P1745Clinical characteristics and long-term outcome in patients with helicopter-transported acute coronary syndrome after primary percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Takahashi ◽  
M Ogita ◽  
S Tsuboi ◽  
R Nishio ◽  
K Yasuda ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Long Term Outcome ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Abstract Background Reducing delay to percutaneous coronary intervention improves functional outcome and reduces long-term mortality. Transportation by helicopter is often quicker than ground transport and thus may improve overall prognosis through reduced ischemic injury and infarction size. Our hospital is located on the medically-depopulated peninsula surrounded by mountain. The journey from the southern tip of the peninsula to the critical care medical center of our hospital take 1.5 hour by a ground ambulance but only 15 minutes by helicopter. We compared the clinical characteristics and long-term mortality between air and ground transport of ACS patients for primary PCI. Methods We conducted an observational cohort study evaluating 2324 patients (mean age 68.5±12.0, male 75.2%) with ACS underwent primary PCI between April 2004 and December 2017 at our hospital. We divided into three groups according to transportation system type (air, ground, walk-in). The primary outcome was defined as all-cause death during the long-term follow-up. Results Among the entire cohort, 577 patients (24.8%) were transported by air. 1326 (57.1%) patients by ambulance, 421 (18.1%) patients by walk. Baseline characteristics were comparable, but patients by air had a higher prevalence of ST-elevation myocardial infarction. The rate of long-term mortality was comparable during the median follow up of 6 years (air, 21.1% vs. ground, 21.4% vs. walk-in, 21.1%, respectively, log-rank p=0.72). Multivariate Cox regression analysis showed no significant association between air transportation and long-term mortality (Adjusted HR [vs ground] 1.05, 95% CI 0.60–1.78, p=0.85 and [vs walk-in] 0.94, 95% CI 0.62–1.43, respectively, p=0.77). Kaplan-Meier curve Conclusions The rate of long-term mortality in patients with ACS transported by air was comparable with those transported by ground.

Abstract 12938: Long-Term Mortality Benefit With Intracoronary Thrombus Aspiration Before Primary Percutaneous Coronary Intervention

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Partha Sardar ◽  
Saurav Chatterjee ◽  
Mandeep Singh ◽  
Ramez Nairooz ◽  
Robert Frankel ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Mortality Benefit ◽  
Thrombus Aspiration ◽  
Aspiration Thrombectomy ◽  
Percutaneous Coronary ◽  
Long Term Mortality

Background: Mortality benefit of routine intracoronary thrombus aspiration during primary percutaneous coronary intervention (PCI) has been questioned. The recent TASTE trial did not show a mortality benefit with thrombus aspiration at 1 month, however benefits from accompanying reductions in myocyte injury might accrue over time. A meta-analysis of randomized trials (RCTs) was performed to evaluate the effect of follow up duration on effectiveness of aspiration thrombectomy. Methods: PubMed, Cochrane Library, EMBASE, Web of Science and CINAHL databases were searched through March, 2014. We included RCTs with acute myocardial infarction (AMI) patients randomized to aspiration thrombectomy prior to primary PCI compared with conventional primary PCI alone. Two individuals reviewed the trials for inclusion and extracted data from the RCTs. We used random-effects models. Results: Data were pooled from 16 RCTs with 11,649 patients. All-cause mortality was significantly lower with aspiration thrombectomy after at least 12 months of follow up (Odds ratio [OR] =0. 61; 95% CI 0.37-0.99; p=0. 05). Pooled data for other time frames, i.e in-hospital, 1 month, 6 month follow up, did not reach statistical significance. Conclusion: Beneficial effects of thrombus aspiration on mortality are not evident until 12 months post-procedure, consistent with the long-term effects of myocardial salvage. Subsequent trials evaluating thrombus removal should accordingly be powered for long-term mortality in addition to known procedural and angiographic endpoints.

scholarly journals Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Vratonjic ◽  
D Milasinovic ◽  
M Asanin ◽  
V Vukcevic ◽  
S Zaharijev ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ejection Fraction ◽  
Primary Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Primary Pci ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Long Term Mortality

Abstract Background Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI). Methods This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (>50%). Results mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF<40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF<40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p<0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p<0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p<0.001) and median age (61 vs. 59 vs. 64 years, p<0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p<0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p<0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p<0.001). Conclusion Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (<40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality. Funding Acknowledgement Type of funding source: None

Comparison of long-term mortality between living alone patients vs. living together patients with acute coronary syndrome treated with percutaneous coronary intervention

2020 ◽  
Vol 6 (4) ◽  
pp. 332-337 ◽  
Author(s):  
Mitsuhiro Takeuchi ◽  
Manabu Ogita ◽  
Hideki Wada ◽  
Daigo Takahashi ◽  
Yui Nozaki ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Coronary Intervention ◽  
Living Alone ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Living Together ◽  
Long Term Mortality

Abstract Aims Living alone is reported as an independent risk factor for cardiovascular disease. However, little is known about the association between clinical outcomes and living alone in patients with acute coronary syndrome (ACS). The aim of this study was to determine whether living alone is an independent prognostic risk factor for long-term mortality stratified by age in patients with ACS who were treated with primary percutaneous coronary intervention (PCI). Methods and results We conducted an observational cohort study of ACS patients who underwent PCI between January 1999 and May 2015 at Juntendo University Shizuoka Hospital, Japan. The primary endpoint was all-cause death. Among 2547 ACS patients, 381 (15.0%) patients were living alone at the onset of ACS. The cumulative incidence of all-cause death was comparable between living alone and living together (34.8% vs. 34.4%, log-rank P = 0.63). However, among younger population (aged <65 years), the incidence of all-cause death was significantly higher in the living alone group (log-rank P = 0.01). Multivariate Cox hazard analysis revealed a significant association between living alone and all-cause death, even after adjusting for other risk factors (hazard ratio 2.30, 95% confidence interval 1.38–3.84, P = 0.001). Conclusion Although living alone was not significantly associated with long-term clinical outcomes in patients with ACS, it was a predictive risk factor among younger ACS patients. Careful attention should be paid to patients’ lifestyle, especially younger patients with ACS.

P5290Impact of extreme obesity on long-term outcomes following percutaneous coronary intervention

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Biswas ◽  
D Dinh ◽  
S Noaman ◽  
S J Duffy ◽  
J Lefkovits ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Obesity Paradox ◽  
Extreme Obesity ◽  
Percutaneous Coronary ◽  
Long Term Follow Up ◽  
Underweight Patients ◽  
Long Term Mortality

Abstract Background Obesity is a growing health concern worldwide, particularly in developed countries where there has been an unprecedented rise in the proportion of overweight and obese individuals in the population. Previous studies have reported a protective effect of obesity compared to normal BMI in patients undergoing percutaneous coronary intervention (PCI). However, it is unclear whether this effect extends to the extremely obese over long-term follow-up. Objective To determine whether an obesity paradox persists in contemporary PCI practice over long-term follow-up, and in particular to further evaluate the association between extreme obesity and long-term clinical outcomes after PCI. Method We prospectively collected data on 25,645 patients undergoing PCI between 1 January 2005 and 30 June 2017 who were enrolled in the statewide multi-centre Melbourne Interventional Group Registry. This registry collects data on all patients undergoing PCI at 6 academic tertiary hospitals. Patients were stratified by World Health Organization-defined BMI categories. Long-term mortality data was obtained by linkage to the National Death Index (NDI), a database that contains records of all deaths occurring in Australia. The primary endpoint was NDI-linked mortality. Median length of follow-up was 4.4 years (IQR 2.0–7.6 years). Results Of the study cohort, 24.6% had normal BMI (18.5–24.9 kg/m2), 0.9% were underweight (BMI <18.5 kg/m2) and 3.3% were extremely obese (BMI ≥40 kg/m2). As BMI increased, mean age decreased while the prevalence of diabetes increased (p<0.001). The proportion of females at both extremes of BMI. Procedural characteristics were similar across the groups although there was more radial access and less femoral access used with increasing BMI (p<0.001). In terms of secondary prevention therapy, underweight patients were significantly less likely to receive a beta blocker, ACE inhibitor and statins, compared to the other BMI groups. In-hospital, 30-day and long-term mortality were all highest for underweight patients (37.7%) and lowest for the moderately obese patients (BMI 35–40 kg/m2) (12.2%). After adjustment for age, comorbidities and presentation with cardiogenic shock, a U-shaped association between the different BMI categories and adjusted hazard ratio for long-term mortality was observed (Figure 1). Figure 1 Conclusion An obesity paradox is still apparent in contemporary practice with elevated BMI up to 35 kg/m2 associated with reduced long-term mortality after PCI. However, this protective effect appears not to extend to patients with extreme obesity. Factors behind this phenomenon are likely multifactorial and require further mechanistic and epidemiological studies.

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.

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