P6144Trends of mortality in patients with acute coronary syndromes submitted to urgent myocardial revascularization procedures in Brazil

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Moreira ◽  
N A Bittar ◽  
I M Venancio ◽  
N T Silva ◽  
A M S Lima ◽  
...  
Keyword(s):  
Public Health ◽  
Hospital Mortality ◽  
Acute Coronary Syndromes ◽  
Artery Bypass ◽  
Myocardial Revascularization ◽  
Death Rates ◽  
Geographical Regions ◽  
Coronary Syndromes ◽  
Revascularization Procedures ◽  
Related Mortality

Abstract Background Acute Coronary Syndromes (ACS) are the most common and life-threatening manifestation of cardiovascular diseases. This disease burden along with progress in cardiovascular technology has led to substantial growth in the number of cardiovascular procedures performed in ACS management. In Brazil, there are no contemporary data about in-hospital mortality related to urgent myocardial revascularization procedures. Purpose To describe trends in mortality in patients with ACS who underwent urgent myocardial revascularization procedures in Brazil, between 2008 and 2016. Methods Data on hospital admission and in-hospital mortality were obtained from the database of the Brazilian Public Health System (DATASUS) over a nine-years period (2008–2016). All admissions due to ACS were identified using standard ICD codes. Additionally, data about percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG) performed as an urgency were retrieved. Trend analyses over the period were performed using Poisson regression. Results Between 2008 and 2016, 472,810 urgent myocardial revascularization procedures were performed, of which 370,018 (78.3%) were PCI and 102,792 (21.7%) were CABG. The in-hospital mortality in patients with ACS submitted to PCI was 3.4%, and 6.8% among those submitted to CABG. There was an increase in the number of PCI procedures from 26,929 in 2008 to 53,542 in 2016 (98%), although the mortality remained stable (3.3% to 3.6%, respectively). CABG procedures also raised 77%, from 9,535 in 2008 to 12,262 in 2016, but the observed related mortality decreased from 8.0% to 6.3%, respectively. However, disparities among Brazilian geographical regions were noted: in 2016, mortality among ACS patients who underwent urgent PCI was lower in Southeast (3.2%) and higher in the Northeast Region (5.9%). The Southeast Region also presented the lowest CABG related mortality (5.7%), whereas the Midwest had the higher death rates (7.8%). Conclusions In this contemporary analysis based on national public health data, there was an increase in the number of urgent myocardial revascularization procedures in patients hospitalized for ACS in Brazil. Despite stable death rates in patients undergoing PCI, CABG-related mortality decreased significantly. Due to the heterogeneity of results among the different geographical Regions of the country, there are still opportunities to improve these national results.

scholarly journals Clinical predictors and angiographic features of acute coronary syndromes caused by systemic embolism

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Jeronimo Baza ◽  
C Salazar ◽  
M.J Perez Vyzcaino ◽  
L Nombela ◽  
P Jimenez Quevedo ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Acute Coronary Syndromes ◽  
Tertiary Hospital ◽  
Control Group ◽  
Systemic Embolism ◽  
Clinical Predictors ◽  
Coronary Syndrome ◽  
Valvular Surgery ◽  
Coronary Syndromes

Abstract Introduction Systemic embolism to coronary arteries is one of the mechanisms of acute myocardial infarction (AMI) of non-atherosclerotic cause. However, its clinical profile has not been properly established yet. Purpose To identify clinical predictors and angiographic characteristics of acute coronary syndromes caused by systemic embolism to a principal coronary artery (ACS-E), as well as to describe in-hospital mortality of these patients. Methods 40 patients with ACS-E, admitted between 2003 and 2018 in a tertiary hospital. Epidemiological, clinical and angiographic characteristics of these cases were compared with those from 4989 patients, attended for acute coronary syndrome of atherosclerotic cause (ACS-A) in the same hospital during the same period. Results Patients with ACS-E were younger (28% vs 10% were <45 years old, p<0.001) and had a higher proportion of women (43% vs 22%, p 0.003), atrial fibrillation (40% vs 5%, p<0.001) and neoplasia (18% vs 7%, p 0.009). They had also undergone previous valvular surgery more frequently than patients with ACS-A (13% vs 0.5%, p<0.001) and a higher proportion of them were under treatment with warfarin (15% vs 3%, p<0.001). Variables identified as independent predictors of ACS-E in the multivariate analysis are shown in the table. Regarding clinical presentation, ST elevation AMI was more frequent in ACS-E cases (83% vs 67%, p 0.04). Patients with ACS-E did not present any significative stenosis in other vessels apart from the culprit one (number of other vessels with at least 1 severe stenosis was 0 in the ACS-E group vs 1.33 + 1 in the ACS-A arm, p<0.001). PCI was attempted in 75% of the patients with ACS-E, resulting successful in 80% of the cases. On the other hand, 100% of SCA-A underwent PCI, with a success proportion of 99% (p<0.001). In-hospital mortality in ACS-E group was 15% and 4% in the control group (p<0.001). Conclusions ACS-E and ACS-A have different clinical and angiographic features. Atrial fibrillation, chronic warfarin treatment, previous valvular surgery, presence of any neoplasia and female sex are independent predictors for ACS-E. Funding Acknowledgement Type of funding source: None

PP-071 [AJC » Acute Coronary Syndromes] Urgent Right Coronary Artery Bypass Surgery Due to Stent Distortion by a Stitched Guidewire

2017 ◽  
Vol 119 (8) ◽  
pp. e80
Author(s):  
Dilşad Amanvermez Senarslan ◽  
Funda Yıldırım ◽  
Alper Özbakkaloğlu ◽  
Adnan Taner Kurdal ◽  
Barış Bayram ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Right Coronary Artery ◽  
Acute Coronary Syndromes ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Coronary Syndromes

Abstract 5584: Heart Failure Eliminates the Risk Gradient Defined by TIMI Risk Score in Non-st-segment Elevation Acute Coronary Syndromes

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sara S Gonçalves ◽  
Pedro Amador ◽  
Lígia Mendes ◽  
Filipe Seixo ◽  
José F Santos
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Hospital Mortality ◽  
Risk Score ◽  
Acute Coronary Syndromes ◽  
Clinical Registry ◽  
St Segment Elevation ◽  
St Segment ◽  
Coronary Syndromes ◽  
Timi Risk Score

The TIMI Risk Score is a simple and effective tool for risk stratification in patients (pts) with non-ST-segment elevation acute coronary syndromes (NSTE-ACS). The presence of heart failure (HF) or a low ejection fraction (EF) has also been associated with a worse outcome. We sought to evaluate the interaction of heart failure on the risk gradient defined by the TIMI Risk Score in a NSTE-ACS population. We studied 9980 pts with NSTE-ACS included in a prospective nationwide clinical registry since 2002. Pts were stratified by TIMI Risk Score in low (0 to 2), intermediate (3 and 4) and high risk (5 to 7) groups. The population was divided in two groups according to the presence or absence of HF. HF was defined as the presence of a Killip class >1 or a systolic EF <30%. In-hospital mortality or re-infarction was assessed in both groups during the index hospitalization and according to TIMI Risk Score Stratification. Results: In-hospital mortality or re-infarction was 1,9% in low risk, 3,7% in intermediate and 6,3% in high risk pts (Qui-square trend p<0,001). The risk gradient defined by the TIMI risk score was not observed in patients without HF (Qui-Square for trend=ns). In pts with HF, the TIMI risk score maintains its predictor value (Qui-square trend=0,014), but the presence of HF identifies a higher risk subgroup. In this population, HF was a strong independent predictor for in-hospital mortality and re-infarction (OR 10,01). In NSTE-ACS pts, the presence of HF identifies the patients with higher risk for in-hospital risk and re-infarction within each TIMI Risk Score subgroup. There was no risk gradient assessed by the TIMI risk score in the absence of HF.

Abstract 250: Economic Burden of Mortality and Cardiovascular Events among Patients with Acute Coronary Syndromes in a Commercial Health Plan

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Kristine Ogden ◽  
Aarti A Patel ◽  
Samir H Mody ◽  
Mark Veerman ◽  
Concetta Crivera ◽  
...  
Keyword(s):  
Health Plan ◽  
Economic Burden ◽  
Acute Coronary Syndromes ◽  
Healthcare Costs ◽  
Anticoagulation Therapy ◽  
Standard Of Care ◽  
Bleeding Events ◽  
Baseline Model ◽  
Coronary Syndromes ◽  
Related Mortality

Introduction: Despite current advances in treatment, acute coronary syndromes (ACS), continues to result in high morbidity and mortality. Annually, an estimated 1.5 million hospital discharges involve patients with ACS. As such, ACS is associated with a substantial economic burden to the US healthcare system, with current estimates ranging from $75-$150 billion annually in aggregate direct medical costs. Adding anticoagulant to standard of care (SOC) may reduce the number of cardiovascular (CV) events in ACS patients. This study estimates the economic burden of mortality and CV events among ACS patients within a commercial health plan. Methods: We developed an Excel-based decision-analytic model to estimate the annual economic burden of mortality and CV events (myocardial infarction (MI), ischemic stroke (IS), stent thrombosis (ST), intracranial hemorrhage (ICH), and major bleeds) in a hypothetical commercial plan with a population of ACS patients who were candidates for rivaroxaban anticoagulation therapy. The baseline ACS population of 6,650 patients was calculated from literature estimates and included 100% on standard of care, and 0% on dual SOC and rivaroxaban anticoagulation therapy. ACS prevalence was adjusted for age and anticoagulation status. Estimates for the two-year rates for mortality and CV events were obtained from the two-year randomized double-blind, placebo-controlled rivaroxaban ATLAS clinical trial. Healthcare costs were drawn from the published literature and adjusted to 2011 USD. Results: The baseline model projected a total of 299 deaths from any cause, resulting in an estimated $9.52 million in two-year mortality-related healthcare costs to a commercial health plan. In addition, the baseline model estimated 439 MI, 67 IS, 193 ST, 13 ICH, and 27 major bleeding events that were not associated with CABG, resulting in a total of $41.3 million in two-year healthcare costs to a commercial health plan. All other factors being equal, a 10% increase in the dual SOC and rivaroxaban anticoagulation therapy from the SOC population would reduce the number of mortalities by 11, ST events by 5, and MI events by 3, while the number of ischemic stroke events would remain the same. Conversely, there would be an increase of 1 ICH event and 7 major bleeding events not associated with CABG. Two-year ACS-related mortality and CV event costs to the commercial health plan would be reduced by $48,437 for every 1,000 patients with ACS. Conclusion: Our findings suggest that a modest 10% increase in anticoagulant use among patients with ACS would reduce mortality, MI, ST and related healthcare costs by 4%, 0.7%, and 3%, respectively. Addition of anticoagulation therapy potentially reduces the incidence of ACS-related mortality, MI, ST and associated healthcare costs to a commercial health plan, and benefits from anticoagulation use should be balanced against the risk of bleeding.

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