P65217.5-Fr sheathless guides versus 7-Fr glidesheath slender sheath/7-Fr guiding catheter combination for acute myocardial infarction: a propensity-matched analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Isawa ◽  
K Horie ◽  
M Taguri ◽  
T Ootomo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Radial Artery ◽  
Academic Research ◽  
Multivariate Logistic Regression Model ◽  
Syntax Score ◽  
Research Consortium ◽  
Guiding Catheter

Abstract Purpose To investigate the differences between a 7.5-Fr sheathless guides and a 7-Fr Glidesheath slender sheath (GSS) /7-Fr guiding catheter combination regarding access-site complications and process time metrics in percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI). Methods We enrolled 609 patients undergoing PCI for AMI at our hospital using either a 7.5-Fr sheathless guides or a 7-Fr GSS/7-Fr guiding catheter combination; 1:1 propensity score matching was performed. A propensity score was estimated using a multivariate logistic regression model. Variables included were age, gender, weight, hypertension, diabetes, smoking, statin, estimated glomerular filtration rate, end-procedural activated clotting time, oral anticoagulants, SYNTAX score I, previous PCI, history of MI, Killip class, prior ipsilateral transradial intervention, and radial artery diameter. Results A total of 336 subjects were included in the propensity-matched sample. Compared with the GSS group, the sheathless group had significantly less frequent severe radial spasm (Sheathless: 0.6% vs. GSS: 4.8%, p=0.037) and Bleeding Academic Research Consortium type 2, 3, or 5 bleeding events (Sheathless: 12.5% vs. GSS: 21.4%, p=0.041). Procedure outcomes Variables Total population Propensity-matched population Sheathless (n=368) Glidesheath (n=241) OR (95% CI) p Sheathless (n=168) Glidesheath (n=168) OR (95% CI) p Primary outcomes   RAO at 30 days 10 (2.7) 3 (1.2) 0.45 (0.08–1.77) 0.26 4 (2.4) 1 (0.6) 0.25 (0.03–2.22) 0.37   Severe radial spasm (grade 3 or 4) 5 (1.4) 12 (5.0) 3.78 (1.22–13.87) 0.011 1 (0.6) 8 (4.8) 8.35 (1.03–67.52) 0.037   BARC type 2, 3, or 5 bleeding within 30 days 40 (10.9) 45 (18.7) 1.87 (1.15–3.05) 0.008 21 (12.5) 36 (21.4) 1.91 (1.06–3.43) 0.041   Procedural success 361 (98.6) 238 (98.8) 1.10 (0.21–7.14) 0.54 167 (99.4) 166 (98.8) 0.50 (0.05–5.53) 1.0 Secondary outcomes   Coronary ostial dissection 7 (1.9) 3 (1.2) 0.65 (0.11–2.87) 0.75 4 (2.4) 3 (1.8) 0.75 (0.16–3.38) 1.0   MACCEs within 30 days 4 (1.1) 7 (2.9) 2.70 (0.68–12.73) 0.12 4 (2.4) 0 (0) n/a 0.12   Puncture to balloon time, min 26.0 (21.0–35.0) 27.0 (20.0–38.0) n/a 0.52 26.5 (21.0–37.0) 27.0 (20.0–38.0) n/a 0.77 Data are presented as median (interquartile range) or n (%), unless otherwise indicated. Bleeding Academic Research Consortium; CI, confidence interval; MACCEs, major adverse cardiac and cerebrovascular events; OR, odds ratio; RAO, radial artery occlusion. MACCEs include all-cause death, myocardial infarction, target-vessel revascularization, and cerebrovascular accident. Conclusions These data demonstrate a clear advantage of sheathless guides over GSS/guiding catheter combination for decreased risk of severe radial spasm and bleeding.

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

2020 ◽  
Vol 9 (5) ◽  
pp. 488-495 ◽  
Author(s):  
Kensaku Nishihira ◽  
Nozomi Watanabe ◽  
Nehiro Kuriyama ◽  
Yoshisato Shibata
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Major Bleeding ◽  
Academic Research ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
Research Consortium ◽  
Therapeutic Decision Making

Background With increases in life expectancy, percutaneous coronary intervention is being performed more often, even in elderly patients with acute myocardial infarction. However, the optimal management of nonagenarians with acute myocardial infarction is uncertain. This study sought to investigate clinical outcomes of nonagenarians who undergo percutaneous coronary intervention. Methods Of 2640 consecutive patients with acute myocardial infarction hospitalised within 24 hours after symptom onset in 2009–2018, we prospectively analysed 96 nonagenarians (median age 92 years; interquartile range 91–94) who underwent percutaneous coronary intervention. Results The median follow-up period was 375 days. Inhospital major bleeding (Bleeding Academic Research Consortium type 3 or 5) and inhospital death occurred in 15.6% and 17.7% of patients, respectively. The proportion of patients with frailty increased during hospitalisation, from 43.8% (mild frailty 37.5%; moderate to severe frailty 6.3%) at admission to 60.7% (mild frailty 46.8%; moderate to severe frailty 13.9%) at discharge ( P < 0.01). The cumulative incidence of all-cause mortality was 22.2% at 180 days and 27.5% at 365 days. After adjusting for confounders, cardiogenic shock (hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.07–7.64) and final thrombolysis in myocardial infarction flow grade less than 3 (HR 2.45; 95% CI 1.03–5.58) were associated with higher mid-term mortality and cardiac rehabilitation (HR 0.25; 95% CI, 0.13–0.50) was associated with lower mid-term mortality. Conclusions The mid-term mortality of selected nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention is reasonable, but older patients have high rates of inhospital major bleeding and progression of frailty. This study provides physicians, patients and families with important information for therapeutic decision-making.

Early and midterm outcomes after transaxillar versus transfemoral TAVI. data from the spanish TAVI registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jimenez-Quevedo ◽  
C Urbano Carrillo ◽  
B Vaquerizo ◽  
D Arzamendi ◽  
M Artaiz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Academic Research ◽  
Pacemaker Implantation ◽  
Vascular Complications ◽  
Group Versus ◽  
Funding Source ◽  
Multilevel Logistic Regression ◽  
Research Consortium ◽  
Transfemoral Tavi

Abstract   Transaxillary access (TAx) has emerged as a less invasive alternative access when transfemoral access (TF) is not possible in patients undergoing TAVI. The primary endpoint of this study was to compare total in-hospital and 30-day mortality of patients included in the Spanish TAVI registry that were treated by TAx versus TF access. Methods All patients included in the Spanish TAVI registry who were treated by TAx or TF access were analyzed. In-hospital and 30-days outcomes were assessed using the Valve Academic Research Consortium definitions. An analyses by propensity score matching and multilevel logistic regression was performed for comparing both groups. Results A total of 6603 patients were included, of whom 191 (2.9%) were treated by TAx and 6412 were treated with TF access. After the adjustment, the device success was similar between both groups (94%, TAx vs 95%, TF p=0.95) as well as the rate of vascular complications (11.9% Tax vs 11.9 TF; p=0.78), bleeding (7.7% TAx vs. 7.9% TF; p=0.62) and stroke (4.2% TAx vs. 2.0 TF; p=0.09). However, in-hospital and 30-day mortality was significantly higher in TAx access group versus TF 2.19 (1.13–4.26): p=0.02 and 2.11 (1.08–4, 13); P=0.02, respectively. Similarly, the rate of acute myocardial infarction 5.05 (1.94–13.1); p=0.001, renal complications 2.07 (1.19–3.60; p =) 0.01 and pacemaker implantation 1.56 (1.01–2.40); p=0.04 was higher in the TAx group versus TF. Conclusions Transaxillary access compared to transfemoral access is associated with an increase in total in-hospital and 30-day mortality, as a result TAx access should be considered only in those cases in which TF is not possible Funding Acknowledgement Type of funding source: None

scholarly journals Role of diuretics on long-term mortality may differ in volume status in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Kawai ◽  
D Nakatani ◽  
T Yamada ◽  
T Watanabe ◽  
T Morita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Plasma Volume ◽  
Cox Regression ◽  
Volume Status ◽  
Increased Risk ◽  
Long Term Mortality

Abstract Background Diuretics has been reported to have a potential for an activation of the renin-angiotensin-aldosterone system and the sympathetic nervous system, leading to a possibility of poor clinical outcome in patients with cardiovascular disease. However, few data are available on clinical impact of diuretics on long-term outcome in patients with acute myocardial infarction (AMI) based on plasma volume status. Methods To address the issue, a total of 3,416 survived patients with AMI who were registered to a large database of the Osaka Acute Coronary Insufficiency Study (OACIS) were studied. Plasma volume status was assessed with the estimated plasma volume status (ePVS) that was calculated at discharge as follows: actual PV = (1 − hematocrit) × [a + (b × body weight)] (a=1530 in males and a=864 in females, b=41.0 in males and b=47.9 in females); ideal PV = c × body weight (c=39 in males and c=40 in females), and ePVS = [(actual PV − ideal PV)/ideal PV] × 100 (%). Multivariable Cox regression analysis and propensity score matching were performed to account for imbalances in covariates. The endpoint was all-cause of death (ACD) within 5 years. Results During a median follow-up period of 855±656 days, 193 patients had ACD. In whole population, there was no significant difference in long-term mortality risk between patients with and without diuretics in both multivariate cox regression model and propensity score matching population. When patients were divided into 2 groups according to ePVS with a median value of 4.2%, 46 and 147 patients had ACD in groups with low ePVS and high ePVS, respectively. Multivariate Cox analysis showed that use of diuretics was independently associated with an increased risk of ACD in low ePVS group, (HR: 2.63, 95% confidence interval [CI]: 1.22–5.63, p=0.01), but not in high ePVS group (HR: 0.70, 95% CI: 0.44–1.10, p=0.12). These observations were consistent in the propensity-score matched cohorts; the 5-year mortality rate was significantly higher in patients with diuretics than those without among low ePVS group (4.7% vs 1.7%, p=0.041), but not among high ePVS group (8.0% vs 10.3%, p=0.247). Conclusion Prescription of diuretics at discharge was associated with increased risk of 5-year mortality in patients with AMI without PV expansion, but not with PV expansion. The role of diuretics on long-term mortality may differ in plasma volume status. Therefore, prescription of diuretics after AMI may be considered based on plasma volume status. Funding Acknowledgement Type of funding source: None

scholarly journals Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Ana Lopez-de-Andres ◽  
Rodrigo Jimenez-Garcia ◽  
Valentin Hernández-Barrera ◽  
Jose M. de Miguel-Yanes ◽  
Romana Albaladejo-Vicente ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Sex Differences ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Hospital Discharge ◽  
St Elevation Myocardial Infarction ◽  
Men And Women ◽  
St Elevation

Abstract Background To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016–2018) and to investigate sex differences. Methods Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM. Results MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28–2.36) and NSTEMI (IRR 2.91; 95% CI 2.88–2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI. Conclusions T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.

PT158 Clinical characteristics, etiology and occurrence of type 2 acute myocardial infarction

Global Heart ◽  
2014 ◽  
Vol 9 (1) ◽  
pp. e197
Author(s):  
Filip M. Szymanski ◽  
Krzysztof J. Filipiak ◽  
Anna E. Platek ◽  
Anna Szymanska ◽  
Grzegorz Karpinski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Characteristics

scholarly journals Clinical SYNTAX Score – a good predictor for renal artery stenosis in acute myocardial infarction patients: analysis from the REN-ACS trial

2017 ◽  
Vol 4 ◽  
pp. 837-844 ◽  
Author(s):  
Alexandru Burlacu ◽  
Dimitrie Siriopol ◽  
Ionut Nistor ◽  
Luminita Voroneanu ◽  
Igor Nedelciuc ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Renal Artery ◽  
Renal Artery Stenosis ◽  
Good Predictor ◽  
Artery Stenosis ◽  
Syntax Score
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