scholarly journals Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial

Heart Asia ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. e011201
Author(s):  
Yotsawee Chotechuang ◽  
Arintaya Phrommintikul ◽  
Srun Kuanprasert ◽  
Roungtiva Muenpa ◽  
Jayanton Patumanond ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Intervention Group ◽  
Coronary Intervention ◽  
Cardiovascular Outcomes ◽  
Intermediate Risk ◽  
Successful Therapy ◽  
Coronary Syndrome ◽  
Risk Patients ◽  
Delayed Group ◽  
Coronary Events

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.MethodsWe randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).ResultsOne hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).ConclusionsThe delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.Trial registration numberNCT02131103.

Abstract 17595: The Value of Continuous ST-Segment Monitoring in the Emergency Department: a Quasi-Experimental Pre-Post Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Leonie L Rose Bovino ◽  
Michele M Pelter ◽  
Mayur M Desai ◽  
Vanessa Jefferson ◽  
Laura K Andrews ◽  
...  
Keyword(s):  
Emergency Department ◽  
Diagnostic Accuracy ◽  
Intermediate Risk ◽  
Intervention Phase ◽  
Coronary Syndrome ◽  
St Segment ◽  
Significant Difference ◽  
Time To Diagnosis ◽  
Before And After ◽  
Risk Patients

Purpose: The AHA Practice Standards for ECG Monitoring recommend continuous ST-segment monitoring (C-STM) in patients presenting to the emergency department (ED) with signs and/or symptoms suggestive of acute coronary syndrome (ACS), but few studies have evaluated its use in the ED. Our aims were to compare the time to diagnosis and 30-day adverse events (return to the ED with signs and/or symptoms of ACS, hospital admission, acute myocardial infarction, use of reperfusion therapy, or mortality) before and after implementation of C-STM. We also evaluated the diagnostic accuracy of C-STM in detecting ischemia or infarction, using stress test and troponin I results as reference standards. Methods: We prospectively studied 163 adults (pre-intervention phase: n=78; intervention phase: n=85) in the ED at a single hospital. We stratified patients into low (n=51), intermediate (n=100), or high (n=12) risk using HEART scores. The principal investigator monitored participants, activating C-STM on bedside monitors in the intervention phase. We used likelihood ratios (LRs) as the measure of diagnostic accuracy. By convention, a positive (+) LR is diagnostic at >10 and a negative (-) LR at <0.1. Results: Overall, 9% of patients were diagnosed with ACS. There was no significant difference in median time to ACS diagnosis before and after implementation of C-STM (5.55 vs. 5.98 hours; p=0.43 for Mann-Whitney U test). In risk-stratified analyses, no significant pre-post difference in time to ACS diagnosis was found in low-, intermediate-, or high-risk patients. There was no difference in the rate of any 30-day adverse event before vs. after C-STM implementation (11.5% vs. 10.6%; p=0.85 Chi-squared test). None of 3 episodes of ST-segment changes on C-STM represented ACS. The +LR and -LR of C-STM for ischemia were 24.0 (95% CI 1.4 - 412.0) and 0.3 (95% CI 0.02 - 2.9), respectively; and for infarction were 13.7 (95% CI 1.7 - 112.3) and 0.7 (95% CI 0.3 - 1.5), respectively. Conclusion: In this sample of mainly low- to intermediate-risk patients, use of C-STM did not improve time to diagnosis or 30-day adverse outcomes, nor provide much benefit in detecting myocardial ischemia or infarction. Use of C-STM may need to be re-evaluated for patients with low to intermediate risk for ACS in the ED.

scholarly journals Indications for an early invasive strategy in NSTE-ACS patients

2019 ◽  
Vol 28 (3) ◽  
pp. 131-135 ◽  
Author(s):  
B. Zwart ◽  
J. M. ten Berg ◽  
A. W. van ’t Hof ◽  
P. A. L. Tonino ◽  
Y. Appelman ◽  
...  
Keyword(s):  
High Risk ◽  
Coronary Angiography ◽  
Risk Score ◽  
Invasive Strategy ◽  
Coronary Syndrome ◽  
Grace Risk Score ◽  
Risk Patients ◽  
Coronary Events ◽  
Early Invasive Strategy ◽  
European Society Of Cardiology

Abstract An early invasive strategy in patients who have acute coronary syndrome without ST-elevation (NSTE-ACS) can improve clinical outcome in high-risk subgroups. According to the current guidelines of the European Society of Cardiology (ESC), the majority of NSTE-ACS patients are classified as “high-risk”. We propose to prioritise patients with a global registry of acute coronary events (GRACE) risk score >140 over patients with isolated troponin rise or electrocardiographic changes and a GRACE risk score <140. We also acknowledge that same-day transfer for all patients at a high risk is not necessary in the Netherlands since the majority of Dutch cardiology departments are equipped with a catheterisation laboratory where diagnostic coronary angiography is routinely performed in NSTE-ACS patients. Therefore, same-day transfer should be restricted to true high-risk patients (in addition to those NSTE-ACS patients with very high-risk (VHR) criteria) in centres without coronary angiography capabilities.

scholarly journals Dual Antiplatelet Therapy Duration in Acute Coronary Syndrome Patients: The State of the Art and Open Issues

2020 ◽  
Vol 2020 ◽  
pp. 1-12 ◽  
Author(s):  
Monica Verdoia ◽  
Cyril Camaro ◽  
Elvin Kedhi ◽  
Marco Marcolongo ◽  
Harry Suryapranata ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Randomized Clinical Trials ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Thrombotic Risk ◽  
Coronary Syndrome ◽  
Modern Drug ◽  
Risk Patients

Conflicting results have been reported so far in pooled analyses and studies evaluating the optimum duration of dual antiplatelet therapy (DAPT) in acute coronary syndrome (ACS) patients. However, randomized clinical trials dedicated to this specific setting of higher thrombotic risk patients have only recently been completed, pointing at the noninferiority of a shorter strategy as compared to the traditional 12-month DAPT, furthermore allowing to reduce the risk of major bleeding complications. Therefore, a reconsideration of current clinical practice and guidelines should be certainly be advocated in light of the most recent updates, especially among ACS patients treated with percutaneous coronary intervention (PCI) and modern drug-eluting stents (DES). Our aim was to provide a comprehensive review of the available evidence on the optimal DAPT duration in ACS patients.

Abstract 16044: Association of Area Deprivation Index With Recurrent Cardiovascular Outcomes: Does Cardiac Rehabilitation Participation Mitigate Effects?

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Emily N Guhl ◽  
Jianhui Zhu ◽  
Amber Johnson ◽  
Utibe Essien ◽  
Floyd W Thoma ◽  
...  
Keyword(s):  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
Primary Diagnosis ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Deprivation Index ◽  
Area Deprivation ◽  
Coronary Syndrome ◽  
Regional Center ◽  
Health Promoting

Introduction: Neighborhood location impacts access to health-promoting resources and outcomes. Cardiac rehabilitation (CR) provides a multidisciplinary approach that improves cardiovascular outcomes. We evaluated the association of Area Deprivation Index (ADI) and cardiovascular events in individuals with incident Heart Failure (HF) or myocardial infarction (MI) and the modifying effect of CR. Methods: We identified an observational cohort admitted with primary diagnosis of 1) MI with percutaneous coronary intervention or 2) a primary diagnosis of incident HF from 2010-2018 at a multi-site regional center. We derived ADI from patient home address and then categorized into quartiles. Demographics, clinical covariates, and CR participation post-hospitalization were obtained from the electronic medical record. We compared rates of readmission for a cardiovascular primary diagnosis and mortality across ADI quartiles. Analyses were then stratified by CR participation. Results: In a cohort of 6957 (38.2% women, 88.7% white) with adjustment for covariates, increasing ADI was significantly associated with higher rates of cardiovascular rehospitalization (p<0.01), Acute Coronary Syndrome (ACS) rehospitalization (p=0.01), HF rehospitalization (p<0.01), and all-cause mortality (p=0.04), Table. When we stratified across CR participation, those with participation had significantly lower rehospitalizations (p<0.01) and mortality (p<0.01) when compared to the no CR group. There was no significant effect of ADI on outcomes in the CR group. Discussion: We found increased ADI was adversely associated with mortality and rehospitalizations in cardiac patients. For those participating in CR, there was 1) no significant effect of ADI and 2) decreased incidence of adverse outcomes vs. those who did not participate in CR. Given the benefit of CR participation on ADI’s adverse effect on outcomes, future interventions should focus on increasing CR participation.

scholarly journals Impact of thrombus aspiration in frail STEMI patients

2021 ◽  
Author(s):  
Pasquale Mone ◽  
Jessica Gambardella ◽  
Antonella Pansini ◽  
Mario Rizzo ◽  
Ciro Mauro ◽  
...  
Keyword(s):  
Coronary Intervention ◽  
Thrombus Aspiration ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Segment Elevation Myocardial Infarction ◽  
Frail Patients ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Risk Patients

Abstract Background Despite primary percutaneous coronary intervention (PPCI) is generally considered the best therapy in older frail adults with ST-segment elevation myocardial infarction (STEMI), the incidence of re-hospitalization for cardiovascular diseases remains significant in these patients. Aims We hypothesized that thrombus aspiration (TA) before PPCI could be a useful treatment for reducing mortality and rehospitalizations in frail patients undergoing PPCI for STEMI. Methods We conducted a study comparing PPCI alone vs TA + PPCI in frail STEMI patients. We examined a cohort of consecutive frail patients aged ≥ 65 years with first STEMI treated with PPCI between February 2008 and July 2015 at the Department of Cardiology of the “Cardarelli” Hospital in Naples, Italy. Results The study was completed by 389 patients (PPCI: 195, TA + PPCI: 194). At 1-month follow-up, the rate of death from any cause was 7.0% in patients treated with PPCI alone vs 3.0% in patients treated with TA + PPCI (p 0.036), whereas death from cardiovascular causes was 6.0% in the PPCI group vs 3.0% in the TA + PPCI group (p 0.028). Equally important, the rate of re-hospitalization due to heart failure was 7.5% in the PPCI group vs 4.0% in TA + PPCI group (p 0.025) and the rate of re-hospitalization due to acute coronary syndrome was 10.0% in the PPCI group vs 4.5% in the TA + PPCI group (p 0.016). Conclusion These results indicate the importance of TA in the treatment of STEMI in a group of high-risk patients such as elderly with frailty.

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