scholarly journals Clinical and Utilization Outcomes of Matched People With and Without HIV Aged 65+

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 938-939
Author(s):  
Brianne Olivieri-Mui ◽  
Sandra Shi ◽  
Gahee Oh ◽  
Ellen McCarthy ◽  
Ira Wilson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Nursing Home ◽  
Muscle Wasting ◽  
Cox Regression ◽  
Home Health ◽  
Apparent Discrepancy ◽  
Sensory Deficits ◽  
Healthcare Needs ◽  
Geriatric Conditions

Abstract The prevalence of age-standardized comorbidities is significantly elevated for PLWH across an array of cohorts. However, healthcare needs of older people living with (PLWH) and without (PWOH) HIV may be similar if they have similar geriatric conditions. PLWH and PWOH aged 65+ and eligible for Medicare from 7/1/2014-1/1/2015 were matched 1:1 on age, sex, race, and census region (n=7654). Cox regression assessed count of prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty, and polypharmacy), and risk for clinical or utilization outcomes (cancer, kidney disease, muscle wasting, hepatitis C, liver disease, myocardial infarction, stroke; hospitalization, nursing home and home health admission) during follow-up between 1/1/2015-12/31/2016. PLWH and PWOH are similar in count of geriatric conditions. Compared to those with none, those having 2+ geriatric conditions were similar across PLWH and PWOH in their risk of ≥1 clinical outcome (PLWH: HR 1.57 95% CI [1.29-1.90]; PWOH: HR 1.31 [1.02-1.67]), hospitalization (PLWH: HR 2.35 [1.96-2.83]; PWOH: HR 2.07 [1.65-2.60]), and home health admission (PLWH: HR 2.09 [1.58-2.76]; PWOH: HR 2.20 [1.55-3.12]). Having 2+ geriatric conditions, PWOH had 4.45 times the risk (95% CI 3.16-6.26) and PLWH had 2.88 times the risk (95% CI 2.18-3.81) of NH admission compared to no geriatric conditions. In this study, PLWH use nursing homes less than PWOH despite having a similar number of geriatric conditions and clinical outcomes. Further research to understand this apparent discrepancy will be critical to achieve equity in nursing home access.

Predicting long-term cardiovascular outcomes of patients with acute myocardial infarction using soluble ST2

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Mustafa Umut Somuncu ◽  
Belma Kalayci ◽  
Ahmet Avci ◽  
Tunahan Akgun ◽  
Huseyin Karakurt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cox Regression ◽  
High Serum ◽  
Major Adverse Cardiovascular Events ◽  
Lower Systolic Blood Pressure ◽  
Cox Regression Analysis ◽  
Killip Class ◽  
Target Vessel Revascularization

AbstractBackgroundThe increase in soluble suppression of tumorigenicity 2 (sST2) both in the diagnosis and prognosis of heart failure is well established; however, existing data regarding sST2 values as the prognostic marker after myocardial infarction (MI) are limited and have been conflicting. This study aimed to assess the clinical significance of sST2 in predicting 1-year adverse cardiovascular (CV) events in MI patients.Materials and methodsIn this prospective study, 380 MI patients were included. Participants were grouped into low sST2 (n = 264, mean age: 60.0 ± 12.1 years) and high sST2 groups (n = 116, mean age: 60.5 ± 11.6 years), and all study populations were followed up for major adverse cardiovascular events (MACE) which are composed of CV mortality, target vessel revascularization (TVR), non-fatal reinfarction, stroke and heart failure.ResultsDuring a 12-month follow-up, 68 (17.8%) patients had MACE. CV mortality and heart failure were significantly higher in the high sST2 group compared to the low sST2 group (15.5% vs. 4.9%, p = 0.001 and 8.6% vs. 3.4% p = 0.032, respectively). Multivariate Cox regression analysis concluded that high serum sST2 independently predicted 1-year CV mortality [hazard ratio (HR) 2.263, 95% confidence interval (CI) 1.124–4.557, p = 0.022)]. Besides, older age, Killip class >1, left anterior descending (LAD) as the culprit artery and lower systolic blood pressure were the other independent risk factors for 1-year CV mortality.ConclusionsHigh sST2 levels are an important predictor of MACE, including CV mortality and heart failure in a 1-year follow-up period in MI patients.

Abstract 5605: Real World Comparison of Long Term Mortality after Primary Percutanous Coronary Intervention (PPCI) versus Fibrinolysis for Acute St Elevation Myocardial Infarction: Initial Experience from the 24 Hour PPCI Program in Nova Scotia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Boniface Chan ◽  
Helen Curran ◽  
Michael P Love ◽  
Stephen Fort
Keyword(s):  
Myocardial Infarction ◽  
Nova Scotia ◽  
Real World ◽  
Cox Regression ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Coronary Artery Patency ◽  
St Elevation ◽  
Door To Balloon

Background Randomized controlled trials indicate that acute ST elevation myocardial infarction (STEMI) patients have better clinical outcomes if rapid, complete and stable coronary artery patency can be achieved. The Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia (QEIIHSC) commenced a 24 hour PPCI program in November 2005. This real world study compares 2 year mortality in STEMI patients treated by PPCI versus patients treated by fibrinolysis with provisional rescue PCI within Nova Scotia, Canada. Methods This was a single center retrospective cohort study. All consecutive Nova Scotia, fibrinolytic and PPCI eligible STEMI patients presenting within 12 hours of symptom onset between July 1 st 2005 and June 30 th 2006 treated by PPCI at the QEIIHSC or fibrinolyis outside the QEIIHSC were included. The outcome measure was all cause mortality censored on June 30 th 2007. The crude and independent association between PPCI versus fibrinolysis on mortality was estimated using a Cox regression model. Results Data for 423 eligible patients (100% of cohort) comprised of 359/423 (85%) patients treated with fibrinolytics and 64/359 (18%) treated by PPCI were analyzed. The median follow-up was 1.4 years. The median (Q25 to Q75) door to needle times in the fibrinolytic group and corresponding door to balloon times in the PPCI group were: 0.5 (.3 to .9) and 1.5 (1.1 to 1.9) hours respectively. PPCI was associated with a consistent trend toward lower mortality versus fibrinolysis during hospitalization: 2/64 (3.1%) vs. 29/359 (8.1%), P=0.16 and at 30 days 2/64 (3.1%) vs. 32/359 (15%), P=0.12. This association was significant at 1 and 2 year follow-up: 2/64 (3.1%) vs. 41/359 (11%), P=0.043 and 2/64 (3.1%) vs. 45/359 (12%), P=0.027 respectively. This corresponded with an independent HR for 2 year mortality of: 0.1 (.01 to 0.8), p=0.03. Conclusion Initial data from the PPCI program at the QEIIHSC in Halifax, Nova Scotia indicates that PPCI was associated significant reductions in mortality versus fibrinolysis for real world patients presenting with STEMI. This mortality reduction was achieved in the early pilot phase of a PPCI program with evolving door to balloon timelines versus an established fibrinolytic program with acceptable door to needle timelines.

scholarly journals Long term perspective with LBBB: role of stress echocardiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Dedic ◽  
N Boskovic ◽  
V Giga ◽  
M Tesic ◽  
S Aleksandric ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Left Bundle Branch Block ◽  
Stress Echocardiography ◽  
Cox Regression ◽  
Survival Curve ◽  
Bundle Branch Block ◽  
Cox Regression Analysis ◽  
Increased Risk

Abstract Background Previous studies have shown that left bundle branch block (LBBB), as a relatively common electrocardiographic (ECG) abnormality, represents the condition with often non benign and sometimes adverse outcome. Purpose The Aim of our study was to determine the predictive value of a stress echocardiography test in patients with LBBB. Methods Our study population included 189 patients (88 male, 46.6%, mean age 63.08±9.65) with diagnosed left bundle branch block who performed stress echocardiography (SECHO) according to Bruce protocol. Median follow-up of the patients was 56 months (IQR 48–71 months) for the occurrence of cardiovascular death and non-fatal myocardial infarction, repeat revascularization (coronary artery bypass grafting-CABG or percutaneous coronary intervention-PCI). Results Out of 189 patients, 32 (16.9%) patients had positive, while 157 (83.1%) patients had negative SECHO test. During the follow up period 28 patients had major adverse cardiac event: 1 nonfatal myocardial infarction, 6 heart failure hospitalizations, 5 CABGs, 8 PCIs, while 8 patients had cardiac death. Using the Cox regression analysis, univariate predictors of adverse cardiac events were diabetes mellitus (HR 4.530 [95% CI 1.355–15.141], p=0.014), PCI (HR 4.288 [95% [95% CI 2.010–9.144], p<0.001) and positive SECHO test (HR 2.289 [95% CI 1.006–5207], p=0.048). In the multivariate analysis only previous PCI remained independent predictor of adverse events (HR 3.650 [95% CI 1.665–8.003], p=0.001). p=0.048). Using the Kaplan-Meier survival curve the patients with negative SECHO had better outcome compared to patients with positive SECHO (140/160; 87,5% vs 21/29; 72.4%, p=0.035) and much longer event-free time (77.4±1.6 months vs 67.1±5.4 months, Log Rank 4.136, p=0.042) Conclusion Patients with LBBB and negative SEHO test have good prognosis. Patients with history of CAD and diabetes mellitus and LBBB are at increased risk for future events and need periodical reassessment. Funding Acknowledgement Type of funding source: None

scholarly journals Evaluation of pulse wave velocity for predicting major advanced cardiovascular events in patients with chronic myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Z Meiszterics ◽  
T Simor ◽  
R J Van Der Geest ◽  
N Farkas ◽  
B Gaszner
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cardiovascular Events ◽  
Pulse Wave ◽  
Cox Regression ◽  
Event Free Survival ◽  
Free Survival ◽  
Cox Regression Analysis ◽  
Kaplan Meier

Abstract Introduction Increased aortic pulse wave velocity (PWV) as a strong predictor of major advanced cardiovascular events (MACE) has a prognostic relevance in patients after myocardial infarction (MI). Several non-invasive methods have been proposed for the assessment of arterial stiffness, but the PWV values show significant differences according to the applied techniques. Cardiac magnetic resonance imaging (CMR) provides an accurate method to measure PWV and infarct size in patients after MI. Purpose Calculated PWV values of CMR based phase-contrast (PC) and invasively validated oscillometric methods were compared in this prospective observational study. We aimed to evaluate the cut-off PWV values for each method, while MACE predicted and validated the prognostic value of high PWV in post-infarcted patients in a 6-year follow-up. Methods 3D aortic angiography and PC velocity imaging was performed using a Siemens Avanto 1,5 T CMR device. Oscillometric based Arteriograph (AG) was used to assess PWV using direct body surface distance measurements. The comparison between the two techniques was tested. Patients received follow-up for MACE comprising all-cause death, non-fatal MI, ischemic stroke, hospitalization for heart failure and coronary revascularization. Event-free survival was analysed using Kaplan-Meier plots and log-rank tests. Univariable and multivariable Cox regression analysis was performed to identify outcome predictors. Results 75 patients (56 male, 19 female, average age: 56±13 years) referred for CMR were investigated, of whom 50 had coronary artery disease (CAD) including 35 patients with previous MI developing ischaemic late gadolinium enhancement (LGE) pattern. AG and CMR derived PWV values were significantly correlated (rho: 0,343, p<0,05), however absolute PWV values were significantly higher for AG (median (IQR): 10,4 (9,2–11,9) vs. 6,44 (5,64–7,5); p<0,001). Bland Altman analysis showed an acceptable agreement with a mean difference of 3,7 m/s between the two measures. In patients with CAD significantly (p<0,01) higher PWV values were measured by AG and CMR, respectively. During the median follow-up of 6 years, totally 69 MACE events occurred. Optimized PWV cut-off values for MACE prediction were calculated (CMR: 6,47 m/s; AG: 9,625 m/s) by receiver operating characteristic analysis. Kaplan-Meier analysis in both methods showed a significantly lower event-free survival in case of high PWV (p<0,01, respectively). Cox regression analysis revealed PWV for both methods as a predictor of MACE (PWV CMR hazard ratio (HR): 2,6 (confidence interval (CI) 1,3–5,1), PWV AG HR: 3,1 (CI: 1,3–7,1), p<0,005, respectively). Conclusions Our study showed good agreement between the AG and CMR methods for PWV calculation. Both techniques are feasible for MACE prediction in postinfarcted patients. However, different AG and CMR PWV cut-off values were calculated to improve risk stratification. FUNDunding Acknowledgement Type of funding sources: None. Agreement between the two methods Kaplan-Meier event curves for MACE

scholarly journals Usefulness of NT-proBNP in the Follow-Up of Patients after Myocardial Infarction

2016 ◽  
Vol 35 (2) ◽  
pp. 158-165 ◽  
Author(s):  
Mina Radosavljevic-Radovanovic ◽  
Nebojsa Radovanovic ◽  
Zorana Vasiljevic ◽  
Jelena Marinkovic ◽  
Predrag Mitrovic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Clinical Chemistry ◽  
Left Ventricular ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
Cut Points ◽  
One Year

SummaryBackground:Since serial analyses of NT-proBNP in patients with acute coronary syndromes have shown that levels measured during a chronic, later phase are a better predictor of prognosis and indicator of left ventricular function than the levels measured during an acute phase, we sought to assess the association of NT-proBNP, measured 6 months after acute myocardial infarction (AMI), with traditional risk factors, characteristics of in-hospital and early postinfarction course, as well as its prognostic value and optimal cut-points in the ensuing 1-year follow-up.Methods:Fasting venous blood samples were drawn from 100 ambulatory patients and NT-proBNP concentrations in lithium-heparin plasma were determined using a one-step enzyme immunoassay based on the »sandwich« principle on a Dimension RxL clinical chemistry system (DADE Behring-Siemens). Patients were followed-up for the next 1 year, for the occurrence of new cardiac events.Results:Median (IQR) level of NT-proBNP was 521 (335–1095) pg/mL. Highest values were mostly associated with cardiac events during the first 6 months after AMI. Negative association with reperfusion therapy for index infarction confirmed its long-term beneficial effect. In the next one-year follow-up of stable patients, multivariate Cox regression analysis revealed the independent prognostic value of NT-proBNP for new-onset heart failure prediction (p=0.014), as well as for new coronary events prediction (p=0.035). Calculation of the AUCs revealed the optimal NT-proBNP cut-points of 800 pg/mL and 516 pg/mL, respectively.Conclusions:NT-proBNP values 6 months after AMI are mainly associated with the characteristics of early infarction and postinfarction course and can predict new cardiac events in the next one-year follow-up.

Abstract P85: Are Myocardial Bridges Associated With Increased Risk of Death or Myocardial Infarction?

2011 ◽  
Vol 4 (suppl_1) ◽  
Author(s):  
Mouaz H Al-Mallah ◽  
Kamal Kassem ◽  
Owais Khawaja ◽  
Thomas Song ◽  
Chad Poopat ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Prognostic Value ◽  
Cox Regression ◽  
Study Cohort ◽  
Risk Of Death ◽  
Increased Risk ◽  
Artery Disease

Background: Myocardial bridging (MB) is frequently seen on coronary CT angiography (CCTA). However, there has been conflicting data on the prognostic value of MB. The aim of this analysis is to determine the prognostic value of MB in patients without obstructive coronary artery disease (CAD) (<50 diameter stenosis). Methods: We included patients with no known prior coronary artery disease (CAD) who underwent CCTA for various clincial reasons. Patients with obstructive CAD on CCTA were excluded. The study cohort was followed for all cause mortality or myocardial infarction (MI) (median follow-up 1.7 years). Group comparisons were made between patients with patients with or without MB. Results: A total of 715 patients were included in this analysis of which 68 patients had MB (10%). 73% of the bridges were in the mid LAD and 22% had bridging in the distal LAD. 48% of the study cohort had normal coronaries, while 52% had evidence of non obstructive CAD. There were no differences in the baseline characteristics, symptomatic status or prevalence of non obstructive CAD between the two groups (all p>0.5). After a median follow-up duration of 1.7 years, 23 patients died and 10 patients experienced myocardial infarction. There were no statistically significant differences in the rate of death/MI between the two groups (figure). Using multivariable Cox regression, the presence of MB was not associated with increased risk for death/MI (Adjusted HR 0.4, 95% confidence interval 0.1 -2.8, p=0.34) Conclusions: In patients with non-obstructive CAD, MB is not associated with increased risk for all cause death or MI.

Abstract 2367: Omega 3 Fatty Acid Supplementation Reduce One-Year Risk of Atrial Fibrillation in Patients Hospitalized with Myocardial Infarction

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alejandro Macchia ◽  
Simona Monte ◽  
Fabio Pellegrini ◽  
Marilena Romero ◽  
Daniel Ferrante ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Sensitivity Analysis ◽  
Cox Regression ◽  
Supraventricular Arrhythmia ◽  
Omega 3 ◽  
Matching Algorithm ◽  
Italian Regions ◽  
One Year

Background: Current medical strategies for avoidance of atrial fibrillation (AF) are of limited value. Anti-arrhythmic agents faced major challenges related to their limited efficacy and their serious and frequent side effects. Epidemiological studies, clinical trials and basic science support the role of Omega-3 fatty acids (n-3 PUFA) in reducing all cause mortality among patients with previous myocardial infarction (MI), mostly by reducing ventricular arrhythmias. However their effects regarding supraventricular arrhythmia are not well characterized. Aim: To assess the effect of supplementation with n-3 PUFA for the prevention of AF. Methods: Population study, linking administrative datasets from hospital discharge, prescription databases and vital statistics, including all consecutive patients with MI (code ICD-9: 410) in 6 Italian regions during a 3-year period. Follow up was extended up to one year or to time to event. A Cox regression model adjusted for propensity score (PS) quintiles was used. Further a PS-based 5 to 1 greedy matching algorithm and sensitivity analysis were used to assess robustness of our findings. Results: Three thousand two hundred and forty-two (3,242) patients were identified and included in the analysis. Of these, 208 (6.4%) were exposed to n-3 PUFA during follow up. Four out of 208 (1.9%) patients exposed to n-3 PUFA were hospitalized with AF during follow up as compared with 467 out of 3,034 (15.4%) of those not exposed to supplement n-3 PUFA. The PS-quintiles adjusted hazard ratio (HR) estimate was 0.19 (95%CI 0.07– 0.51; p=0.001). The PS based 5 to 1 greedy matching algorithm and sensitivity analysis confirm main results (HR=0.13; 95%CI 0.04 – 0.44; p=0.001). Conclusion: n-3 PUFA reduce the occurrence of one year AF in patients hospitalized with MI.

scholarly journals Managed Care after Acute Myocardial Infarction (MC-AMI) Reduces Total Mortality in 12-Month Follow-Up—Results from a Poland’s National Health Fund Program of Comprehensive Post-MI Care—A Population-Wide Analysis

2020 ◽  
Vol 9 (10) ◽  
pp. 3178
Author(s):  
Krystian Wita ◽  
Andrzej Kułach ◽  
Jacek Sikora ◽  
Joanna Fluder ◽  
Ewa Nowalany-Kozielska ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Managed Care ◽  
Cardiac Rehabilitation ◽  
National Health ◽  
Cox Regression ◽  
Mortality Reduction ◽  
Health Fund ◽  
One Year

Introduction: Advances in the acute treatment of myocardial infarction (AMI) substantially reduced in-hospital mortality, but the post-discharge prognosis is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI) is a program of Poland’s National Health Fund that aims at comprehensive post-AMI care to improve long-term prognosis. The aim of the study was to assess the effect of MC-AMI on all-cause mortality in one-year follow-up. Methods: MC-AMI includes acute MI treatment, complex revascularization, cardiac rehabilitation (CR), scheduled one-year outpatient follow-up, and prevention of sudden cardiac death. In this retrospective observational study performed in a province of Silesia, Poland, we analyzed 3893 MC-AMI participants, and compared them to 6946 patients in the control group. After propensity score matching, we compared two groups of 3551 subjects each. To assess the effect of MC-AMI and other variables on mortality, we preformed a Cox regression. Results: MC-AMI was related with mortality reduction by 38% in a 12-month observation period and the effect persisted even after. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with 1-year mortality (HR 0.52, 95%CI 0.42–0.65, p < 0.001). Besides that, older age (HR 1.47/10 y), ST-elevation AMI (HR 1.41), heart failure (HR 2.08), diabetes (HR 1.52), and dialysis (HR 2.38) were significantly associated with the primary endpoint. Among MC-AMI components, cardiac rehabilitation (HR 0.34) and strict outpatient care (HR 0.42) are the crucial factors affecting mortality reduction. Conclusions: Participation in MC-AMI reduced 1-year mortality by 38% and the effect persisted after the program had been completed.

scholarly journals Oxygen-regulated protein 150 and prognosis following myocardial infarction

2007 ◽  
Vol 112 (9) ◽  
pp. 477-484 ◽  
Author(s):  
Leong L. Ng ◽  
Russell J. O'Brien ◽  
Paulene A. Quinn ◽  
Iain B. Squire ◽  
Joan E. Davies
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Endoplasmic Reticulum ◽  
Odds Ratio ◽  
Acute Coronary Syndromes ◽  
Cox Regression ◽  
Cardiovascular Morbidity ◽  
Prognostic Information ◽  
Coronary Syndromes

ORP150 (oxygen-regulated protein 150) is a chaperonin expressed in tissues undergoing hypoxic or endoplasmic reticulum stress. In the present study, we investigated plasma levels of ORP150 in patients with AMI (acute myocardial infarction) and its relationship with prognosis, together with a known risk marker N-BNP (N-terminal pro-B-type natriuretic peptide). Plasma from 396 consecutive patients with AMI was obtained for measurement of ORP150 and N-BNP. Mortality and cardiovascular morbidity (acute coronary syndromes/heart failure) was determined during follow-up. A specific ORP150 assay detected the 150 kDa protein in plasma extracts, including 3 and 7 kDa fragments. During follow-up (median, 455 days), 43 (10.9%) patients died. Both N-BNP and ORP150 levels were higher in those who died compared with the survivors [N-BNP, 724 (14.5–28840) compared with 6167 (154.9–33884) pmol/l (P<0.0005); ORP150, 257 (5.9–870.9) compared with 331 (93.3–831.8) pmol/l (P<0.001); values are medians (range)]. In a Cox regression model for mortality prediction, both N-BNP (odds ratio, 5.06; P<0.001) and ORP150 (odds ratio, 2.39; P<0.01) added prognostic information beyond creatinine and the use of thrombolytics. A Kaplan–Meier survival analysis revealed that ORP150 added prognostic information to N-BNP, especially in those with supra-median N-BNP levels. A simplified dual-marker approach with both markers below and either above or both above their respective medians effectively stratified mortality risk (log rank statistic for trend, 32.7; P<0.00005). ORP150 levels were not predictive of other cardiovascular morbidity (acute coronary syndromes or heart failure). In conclusion, ORP150 and peptide fragments derived from it are secreted following AMI and provide independent prognostic information on mortality. High levels associated with endoplasmic reticulum/hypoxic stress predict a poor outcome.

scholarly journals Prognostic value of vasodilator stress perfusion CMR in patients with known myocardial infarction

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
T Pezel ◽  
P Garot ◽  
M Kinnel ◽  
V Landon ◽  
T Hovasse ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Prognostic Value ◽  
Cox Regression ◽  
Vasodilator Stress ◽  
Stress Perfusion ◽  
Inducible Ischemia ◽  
Kaplan Meier ◽  
Stress Cmr ◽  
Perfusion Cmr

Abstract Funding Acknowledgements Type of funding sources: None. BACKGROUND Several studies have demonstrated the consistently high prognostic value of stress perfusion cardiovascular magnetic resonance (CMR). This prognostic value in patients with known myocardial infarction (MI) is poorly described. There remains some skepticism about the capacity of stress CMR in predicting the clinical outcome due to the technical challenge during image analysis causes by myocardial scar. PURPOSE The aim of our study was to assess the prognostic value of vasodilator stress perfusion CMR in patients with known MI. METHODS We prospectively included consecutive patients with known MI referred for vasodilator stress perfusion CMR with dipyridamole. They were followed for the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death or recurrent non-fatal myocardial infarction (MI). Univariable and multivariable Cox regressions for MACE were performed to determine the prognostic value of inducible ischemia or late gadolinium enhancement (LGE) by CMR. RESULTS Of 1602 patients with known MI (68 ± 17 years, 78% men), 1556 (97%) completed the CMR protocol, and among those 1401 (90%) completed the follow-up (median follow-up 5.7 (3.9–7.6) years). Reasons for failure to complete CMR included ECG-gating problems (n = 13), intolerance to stress agent (n = 12), renal failure (n = 12), declining participation (n = 4) and claustrophobia (n = 5). Stress CMR was well tolerated without occurrence of death or severe adverse event. Patients without inducible ischemia experienced a substantially lower annual event rate of MACE (3.1%) than those with 1 or 2 segments of ischemia (4.5%), than those with 3 to 5 segments of ischemia (21.5%), than those with 6 or more segments of ischemia (45.7%, for all p &lt; 0.01). Using Kaplan-Meier analysis, the presence of myocardial ischemia identified the occurrence of MACE (hazard ratio HR 3.52; 95% confidence interval CI: 2.67 – 4.65; p &lt; 0.001). In a multivariable stepwise Cox regression including clinical characteristics and CMR indexes, the presence of inducible ischemia was an independent predictor of a higher incidence of MACE (HR 2.84; 95% CI: 2.14 to 3.78; p &lt; 0.001). CONCLUSION Stress CMR is technically feasible and has a good discriminative prognostic value to predict the occurrence of MACE in patients with known MI. Abstract Figure. Kaplan-Meier curves for MACE

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