scholarly journals STEMI around-the-clock: how off-hours admissions impact door-to-balloon time and the long-term prognosis of ST-segment Elevation Myocardial Infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M Martinho ◽  
A Briosa ◽  
R Cale ◽  
E Pereira ◽  
A R Pereira ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cox Regression ◽  
Clinical Severity ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Door To Balloon ◽  
Long Term Mortality

Abstract Introduction The outcomes of reperfusion in ST-segment Elevation Myocardial Infarction (STEMI) are time-dependent, and percutaneous coronary intervention (PCI) should be performed within 60 minutes from hospital admission in PCI centers – door-to-balloon time (D2B). The association between Off-Hours Admission (OHA) and long-term outcomes is controversial when considering contemporary organized STEMI networks. Purpose This study aims to analyze how OHA influences D2B and long-term mortality. Methods Retrospective study of consecutive STEMI patients (pts), admitted in a PCI-centre with a local Emergency Department, between 2010 and 2015. Pts submitted to rescue-PCI were excluded. OHA was defined as admission at night (8p.m. to 8a.m), weekends and nonworking holidays. Predictors of OHA and D2B were studied by logistic regression analysis. Demographic, clinical, angiographic and procedural variables were evaluated using stepwise Cox regression analysis to determine independent predictors of 5-year all-cause mortality (5yM). The cumulative incidence of 5yM stratified by hours of admission was calculated according to the Kaplan-Meier method. Results Of 901 pts, 472pts (52.4%) were admitted during off-hours. These pts were younger (61±13 vs 64±12, p=0.002) and had a lower median patient-delay time (128min vs 157min, p=0.014). Clinical severity at presentation, defined by systolic arterial pressure and Killip-Kimball (KK) class, did not differ between groups. OHA did not impact D2B (89 min vs 88 min, p=0.550), which was in turn influenced by age ≥75y (OR 1.85, 95% CI 1.31–2.61, p<0.001). Mean clinical follow-up (FUP) was 68±37 months, with 75.1% of pts achieving a FUP >5 years. 5yM rate was 9.7%. After multivariate cox regression analysis, independent determinants of long-term mortality were age (HR 1.05, 95% CI 1.02–1.08, p<0.001), previous history of heart failure (HR 6.76, 95% CI 1.32–34.72, p=0.022) and pulmonary disease (HR 3.79, 95% CI 1.16–12.33, p=0.027), presentation with KK ≥2 (HR 2.82, 95% CI 1.32–6.01, p=0.007) and radial artery access in catheterization (HR 0.39, 95% CI 0.18–0.83, p=0.014) – figure 1. Although there was an association between a higher D2B time and 5yM (87min vs 101min, p=0.024), neither OHA nor D2B were independent predictors of long-term mortality – figure 2. Conclusion OHA did not seem to influence D2B and long-term STEMI outcomes in our PCI-centre. 5yM was mostly influenced by patient characteristics and clinical severity at presentation. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Predictors of long-term mortality Figure 2. 5-year survival stratified by OHA

scholarly journals Incidence and Long‐Term Outcomes of Stroke in Patients Presenting With ST‐Segment Elevation–Myocardial Infarction: Insights From the Midwest STEMI Consortium

2021 ◽  
Author(s):  
Michael Megaly ◽  
Mehmet Yildiz ◽  
Edward Tannenbaum ◽  
Brynn Okeson ◽  
Marshall W. Dworak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Incidence Trends ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Increased Risk

Background Contemporary real‐world data on stroke in patients presenting with ST‐segment–elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long‐term impact of stroke on 5‐year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5‐year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P ‐trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4–72 hours), which led to a small minority (3%) receiving endovascular treatment and high in‐hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10–1.58; P ‐value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03–3.78; P =0.032)) were associated with a higher risk of in‐hospital stroke. In‐hospital stroke was independently associated with increased risk of 5‐year mortality (hazard ratio, 2.01; 95% CI, 1.13–3.57; P =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

Comparing the Prognostic Value of Hematological Indices in Patients With ST Segment Elevation Myocardial Infarction: “A Head to Head” Analysis

Angiology ◽  
2020 ◽  
pp. 000331972097775
Author(s):  
Serhat Sigirci ◽  
Özgür Selim Ser ◽  
Kudret Keskin ◽  
Süleyman Sezai Yildiz ◽  
Ahmet Gurdal ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Hematological Indices ◽  
St Segment Elevation ◽  
Lymphocyte Ratio ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Long Term Mortality

Although there are reviews and meta-analyses focusing on hematological indices for risk prediction of mortality in patients with ST segment elevation myocardial infarction (STEMI), there are not enough data with respect to direct to head-to-head comparison of their predictive values. We aimed to investigate which hematological indices have the most discriminatory capability for prediction of in-hospital and long-term mortality in a large STEMI cohort. We analyzed the data of 1186 patients with STEMI. In-hospital and long-term all-cause mortality was defined as the primary end point of the study. In-hospital mortality rate was 8.6% and long-term mortality rate 9.0%. Although the neutrophil to lymphocyte ratio (NLR) and age were found to be independent predictors of in-hospital mortality in the multivariate regression analyses; Cox regression analysis revealed that age, ejection fraction, red cell distribution width (RDW), and monocyte to high-density lipoprotein ratio (MHDLr) were independently associated with long-term mortality. Neutrophil to lymphocyte ratio had the highest area under curve value in the receiver operating characteristic curve analyses for prediction of in-hospital mortality. In conclusion, while NLR may be used for prediction of in-hospital mortality, RDW and MHDLr ratio are better hematological indices for long-term mortality prediction after STEMI than other most common indices.

Effect of Dynamic Potassium Change on In-Hospital Mortality, Ventricular Arrhythmias, and Long-Term Mortality in STEMI

Angiology ◽  
2018 ◽  
Vol 70 (1) ◽  
pp. 69-77 ◽  
Author(s):  
Adnan Kaya ◽  
Muhammed Keskin ◽  
Mustafa Adem Tatlisu ◽  
Osman Kayapinar
Keyword(s):  
Regression Analysis ◽  
Ventricular Arrhythmia ◽  
Hospital Mortality ◽  
Mortality Risk ◽  
Ventricular Arrhythmias ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
Normal Ranges ◽  
Long Term Mortality

We evaluated the effect of serum potassium (K) deviation on in-hospital and long-term clinical outcomes in patients with ST-segment elevation myocardial infarction who were normokalemic at admission. A total of 2773 patients with an admission serum K level of 3.5 to 4.5 mEq/L were retrospectively analyzed. The patients were categorized into 3 groups according to their K deviation: normokalemia-to-hypokalemia, normokalemia-to-normokalemia, and normokalemia-to-hyperkalemia. In-hospital mortality, long-term mortality, and ventricular arrhythmias rates were compared among the groups. In a hierarchical multivariable regression analysis, the in-hospital mortality risk was higher in normokalemia-to-hypokalemia (odds ratio [OR] 3.03; 95% confidence interval [CI], 1.72-6.82) and normokalemia-to-hyperkalemia groups (OR 2.81; 95% CI, 1.93-4.48) compared with the normokalemia-to-normokalemia group. In a Cox regression analysis, long-term mortality risk was also higher in normokalemia-to-hypokalemia (hazard ratio [HR] 3.78; 95% CI, 2.07-7.17) and normokalemia-to-hyperkalemia groups (HR, 2.97; 95% CI, 2.10-4.19) compared with the normokalemia-to-normokalemia group. Ventricular arrhythmia risk was also higher in normokalemia-to-hypokalemia group (OR 2.98; 95% CI, 1.41-5.75) compared with normokalemia-to-normokalemia group. The current study showed an increased in-hospital ventricular arrhythmia and mortality and long-term mortality rates with the deviation of serum K levels from normal ranges.

Prognostic value of glycated hemoglobin among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

2017 ◽  
Vol 55 (8) ◽  
pp. 1090-1099 ◽  
Author(s):  
Guangxiao Li ◽  
Xiaowen Hou ◽  
Ying Li ◽  
Peng Zhang ◽  
Qiongrui Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Risk ◽  
Glycated Hemoglobin ◽  
Meta Analysis ◽  
Sufficient Information ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Long Term Mortality

Abstract Many studies have shown the prognostic significance of glycated hemoglobin (HbA1c) for overall coronary artery disease (CAD). But less is known about the role that HbA1c played in the prognosis of patients diagnosed with ST-segment elevation myocardial infarction (STEMI). Results from previous studies were controversial. Therefore, a meta-analysis was conducted to investigate whether admission HbA1c level was a predictor of short- and long-term mortality rates among patients diagnosed with STEMI. Relevant literatures were retrieved from the electronic databases up to March 2016. Reference lists were hand searched to identify eligible studies. Articles were included if they provided sufficient information for the calculation of pooled relative risk (RR) and its corresponding 95% confidence interval (CI). Finally, we got 19 prospective studies involving a total of 35,994 STEMI patients to evaluate the associations between HbA1c level and their in-hospital, 30-day and long-term mortality. Among STEMI patients, HbA1c level was not significantly associated with in-hospital mortality (RR 1.20, 95% CI 0.95–1.53, p=0.13). However, elevated HbA1c level was positively associated with risk of 30-day and long-term mortality (for 30-day mortality, RR 1.25, 95% CI 1.03–1.52, p=0.02; for long-term mortality, RR 1.45, 95% CI 1.20–1.76, p<0.01). In conclusion, our findings suggested elevated HbA1c level among STEMI patients was an indicator of 1.25-fold 30-day mortality risk and 1.45-fold long-term mortality risk, respectively. STEMI patients with high HbA1c level should have their chronic glucose dysregulation under intensive control.

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