scholarly journals 342 Impact of temporary traffic bans on the risk of acute coronary syndromes in a large metropolitan area

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N81-N82
Author(s):  
Alessandra De Luca ◽  
Igino Proietti ◽  
Carlo Trani ◽  
Andrea Berni ◽  
Sonia Cristina Sergi ◽  
...  
Keyword(s):  
Nitric Oxide ◽  
Myocardial Infarction ◽  
Metropolitan Area ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Large Metropolitan Area ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Impact

Abstract Aims Strong epidemiologic evidence has highlighted the role of pollution, on top of adverse climate features, as a novel cardiovascular risk factor. However, mechanistic proof that reducing pollution may be beneficial to prevent atherothrombotic events is limited. We aimed at appraising the impact of temporary traffic bans in a large metropolitan area on the risk of acute coronary syndromes. Methods and results Aggregate and anonymized data from 15 tertiary cardiac care centers were obtained detailing pre-coronarivus disease 2019 (COVID-19) daily cases of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including those treated with percutaneous coronary intervention (PCI). Data on pollutants and climate were sought for the same days. Mixed level regression was used to compare the week before vs. after the traffic ban (Fortnight analysis), the 3 days before vs. after (Weekly analysis) and the Sunday before vs. after (Sunday analysis). A total of 8 days of temporary traffic bans were included, occurring between 2017 and 2020, totaling 802 STEMI and 1196 NSTEMI in the Fortnight analysis, 382 STEMI and 585 in the Weekly analysis, and 148 STEMI and 210 NSTEMI in the Sunday analysis. Fortnight and Sunday analysis did not disclose a significant impact of traffic ban on STEMI or NSTEMI (all P > 0.05). Conversely, Weekly analysis showed non-significant changes for STEMI but a significant decrease in daily NSTEMI when comparing the 3 days before the traffic ban with the ban day (P = 0.043), as well as the 3 days before vs. the 3 days after the ban (P = 0.025). No statistically significant effect of traffic ban was found at Fortnight, Weekly or Sunday analyses for daily mean concentrations of benzene, carbon monoxide, nitric oxide, nitrogen dioxide, ozone, sulfur dioxide, particulate matter (PM) <2.5 µm or PM < 10 µm (all P > 0.05). However, minimum daily concentrations showed a significant reduction of ozone during the ban in comparison to the week preceding it (P = 0.034), nitric oxide during the ban in comparison to the 3 days preceding it (P = 0.046), and an increase in benzene during the ban in comparison to the Sunday before (P = 0.039). Conclusion Temporary traffic bans may favorably reduce coronary atherothrombotic events, and in particular NSTEMI, even if not globally and immediately impacting on environmental pollution. Further controlled studies are required to confirm and expand this hypothesis-generating results.

scholarly journals 339 Interplay between COVID-19, pollution, and weather features on changes in the incidence of acute coronary syndromes in early 2020

2020 ◽  
Vol 22 (Supplement_N) ◽  
pp. N17-N18
Author(s):  
Simone Griffo ◽  
Achille Gaspardone ◽  
Alessandro Danesi ◽  
Fabio Ferranti ◽  
Enrica Mariano ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Metropolitan Area ◽  
Acute Coronary Syndromes ◽  
Tertiary Care ◽  
St Elevation Myocardial Infarction ◽  
Lazio Region ◽  
Multi Stage ◽  
Coronary Syndromes ◽  
St Elevation ◽  
The Impact

Abstract Aims Coronavirus disease 2019 (COVID-19) has caused an unprecedented change in the apparent epidemiology of acute coronary syndromes (ACS). However, the interplay between this disease, changes in pollution, climate, and aversion to activation of emergency medical services represents a challenging conundrum. We aimed at appraising the impact of COVID-19, weather, and environment features on the occurrence of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in a large Italian region and metropolitan area. Methods and results Italy was hit early on by COVID-19, such that state of emergency was declared on January 31, 2020, and national lockdown implemented on March 9, 2020, mainly because the accrual of cases in Northern Italy. In order to appraise the independent contribution on changes in STEMI and NSTEMI daily rates of COVID-19, climate and pollution, we collected data on these clinical events from tertiary care cardiovascular centers in the Lazio region and Rome metropolitan area. Multilevel Poisson modeling was used to appraise unadjusted and adjusted effect estimates for the daily incidence of STEMI and NSTEMI. The sample included 1448 STEMI and 2040 NSTEMI, with a total of 2882 PCI spanning 6 months. Significant reductions in STEMI and NSTEMI were evident already in early February 2020 (all P < 0.05), concomitantly with COVID-19 spread and institution of national countermeasures. Changes in STEMI and NSTEMI were inversely associated with daily COVID-19 tests, cases, and/or death (P < 0.05). In addition, STEMI and NSTEMI incidences were associated with daily NO2, PM10, and O3 concentrations, as well as temperature (P < 0.05). Multi-stage and multiply adjusted models highlighted that reductions in STEMI were significantly associated with COVID-19 data (P < 0.001), whereas changes in NSTEMI were significantly associated with both NO2 and COVID-19 data (both P < 0.001). Conclusion Reductions in STEMI and NSTEMI in the COVID-19 pandemic may depend on different concomitant epidemiologic and pathophysiologic mechanisms. In particular, recent changes in STEMI may depend on COVID-19 scare, leading to excess all-cause mortality, or effective reduced incidence, whereas reductions in NSTEMI may also be due to beneficial reductions in NO2 emissions in the lockdown phase.

scholarly journals Assessment of quality of care of patients with ST-segment elevation myocardial infarction

2019 ◽  
Vol 9 (8) ◽  
pp. 893-901
Author(s):  
Bartosz Hudzik ◽  
Andrzej Budaj ◽  
Marek Gierlotka ◽  
Adam Witkowski ◽  
Wojciech Wojakowski ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Quality Indicators ◽  
Acute Coronary Syndromes ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Percutaneous Coronary ◽  
Patient Reported ◽  
Coronary Syndromes ◽  
St Elevation

Aims: The 2017 European Society of Cardiology guidelines for the management of ST-elevation myocardial infarction recommended assessing quality of care to establish measurable quality indicators in order to ensure that every ST-elevation myocardial infarction patient receives the best possible care. We investigated the quality indicators of healthcare services in Poland provided to ST-elevation myocardial infarction patients. Methods and results: The Polish Registry of Acute Coronary Syndromes is a nationwide, multicentre, prospective study of acute coronary syndrome patients in Poland. For the purpose of assessing quality indicators, we included 8279 patients from the Polish Registry of Acute Coronary Syndromes hospitalised with ST-elevation myocardial infarction in 2018. Four hundred and eight of 8279 patients (4.9%) arrived at percutaneous coronary intervention centre by self-transport, 4791 (57.9%) arrived at percutaneous coronary intervention centre by direct emergency medical system transport, and 2900 (37.2%) were transferred from non-percutaneous coronary intervention facilities. Whilst 95.1% of ST-elevation myocardial infarction patients arriving in the first 12 h received reperfusion therapy, the rates of timely reperfusion were much lower (ranging from 39.4% to 55.0% for various ST-elevation myocardial infarction pathways). The median left ventricular ejection fraction was 46% and was assessed before discharge in 86.0% of patients. Four hundred and eighty-nine of 8279 patients (5.9%) died during hospital stay. Optimal medical therapy is prescribed in 50–85% of patients depending on various clinical settings. Only one in two ST-elevation myocardial infarction patients is enrolled in a cardiac rehabilitation program at discharge. No patient-reported outcomes were recorded in the Polish Registry of Acute Coronary Syndromes. Conclusions: The results of this study identified areas of healthcare system that require solid improvement. These include direct transport to percutaneous coronary intervention centre, timely reperfusion, guidelines-based medical therapy (in particular in patients with heart failure), referral to cardiac rehabilitation/secondary prevention programs. Also, there is a need for recording quality indicators associated with patient-reported outcomes.

Changes in Hemoglobin and Hematocrit May Predict Mortality in Patients with Acute Coronary Syndromes.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3171-3171
Author(s):  
Zaid Alirhayim ◽  
Waqas Qureshi ◽  
Vijaya Donthireddy ◽  
Syed Hassan ◽  
Fatima Khalid
Keyword(s):  
Myocardial Infarction ◽  
Plasma Volume ◽  
Acute Coronary Syndromes ◽  
St Elevation Myocardial Infarction ◽  
Receiver Operating Curve ◽  
Mortality Data ◽  
Volume Changes ◽  
Social Security Death Index ◽  
Coronary Syndromes ◽  
St Elevation

Abstract Abstract 3171 Introduction: Changes in plasma volume, the intravascular portion of the extracellular fluid volume, can be estimated by measuring changes in the levels of hemoglobin and hematocrit in the blood. In addition to hemoglobin & hematocrit levels, we are also able to use standard dilution techniques with radiolabeled albumin to accurately measure plasma volume changes. It is not known if plasma volume changes influence outcomes in patients with acute coronary syndromes. The aim of this study was to evaluate the effects of plasma volume changes in patients presenting with the acute coronary syndromes. Methods: Consecutive patients presenting to a single tertiary care center from January 2001 to December 2010 with non ST elevation myocardial infarction (NSTEMI) or ST elevation myocardial infarction (STEMI) were enrolled. Admission hemoglobin (Hbpre) & hematocrit (Hctpre) and discharge hemoglobin (Hbpost) and hematocrit levels (Hctpost) were obtained. Plasma volume changes were measured and a validated formula (ΔPV = ((Hbpre/Hbpost) × (100-Hctpost/100-Hctpre)-1) × 100%) was used to calculate the changes in plasma volumes. A detailed chart review was performed to collect information about baseline variables such as age, gender, hypertension, diabetes, hyperlipidemia, smoking status, and congestive heart failure. The Framingham Risk score was also calculated for each individual. Survival analysis was carried out for plasma volume changes of -20% - 0%, 0 – 20%, and ≥20%. Mortality data was collected from the social security death index for the first 60 days post-discharge. Results: A total of 9770 patients with confirmed NSTEMI or STEMI (mean age 61.8 ± 4.8 years, 48.8% women) were included in the final analysis. Mean pre admission hemoglobin (Hbpre) was 10.2 ± 1.4 g/dl and post admission hemoglobin (Hbpost) was 10.4 ± 1.3 g/dl. Change in plasma volume, ΔPV, was categorized into one of four categories, with 131 (1.3%) ≤20%, 6126 (62.7%) -20% - 0%, 3393 (34.7%) 0 – 20%, and 120 (1.2%) ≥20%. There were 509 deaths within 60 days of discharge. Change in plasma volume was found to be an independent predictor of mortality (HR 5.71; 95% CI 4.75 – 6.86, p = 0.0001) in a Cox proportional hazard model. Most of the deaths occurred during the first thirty days as demonstrated by the Kaplan – Meier's survival curve (Figure 1). Receiver operating curve showed an area under the curve of 0.876 for changes in plasma volume. Conclusion: This study shows that hemoglobin and hematocrit, although simple tests, can provide important prognostic information strongly predictive of short term mortality in patients with acute coronary syndromes. Further studies are required to see if monitoring of plasma volume and correction with pharmacological agents such as diuretics may lead to better outcomes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Association of thrombocytopenia and infection in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Litao Wang ◽  
Weijiang Su ◽  
Jinhua Xue ◽  
Xiao Gong ◽  
Yining Dai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Multivariable Analysis ◽  
Coronary Intervention ◽  
Hospital Infection ◽  
St Elevation Myocardial Infarction ◽  
Clinical Events ◽  
Percutaneous Coronary ◽  
Secondary Endpoints ◽  
St Elevation ◽  
The Impact

Abstract Background The impact of thrombocytopenia on infection in patients with ST-elevation myocardial infarction (STEMI) remains poorly understood. Aims To evaluate the association between thrombocytopenia and infection in patients with STEMI. Methods Patients diagnosed with STEMI were identified from January 2010 to June 2016. The primary endpoint was in-hospital infection, and major adverse clinical events (MACE) and all-cause death were considered as secondary endpoints. Results A total of 1401 STEMI patients were enrolled and divided into two groups according to the presence (n = 186) or absence (n = 1215) of thrombocytopenia. The prevalence of in-hospital infection was significantly higher in the thrombocytopenic group (30.6% (57/186) vs. 16.2% (197/1215), p < 0.001). Prevalence of in-hospital MACE (30.1% (56/186) vs. 16.4% (199/1215), p < 0.001) and all-cause death (8.1% (15/186) vs. 3.8% (46/1215), p = 0.008) revealed an increasing trend. Multivariate analysis indicated that thrombocytopenia was independently associated with increased in-hospital infection (OR, 2.09; 95%CI 1.32–3.27; p = 0.001) and MACE (1.92; 1.27–2.87; p = 0.002), but not all-cause death (1.87; 0.88–3.78; p = 0.091). After a median follow-up of 2.85 years, thrombocytopenia was not associated with all-cause death at multivariable analysis (adjusted hazard ratio, 1.19; 95%CI 0.80–1.77; p = 0.383). Conclusions Thrombocytopenia is significantly correlated with in-hospital infection and MACE, and might be used as a prognostic tool in patients with STEMI.

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