P3614Impact of renal dysfunction in patients with acute myocardial infarction on early management and outcome: a first observational French study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Bernard ◽  
C El Khoury ◽  
L Fraticelli
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Hospital Mortality ◽  
Real Life ◽  
Patient Characteristics ◽  
Hospital Treatment ◽  
Kidney Dysfunction ◽  
Early Management ◽  
St Segment Elevation ◽  
One Year

Abstract Background Kidney dysfunction (KD) is largely associated to cardiovascular mortality. Purpose Analyse early management and outcome in real life of ST segment elevation myocardial infarction (STEMI) patients with KD compared to STEMI patients with normal renal function. Methods Using 10 years' data from OSCAR regional registry, we investigated the early management and outcome of all patients with STEMI. Kidney dysfunction (KD) has been defined by creatinine clearance (CrCl) <90mL/min and was assessed using Cockcroft-Gault (CG) equation. Among them, two groups were identified: patients with normal kidney function (NKF) (CrCl ≥90mL/min) and patients with KD (CrCl <90mL/min). KD patients were stratified into 3 groups: patients with mild KD (CrCl 60–90mL/min), patients with moderate KD (CrCl 30–60mL/min) and patients with severe KD (CrCl <30mL/min). The comparison of the groups concerned patient characteristics, therapeutic strategy and follow-up at 1, 6 and 12 months. Results Our study included 8 003 STEMI patients from 2009 to 2018, 4 234 (52.9%) of them with KD. Among these, 2441 (57.6%) patients had mild KD, 1494 (35.3%) moderate KD and 299 (7.1%) severe KD. NKF patients were younger than KD group (54 [48–61] vs 72 [63–81]). KD patients had more cardiovascular risk factors such as diabetes, hypertension and personal history of coronary disease (p<0.001), but were less smokers (p<0,001). KD patients presented less often chest pain, and more dyspnea or cardiac arrest (p<0,001). There was no difference in symptom-first medical contact delay (p=0.30). More than 14% of patients with KD presented with Killip≥2. In the KD group location of infarction was more often anterior and lateral. In-hospital treatment differed among the groups: KD patients received less prasugrel (11% vs 20%), ticagrelor (44% vs 49%), enoxaparin (70% vs 80%), morphine (29% vs 39%) or other analgesic (30% vs 35%), but more clopidogrel (33% vs 23%), diuretics (3% vs 0,7%) and catecholamines (5% vs 2%) (p<0.001). In-hospital mortality was higher in the KD group (9% vs 1%, p<0.001). One-year mortality was 14% in the KD group compared to 2% for patients with NKF (p<0.001). Also, in-hospital mortality was increasing exponentially with KD severity (2%, 8% and 24% for mild, moderate and severe KD) (p<0,001) as well as 1-year mortality (respectively 1%, 6% and 12% after 1 year) (p<0,001). Conclusion Kidney insufficiency is an independent risk factor for death in patients after myocardial infarction and was associated with poor prognosis at short- and long-term. We observed that mortality increased with KD severity. Despite a high cardiovascular risk, KD patients presenting STEMI are less likely to receive therapy, while having more co-morbidities and extended infarction. To achieve an optimal medical care of KD patients with STEMI, we should introduce evidence-based therapies in the acute phase.

scholarly journals The prediction of cardiac events in patients with acute ST segment elevation myocardial infarction: A meta–analysis of serum uric acid

2018 ◽  
Vol 13 (1) ◽  
pp. 413-421
Author(s):  
Hailong Wang ◽  
Jianjun Yang ◽  
Jiang Sao ◽  
Jianming Zhang ◽  
Xiaohua Pang
Keyword(s):  
Myocardial Infarction ◽  
Uric Acid ◽  
Hospital Mortality ◽  
Serum Uric Acid ◽  
Meta Analysis ◽  
Systematic Analysis ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
One Year

AbstractObjectiveThe current study aimed to explore the predictive ability of serum uric acid (SUA) in patients suffering from acute ST segment elevation myocardial infarction (STEMI).MethodPubMed, EMBASE, Cochrane Library, and Medline databases were systematically searched from their respective inceptions to February 2018. Systematic analysis and random-effects meta–analysis of prognostic effects were performed to evaluate STEMI outcomes [i.e., in-hospital mortality, one-year mortality, in-hospital Major Adverse Cardiovascular Events (MACE)] in relation to SUA.ResultsA total of 12 studies (containing 7,735 patients with acute STEMI) were identified (5,562 low SUA patients and 3,173 high SUA patients). Systematic analysis of these studies showed that high SUA patients exhibited a higher incidence of in-hospital MACE (OR, 2.30; P < 0.00001), in-hospital mortality (OR, 3.03; P < 0.0001), and one-year mortality (OR, 2.58; P < 0.00001), compared with low SUA patients.ConclusionsAcute STEMI patients with high SUA exhibited an elevated incidence rate of in-hospital MACE, in-hospital mortality, and one-year mortality. Further randomized controlled trials will be needed to verify these results.

scholarly journals Assessment of morbidity and fatal outcomes of Acute Coronary Syndrome in Scotland

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Grant Wyper ◽  
Samantha Alvarez-Madrazo ◽  
Kim Kavanagh ◽  
Martin Denvir ◽  
Marion Bennie
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Secondary Care ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Diagnostic Threshold ◽  
St Segment ◽  
One Year

ABSTRACTObjectivesThere have been a number of key changes in the clinical definition and diagnostic threshold of acute coronary syndromes in the last 10 years. We have characterised temporal and geographic changes in the incidence and outcomes following Acute Coronary Syndrome (ACS: Unstable Angina (UA), Non ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI)) between 2009 and 2013. Approach65,137 hospitals stays were identified involving ACS (ICD-10: I20.0, I21 and I22) relating to 55,369 individuals identified through secondary care primary diagnosis records during 2009-2013. All prior and subsequent secondary care diagnoses from 1981-2014 were sourced for these patients and records were deterministically matched on a pseudo patient identifier to obtain the cause and date of death for purposes of follow-up. An incident ACS case was defined as such if the patient had not suffered an ACS in the five years prior to the hospital admission and all co-morbidities were derived from hospital diagnostic codes accompanying the ACS codes. ResultsFor the entire cohort, patients with an incident ACS were predominantly male (61.5%) with mean age 68 (SD=13.7 years). Co-morbidities included: 65.5% Other Ischaemic Heart Disease; 5.2% Stroke; 7.5% Peripheral Artery Disease; 14.8% Atrial Fibrillation; 42.0% Hypertension; 18.0% Diabetes Mellitus and 8.4% Chronic Kidney Disease. The overall incidence of ACS in 2009 was 204/100,000 and fell by 8.1% to 188/100,000 in 2013. Subtypes of ACS comprised 9.4% UA, 50.9% NSTEMI, 29.0% STEMI and 10.8% MI unspecified in 2013. In-hospital mortality following an incident ACS was 9.7% (95% CI: 9.2-10.3%) in 2009 and varied from 7.9 to 19.0% across the NHS boards. In 2013, in-hospital mortality was 8.5% (95% CI: 7.9-9.0%) ranging from 4.5 to 10.5% across the NHS boards. One-year mortality following an incident ACS in 2009 was 18.6% (95% CI: 17.9-19.4%) falling to 16.8% (95% CI: 16.1-17.5%) in 2013. Stratified by NHS board, the one-year mortality rate in 2009 varied from 16.9 to 28.0% and in 2013 ranged from 11.9 to 20.0% across the NHS boards. ConclusionThese findings highlight the importance of a cohort based record linkage approach to routine healthcare datasets. While there appears to be changes in incidence of ACS and its subtypes and changes in mortality over time, these findings reflect significant changes in clinical practice with respect to definition and diagnosis. Cautious interpretation is needed combined with further research to fully understand the epidemiological implications of our findings.

Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Arroyo-Espliguero ◽  
M.C Viana-Llamas ◽  
A Silva-Obregon ◽  
A Estrella-Alonso ◽  
C Marian-Crespo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Primary Angioplasty ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
One Year ◽  
The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI&lt;97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P&lt;0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P&lt;0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P&lt;0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

scholarly journals Total numbers and in-hospital mortality of patients with myocardial infarction in Germany during the FIFA soccer world cup 2014

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Karsten Keller ◽  
Lukas Hobohm ◽  
Volker H. Schmitt ◽  
Martin Engelhardt ◽  
Philip Wenzel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Environmental Stress ◽  
Nationwide Inpatient Sample ◽  
Hospital Admissions ◽  
Patient Characteristics ◽  
World Cup ◽  
National Team ◽  
Comparison Period

AbstractEnvironmental stress like important soccer events can induce excitation, stress and anger. We aimed to investigate (i) whether the FIFA soccer world cup (WC) 2014 and (ii) whether the soccer games of the German national team had an impact on total numbers and in-hospital mortality of patients with myocardial infarction (MI) in Germany. We analyzed data of MI inpatients of the German nationwide inpatient sample (2013–2015). Patients admitted due to MI during FIFA WC 2014 (12th June–13th July2014) were compared to those during the same period 2013 and 2015 (12th June–13th July). Total number of MI patients was higher during WC 2014 than in the comparison-period 2013 (18,479 vs.18,089, P < 0.001) and 2015 (18,479 vs.17,794, P < 0.001). WC was independently associated with higher MI numbers (2014 vs. 2013: OR 1.04 [95% CI 1.01–1.07]; 2014 vs. 2015: OR 1.07 [95% CI 1.04–1.10], P < 0.001). Patient characteristics and in-hospital mortality rate (8.3% vs. 8.3% vs. 8.4%) were similar during periods. In-hospital mortality rate was not affected by games of the German national team (8.9% vs. 8.1%, P = 0.110). However, we observed an increase regarding in-hospital mortality from 7.9 to 9.3% before to 12.0% at final-match-day. Number of hospital admissions due to MI in Germany was 3.7% higher during WC 2014 than during the same 31-day period 2015. While in-hospital mortality was not affected by the WC, the in-hospital mortality was highest at WC final.

P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Soeda ◽  
M Ishihara ◽  
F Fujino ◽  
H Ogawa ◽  
K Nakao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiac Troponin ◽  
Clinical Characteristics ◽  
St Segment Elevation ◽  
The Poor ◽  
St Segment ◽  
Universal Definition ◽  
Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

Quality and clinical outcomes of primary percutaneous coronary intervention after ST-segment elevation myocardial infarction: a population density analysis of a Japanese nationwide registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Yamaji ◽  
S Kohsaka ◽  
T Inohara ◽  
Y Numasawa ◽  
H Ishii ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Population Density ◽  
Hospital Mortality ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Inverse Association ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary

Abstract Background Despite progress in acute myocardial infarction (MI) treatment, data on geographical disparities in its care remain limited. Purpose We aimed to assess the discrepancy by population density (PD) on the quality and clinical outcomes of patients with primary percutaneous coronary intervention (PCI) after ST-segment elevation MI (STEMI). Methods The J-PCI registry is a prospective procedural registry conducted by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT) to assure the quality of delivered care. Between January 2014 and December 2018, 209,521 patients underwent PCI for STEMI in 1,126 institutes. Population of administrative municipal-level districts was determined through the complete population census. The patients were divided into tertiles according to the PD of the PCI institution location (low: &lt;951.7/km2, n=69,797; middle: 951.7–4,729.7/km2, n=69,750; high: ≥4,729.7/km2, n=69,974). Results Patients treated in high PD administrative districts were younger (low: 69.1±12.9, middle: 68.7±12.9, high: 68.0±13.1) and likely to be male (low: 75.6%, middle: 76.0%, high: 76.6%). No significant correlation was observed between PD and door-to-balloon time (DTB: regression coefficients: 0.036 per 1000 people/km2, 95% CI: −0.232 to 0.304, P=0.79). Patients treated in low PD areas had higher crude in-hospital mortality rates than those treated in high PD areas (low: 2.89%, middle: 2.60%, high: 2.38%; P&lt;0.001). Moreover, PD and in-hospital mortality had a significantly inverse association, before and after adjusting for baseline characteristics (crude odds ratio [OR]: 0.983 per 1,000/km2, 95% confidence interval [CI]: 0.973–0.992, P&lt;0001; adjusted OR: 0.980 per 1,000/km2, 95% CI: 0.964–0.996, P=0.01, respectively). Higher PD districts had more operators per institute (low: 6, interquartile range [IQR] 3–10; middle: 7, IQR 3–13; high: 8, IQR 5–13, P&lt;0.001), suggesting an inverse association with in-hospital mortality (OR: 0.992, 95% CI: 0.986–0.999, P=0.03). Conclusions Marked geographical inequality was observed in immediate case fatality; patients treated in population-dense areas had a lower in-hospital mortality than those treated in less dense areas. Variation in the number of operators per institute, rather than traditional quality indicators (e.g. DTB) may explain the difference in in-hospital mortality. Funding Acknowledgement Type of funding source: None

3333Contemporary mortality rates in myocardial infarction patients in Sweden: a tale of two registries

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Siverskog ◽  
M Janzon ◽  
L.-Å Levin ◽  
J Alfredsson ◽  
M Henriksson
Keyword(s):  
Myocardial Infarction ◽  
Intensive Care ◽  
Patient Characteristics ◽  
Primary Diagnosis ◽  
Age And Gender ◽  
Quality Registry ◽  
Mortality Outcome ◽  
Mortality Difference ◽  
And Gender ◽  
One Year

Abstract Background Sweden has contributed to the understanding of the long-term prognosis after myocardial infarction (MI) utilising the quality registry SWEDEHEART, including patients admitted to heart intensive care, and the National Patient Registry (PAR), based on administrative records for Swedish hospitals. As registration procedures differ between the registries, and not all MI patients are admitted to heart intensive care, MI patients identified in SWEDEHEART and PAR, respectively, will yield different cohorts of patients. This may result in different epidemiological research findings regarding prognosis after MI. Purpose To study MI populations identified in SWEDEHEART and PAR, respectively, and investigate potential differences in mortality outcome. Methods Patients hospitalised with an MI primary diagnosis (ICD-10 I21) between 2002 and 2015 were identified using SWEDEHEART and PAR. The analysis time started at the date of hospital admission and survivors were followed for 365 days. Kaplan-Meier analysis was used to estimate survival by cohort category controlling for age and gender. Results Excluding cases with invalid data (n=1,905), 225,612 and 282,118 SWEDEHEART and PAR patients, respectively, were identified. We found 213,367 patients in both SWEDEHEART and PAR, whereas 12,245 and 68,751 patients were unique to SWEDEHEART and PAR, respectively. The one-year survival probability after MI in the SWEDEHEART population was 0.841, compared to 0.788 in PAR (Figure). This discrepancy can be explained by high mortality among patients not covered by SWEDEHEART and persists after controlling for age and gender (Table). To what extent differences in registration procedures and other patient characteristics can explain the mortality difference is an area for further research. One-year survival by age and gender Age ± 1 year Male Female PAR S.H. Diff. PAR S.H. Diff. 65 0.922 0.936 0.015 0.919 0.936 0.017 70 0.893 0.909 0.016 0.889 0.908 0.019 75 0.829 0.858 0.029 0.834 0.860 0.026 80 0.743 0.783 0.040 0.768 0.800 0.033 85 0.625 0.677 0.052 0.662 0.705 0.042 One-year survival after MI Conclusion Estimated one-year survival for MI patients differs by up to 5 percentage points depending on the registry used. Although further research is needed to fully understand these differences, epidemiological findings regarding MI prognosis should be interpreted in light of registry type used and population represented. Acknowledgement/Funding Region Östergötland

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