scholarly journals 86 STEMI and multivessel disease: medical therapy amplifies the benefit of complete myocardial revascularization

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Enrico Fabris ◽  
Andrea Pezzato ◽  
Caterina Gregorio ◽  
Giulia Barbati ◽  
Luca Falco ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Myocardial Revascularization ◽  
Treatment Strategies ◽  
Multivessel Disease ◽  
Prognostic Impact ◽  
Renin Angiotensin ◽  
The Impact

Abstract Aims Patients with ST-elevation myocardial infarction (STEMI) with multivessel disease (MVD) may be treated with different revascularization strategies. However, the potential predictors of outcomes on top of different revascularization strategies are poorly studied. This study aimed to evaluate the prognostic impact of two different revascularization strategies and the potential impact of medical therapy. Methods and results Using a propensity score approach, the impact of two treatment strategies was analysed—staged non-culprit revascularization group vs. culprit-lesion-only percutaneous coronary intervention (PCI) group—on a composite outcome of cardiovascular death (CVD), myocardial infarction, and repeated revascularization. Moreover, models were further adjusted for medication at discharge. Among 1385 STEMI patients treated with primary PCI, a subgroup of 433 with MVD was analysed. At the median follow-up of 41 (IQR, 21–65) months, after propensity-score adjustment, the multivariable Cox proportional hazard analysis showed that the staged non-culprit revascularization group was associated with a lower composite endpoint (HR, 0.44; 95% CI, 0.24–0.82; P = 0.01), lower CVD (HR, 0.34; 95% CI, 0.14–0.82; P = 0.02), and lower all-cause death (HR, 0.46; 95% CI, 0.24–0.86; P = 0.02). Use of renin–angiotensin inhibitors was associated with lower CVD (HR, 0.51; 95% CI, 0.27–0.95; P = 0.03), and both renin–angiotensin inhibitors (HR, 0.52; 95% CI, 0.32–0.86; P = 0.01) and beta blockers (HR, 0.48; 95% CI, 0.29–0.79; P = 0.01) were associated with lower all-cause death. Conclusions In a real-word STEMI population with multivessel disease, staged non-culprit revascularization was associated with lower cardiovascular mortality compared with a culprit-only PCI strategy. However, both revascularization and medical therapy played a role in the improvement of mortality outcomes. Medical therapy amplified the benefit of myocardial revascularization.

Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Arroyo-Espliguero ◽  
M.C Viana-Llamas ◽  
A Silva-Obregon ◽  
A Estrella-Alonso ◽  
C Marian-Crespo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Mortality Rate ◽  
Primary Angioplasty ◽  
Prognostic Impact ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Kaplan Meier ◽  
St Segment ◽  
One Year ◽  
The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

scholarly journals Long-Term Effect of Non-Selective Beta-Blockers in Patients With Rheumatoid Arthritis After Myocardial Infarction—A Nationwide Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Sheng-Fu Liu ◽  
Chih-Kuo Lee ◽  
Kuan-Chih Huang ◽  
Lian-Yu Lin ◽  
Mu-Yang Hsieh ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Protective Effect ◽  
Lower Risk ◽  
Beta Blockers ◽  
Term Survival ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
The Impact

Objectives: Rheumatoid arthritis (RA) is an independent nontraditional risk factor for incidence of myocardial infarction (MI) and post-MI outcome is impaired in the RA population. Use of beta-blockers improves the long-term survival after MI in the general population while the protective effect of beta-blockers in RA patients is not clear. We investigate the impact of beta-blockers on the long-term outcome of MI among RA patients.Methods: We identified RA subjects from the registries for catastrophic illness and myocardial infarction from 2003 to 2013. The enrolled subjects were divided into three groups according to the prescription of beta-blockers (non-user, non-selective, and β1-selective beta-blockers). The primary endpoint was all-cause mortality. We adjusted clinical variables and utilized propensity scores to balance confounding bias. Cox proportional hazards regression models were used to estimate the incidence of mortality in different groups.Results: A total of 1,292 RA patients with myocardial infarction were enrolled, where 424 (32.8%), 281 (21.7%), and 587 (45.5%) subjects used non-user, non-selective, and β1-selective beta-blockers, respectively. Use of beta-blockers was associated with lower risk of all-cause mortality after adjustment with comorbidities, medications (adjusted hazard ratio [HR] 0.871; 95% confidence interval [CI] 0.727–0.978), and propensity score (HR 0.882; 95% CI 0.724–0.982). Compared with β1-selective beta-blockers, treatment with non-selective beta-blockers (HR 0.856; 95% CI 0.702–0.984) was significantly related to lower risk of mortality. The protective effect of non-selective beta-blockers remained in different subgroups including sex and different anti-inflammatory drugs.Conclusion: Use of beta-blockers improved prognosis in post-MI patients with RA. Treatment with non-selective beta-blockers was significantly associated with reduced risk of mortality in RA patients after MI rather than β1-selective beta-blockers.

scholarly journals Association of hyperlipidaemia with 5-year survival after hospitalisation for acute myocardial infarction: a propensity score matched analysis

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001163
Author(s):  
Mohammed Yousufuddin ◽  
Ye Zhu ◽  
Ruaa Al Ward ◽  
Jessica Peters ◽  
Taylor Doyle ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Propensity Score ◽  
Primary Objective ◽  
Life Years ◽  
Statin Prescription ◽  
Statin Adherence ◽  
The Impact

ObjectivesThe primary objective was to examine the association between hyperlipidaemia (HLP) and 5-year survival after incident acute myocardial infarction (AMI). The secondary objectives were to assess the effect of HLP on survival to discharge across patient subgroups, and the impact of statin prescription, intensity and long-term statin adherence on 5-year survival.MethodsRetrospective cohort study of 7071 patients hospitalised for AMI at Mayo Clinic from 2001 through 2011. Of these, 2091 patients with HLP (age (mean±SD) 69.7±13.5) were propensity score matched to 2091 patients without HLP (age 70.6±14.2).ResultsIn matched patients, HLP was associated with higher rate of survival to discharge than no HLP (95% vs 91%; log-rank <0.0001). At year 5, the adjusted HR for all-cause mortality in patients with HLP versus no HLP was 0.66 (95% CI 0.58–0.74), and patients with prescription statin versus no statin was 0.24 (95% CI 0.21 to 0.28). The mean survival was 0.35 year greater in patients with HLP than in those with no HLP (95% CI 0.25 to 0.46). Patients with HLP gained on an average 0.17 life year and those treated with statin 0.67 life year at 5 years after AMI. The benefit of concurrent HLP was consistent across study subgroups.ConclusionsIn patients with AMI, concomitant HLP was associated with increased survival and a net gain in life years, independent of survival benefit from statin therapy. The results also reaffirm the role of statin prescription, intensity and adherence in reducing the mortality after incident AMI.

P5475Essential thrombocytosis is associated with worse hospital outcomes in patients presented with acute myocardial infarction: a propensity score analysis of the National Inpatient Sample

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Wu ◽  
B Liu ◽  
Y Zheng
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Propensity Score ◽  
Matched Control ◽  
National Inpatient Sample ◽  
Essential Thrombocytosis ◽  
The Impact

Abstract Background/Introduction Essential thrombocytosis (ET) is a rare disease characterized by vasomotor symptom, thrombotic event, and hemorrhage. Due to its rare occurrence, limited data are available to examine the impact of ET on acute myocardial infarction (AMI). Purpose To evaluate the impact of ET on hospital outcomes of AMI. Methods We use the 2016 National Inpatient sample database to identify all the admissions with a principal diagnosis of AMI with or without ET. A matched control group was then generated using propensity score from age, sex, race, location, insurance, income, hospital type, hospital location, Charlsoncat Comorbidity Score. Prevalence, baseline characteristic of AMI patient with or without ET was described and compared. Univariable logistic regression was used to measure mortality and the rate of catheterization. Results ET was found in 0.28% (1,814) in total AMI admissions (641,854). Age (69.52 vs 69.70), female percentage (48.04% vs 48.03%) and baseline comorbidities including STEMI (27.49% vs 25.08%), diabetes (33.03% vs 30.51%), heart failure (40.18 vs 45.89%) and chronic kidney disease (22.05% vs 26.28%) was found to be comparable between two groups (p>0.05, table 1). Compared to non ET group, ET is associated with significantly higher hospital mortality (5.74% vs 2.43%, OR 2.44 [1.09–5.48], p=0.03), prolonged length of stay (7.61 vs 4.30 days, p<0.01). Interestingly, ET is also associated with lower utilization of cardiac catheterization (37.46% vs 46.52%, p=0.01). Essential Thrombocytosis and AMI Parameter AMI with ET Matched control: AMI without ET Odds ratio (95% CI) P value (n=1,814) (n=1,814) Age, years 69.52±0.72 69.70±0.70 p>0.05 Female, % 48.04 48.03 p>0.05 STEMI, % 27.49 25.08 p>0.05 Hypertension, % 81.57 83.08 p>0.05 Diabetes, % 33.03 30.51 p>0.05 Heart failure, % 40.18 45.89 p>0.05 Chronic kidney disease, % 22.05 26.28 p>0.05 Mortality, % 5.74 2.43 2.44 (1.09–5.48) p=0.03 Catheterization, % 37.46 46.52 0.68 (0.51–0.91) P=0.01 Length of stay, days 7.61±0.48 4.30±0.21 P<0.01 Values are reported as mean ± S.E. Categorical variables are represented as frequency. Conclusion ET is infrequently observed in patients with AMI. Having ET is associated with higher hospital mortality, longer hospital stay and lower utilization of cardiac catheterization. Acknowledgement/Funding None

scholarly journals PROGNOSTIC VALUE OF RENAL DYSFUNCTION AND THE IMBALANCE OF BODY AQUATIC ENVIRONMENTS IN PATIENTS WITH ACUTE CORONARY PATHOLOGY

2017 ◽  
Vol 21 (1) ◽  
pp. 39-45
Author(s):  
E. O. Golovinova ◽  
M. M. Batiushin ◽  
E. S. Levitskaya ◽  
A. V. Khripun
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Dysfunction ◽  
Myocardial Revascularization ◽  
Kidney Injury ◽  
Cardiovascular Complications ◽  
Aquatic Environments ◽  
Prognostic Impact ◽  
Late Period ◽  
The Impact

THE AIM. Assessment of the impact of renal dysfunction and imbalance of body aquatic environments distribution on the risk of developing cardiovascular complications in the late period after acute coronary syndrome (ACS) and myocardial revascularization. PATIENTS AND METHODS. We examined 120 patients with ACS undergoing myocardial revascularization. We estimated traditonal and renal risk factors (albuminuria 30-300 mg/l, the value of GFR, acute kidney injury development), and body aquatic environments factors. Upon completion of the primary material processing, to determine the effect of the studied risk factors, we selected combined endpoint of the study – development of arrhythmias or death of patients, which were registered 6 months after restoration of coronary blood flow. RESULTS. By results of the carried out research we established effect on the probability of cardiovascular complications (CVC) by such risk factors as the presence of albuminuria, and acute kidney injury (AKI). AKI episode in patients with ACS associated with increase of arrhythmias and death possibilities in late period. It is established that AKI coupled with an imbalance of body aquatic environments increases the CVC development possibility 6 months after percutaneous coronary intervention in patients with ACS. CONCLUSION. In patients with ACS and myocardial revascularization revealed prognostic impact of the AKI and failure of body aquatic environments at the risk of CVC. 

P3122Complete versus culprit-vessel only revascularization for patients with acute coronary syndromes and multivessel disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Ferreira ◽  
S Monteiro ◽  
R Baptista ◽  
F Goncalves ◽  
P Monteiro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular ◽  
Multivessel Disease ◽  
Left Ventricular Ejection ◽  
Great Loss ◽  
Coronary Syndrome ◽  
Propensity Matching ◽  
All Cause Mortality ◽  
The Impact

Abstract Background Recent randomized clinical trials have suggested that complete revascularization (CR) instead of culprit-vessel only revascularization (CVO) strategies may take a stand in the optimal management of patients admitted for acute myocardial infarction (AMI) with multivessel (MV) disease undergoing primary percutaneous coronary intervention (P-PCI). However, despite the 2017 ST-elevation acute coronary syndrome (STEMI) guidelines update with a new class of recommendation for CR, it remains controversial whether this strategy leads to better outcomes. Purpose To compare CR versus CV strategies during hospitalization in patients presenting with AMI with multivessel disease at P-PCI. Methods We analyzed data from all patients admitted with non-ST acute myocardial infarction (NSTEMI) and STEMI in a portuguese coronary care unit (CCU), between 2007 and 2016. We then evaluated potential differences of CR versus CVO with PCI during hospitalization in AMI patients with multivessel disease, defined by at least 2 different diseased main coronary vessels, saphenous vein or mammary artery conduits. We used 1:1 ratio propensity score matching to study the impact of CR on patient mortality and adjusted data for relevant risk factors at admission time. Results A total of 4758 patients were admitted for AMI, 2690 NSTEMI (56.5%) and 2068 STEMI (43.5%). Access to PCI records was possible in 3162 (66.5%) patients, of which 1707 (54%) underwent CR versus 1455 (46%) who underwent CVO. CVO patients were older (67.9±11.8 vs. 63.5±13.1 years, p<0.001), more diabetic (56.5% vs. 47.1%, p<0.001), hypertensive (78.4% vs. 72.2%, p<0.001), dyslipidemic (82.1% vs. 75%, p<0.001), had greater GRACE score at admission (mean score 143.4±37.2 vs. 131.2±131.2, p<0.001), had more severe coronary disease (mean number of diseased vessels – 2.56±0.6 vs. 2.18±0.4, p<0.004), reached higher Killip class (mean – 1.42±0.9 vs. 1.26±0.7, p<0.001) and had lower left ventricular ejection fraction (48.07±11.6 vs. 51.25±10.5, p<0.001). No significant differences were found in peak troponin-I release between CR and CV (44.7±69 vs. 46.9±76, respectively, p=0.468). After propensity matching, we obtained 130 CR and 133 CVO patients. In this cohort all-cause mortality was lower in CR group at 6-month (RR 0.262, CI 95% 0.071–0.962, p=0.031) and 1-year (RR 0.340, CI 95% 0.119–0.973, p=0.036) follow-up. When comparing STEMI versus NSTEMI all-cause mortality was nonsignificantly lower in CR (RR 0.394 vs. 0.226, p=0.12 vs. p=0.16). Conclusions In patients presenting with AMI and MV disease, CR strategy during hospitalization leads to greater 6-month and 1-year survival when compared with CVO strategy. Despite not having found significant differences when STEMI was directly compared to NSTEMI, we believe this was due to the great loss of patient numbers after propensity matching, requiring larger trials to prove the effect.

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