P3621Epidemiology of acute coronary syndrome by subtype in New Zealand 2006–2016: an ANZACS-QI nationwide linkage study of hospitalisation, procedures and case fatality

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T K M Wang ◽  
C Grey ◽  
Y Jiang ◽  
R Jackson ◽  
A Kerr
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Artery Bypass ◽  
Case Fatality ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Invasive Management

Abstract Background Acute coronary syndrome (ACS) is a common manifestation of cardiovascular disease. Inconsistent trends have been reported in the management and outcomes of the three main categories of ACS (ST-elevation myocardial infarction [STEMI], non ST-elevation myocardial infarction [NSTEMI] and unstable angina [UA]). The aims of this study were to evaluate recent trends in the incidence, invasive management and case fatality of these ACS subtypes in New Zealand. Methods All ACS hospitalisations between 2006–2016 were identified from routinely collected national data, and categorised into STEMI, NSTEMI, UA, and unspecified myocardial infarction (MI). For each ACS subtype, annual hospitalisation and coronary procedure rates, 28-day and 1-year fatality rates were calculated and trends tested using Poisson regression adjusted for age and sex. Results There were 188,264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MI unspecified. During this period, the incidence of all ACS subtypes fell, STEMI by 3.4%/y, NSTEMI by 5.9%/year and UA by 8.5%/year. There was also a rise in the proportion of ACS patients receiving angiography and revascularisation. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but rates of coronary artery bypass grafting increased only for NSTEMI and UA. Case fatality at 28 days and 1 year was higher for STEMI than NSTEMI, and lowest for UA. Over the period there was a relative 1.6%/y decline in one-year case fatality for NSTEMI (p<0.001), but no significant change for STEMI and UA. Conclusions The observed declines in the incidence of all ACS subtypes is reassuring, as is the increase in the rate of revascularisation among these patients. The finding that case fatality declined in NSTEMI patients but not in STEMI and UA patients, despite an increase in invasive management in all groups, require further investigation.

Nationwide trends in acute coronary syndrome by subtype in New Zealand 2006–2016

Heart ◽  
2019 ◽  
pp. heartjnl-2019-315655 ◽  
Author(s):  
Tom Kai Ming Wang ◽  
Corina Grey ◽  
Yannan Jiang ◽  
Rodney T Jackson ◽  
Andrew J Kerr
Keyword(s):  
Acute Coronary Syndrome ◽  
New Zealand ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Coronary Procedure ◽  
St Elevation ◽  
Event Rates ◽  
Invasive Management

ObjectivesRecent studies in acute coronary syndrome (ACS) have reported mixed results for trends in ACS subtypes. The All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) 31 study evaluated trends in ACS event rates, invasive management and mortality of ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and unstable angina (UA) in New Zealand.MethodsAll ACS hospitalisations between 2006 and 2016 were identified from routinely collected national data and categorised into STEMI, NSTEMI, UA and MI unspecified (MIU). Annual hospitalisation, coronary procedure, 28-day and 1-year mortality rates were calculated and trends tested using Poisson regression adjusting for age and sex.ResultsOver the 11-year study period, there were 188 264 ACS admissions, of which 16.0% were STEMI, 54.5% NSTEMI, 25.7% UA and 3.8% MIU. Event rates of all ACS subtypes fell: STEMI by 3.4%/year, NSTEMI by 5.9%/year and UA by 8.5%/year, while the proportion of patients with ACS receiving angiography and revascularisation increased by 5.6% per year. Rates of percutaneous coronary intervention rose for STEMI, NSTEMI and UA, but coronary artery bypass grafting increased only for NSTEMI and UA. Mortality at 28 days and 1 year was higher for STEMI than NSTEMI and lowest for UA. There was a relative 1.6%/year decline in 1 year mortality for NSTEMI (p<0.001), but no significant change for STEMI and UA.ConclusionsWe observed declines in the event rates of all ACS subtypes and increases in revascularisation rates. The finding that mortality declined in patients with NSTEMI, but not in patients with STEMI and UA, despite increases in invasive procedures, requires further investigation.

Biological efficacy of a 600 mg loading dose of clopidogrel in ST-elevation myocardial infarction

2012 ◽  
Vol 108 (07) ◽  
pp. 101-106 ◽  
Author(s):  
Julie Berbis ◽  
Marc Laine ◽  
Sébastien Armero ◽  
Jacques Bessereau ◽  
Laurent Jacquin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Fibrinogen Level ◽  
Platelet Reactivity ◽  
Coronary Intervention ◽  
Individual Variability ◽  
St Elevation Myocardial Infarction ◽  
Loading Dose ◽  
Coronary Syndrome ◽  
St Elevation

SummaryOptimal platelet reactivity (PR) inhibition is critical to prevent thrombotic events in primary percutaneous coronary intervention (PCI). We aimed to determine the relationship between high on-treatment platelet reactivity (HTPR) and ST-elevation myocardial infarction (STEMI) following a 600 mg loading dose (LD) of clopidogrel. We performed a prospective monocentre study enrolling patients on clopidogrel undergoing PCI. The VASP index was used to assess PR inhibition after clopidogrel LD. HTPR was defined according to the consensus as a VASP index ≥50%. The present study included 833 patients undergoing PCI. Most patients had PCI for an acute coronary syndrome (58.7%). The mean VASP index was 50 ± 23% with a large inter-individual variability (range: 1–94%). Patients with a VASP index ≥50% were significantly older (p= 0.03), with a higher body mass index (BMI) (p<0.001), more often diabetic (p=0.03), taking omeprazole (p=0.03), admitted for an acute coronary syndrome (ACS) and with a high fibrinogen level compared to good responders (VASP <50%). In multivariate analysis BMI, omeprazole use, ACS and high fibrinogen level (p<0.001) remained significantly associated with HTPR. Of importance, in this analysis STEMI was independently associated with HTPR when compared with the other forms of ACS (NSTEMI and unstable angina) with an odd ratio of 2.14 (95% CI: 1.3 –3.5; p=0.003). In conclusion, STEMI is associated with high on-treatment platelet reactivity following 600 mg of clopidogrel. The present results suggest that 600 mg of clopidogrel may not be able to achieve an optimal PR inhibition in STEMI patients undergoing PCI and more potent drugs may be preferred.

scholarly journals Healthcare disparities for women hospitalized with myocardial infarction and angina

2019 ◽  
Vol 6 (2) ◽  
pp. 156-165 ◽  
Author(s):  
Alice M Jackson ◽  
Ruiqi Zhang ◽  
Iain Findlay ◽  
Keith Robertson ◽  
Mitchell Lindsay ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Baseline Risk ◽  
Mortality Data ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Sex Disparities ◽  
Invasive Management

Abstract Aims Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina. Methods and results We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37–1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52–1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P &lt; 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16–2.56] and 1 year (adjusted HR 1.38, CI 1.12–1.69). Conclusion After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.

P6256Revascularisation for acute coronary syndrome: are we offering elderly patients the correct treatment?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Al-Othman ◽  
Y Zheng ◽  
N Malik
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Intervention Group ◽  
St Elevation Myocardial Infarction ◽  
P Value ◽  
Coronary Syndrome ◽  
St Elevation ◽  
One Year

Abstract Purpose Acute coronary syndrome (ACS) is treated with revascularisation procedures such as percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Whilst reasonable clinical exclusion criteria exist, age is not one of them and patients of advanced years have been shown to have better outcomes with both treatments than with medical management. We set out to investigate the management and outcomes of patients age seventy five and over, with ACS. Methods A retrospective data analysis of all patients age seventy five and above, prescribed dual antiplatelet therapy (DAPT - aspirin plus clopidogrel or aspirin plus ticagrelor), admitted to our institution over a one year period (April 2015 to April 2016). We analysed electronic records and discharge documents and excluded patients without a diagnosis of ACS. Results 207 patients over 75 years old were treated for ACS; 83.6% (173) were diagnosed with non ST elevation myocardial infarction (NSTEMI), 9.6% (20) diagnosed with ST elevation myocardial infarction (STEMI) and 6.8% (14) diagnosed with unstable angina. 73.4% (152) of patients were managed medically, 14.5% (30) had an angiogram, 11.1% (23) had PCI and 1.0% (2) had CABG. 74.0% (153) of patients were treated with aspirin plus clopidogrel, 26.0% (54) with aspirin plus ticagrelor. Major bleeds were reported in 21 patients (10.1%), 18 of the medically managed patients (8.7%) and 3 in the intervention group (5.5%) (P value 0.30). There were 17 major bleeds in the aspirin and clopidogrel group (11.1%) and 4 in the aspirin and ticagrelor group (7.4%) (P value 0.60). 93 (61.2%) of the medically treated group were alive at one year compared to 47 (85.5%) of the intervention group (P value 0.0008). Conclusion Our data show a clear survival benefit in the intervention group, although comparisons between the groups are challenging given confounding factors, such as co-morbidities and patient preference. However, the high proportion (73.4%) of over 75-years old treated medically warrants further evaluation, given the evidence of benefit for patients in this age group, treated with PCI. We feel there is a need for further research in to the ideas and practice surrounding the management of ACS in the over 75's, and their relation to the available evidence.

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