions A CSP was associated with improved STEMI care across all deprivation groups and reduced mortality in those with moderate or high deprivation. Standardized initiatives to reduce care variability may mitigate social determinants of health in time‐sensitive conditions such as STEMI.

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