scholarly journals Hemoglobin glycation index, calculated from a single fasting glucose value, as a prediction tool for severe hypoglycemia and major adverse cardiovascular events in DEVOTE

2021 ◽  
Vol 9 (2) ◽  
pp. e002339
Author(s):  
Klara R Klein ◽  
Edward Franek ◽  
Steven Marso ◽  
Thomas R Pieber ◽  
Richard E Pratley ◽  
...  
Keyword(s):  
Cox Regression ◽  
Severe Hypoglycemia ◽  
Population Data ◽  
Major Adverse Cardiovascular Event ◽  
Secondary Outcome ◽  
Major Adverse Cardiovascular Events ◽  
Insulin Initiation ◽  
Adverse Cardiovascular Event ◽  
Double Blind ◽  
Hemoglobin Glycation

IntroductionHemoglobin glycation index (HGI) is the difference between observed and predicted glycated hemoglobin A1c (HbA1c), derived from mean or fasting plasma glucose (FPG). In this secondary, exploratory analysis of data from DEVOTE, we examined: whether insulin initiation/titration affected the HGI; the relationship between baseline HGI tertile and cardiovascular and hypoglycemia risk; and the relative strengths of HGI and HbA1c in predicting these risks.Research design and methodsIn DEVOTE, a randomized, double-blind, cardiovascular outcomes trial, people with type 2 diabetes received once per day insulin degludec or insulin glargine 100 units/mL. The primary outcome was time to first occurrence of a major adverse cardiovascular event (MACE), comprising cardiovascular death, myocardial infarction or stroke; severe hypoglycemia was a secondary outcome. In these analyses, predicted HbA1c was calculated using a linear regression equation based on DEVOTE data (HbA1c=0.01313 FPG (mg/dL) (single value)+6.17514), and the population data were grouped into HGI tertiles based on the calculated HGI values. The distributions of time to first event were compared using Kaplan–Meier curves; HRs and 95% CIs were determined by Cox regression models comparing risk of MACE and severe hypoglycemia between tertiles.ResultsChanges in HGI were observed at 12 months after insulin initiation and stabilized by 24 months for the whole cohort and insulin-naive patients. There were significant differences in MACE risk between baseline HGI tertiles; participants with high HGI were at highest risk (low vs high, HR: 0.73 (0.61 to 0.87)95% CI; moderate vs high, HR: 0.67 (0.56 to 0.81)95% CI; p<0.0001). No significant differences between HGI tertiles were observed in the risk of severe hypoglycemia (p=0.0911). With HbA1c included within the model, HGI no longer significantly predicted MACE.ConclusionsHigh HGI was associated with a higher risk of MACE; this finding is of uncertain significance given the association of HGI with insulin initiation and HbA1c.Trial registration numberNCT01959529.

scholarly journals Effects of exenatide and open-label SGLT2 inhibitor treatment, given in parallel or sequentially, on mortality and cardiovascular and renal outcomes in type 2 diabetes: insights from the EXSCEL trial

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Lindsay E. Clegg ◽  
Robert C. Penland ◽  
Srinivas Bachina ◽  
David W. Boulton ◽  
Marcus Thuresson ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Mixed Model ◽  
Cox Regression ◽  
Sglt2 Inhibitor ◽  
Major Adverse Cardiovascular Event ◽  
Cardiovascular Outcomes ◽  
Open Label ◽  
Adverse Cardiovascular Event ◽  
Renal Outcomes

Abstract Background Sodium-glucose cotransporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP-1 RA) improve cardiovascular and renal outcomes in patients with type 2 diabetes through distinct mechanisms. However, evidence on clinical outcomes in patients treated with both GLP-1 RA and SGLT2i is lacking. We aim to provide insight into the effects of open-label SGLT2i use in parallel with or shortly after once-weekly GLP-1 RA exenatide (EQW) on cardiorenal outcomes. Methods In the EXSCEL cardiovascular outcomes trial EQW arm, SGLT2i drop-in occurred in 8.7% of participants. These EQW+SGLT2i users were propensity-matched to: (1) placebo-arm participants not taking SGLT2i (n = 572 per group); and to (2) EQW-arm participants not taking SGLT2i (n = 575), based on their last measured characteristics before SGLT2i initiation, and equivalent study visit in comparator groups. Time-to-first major adverse cardiovascular event (MACE) and all-cause mortality (ACM) were compared using Cox regression analyses. eGFR slopes were quantified using mixed model repeated measurement analyses. Results In adjusted analyses, the risk for MACE with combination EQW+SGLT2i use was numerically lower compared with both placebo (adjusted hazard ratio 0.68, 95% CI 0.39–1.17) and EQW alone (0.85, 0.48–1.49). Risk of ACM was nominally significantly reduced compared with placebo (0.38, 0.16–0.90) and compared with EQW (0.41, 0.17–0.95). Combination EQW+SGLT2i use also nominally significantly improved estimated eGFR slope compared with placebo (+ 1.94, 95% CI 0.94–2.94 mL/min/1.73 m2/year) and EQW alone (+ 2.38, 1.40–3.35 mL/min/1.73 m2/year). Conclusions This post hoc analysis supports the hypothesis that combinatorial EQW and SGLT2i therapy may provide benefit on cardiovascular outcomes and mortality. Trial registration Clinicaltrials.gov, Identifying number: NCT01144338, Date of registration: June 15, 2010.

Terminal QRS Distortion on Admission ECG as a Predictor for Major Cardiovascular Adverse Events during Hospitalization in Patient with ST Segment Elevation Myocardial Infarction in Haji Adam Malik General Hospital

2020 ◽  
Vol 6 (2) ◽  
pp. 121-126
Author(s):  
Kamal Kharrazi Ilyas ◽  
Zainal Safri ◽  
Harris Hasan ◽  
Zulfikri Mukhtar ◽  
Nizam Zikri Akbar ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Major Adverse Cardiovascular Event ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Significant Variable ◽  
S Wave ◽  
Adverse Cardiovascular Event ◽  
St Segment Elevation ◽  
Coronary Syndrome

Background: Mortality in patient with acute myocardial infarction has decreased due to evolution in management system in patient with acute coronary syndrome, but mortality rate during hospitalization remains high, especially STEMI. Electrocardiography (ECG) has a role for diagnosing and predict prognosis in acute myocardial infarction. Terminal QRS distortion defined as J point elevation more than 50% of R wave in lead with qR configuration and/or loss of S wave with RS configuration. Changes of terminal QRS segment believed to be caused by electrical conduction elongation in Purkinje fiber or myocardial ischemic zone that represent severe ischemia. The purpose of this study is to assess the role of terminal QRS distortion as one of the parameter to predict major adverse cardiovascular events during hospitalization in ST elevation myocardial infarction in RSUP H. Adam Malik Methods: This is a ambispective observational study consist of STEMI patients who were hospitalized from Mei 2019 to September 2019. All subjects diagnosed with STEMI and already fulfilled the inclusion and exclusion criterias. The terminal QRS distortion on the ECGs was assessed when the patient came to emergency departement. Then during hospitalization, the patients will undergo intervention and then observed during hospitalization for MACE occurrence. Results: Of the 78 STEMI patients, 44 people had terminal QRS distortion and 34 did not have terminal QRS distortion. In group with terminal QRS distortion, 27 people experiences MACE. From the correlation analysis, there is positive correlation between terminal QRS distortion with MACE with correlation coefficient 0.317 (p value < 0.001). Multivariate analysis for most significant variable for MACE occurrence shows that terminal QRS distortion can predict MACE (OR 3.66 [1.317-10.166], 95% CI, p = 0.013) Conclusion: Terminal QRS distortion found in ECG at admission in STEMI patient correlate with major adverse cardiovascular event during hospitalization.

Percutaneous Coronary Intervention Following Diagnostic Angiography by Noninterventional Versus Interventional Cardiologists: Insights From the CathPCI Registry

2021 ◽  
Author(s):  
Fabio V. Lima ◽  
Pratik Manandhar ◽  
Daniel Wojdyla ◽  
Tracy Wang ◽  
Herbert D. Aronow ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Cardiovascular Event ◽  
Cardiovascular Events ◽  
Ad Hoc ◽  
Major Adverse Cardiovascular Event ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Diagnostic Cardiac Catheterization ◽  
Percutaneous Coronary

Background: There are limited contemporary, national data describing diagnostic cardiac catheterization with subsequent percutaneous coronary intervention (ad hoc percutaneous coronary intervention [PCI]) performed by an invasive-diagnostic and interventional (Dx/IC) operator team versus solo interventional operator (solo-IC). Using the CathPCI Registry, this study aimed at analyzing trends and outcomes in ad hoc PCI among Dx/IC versus solo-IC operators. Methods: Quarterly rates (January 2012 to March 2018) of ad hoc PCI cases by Dx/IC and solo-IC operators were obtained. Odds of inhospital major adverse cardiovascular events, net adverse cardiovascular events (ie, composite major adverse cardiovascular event+bleeding), and rarely appropriate PCI were estimated using multivariable regression. Results: From 1077 sites, 1 262 948 patients were included. The number of invasive-diagnostic operators and cases performed by Dx/IC teams decreased from nearly 9% to 5% during the study period. Patients treated by Dx/IC teams were more often White and had fewer comorbidities compared with patients treated by solo-IC operators. Considerable variation existed across sites, and over two-fifths of sites had 0% ad hoc PCI performed by Dx/IC. In adjusted analyses, ad hoc performed by Dx/IC had similar risks of major adverse cardiovascular event (OR, 1.04 [95% CI, 0.97–1.11]) and net adverse cardiovascular events (OR, 0.98 [95% CI, 0.94–1.03]) compared with solo-IC. Rarely appropriate PCI, although low overall (2.1% versus 1.9%) occurred more often by Dx/IC compared with solo-IC (OR, 1.20 [95% CI, 1.13–1.26]). Conclusions: Contemporary, nationwide data from the CathPCI Registry demonstrates the number of Dx/IC operator teams and cases has decreased but that case volume is stable among operators. Outcomes were independent of operator type, which supports current practice patterns. The finding of a higher risk of rarely appropriate PCI in Dx/IC teams should be further studied.

scholarly journals Major Adverse Cardiovascular Events During Invasive Pneumococcal Disease Are Serotype Dependent

2020 ◽  
Author(s):  
Hector F Africano ◽  
Cristian C Serrano-Mayorga ◽  
Paula C Ramirez-Valbuena ◽  
Ingrid G Bustos ◽  
Alirio Bastidas ◽  
...  
Keyword(s):  
Invasive Pneumococcal Disease ◽  
Pneumococcal Disease ◽  
Bacterial Pathogen ◽  
Retrospective Chart Review ◽  
Clinical Information ◽  
Major Adverse Cardiovascular Event ◽  
Community Acquired Pneumonia ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Reactive Protein

Abstract Background Up to 30% of patients admitted to hospitals with invasive pneumococcal disease (IPD) experience major adverse cardiovascular event (MACE) including new/worsening heart failure, new/worsening arrhythmia, and/or myocardial infarction. Streptococcus pneumoniae (Spn) is the most frequently isolated bacterial pathogen among community-acquired pneumonia (CAP) patients and the only etiological agent linked independently to MACE. Nevertheless, no clinical data exist identifying which serotypes of Spn are principally responsible for MACE. Methods This was an observational multicenter retrospective study conducted through the Public Health Secretary of Bogotá, Colombia. We included patients with a confirmed clinical diagnosis of IPD with record of pneumococcal serotyping and clinical information between 2012 and 2019. Spn were serotyped using the quellung method by the National Center of Microbiology. MACE were determined by a retrospective chart review. Results The prevalence of MACE was 23% (71/310) in IPD patients and 28% (53/181) in patients admitted for CAP. The most prevalent S. pneumoniae serotype identified in our study was the 19A, responsible for the 13% (42/310) of IPD in our cohort, of which 21% (9/42) presented MACE. Serotypes independently associated with MACE in IPD patients were serotype 3 (odds ratio [OR] 1, 48; 95% confidence interval [CI] [1.21–2.27]; P = .013) and serotype 9n (OR 1.29; 95% CI [1.08–2.24]; P = .020). Bacteremia occurred in 87% of patients with MACE. Moreover, serum concentrations of C-reactive protein were elevated in patients with MACE versus in non-MACE patients (mean [standard deviation], 138 [145] vs 73 [106], P = .01). Conclusions MACE are common during IPD with serotype 3 and 9n independently of frequency.

scholarly journals Influence of sex and phenotype on cardiac outcomes in patients with Fabry disease

Heart ◽  
2021 ◽  
pp. heartjnl-2020-317922
Author(s):  
Mohamed El Sayed ◽  
Alexander Hirsch ◽  
Matthijs Boekholdt ◽  
Laura van Dussen ◽  
Mareen Datema ◽  
...  
Keyword(s):  
Fabry Disease ◽  
Cox Regression ◽  
Age Of Onset ◽  
Major Adverse Cardiovascular Event ◽  
Cardiovascular Death ◽  
Disease Phenotype ◽  
Cardiac Events ◽  
Adverse Cardiovascular Event ◽  
Major Cardiovascular Events ◽  
Event Rates

ObjectiveThis study describes the influence of sex and disease phenotype on the occurrence of cardiac events in Fabry disease (FD).MethodsCardiac events from birth to last visit (median age 50 years) were recorded for 213 patients with FD. Patients were categorised as follows : men with classical FD (n=57), men with non-classical FD (n=26), women with classical FD (n=98) and women with non-classical FD (n=32), based on the presence of classical FD symptoms, family history (men and women), biomarkers and residual enzyme activity (men). Event rates per 1000 patient-years after the age of 15 years and median event-free survival (EVS) age were presented. Influence of disease phenotype, sex and their interaction was studied using Firth’s penalised Cox regression.ResultsThe event rates of major cardiovascular events (combined endpoint cardiovascular death (CVD), heart failure (HF) hospitalisation, sustained ventricular arrhythmias (SVAs) and myocardial infarction) were 11.0 (95% CI 6.6 to 17.3) in men with classical FD (EVS 55 years), 4.4 (95% CI 2.5 to 7.1) in women with classical FD (EVS 70 years) and 5.9 (95% CI 2.6 to 11.6) in men with non-classical FD (EVS 70 years). None of these events occurred in women with non-classical FD. Sex and phenotype significantly influenced the risk of major adverse cardiovascular event. CVD was the leading cause of death (75%) to which HF contributed most (42%). The overall rate of SVA was low (14 events in nine patients (4%)).ConclusionsSex and phenotype greatly influence the risk and age of onset of cardiac events in FD. This indicates the need for patient group-specific follow-up and treatment.

scholarly journals Major adverse cardiovascular event definitions used in observational analysis of administrative databases: a systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Elliott Bosco ◽  
Leon Hsueh ◽  
Kevin W. McConeghy ◽  
Stefan Gravenstein ◽  
Elie Saade
Keyword(s):  
Unstable Angina ◽  
Administrative Data ◽  
Observational Studies ◽  
Major Adverse Cardiovascular Event ◽  
International Classification Of Diseases ◽  
Cardiovascular Death ◽  
Administrative Databases ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Primary Position

Abstract Background Major adverse cardiovascular events (MACE) are increasingly used as composite outcomes in randomized controlled trials (RCTs) and observational studies. However, it is unclear how observational studies most commonly define MACE in the literature when using administrative data. Methods We identified peer-reviewed articles published in MEDLINE and EMBASE between January 1, 2010 to October 9, 2020. Studies utilizing administrative data to assess the MACE composite outcome using International Classification of Diseases 9th or 10th Revision diagnosis codes were included. Reviews, abstracts, and studies not providing outcome code definitions were excluded. Data extracted included data source, timeframe, MACE components, code definitions, code positions, and outcome validation. Results A total of 920 articles were screened, 412 were retained for full-text review, and 58 were included. Only 8.6% (n = 5/58) matched the traditional three-point MACE RCT definition of acute myocardial infarction (AMI), stroke, or cardiovascular death. None matched four-point (+unstable angina) or five-point MACE (+unstable angina and heart failure). The most common MACE components were: AMI and stroke, 15.5% (n = 9/58); AMI, stroke, and all-cause death, 13.8% (n = 8/58); and AMI, stroke and cardiovascular death 8.6% (n = 5/58). Further, 67% (n = 39/58) did not validate outcomes or cite validation studies. Additionally, 70.7% (n = 41/58) did not report code positions of endpoints, 20.7% (n = 12/58) used the primary position, and 8.6% (n = 5/58) used any position. Conclusions Components of MACE endpoints and diagnostic codes used varied widely across observational studies. Variability in the MACE definitions used and information reported across observational studies prohibit the comparison, replication, and aggregation of findings. Studies should transparently report the administrative codes used and code positions, as well as utilize validated outcome definitions when possible.

scholarly journals Biomaker evaluation for major adverse cardiovascular event development in patients undergoing cardiac Surgery

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Claudia E. Imperiali ◽  
Juan C. Lopez-Delgado ◽  
Macarena Dastis-Arias ◽  
Lourdes Sanchez-Navarro
Keyword(s):  
Cardiac Surgery ◽  
Troponin T ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Final Analysis ◽  
Major Adverse Cardiovascular Event ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
Icu Admission ◽  
Immature Platelet Fraction

AbstractObjectivesThe postoperative period of cardiac surgery (CS) is associated with the development of major adverse cardiovascular events (MACEs). However, the evaluation of MACE after CS by means of biomarkers is poorly developed. We aimed to evaluate postoperative biomarkers that could be associated with MACE.MethodsTwo Hundred and ten patients who underwent CS were enrolled during the study period. The diagnosis of MACE was defined as the presence of at least one of the following complications: acute myocardial infarction, heart failure, stroke presented during intensive care unit (ICU) stay, and 30-day mortality after CS. High-sensitive troponin T (hs-TnT), C-reactive protein, procalcitonin, interleukin-6, and immature platelet fraction (IPF) were measured on ICU admission and after 24 h. The difference between both measurements (Δ) was calculated to assess their association with MACE. Early infected patients (n=13) after CS were excluded from final analysis.ResultsThe most frequent surgery was single-valve surgery (n=83; 38%), followed by coronary artery bypass graft (n=72; 34%). Postoperative MACE was diagnosed in 31 (14.8%) patients. Biomarker dynamics showed elevated values at 24 h compared with those at ICU admission in patients with MACE versus no-MACE. Multivariate analysis showed that ΔIPF (OR: 1.47; 95% CI: 1.110–1.960; p=0.008) and Δhs-TnT (OR: 1.001; 95% CI: 1.0002–1.001; p=0.008) were independently associated with MACE.ConclusionsThese findings suggest that postoperative ΔIPF and Δhs-TnT may be useful biomarkers for the identification of patients at risk of MACE development.

Abstract 16713: Major Adverse Cardiovascular Events are Linked to Risk of Mortality in Covid-19 Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Chirag Patel ◽  
Farukh Ikram ◽  
Nicholas Nguyen ◽  
Hao Nguyen ◽  
Priyanka Acharya ◽  
...  
Keyword(s):  
Major Adverse Cardiovascular Event ◽  
Hospitalized Patients ◽  
Major Adverse Cardiovascular Events ◽  
P Value ◽  
Care Hospital ◽  
Adverse Cardiovascular Event ◽  
Chi Square ◽  
Discharge Disposition ◽  
Risk Of Mortality ◽  
Significant Difference

Introduction: As a predominantly respiratory viral illness, it comes as no surprise that severe respiratory failure has portended greater risk of mortality in COVID-19 patients. We aimed to investigate whether the occurrence of a major adverse cardiovascular event (MACE) was an indicator of higher risk of eventual death in COVID-19 infected and hospitalized patients. Methods: A retrospective review was performed on 225 hospitalized patients that tested positive for COVID-19 between March and May 2020 at a major quaternary care hospital in a metropolitan area of the southwestern United States. Baseline characteristics and clinical outcomes of their disease course were identified. Survival analyses were performed on this patient pool, which was divided into two cohorts: (i) patients that experienced a MACE [a composite of myocardial infarction (MI), stroke, pulmonary embolism (PE), deep venous thrombosis (DVT), or shock requiring vasopressor support] and (ii) patients that did not experience a MACE. Pearson’s chi square test was used to examine the difference in mortality between those who had a MACE and those who did not have a MACE. Results: Of the 222 hospitalized patients for whom final discharge disposition was available, 59 had a MACE, and 163 did not. Specifically, 19 (8.59%) patients experienced a type 1 or type 2 MI, 3 (1.36%) experienced stroke, 7 (3.20%) experienced PE/DVT, and 37 (16.67%) experienced shock. A significant difference in mortality was observed between those who had a MACE and those who did not have a MACE [p-value <0.0001, OR = 11.23; 95% CI = 4.29 31.33]. In the “No MACE” cohort, 61.52% were alive after t = 43 days; 30.33% of the “Yes MACE” were alive after t = 43 days. More than 50% of the COVID-19 patients that had a MACE died by day 23 of hospitalization. Conclusions: Based on our data, hospitalized COVID-19 patients who experience a MACE are over 11 times more likely to die than those who did not experience a MACE. As such, it is important for clinicians to remain vigilant in assessing for the occurrence of these events, and to promptly respond to them with an evidence-based approach.

scholarly journals Association Between Moderate‐to‐Vigorous Physical Activity and the Risk of Major Adverse Cardiovascular Events or Mortality in People With Various Metabolic Syndrome Status: A Nationwide Population‐Based Cohort Study Including 6 Million People

2020 ◽  
Vol 9 (22) ◽  
Author(s):  
Sehoon Park ◽  
Kyungdo Han ◽  
Soojin Lee ◽  
Yaerim Kim ◽  
Yeonhee Lee ◽  
...  
Keyword(s):  
Physical Activity ◽  
Metabolic Syndrome ◽  
Cohort Study ◽  
Lower Risk ◽  
Vigorous Physical Activity ◽  
Major Adverse Cardiovascular Event ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Adverse Cardiovascular Event ◽  
All Cause Mortality

Background A population‐scale evidence for the association between moderate‐to‐vigorous physical activity (MV‐PA) and risks of major adverse cardiovascular event (MACE) or all‐cause mortality in people with various metabolic syndrome (MetS) status is warranted. Methods and Results We performed a nationwide retrospective cohort study based on the claims database of South Korea. We included people who received ≥3 national health screenings from 2009 to 2013 without a previous MACE history. We determined the MetS status of 6 108 077 people: MetS‐chronic (N=864 063), MetS‐developed (N=348 163), MetS‐recovery (N=348 313), and MetS‐free (N=4 547 538). The exposure was self‐reported MV‐PA frequencies. The outcome was incident MACEs or all‐cause mortality. The incidence rate ratios (IRR) were calculated with adjustments for clinical/demographic characteristics. During the median follow‐up of 4.28 years, 78 770 and 51 840 people experienced MACEs or died, respectively. Those who engaged in MV‐PA had a significantly lower risk of MACEs or all‐cause mortality than those not engaged in MV‐PA in every spectrum of MetS. Even among those who were free from MetS (for MACEs, IRR 0.94 [0.92–0.97], for all‐cause mortality, IRR 0.85 [0.82–0.87]) or who had already recovered from MetS (for MACEs, IRR 0.89 [0.84–0.95], for all‐cause mortality, IRR 0.74 [0.68–0.81]), 1 to 2 days per week of MV‐PA were significantly associated with lower risk of the adverse outcomes when compared with not being engaged in MV‐PA. Those who were engaged in MV‐PA more frequently also had significantly lower risks of MACEs or all‐cause mortality. Conclusions This nationwide study suggests that MV‐PA may be recommended to the general population regardless of recent MetS status.

scholarly journals Do Cardiac Rehabilitation Affect Clinical Prognoses Such as Recurrence, Readmission, Revascularization, and Mortality After AMI?: Systematic Review and Meta-Analysis

2021 ◽  
Vol 45 (1) ◽  
pp. 57-70
Author(s):  
Chul Kim ◽  
Insun Choi ◽  
Songhee Cho ◽  
Ae Ryoung Kim ◽  
Wonseok Kim ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Rehabilitation ◽  
Meta Analysis ◽  
Major Adverse Cardiovascular Event ◽  
Major Adverse Cardiovascular Events ◽  
Care Group ◽  
Post Discharge ◽  
Adverse Cardiovascular Event ◽  
Beneficial Effects ◽  
All Cause Mortality

Objective We conducted a systematic review and meta-analysis to analyze the effects of cardiac rehabilitation (CR) on post-discharge prognoses of patients with acute myocardial infarction (AMI).Methods A literature search was conducted through four international medical and two Korean databases. Primary outcomes for the effectiveness of CR included all-cause mortality, cardiovascular mortality, recurrence, revascularization, major adverse cardiovascular event, major adverse cardiocerebrovascular event, and readmission. We summarized and analyzed results of studies about CR for AMI, including not only randomized controlled trials (RCTs) but also non-RCTs. We calculated the effect size separately by the study type.Results Fourteen articles were finally selected. Of these, two articles were RCTs, while 12 were non-RCTs. In RCTs, the overall mortality rate was lower in the group that participated in CR than that in the conventional care group by 28% (relative risk=0.72; 95% confidence interval, 0.34–1.57). Among non-RCTs, CR participation significantly decreased the overall risk of mortality. Moreover, the rates of recurrence and major adverse cardiovascular events were lower in the group that participated in CR compared to those in the non-CR group.Conclusion The meta-analysis shows that CR reduces the risk of re-hospitalization and all-cause mortality after AMI, compared to no participation in CR. This outcome was seen in RCTs as well as in non-RCTs. More studies are necessary for concrete conclusions about the beneficial effects of CR after AMI in various settings.

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