scholarly journals Killip-Kimball Classification Validation, Outcomes and Demographics in an Octogenarian Cohort with Acute Coronary Syndrome in a Developing Country: A Third-Level Multicenter 11-Year Experience

2020 ◽  
Author(s):  
Diego Ramonfaur ◽  
David E Hinojosa-Gonzalez ◽  
Jose G Paredes-Vazquez
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Kidney Injury ◽  
The Elderly ◽  
Killip Class ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Catheterization Procedure ◽  
Long Term Mortality

Introduction: The Killip-Kimball Classification (KC) is used to group patients with acute coronary syndrome (ACS) based on their clinical profile. It has proven to be useful while predicting both short- and long-term mortality. Contemporary data in the elderly population is limited. We sought to analyze trends in outcomes of patients 80 years or older admitted for ACS, by Killip Class. In addition, we assess the validity of the KC in this population. Methodology: A retrospective analysis of patients who underwent a catheterization procedure for ACS was performed. ACS was defined as per AHA guidelines, and included STEMI, non-STEMI and Unstable Angina. We determined factors influencing the KC in which patients present to the emergency room. Likewise, we compared in-hospital mortality, length of stay, and other outcomes dividing the patients by KC. Results: A total of 133 patients were analyzed. Included were: 86, 9, 23 and 15 patients in KC-I through IV respectively with a mean age of 83. The main comorbidities were hypertension (73%), and diabetes (43%). In-hospital mortality was 12%, which was different between KC groups (p< 0.01). In addition, we found higher KC groups to be associated with acute kidney injury during the hospitalization (p< 0.01). Conclusion: Despite a strong reduction in mortality for elderly patients with ACS in recent decades, patients presenting with ACS and higher Killip class have a high mortality rate, as described in younger cohorts. The Killip-Kimball classification remains a reliable prognostic tool, with applicability in octogenarian patients.

Prehospital tele-electrocardiographic triage improves the management of acute coronary syndrome in rural populations: A systematic review and meta-analysis

2020 ◽  
pp. 1357633X2096062
Author(s):  
Gilbert Lazarus ◽  
HL Kirchner ◽  
Bambang B Siswanto
Keyword(s):  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Rural Areas ◽  
Emergency Services ◽  
Meta Analysis ◽  
Coronary Syndrome ◽  
Evidence Quality ◽  
Poor Outcomes ◽  
Long Term Mortality

Introduction Acute coronary syndrome (ACS) patients residing in rural areas are predisposed to higher risk of poor outcomes due to substantial delays in disease management, emphasising the importance of emerging telecardiology technologies in delivering emergency services in such settings. This meta-analysis aimed to investigate the impacts of prehospital telecardiology strategies on the clinical outcomes of rural ACS patients. Methods A literature search was performed of articles published up to April 2020 through six databases. Included studies were assessed for bias risk using the ROBINS-I tool, and a random-effects model was utilised to estimate effect sizes. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Results Twelve studies with a total of 3989 patients were included in this review. Prehospital telecardiology in the form of tele-electrocardiography (tele-ECG) enabled prompt diagnosis and triage, resulting in a decreased door-to-balloon (DTB) time (mean difference = –25.53 minutes, 95% confidence interval (CI) –36.08 to –14.97 minutes; I2 = 98%), as well as lower in-hospital mortality (odds ratio (OR) = 0.57, 95% CI 0.36–0.92) and long-term mortality (OR = 0.52, 95% CI 0.39–0.69) rates, both with negligible heterogeneity ( I2 = 0%). GRADE assessment yielded very low to moderate certainty of evidence. Conclusion Prehospital tele-ECG appeared to be an effective and worthwhile approach in the management of rural ACS patients, as shown by moderate quality evidence on lower long-term mortality. Given the uncertainties of the evidence quality on DTB time and in-hospital mortality, future studies with a higher quality of evidence are required to confirm our findings.

Seventeen-Year Mortality following the Acute Coronary Syndrome: Gender-Specific Baseline Variables and Impact on Outcome

Cardiology ◽  
2019 ◽  
Vol 143 (1-2) ◽  
pp. 22-31
Author(s):  
Annica Ravn-Fischer ◽  
Elisabeth Perers ◽  
Thomas Karlsson ◽  
Kenneth Caidahl ◽  
Marianne Hartford
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiogenic Shock ◽  
Cox Regression ◽  
Late Mortality ◽  
Killip Class ◽  
Coronary Syndrome ◽  
Gender Specific ◽  
Long Term Mortality

Background: Gender differences in outcome and its predictors in patients with acute coronary syndrome (ACS) continue to be debated. Objectives: To assess long-term mortality and explore its association with the baseline variables in women and men. Methods: We followed 2,176 consecutive patients (665 women and 1,511 men) with ACS admitted to a single hospital and still alive after 30 days for a median of 16 years 8 months. Results: At the end of the follow-up, 415 (62.4%) women and 849 (56.2%) men had died (unadjusted hazard ratio [HR] for women/men 1.18 (95% confidence interval [CI], 1.05–1.33, p =0.005). After adjustment for age, the HR was reversed to 0.88 (95% CI, 0.78–1.00, p =0.04). Additional adjustment for potential confounders yielded a HR of 0.86 (95% CI, 0.76–0.98, p = 0.02). Using multivariable Cox regression, previous heart failure, previous or new-onset atrial fibrillation, and psychotropic drugs at discharge were significantly associated with increased long-term mortality in men only. Known hypertension, elevated creatinine, and inhospital Killip class >1/cardiogenic shock were significantly associated with mortality only in women. For late mortality, hypertension and inhospital Killip class >1/cardiogenic shock interacted significantly with gender. Conclusion: For patients with ACS surviving the first 30 days, late mortality was lower in women than in men after adjusting for age. The effects of several baseline characteristics on late outcome differed between women and men. Gender-specific strategies for long-term follow-up of ACS patients should be considered.

scholarly journals Temporal Trends in Prognosis of Patients with Acute Coronary Syndrome Complicated by Ventricular Tachyarrhythmia

2021 ◽  
Author(s):  
Ella Yahud ◽  
Avishag Laish Farkash ◽  
Nir Shlomo ◽  
Noam Fink ◽  
Ilan Goldenberg ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Mortality Rate ◽  
Clinical Characteristics ◽  
Ventricular Tachyarrhythmia ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Previous Decade ◽  
Short And Long Term ◽  
Long Term Mortality

Objectives: To evaluate clinical characteristics and prognosis of patients presented with ventricular tachyarrhythmia (VTA) during the course of acute coronary syndrome (ACS) and to analyze it according to period of presentation. Background: VTA is an infrequent yet serious complication of ACS. There is limited data regarding the incidence and prognostic implications of VTA in the last decade as compared with the previous decade. Methods: We evaluated clinical characteristics, major adverse cardiovascular events, short and long- term mortality of patients hospitalized with ACS who were enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) during the years 2000-2016. Patients were classified into three groups: no VTA, early VTA (≤48h of onset) and late VTA (>48h of onset). Data were analyzed according to decades of presentation (current decade vs. previous decade). Results: The study population comprised 15,200 patients. VTA occurred in 487 (3.2%) of patients. Early VTA presented in 373/487 (77%) patients and late VTA in 114/487 (23%) patients. VTA’s, occurring in ACS patients were associated with increased risk of in-hospital, 30-days, 1-year and 5-year mortality rates during both early and late periods in compared with no VTA. Moreover, late VTA was associated with the highest mortality rate with up to 65% in 5-year follow up (p<0.001). Nevertheless, late VTA was associated with lower mortality rate in the current decade (2008-2016) compared with last decade (2000-2006). Conclusions: Any VTA following ACS was associated with high short and long-term mortality rate. However, over the past decade there has been a significant improvement in survival rates, especially in patients with late VTA. This may be attributed to early and invasive reperfusion therapy, implantable cardioverter defibrillator implantation and better medical treatment.

Prognostic value of carotid intima-media in the short- and long-term mortality in the Strategy of Registry of Acute Coronary Syndrome (ERICO) study

2018 ◽  
Vol 35 (9) ◽  
pp. 1351-1361
Author(s):  
Danilo P. Meireles ◽  
Itamar S. Santos ◽  
Airlane P. Alencar ◽  
Paulo A. Lotufo ◽  
Isabela M. Benseñor ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Prognostic Value ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Long Term Mortality

Impact of evidence-based cardiac medications on short and long-term mortality in 7,567 acute coronary syndrome patients in the Gulf RACE-II registry

2012 ◽  
Vol 50 (06) ◽  
pp. 418-425 ◽  
Author(s):  
Ibrahim Al-Zakwani ◽  
Kadhim Sulaiman ◽  
Mohammed Al Za’abi ◽  
Prashanth Panduranga ◽  
Khalid Al-Habib ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Evidence Based ◽  
Coronary Syndrome ◽  
Short And Long Term ◽  
Long Term Mortality

Prognostic Factors and Outcomes in Young Patients With Presented of Different Types Acute Coronary Syndrome

Angiology ◽  
2020 ◽  
Vol 71 (10) ◽  
pp. 894-902
Author(s):  
Sabiye Yılmaz ◽  
Kahraman Coşansu
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Hospital Mortality ◽  
Young Patients ◽  
Hospital Death ◽  
Coronary Syndrome ◽  
Different Types ◽  
Long Term Mortality

The prevalence of coronary artery disease is increasing in young adults. We evaluated the outcomes of different types of acute coronary syndrome in 917 patients undergoing coronary angiography aged ≤45 years. Male sex, smoking, dyslipidemia were the most important risk factors. ST-elevation myocardial infarction (STEMI; 54.8%) predominated. The STEMI patients had higher risk of hospital mortality (3.6% vs 0.6%; P = .004) and major adverse cardiac and cerebrovascular events (MACCE; 13.8% vs 3.3%; P < .001, hazard ratio [HR], 4.65; 95% CI, 2.45-8.82). Presentation heart rate, blood pressure, heart failure, shock, arrhythmia, ejection fraction (EF), diabetes, contrast-induced nephropathy (CIN), and elevated troponin were associated with hospital mortality and MACCE. But only heart failure (HR, 5.816; 95% CI, 2.254-15.008) and CIN (HR, 6.241; 95% CI, 2.340-16.641) were independent risk factors for hospital MACCE. There was no difference in long-term mortality between the 2 groups, but non-STEMI patients had higher risk for MACCE after 3 years (14.4% vs 9.9%, P = .033). Although shock (HR, 0.814; 95% CI, 0.699-0.930), Killip class ≥2 (HR, 0.121; 95% CI, 0.071-0.170), CIN (HR, 0.323; 95% CI, 0.265-0.380), and EF (HR, 0.917; 95% CI, 0.854-0.984) were independent predictors of hospital death, only EF was the independent predictor of long-term mortality (HR, 0.897; 95% CI, 0.852-0.944).

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