scholarly journals Women who experience a myocardial infarction at a young age have worse outcomes compared with men: the Mass General Brigham YOUNG-MI registry

2020 ◽  
Vol 41 (42) ◽  
pp. 4127-4137 ◽  
Author(s):  
Ersilia M DeFilippis ◽  
Bradley L Collins ◽  
Avinainder Singh ◽  
David W Biery ◽  
Amber Fatima ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Sex Differences ◽  
Cardiovascular Mortality ◽  
Angiotensin Receptor Blockers ◽  
Coronary Revascularization ◽  
Invasive Coronary Angiography ◽  
Young Age ◽  
Converting Enzyme Inhibitors ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Aims There are sex differences in presentation, treatment, and outcomes of myocardial infarction (MI) but less is known about these differences in a younger patient population. The objective of this study was to investigate sex differences among individuals who experience their first MI at a young age. Methods and results Consecutive patients presenting to two large academic medical centres with a Type 1 MI at ≤50 years of age between 2000 and 2016 were included. Cause of death was adjudicated using electronic health records and death certificates. In total, 2097 individuals (404 female, 19%) had an MI (mean age 44 ± 5.1 years, 73% white). Risk factor profiles were similar between men and women, although women were more likely to have diabetes (23.7% vs. 18.9%, P = 0.028). Women were less likely to undergo invasive coronary angiography (93.5% vs. 96.7%, P = 0.003) and coronary revascularization (82.1% vs. 92.6%, P < 0.001). Women were significantly more likely to have MI with non-obstructive coronary disease on angiography (10.2% vs. 4.2%, P < 0.001). They were less likely to be discharged with aspirin (92.2% vs. 95.0%, P = 0.027), beta-blockers (86.6% vs. 90.3%, P = 0.033), angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers (53.4% vs. 63.7%, P < 0.001), and statins (82.4% vs. 88.4%, P < 0.001). There was no significant difference in in-hospital mortality; however, women who survived to hospital discharge experienced a higher all-cause mortality rate (adjusted HR = 1.63, P = 0.01; median follow-up 11.2 years) with no significant difference in cardiovascular mortality (adjusted HR = 1.14, P = 0.61). Conclusions Women who experienced their first MI under the age of 50 were less likely to undergo coronary revascularization or be treated with guideline-directed medical therapies. Women who survived hospitalization experienced similar cardiovascular mortality with significantly higher all-cause mortality than men. A better understanding of the mechanisms underlying these differences is warranted.

scholarly journals Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hui Wen Sim ◽  
Huili Zheng ◽  
A. Mark Richards ◽  
Ruth W. Chen ◽  
Anders Sahlen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Incidence ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Coronary Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70–0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55–0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66–0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68–0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.

scholarly journals 464Optimal timing of invasive coronary angiography following NSTEMI

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Mahendiran ◽  
D Nanchen ◽  
D Meier ◽  
B Gencer ◽  
R Klingenberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
Invasive Coronary Angiography ◽  
Cox Proportional Hazards ◽  
Major Adverse Cardiovascular Events ◽  
Significant Difference ◽  
All Cause Mortality ◽  
One Year ◽  
The Impact ◽  
Grace Score

Abstract Introduction Current guidelines recommend angiography within 24 hours of hospitalisation for patients with non-ST elevation myocardial infarction (NSTEMI). The recent VERDICT study found that angiography within 12 hours of hospitalisation was associated with improved cardiovascular outcomes among high-risk patients. We aimed to obtain a real-world perspective of the impact of angiography timing on one-year outcomes of patients admitted with NSTEMI. Methods Data was obtained from the SPUM-ACS registry, a cohort of consecutive patients hospitalised with acute coronary syndromes in four university hospitals in Switzerland between 2009 and 2017. Patients without a door-to-catheter (DTC) time and those with life-threatening features were excluded. Cox proportional hazards models evaluated the impact of DTC time on the primary endpoint, defined as one-year major adverse cardiovascular events (MACE: cardiovascular mortality, myocardial infarction, stroke), and on one-year all-cause mortality. Results Of 2,672 NSTEMI patients, 1,832 met the inclusion criteria. Among them, 1,464 patients underwent angiography within 12 hours of admission (12h group) while 368 patients underwent angiography between 12 and 24 hours (12–24h group). After 2:1 propensity score matching, 736 patients from the 12h group and 368 patients from the 12–24h group were deemed equivalent in terms of main baseline clinical characteristics. Multiple logistic regression identified admission out-of-hours (night or weekend) as the most significant factor associated with delayed angiography. Cox models found no significant association between early angiography and one-year MACE (12h group: n=57 (7.7%) vs. 12–24h group: n=27 (7.3%), HR: 1.050, 95% CI 0.637- 1.733, p=0.847), or one-year all-cause mortality (12h group: n=25 (3.4%) vs. 12–24h group: n=17 (4.6%), HR: 1.514, 95% CI 0.774- 2.962, p=0.225) (Figure 1A). After stratification based on GRACE score (>140 vs. ≤140), there was no significant difference in one-year MACE or one-year all-cause mortality in the 12h group compared with the 12–24h group (p for interaction=0.601 and 0.463, respectively) (Figure 1A + 1B). Figure 1 Conclusion In an unselected real-world cohort of NSTEMI patients, angiography within 12 hours of hospitalisation was not associated with improved one-year outcomes when compared with angiography between 12 and 24 hours, even among patients with an elevated GRACE score.

scholarly journals Efficacy and safety of colchicine after myocardial infarction: a systematic review and meta- analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Diaz-Arocutipa ◽  
J Benites-Meza ◽  
D Chambergo-Michilot ◽  
J Barboza ◽  
V Pasupuleti ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Adverse Events ◽  
Cardiovascular Mortality ◽  
Coronary Revascularization ◽  
Control Group ◽  
Efficacy And Safety ◽  
All Cause Mortality ◽  
Acute Mi ◽  
Hs Crp

Abstract Background Inflammation plays a key role in atherosclerotic plaque destabilization and adverse cardiac remodeling. Recent evidence has shown a promising role of colchicine in patients with coronary artery disease. Purpose We evaluated the efficacy and safety of colchicine in post-acute myocardial infarction (MI) patients. Methods We searched five electronic databases from inception to January 18, 2021, for randomized controlled trials (RCTs) evaluating colchicine in post-acute MI patients. Primary outcomes were cardiovascular mortality and recurrent MI. Secondary outcomes were all-cause mortality, stroke, urgent coronary revascularization, levels of follow-up high-sensitivity C-reactive protein (hs-CRP), and drug-related adverse events. All meta-analyses used inverse-variance random-effects models. Results Six RCTs (n=6005) patients were included. Colchicine did not significantly reduce cardiovascular mortality (risk ratio [RR], 0.91; 95% confidence interval [95% CI], 0.52–1.61; p=0.64), recurrent MI (RR, 0.87; 95% CI, 0.62–1.22; p=0.28), all-cause mortality (RR, 1.06; 95% CI, 0.61–1.85; p=0.78), stroke (RR, 0.28; 95% CI, 0.07–1.09; p=0.05), urgent coronary revascularization (RR, 0.46; 95% CI, 0.02–8.89; p=0.19), or decreased levels of follow-up hs-CRP (MD, −1.95 mg/L; 95% CI, −12.88 to 8.98; p=0.61) compared to the control group. There was no increase of any adverse event (RR, 0.97; 95% CI, 0.89–1.07; p=0.34) or gastrointestinal adverse events (RR, 2.49; 95% CI, 0.48–12.99; p=0.20). Subgroup analyses by colchicine dose (0.5 versus 1 mg/day), time of follow-up (&lt;1 versus ≥1 year), and treatment duration (≤30 versus &gt;30 days) showed no changes in the overall findings. Conclusion In post-acute MI patients, colchicine does not reduce cardiovascular or all-cause mortality, recurrent MI, or other cardiovascular outcomes. Also, colchicine did not increase drug-related adverse events. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Benefit of cardiac rehabilitation for elderly patients

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
H Scherrenberg ◽  
M Scherrenberg ◽  
M Falter ◽  
V Intan-Goey ◽  
T Kaihara ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Cardiovascular Mortality ◽  
Coronary Revascularization ◽  
Age Groups ◽  
Risk Profile ◽  
Baseline Risk ◽  
Years Of Life Lost ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Benefit of cardiac rehabilitation for elderly patients Background Comprehensive cardiac rehabilitation (CR) is a class IA recommendation by European guidelines for all patients with ischemic heart disease (IHD). The risk profile of older IHD patients is often different from younger patients and there is less evidence available about the effects of CR. Therefore, it is still unclear if a one-size-fits-all centre-based CR focusing on the core components such as education, diet, risk reduction and optimal medication is as effective for elderly patients as for younger adults. Methods Patients with a revascularization for IHD who participated in at least 8  phase II center-based CR sessions between 2011–2014 were identified. A total of 294 patients were included in this study. The patients were divided in two groups: 0-64 years old and ≥ 65 years. The primary outcome was the incidence of major adverse cardiovascular events (MACE) during the 5-year follow-up. MACE is the composite of all-cause mortality, stroke and coronary artery revascularization. Results The medical records of 294 patients were retrospectively reviewed. Statistically significant baseline risk profile differences between the two groups were observed for the prevalence of current smokers (P &lt;0.001) and diabetes mellitus (P= 0.002). Furthermore, significant differences in blood pressure and lipid levels were present. No statistically significant differences between the two age groups were observed for 5-year coronary revascularizations (P = 0.794) and 5-year MACE (P = 0.221). Only significant differences between the age groups could be found in cardiovascular mortality (P = 0.023) and in all-cause mortality (P &lt; 0.001). However, the total years of life lost were lower in the group with patients older than 64 year (14 vs 32 years). Conclusion There is clear difference in cardiovascular risk profile between younger and older IHD patients that participate in CR. There was no significant difference in 5-year MACE between the two groups. These results underline the importance to not forget recommending CR to elderly patients. Outcomes All (n = 294) &lt;65 y (n = 153) +65 y (n = 141) P-value 1-year coronary revascularization 11 (3.7%) 5 (3.3%) 6 (4.3%) 0.656 2-year coronary revascularization 23 (7.8%) 12 (7.8%) 11 (7.8%) 0.989 5-year coronary revascularization 36 (12.2%) 18 (11.8%) 18 (12.8%) 0.794 Cardiovascular mortality 8 (2.7%) 1 (6.5%) 7 (5%) 0.023 All-cause mortality 14 (4.8%) 2 (1.4%) 12 (8.5%) &lt;0.001 5-year MACE 49 (16.7%) 20 (13.1%) 29 (20.1%) 0.221

Abstract P258: The Use Of Ace Inhibitors And Angiotensin Receptor Blockers Is Associated With Decreased Mortality And Increased Hospitalization Rate In Covid-19 Patients

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Aaron Douen ◽  
Jeremy Oh ◽  
Wesley Romney ◽  
Ryan Panetti ◽  
Prakash Ramdass ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Angiotensin Receptor Blockers ◽  
Hospitalization Rate ◽  
Host Cells ◽  
Channel Blockers ◽  
Multivariate Logistic Regression ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Secondary Outcomes

Introduction: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well known for upregulating ACE2 receptors. SARS-Cov-2 (COVID-19) infection utilizes the ACE2 receptor for proliferation and infection of host cells. Hypothesis: We hypothesize that the use of ACEI/ARBs will lead to a higher mortality and hospitalization rate among COVID-19 infected patients. Methods: The electronic health database at a public hospital in New York City was queried retrospectively for patients 18 years and older with a positive test for COVID-19 between 3/1/2020 - 4/1/2021. We examined baseline characteristics including comorbidities and whether they were prescribed ACEI/ARBs versus other medications including beta-blockers, calcium channel blockers, thiazides, or hydralazine. We categorized patients based on ACEI/ARB. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We adjusted for comorbidities using multivariate logistic regression. Results: We identified 23,068 patients positive for SARS-CoV-2; 1,385 on ACEI/ARBs and 21,683 not on ACE/ARBs. The mean age in years was 65.90 +- 14.35 (SEM 0.386) and 44.01+-16.76, (SEM 0.114) for ACEI/ARB and non-ACEI/ARB respectively (p<0.001). The incidence of all cause mortality and hospitalization rate were significantly greater in the ACEI/ARB group. However, when adjusted for comorbidities using multivariate logistic regression, OR for mortality was 0.41 (CI 0.32-0.52, p<0.001) and for hospitalization was 4.12 (CI 3.49-4.86 p<0.001). For the secondary outcomes, non-ACEI/ARB patients had significantly increased unadjusted odds of all outcomes (p<0.001), except for ventricular tachycardia (p<0.618) and intubation (p< 0.214). Conclusion: Patients in the ACEI/ARB group demonstrated significantly lower mortality and increased hospitalization rates. Increased hospitalization may be due to more comorbidities. These results highlight the importance of continuing the use of ACEI and ARBs in COVID-19 patients for treatment of comorbidities and cardioprotective effects.

Abstract 429: First-Line Vasopressor Agent for Cardiogenic Shock Due to Acute Myocardial Infarction: Results From Tokyo CCU Network Registry

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Tadashi Ashida ◽  
Tsukasa Yagi ◽  
Ken Nagao ◽  
Norihiro Kuroki ◽  
Tadateru Takayama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Function ◽  
Mortality Rate ◽  
Cardiogenic Shock ◽  
First Line ◽  
Poor Renal Function ◽  
Vasopressor Agent ◽  
Significant Difference ◽  
All Cause Mortality

Background: In the guidelines for cardiogenic shock, norepinephrine, as compared with dopamine, was associated with fewer cases of arrhythmia and may be a better first-line vasopressor agent. However, few clinical studies have investigated the effects of optimal first-line vasopressor agents for patients with poor renal function. Methods: From a multicenter, prospective, cohort registry of emergency cardiovascular patients in Tokyo between 2013 and 2016, we identified adult patients with cardiogenic shock due to acute myocardial infarction (AMI) who received either norepinephrine, dopamine or both as a vasopressor agent without mechanical circulatory supports. Study patients were divided into 4 groups according to estimated glomerular filtration rate (eGFR). The primary endpoint was all-cause mortality at 30 days after admission. Results: Of the 4,034 patients with cardiogenic shock due to AMI, 665 were eligible for this study; 419 received norepinephrine (N group), 154 dopamine (D group), and 92 both agents (B group). There was a significant difference in the all-cause mortality rate between the three groups in the whole cohort (16.0% in the N group, 9.7% in the D group and 40.2% in the B group, P<0.001). In addition, there was a significant difference in the all-cause mortality rate between the three groups in the subgroups of patients with eGFR stage 3a and 3b. (Figure). After adjustment of independent factors for mortality, the odds ratio of the D group (reference, the N group) was 0.51 (95%CI 0.26-0.99, p=0.049). Conclusion: Compared with norepinephrine, dopamine was associated with a lower all-cause mortality rate for patients with cardiogenic shock due to AMI, especially patients with poor renal function.

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