scholarly journals Changes in ST segment elevation myocardial infarzzction hospitalisations in China from 2011 to 2015

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001666
Author(s):  
Tianna Zhou ◽  
Xi Li ◽  
Yuan Lu ◽  
Karthik Murugiah ◽  
Xueke Bai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Patient Characteristics ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Prehospital Delay ◽  
The Past ◽  
Representative Study ◽  
St Segment ◽  
Nationally Representative ◽  
Cardiovascular Care

ObjectiveAccess to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011–2015 in China.MethodsIn a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions.ResultsWhile the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%–76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015.ConclusionsIn this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.

The risk score for in-hospital mortality in patients with ST-segment elevation myocardial infarction

Kardiologiia ◽  
2021 ◽  
Vol 61 (9) ◽  
pp. 11-19
Author(s):  
I. S. Bessonov ◽  
V. A. Kuznetsov ◽  
S. S. Sapozhnikov ◽  
E. A. Gorbatenko ◽  
A. A. Shadrin
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Scale Score ◽  
Test Sample ◽  
Training Sample ◽  
Individual Risk ◽  
Hospital Death ◽  
St Segment Elevation ◽  
St Segment ◽  
History Of

Aim    To develop a scale (score system) for predicting the individual risk of in-hospital death in patients with ST segment elevation acute myocardial infarction (STEMI) with an account of results of percutaneous coronary intervention (PCI).Material and methods    The analysis used data of 1 649 sequential patients with STEMI included into the hospital registry of PCI from 2006 through 2017. To test the model predictability, the original sample was divided into two groups: a training group consisting of 1150 (70 %) patients and a test group consisting of 499 (30 %) patients. The training sample was used for computing an individual score. To this purpose, β-coefficients of each variable obtained at the last stage of the multivariate logistic regression model were subjected to linear transformation. The scale was verified using the test sample.Results    Seven independent predictors of in-hospital death were determined: age ≥65 years, acute heart failure (Killip class III-IV), total myocardial ischemia time ≥180 min, anterior localization of myocardial infarction, failure of PCI, SYNTAX scale score ≥16, glycemia on admission ≥7.78 mmol/l for patients without a history of diabetes mellitus and ≥14.35 mmol/l for patients with a history of diabetes mellitus. The contribution of each value to the risk of in-hospital death was ranked from 0 to 7. A threshold total score of 10 was determined; a score ≥10 corresponded to a high probability of in-hospital death (18.2 %). In the training sample, the sensitivity was 81 %, the specificity was 80.6 %, and the area under the curve (AUC) was 0.902. In the test sample, the sensitivity was 96.2 %, the specificity was 83.3 %, and the AUC was 0.924.Conclusion    The developed scale has a good predictive accuracy in identifying patients with acute STEMI who have a high risk of fatal outcome at the hospital stage.

Circadian Variation in Patient Characteristics and Outcomes in ST-Segment Elevation Myocardial Infarction

2012 ◽  
Vol 29 (10) ◽  
pp. 1390-1396 ◽  
Author(s):  
Owen Mogabgab ◽  
Robert P. Giugliano ◽  
Marc S. Sabatine ◽  
Christopher P. Cannon ◽  
Satishkumar Mohanavelu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Circadian Variation ◽  
Patient Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

scholarly journals Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Bingqi Fu ◽  
Xuebiao Wei ◽  
Qi Wang ◽  
Zhiwen Yang ◽  
Jiyan Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Assessment Tool ◽  
Risk Index ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: &lt;27 (n = 348), 27–36 (n = 360) and &gt;36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p &lt; 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p &lt; 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p &lt; 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p &lt; 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p &lt; 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p &lt; 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p &lt; 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI &gt; 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI &gt; 42.0 had higher 1 year mortality (Log-rank = 79.2, p &lt; 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.

scholarly journals Epidemiological Trends in the Timing of In-Hospital Death in Acute Myocardial Infarction-Cardiogenic Shock in the United States

2020 ◽  
Vol 9 (7) ◽  
pp. 2094 ◽  
Author(s):  
Saraschandra Vallabhajosyula ◽  
Shannon M. Dunlay ◽  
Malcolm R. Bell ◽  
P. Elliott Miller ◽  
Wisit Cheungpasitporn ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiac Arrest ◽  
Cardiogenic Shock ◽  
Organ Failure ◽  
The United States ◽  
Hospital Death ◽  
Do Not Resuscitate ◽  
St Segment Elevation ◽  
St Segment

Background: There are limited data on the epidemiology and timing of in-hospital death (IHD) in patients with acute myocardial infarction-cardiogenic shock (AMI-CS). Methods: Adult admissions with AMI-CS with IHDs were identified using the National Inpatient Sample (2000–2016) and were classified as early (≤2 days), mid-term (3–7 days), and late (>7 days). Inter-hospital transfers and those with do-not-resuscitate statuses were excluded. The outcomes of interest included the epidemiology, temporal trends and predictors for IHD timing. Results: IHD was noted in 113,349 AMI-CS admissions (median time to IHD 3 (interquartile range 1–7) days), with early, mid-term and late IHD in 44%, 32% and 24%, respectively. Compared to the mid-term and late groups, the early IHD group had higher rates of ST-segment-elevation AMI-CS (74%, 63%, 60%) and cardiac arrest (37%, 33%, 29%), but lower rates of acute organ failure (68%, 79%, 89%), use of coronary angiography (45%, 56%, 67%), percutaneous coronary intervention (33%, 36%, 42%), and mechanical circulatory support (31%, 39%, 50%) (all p < 0.001). There was a temporal increase in the early (adjusted odds ratio (aOR) for 2016 vs. 2000 2.50 (95% confidence interval (CI) 2.22–2.78)) and a decrease in mid-term (aOR 0.75 (95% CI 0.71–0.79)) and late (aOR 0.34 (95% CI 0.31–0.37)) IHD. ST-segment-elevation AMI-CS and cardiac arrest were associated with the increased risk of early IHD, whereas advanced comorbidity and acute organ failure were associated with late IHD. Conclusions: Early IHD after AMI-CS has increased between 2000 and 2016. The populations with early vs. late IHD were systematically different.

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