scholarly journals P2303Low serum triglyceride in combination with low total cholesterol levels associate increased risk of long-term all-cause mortality in patients undergoing percutaneous coronary intervention

2017 ◽  
Vol 38 (suppl_1) ◽  
Author(s):  
S.D. Doi ◽  
H.I. Iwata ◽  
R.N. Naito ◽  
H.E. Endo ◽  
H.W. Wada ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Total Cholesterol ◽  
Serum Triglyceride ◽  
Coronary Intervention ◽  
Cholesterol Levels ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
All Cause Mortality

scholarly journals Long term outcomes of patients with chronic inflammatory diseases after percutaneous coronary intervention

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
E Marcusohn ◽  
R Zukermann ◽  
A Roguin ◽  
O Kobo
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cox Regression ◽  
Inflammatory Diseases ◽  
Tertiary Care ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Chronic Inflammatory Diseases ◽  
Increased Risk ◽  
Percutaneous Coronary

Abstract Introduction Patients with chronic inflammatory diseases are at increased risk for coronary artery disease. Aim We aimed to assess the long-term outcomes of patients with chronic inflammatory diseases who underwent percutaneous coronary intervention. Methods A Retrospective cohort study of all adult (>18 years) patients who underwent PCI in a large [1000 bed] tertiary care centerfrom January 2002 to August 2020. Results A total of 12,951 patients underwent PCI during the study period and were included in the cohort. The population of chronic inflammatory diseases includes 247/12,951 [1.9%]; 70 with IBD and 173 with AIRD. The composite endpoint of mortality, ACS or CHF admission was more frequent in the inflammatory disease group (77.5% in AIRD group, 72.9% in the IBD group and 59.6% in the non-inflammatory group, p<0.001). The adjusted cox regression model found a statistically significant increased risk of the composite primary endpoints of around 40% for patients both with AIRD and IBD. The increased risk for ACS was 61% for AIRD patients and 37% for IBD patients. Patients with inflammatory diseases were found to have a significant increased risk CHF admission, while both IBD and AIED patients had a non-significant increased risk for mortality. Conclusion Patients with AIRD and IBD are at higher risk for cardiovascular events also in long term follow up once diagnosed with CAD and treated with PCI. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Discharge Hemoglobin Association with Long-Term Outcomes of ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Ming Gao ◽  
Xinying Zhang ◽  
Ling Qin ◽  
Yang Zheng ◽  
Zhiguo Zhang ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Bleeding Event ◽  
Coronary Intervention ◽  
Minor Bleeding ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Lower Discharge

Background. Anemia following acute myocardial infarction (AMI) is associated with poor outcomes. While previous studies in patients with AMI have focused on anemia at admission, we hypothesized that hemoglobin (Hb) decline during hospitalization and lower discharge Hb would be associated with greater long-term mortality in patients undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods. We analyzed records of 983 STEMI patients who were treated with primary PCI. The primary end point was all-cause mortality at 1 year and 2 years. The relationship between discharge Hb levels, decline in Hb levels, bleeding event classification, and all-cause mortality was determined. Results. Overall, 16.4% of patients had bleeding events, which were classified by the Thrombolysis in Myocardial Infarction (TIMI) score as 7% minimal, 8.6% minor, and 0.9% major. No significant gastrointestinal bleed and cerebral hemorrhage occurred in hospitals among these patients. The incidence rate of the 2-year all-cause mortality increased with severity of the bleeding event score (8.78% for no bleeding vs. 11.59% for minimal bleeding vs. 20.24% for minor bleeding vs. 55.56% for major bleeding, P<0.001). Discharge Hb was significantly associated with 2-year mortality in an unadjusted model (hazard ratio (HR) per 1 g/L decrease in discharge Hb = 1.020, 95% confidence interval (CI): 1.006–1.034, P=0.004) and in a confounder-adjusted model (HR per 1 g/L decrease in discharge Hb = 1.024, 95% CI: 1.011–1.037, P<0.001). The odds ratio (OR) for all-cause mortality at 2 years for participants with Hb below the twentieth percentile was 3.529 (95% CI: 1.976–6.302) and 2.968 (95% CI: 1.614–5.456) after adjustment for age and gender and 2.485 (95% CI: 1.310–4.715) after adjustment for all covariates. Conclusions. In this population of patients hospitalized for STEMI, all-cause mortality increased with lower discharge Hb, and discharge Hb was a significant predictor of mortality risk.

scholarly journals Long-term impact of baseline anaemia on clinical outcomes following percutaneous coronary intervention in stable angina

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001319
Author(s):  
Line Davidsen ◽  
Kristian Hay Kragholm ◽  
Mette Aldahl ◽  
Christoffer Polcwiartek ◽  
Christian Torp-Pedersen ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Stable Angina ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
The Impact

BackgroundIn patients with stable angina (SA), the clinical benefits of percutaneous coronary intervention (PCI) reside almost exclusively within the realm of symptomatic improvement rather than improvement in hard clinical endpoints. The benefits of PCI should always be balanced against its potential short-term and long-term risks. Common among these risks is the presence of anaemia and its interaction with poor clinical outcomes and increased morbidity; this study aims to elucidate the impact of anaemia on long-term clinical outcomes of this patient group.MethodsFrom Danish national registries, we identified patients with SA treated with PCI who had a haemoglobin measurement maximum of 90 days prior to PCI procedure. Anaemia was defined as haemoglobin <130 and <120 g/L in men and women, respectively. Follow-up was up to 3 years after PCI, and Cox regression was used to estimate HRs with 95% CIs of hospitalisation due to bleeding, acute coronary syndrome (ACS) and all-cause mortality in patients with anaemia compared with patients without anaemia.ResultsOf 2837 included patients, 14.6% had anaemia prior to PCI. During follow-up, 93 patients (3.3%) had a bleeding episode, which was higher in patients with anaemia (5.8%) compared with patients without anaemia (2.8%). A total of 213 patients (7.5%) developed ACS, which was higher in patients with anaemia (10.6%) compared with patients without anaemia (7.0%). Furthermore, 185 patients (6.5%) died, with a mortality rate of 18.1% in patients with anaemia compared with 4.5% in patients without anaemia. In multivariable analyses, anaemia was associated with a significantly increased risk of bleeding (HR 1.69; 95% CI 1.04 to 2.73; P 0.033), ACS (HR 1.47; 95% CI 1.04 to 2.10; P 0.031) and all-cause mortality (HR 2.41; 95% CI 1.73 to 3.30; P <0.001).ConclusionAnaemia in patients with SA was significantly associated with bleeding, ACS and all-cause mortality following PCI.

Prognostic Value of Admission Blood Urea Nitrogen/Creatinine Ratio in Patients with STEMI Undergoing Late Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
Caijuan Dong ◽  
Yanbo Xue ◽  
Yan Fan ◽  
Ruochen Zhang ◽  
Yunfei Feng ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Blood Urea Nitrogen ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Creatinine Ratio ◽  
Cardiac Mortality ◽  
Urea Nitrogen ◽  
Percutaneous Coronary ◽  
All Cause Mortality

Abstract Objective: Numerous patients with ST-segment elevation myocardial infarction (STEMI), especially in developing countries, undergo late percutaneous coronary intervention (PCI), defined as time of PCI > 24 hours from symptom onset. This study is aimed to identify the predictive value of admission blood urea nitrogen/creatinine ratio (BUN/Cr) on long-term all-cause mortality and cardiac mortality in STEMI patients receiving late PCI. Methods: Eligible STEMI patients who received late PCI between 2009 and 2011 were consecutively enrolled. They were classified into two groups based on the median BUN/Cr: low BUN/Cr group and high BUN/Cr group. Patients were followed up by phone or face to face interviews and medical records review. The primary endpoint was defined as all-cause mortality and cardiac mortality. Results: 780 STEMI patients were enrolled finally. The median BUN/Cr was 14.29. The median follow-up period was 41 months, with 37 all-cause deaths and 25 cardiac deaths. Compared to the low BUN/Cr group, high BUN/Cr group had higher all-cause mortality (6.4% vs. 3.1%, P=0.029), and cardiac mortality (6.3% vs. 1.5%, P<0.001). The Cox proportional hazard analysis revealed that high BUN/Cr at admission was an independent predictor of long-term cardiac mortality (P=0.003), but not of all-cause mortality (P=0.077). Conclusions: High BUN/Cr ratio at admission was an independent predictor of cardiac mortality in STEMI patients receiving late PCI. Brief Summary: In a retrospective study of STEMI patients receiving late PCI, we found that high BUN/Cr ratio (BUN/Cr>14.29) at admission was an independent predictor of long-term cardiac mortality, but not of all-cause mortality. The study showed that BUN/Cr ratio could be a potential indicator of risk stratification models for STEMI patients undergoing late PCI.

Abstract 14591: Persistent Racial Disparities in Risks of Readmission and Mortality After Percutaneous Coronary Intervention in the Contemporary Era: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Stephanie Spehar ◽  
Milan Seth ◽  
Khaldoon Alaswad ◽  
Theodore Schreiber ◽  
Aaron Berman ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Racial Disparities ◽  
Cox Model ◽  
Coronary Intervention ◽  
Black Race ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Contemporary Practice ◽  
Long Term Mortality

Introduction: Racial disparities in the management and outcomes following acute myocardial infarction are well-established. However, there remains conflicting data on whether such disparities exist between black and non-black patients (pts) after percutaneous coronary intervention (PCI) in contemporary practice. Hypothesis: We hypothesize that compared with non-black race, black race is associated with increased risks of post-PCI readmission and mortality. Methods: We linked clinical registry data from PCIs performed between 1/2013 and 3/2018 at 48 Michigan hospitals to Medicare Fee-for-service claims. Patient race as recorded in the registry was dichotomized as black and non-black. The date of death was obtained from the Medicare beneficiary file. We used a logistic regression model to estimate the odds of 90-day readmission and a Cox model to estimate the association between race and post-discharge mortality after adjusting for important clinical characteristics. Results: A total of 30,206 pts (10.0% black, 59.9% men) were included. Black pts tended to be younger (68.9 vs 72.2 yrs), were more likely to smoke (27.7% vs. 19.5%), and had a higher burden of cardiovascular comorbidities. Compared with non-black pts, black pts had an increased risk of 90-day readmission (26.5% vs. 18.2%; adjusted OR 1.34; 95% CI 1.22-1.47; p<0.001) and long-term mortality after PCI (HR 1.13; 95% CI 1.05-1.21; p=0.001) (Figure). Conclusions: Even after accounting for clinical comorbidities, in contemporary practice black pts are at an increased risk of readmission and long-term mortality after PCI discharge. Future studies investigating differences in care and social determinants of health are needed to elucidate the mechanisms behind these disparate outcomes and identify potential opportunities to reduce these dramatic and persistent health care disparities.

Abstract 14589: The Zip Code Jeopardy: Living in Disadvantaged Areas is Associated With Significantly Increased Mortality After Percutaneous Coronary Intervention: Insights From the Blue Cross Blue Shield of Michigan Cardiovascular Consortium

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Devraj Sukul ◽  
Milan Seth ◽  
Stephanie Spehar ◽  
Michael Thompson ◽  
Daniel Bonifacio ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cox Model ◽  
Coronary Intervention ◽  
Neighborhood Disadvantage ◽  
Area Deprivation ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
Zip Code ◽  
Long Term Mortality

Introduction: Research suggests that neighborhood-level factors are associated with long-term health; however, there is a dearth of research evaluating this association among patients (pts) undergoing percutaneous coronary intervention (PCI), a population that is usually optimally treated with respect to long-term risk management. Hypothesis: We hypothesize that pts living in the most disadvantaged areas have a higher risk of post-discharge mortality after PCI compared with pts not living in the most disadvantaged areas. Methods: Using a clinical registry of pts with valid zip codes who underwent PCI between 1/2013 - 3/2018 at 47 Michigan hospitals linked to Medicare claims, we compared long-term outcomes between pts in the highest ADI decile (i.e. most disadvantaged) with the remainder. The Area Deprivation Index (ADI) is a zip-code-level composite measure of neighborhood disadvantage. Unadjusted mortality was depicted on a Kaplan-Meier plot. We used a Cox model to assess the association between the ADI and mortality after adjusting for pt factors. Results: Among 26,164 pts, 9.9% lived in the most disadvantaged zip codes and were more likely to be younger, of black race, have both Medicare and Medicaid insurance, and have more cardiovascular comorbidities. Unadjusted rates of mortality were higher among pts living in the most disadvantaged areas compared with the remainder (5-yr mortality: 64.5% vs 70.9%; Fig). After adjusting for pt factors, those living in the most disadvantaged areas had a significantly increased risk of long-term mortality (HR 1.16; 95% CI 1.08 - 1.25), a risk equivalent to an 8% reduction in one’s ejection fraction (HR for 8% EF reduction: 1.16; 95% CI 1.14 - 1.17). Conclusions: Medicare pts living in the most disadvantaged areas have a higher risk of post-PCI long-term mortality compared with the remainder. Policies targeting the deleterious health effects of neighborhood disadvantage and social risk are needed to improve survival after PCI.

scholarly journals Plasma Trimethylamine-N-Oxide Is an Independent Predictor of Long-Term Cardiovascular Mortality in Patients Undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome

2021 ◽  
Vol 8 ◽  
Author(s):  
Ceren Eyileten ◽  
Joanna Jarosz-Popek ◽  
Daniel Jakubik ◽  
Aleksandra Gasecka ◽  
Marta Wolska ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Predictive Value ◽  
Cox Regression ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
All Cause Mortality

To investigate the association of liver metabolite trimethylamine N-oxide (TMAO) with cardiovascular disease (CV)-related and all-cause mortality in patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention. Our prospective observational study enrolled 292 patients with ACS. Plasma concentrations of TMAO were measured during the hospitalization for ACS. Observation period lasted seven yr in median. Adjusted Cox-regression analysis was used for prediction of mortality. ROC curve analysis revealed that increasing concentrations of TMAO levels assessed at the time point of ACS significantly predicted the risk of CV mortality (c-index=0.78, p &lt; 0.001). The cut-off value of &gt;4 μmol/L, labeled as high TMAO level (23% of study population), provided the greatest sum of sensitivity (85%) and specificity (80%) for the prediction of CV mortality and was associated with a positive predictive value of 16% and a negative predictive value of 99%. A multivariate Cox regression model revealed that high TMAO level was a strong and independent predictor of CV death (HR = 11.62, 95% CI: 2.26–59.67; p = 0.003). High TMAO levels as compared with low TMAO levels were associated with the highest risk of CV death in a subpopulation of patients with diabetes mellitus (27.3 vs. 2.6%; p = 0.004). Although increasing TMAO levels were also significantly associated with all-cause mortality, their estimates for diagnostic accuracy were low. High TMAO level is a strong and independent predictor of long-term CV mortality among patients presenting with ACS.

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