scholarly journals Management and Outcome of Ventricular Septal Rupture Complicating Acute Myocardial Infarction: What Is New in the Era of Percutaneous Intervention?

Cardiology ◽  
2018 ◽  
Vol 141 (4) ◽  
pp. 226-232 ◽  
Author(s):  
Shi Tai ◽  
Jian-jun Tang ◽  
Liang Tang ◽  
Yu-qing Ni ◽  
Yanan Guo ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
Acute Phase ◽  
Percutaneous Intervention ◽  
Percutaneous Closure ◽  
Ventricular Septal Rupture ◽  
Female Sex ◽  
Survivor Group

Background: Postinfarction ventricular septal rupture (PI-VSR) is a rare but devastating complication of acute myocardial infarction (AMI). Risk stratification in the acute phase is crucial for decision-making, and this study analyzed the risk factors for early mortality and the effects of various management options on the outcome of PI-VSR patients in the era of percutaneous intervention. Methods: A total of 96 patients with PI-VSR were identified and divided into an acute-phase survivor group (n = 46, survived ≥2 weeks after admission) and a nonsurvivor group (n = 50, died within 2 weeks after admission). Percutaneous closure was considered in acute-phase survivors. Patients were followed up for a mean 47 (quartiles 15–71) months by clinical visit or telephone interview. Results: The overall acute-phase (i.e., < 2 weeks after the diagnosis of PI-VSR) mortality rate was 52%. Female sex and Killip Class III–IV at admission were associated with an increased risk of acute-phase death. Of the 46 patients who survived ≥2 weeks, 20 underwent interventional occlusion and the procedure was successful in 19. Percutaneous closure in the acute-phase survivor group improved the immediate (21% in-hospital mortality rate) and long-term (53% mortality) outcomes. Conclusions: Patients with PI-VSR are at a high risk of acute-phase mortality. Female sex and severe cardiac dysfunction at admission are linked with a high rate of acute-phase deaths. Percutaneous closure in acute-phase survivors results in favorable short- and long-term benefits for PI-VSR patients.

scholarly journals Short and Long-term Effects of Coronary Thrombolysis in Acute Myocardial Infarction : The treatments for myocardial infarction in acute phase

1993 ◽  
Vol 56 (SupplementV) ◽  
pp. 1409-1413
Author(s):  
Takeshi Motomiya ◽  
Yoshiki Tokuyasu ◽  
Harumizu Sakurada ◽  
Osamu Yanase ◽  
Shuzo Nomura ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Phase ◽  
Long Term Effects ◽  
Coronary Thrombolysis ◽  
Short And Long Term

Long term prognostic impact of gender in patients with stable coronary disease: an analysis of the CICCOR registry, a seventeen years, prospective, monocentric, cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ruiz Ortiz ◽  
J.J Sanchez Fernandez ◽  
C Ogayar Luque ◽  
E Romo Penas ◽  
M Delgado Ortega ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cohort Study ◽  
Cardiovascular Death ◽  
Female Sex ◽  
The Impact ◽  
Overall Mortality

Abstract Purpose Women and men with stable coronary artery disease (sCAD) have different clinical features and management, but 1-year prognosis has been reported to be similar in large observational registries. The objective of the present study was to investigate the impact of female sex in the prognosis of the disease in the very long-term. Methods The CICCOR registry (“Chronic ischaemic heart disease in Cordoba”) is a prospective, monocentric, cohort study. From February 1, 2000 to January 31, 2004, all consecutive patients with sCAD attended at two outpatient cardiology clinics in a city of the south of Spain were included in the study and prospectively followed. Differential clinical features of women and men were described and the impact of female sex in long term prognosis was investigated. Results The study sample included 1268 patients, 337 women (27%) and 931 men (73% male). Women were older than men (70±9 versus 65±11 years, p&lt;0.0005), more likely to have hypertension (72% versus 49%, p&lt;0.0005) and diabetes (45% versus 26%), and less likely to be ex-smoker/active smoker (5%/2% versus 49%/9%, p&lt;0.0005). They had more frequently angina in functional class ≥II (22% versus 17%, p=0.04) and atrial fibrillation (8% versus 5%, p=0.04), but had received less frequently coronary revascularization (32% versus 44%, p&lt;0.0005). Prescription of statins (64% versus 68%, p=0.22), antiplatelets (89% versus 93%, p=0.07) and betablockers (67% versus 63%, p=0.28) at first visit was similar than men, but women received more frequently nitrates (78% versus 64%, p&lt;0.0005), angiotensin-conversing enzyme inhibitors or receptor antagonists (56% versus 47%, p=0.004) and diuretics (41% versus 22%, p&lt;0.0005). After up to 17 years of follow-up (median 11 years, IQR 4–15 years, with a total of 12612 patients-years of observation), probabilities of acute myocardial infarction (12% versus 14%, p=0.55) or stroke (14% versus 12%, p=0.40) at median follow up were similar for women and men. However, the risks of hospital admission for heart failure (22% versus 13%, p&lt;0.0005) or cardiovascular death (35% versus 24%, p&lt;0.0005) were significantly higher for women, with a non-significant trend to higher overall mortality (45% versus 39%, p=0.07). After multivariate adjustment, the risks of most events were similar for women and men (Hazard Ratios [95% confidence intervals]: 0.79 [0.55–1.14], p=0.21 for acute myocardial infarction; 0.89 [0.61–1.29], p=0.54 for stroke; 1.13 [0.82–1.57], p=0.46 for admission for heart failure; and 0.92 [0.73–1.16], p=0.48 for cardiovascular death), with a non-significant trend to lower overall mortality (0.83 [0.67–1.02], p=0.08). Conclusion Although women and men with sCAD presents a different clinical profile, and crude rates of hospital admissions for heart failure and cardiovascular death were higher in women, female sex was not an independent prognostic factor in this observational study with up to 17 years of follow-up. Funding Acknowledgement Type of funding source: None

Abstract 16483: Marital Status and Long-Term Mortality of Male Patients Presenting With Acute Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hiroaki Yokoyama ◽  
Takumi Higuma ◽  
Fumie Nishizaki ◽  
Kei Izumiyama ◽  
Shuji Shibutani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Marital Status ◽  
Acute Phase ◽  
Rank Test ◽  
Never Married ◽  
Log Rank Test ◽  
All Cause Mortality ◽  
Long Term Mortality

Background: Although unmarried has been associated with an increased risk of acute coronary syndrome, little is known about the relationship between marital status and long-term mortality after acute myocardial infarction (AMI). Methods and Results: To elucidate the clinical characteristics and outcomes of AMI patients who have never married, the consecutive 364 male AMI patients (mean age; 63±13 years) admitted to our hospital were studied. Mean follow-up period was 1.7 years. The patients were divided into 2 groups by their marital status: those who had married at least one time (Married Group (MG), n=328) and those who had never married (Unmarried Group (UG), n=36 (9.9%)). UG patients were younger (54±11 vs 65±12 years, p<0.0001) and had a higher level of body mass index (BMI) (26.5±4.5 vs 24.1±3.5 kg/m2, p=0.0002) than MG. None of coronary risk factors including hypertension, dyslipidemia, diabetes mellitus and smoking habit, Killip classification, culprit lesion of AMI nor maximal creatine phosphokinase-MB (CPK-MB) level was different between 2 groups. The time from the symptom onset to admission was significantly longer in UG (6.1 (2.6-14.3) vs 3.8 (2.3-8.3) hours, p=0.033). Left ventricular ejection fraction (LVEF) assessed at the acute phase of AMI was not different between 2 groups. Kaplan-Meier Curve showed no significant difference of all-cause mortality between 2 groups (20% in UG vs 12% in MG, p=0.27 by Log-rank test). When the analysis is done in patients with the ages >50 years (272 patients in MG and 19 in UG), all-cause mortality tended to be higher in UG than in MG (38% vs 15%, p=0.098 by Log-rank test). After adjustment for age, Killip IV and LVEF at the acute phase, unmarried status was independently associated with all-cause long-term mortality after AMI (hazard ratio (HR); 3.84, 95% confidence interval (CI); 1.22-10.2, p=0.024). Conclusions: Unmarried status is independently associated with significantly increased all-cause long-term mortality in the male AMI patients with the ages >50 years.

scholarly journals Trends in mortality and heart failure after acute myocardial infarction in Italy from 2007 to 2017

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Rosato ◽  
P D'Errigo ◽  
V Manno ◽  
A Maraschini ◽  
F Cerza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Mortality Rate ◽  
Cox Model ◽  
Total Mortality ◽  
Index Admission ◽  
Hospital Treatment ◽  
Risk Of Death

Abstract Background Uncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI. This study aims to appraise early and 1-year outcome of patients hospitalized due to AMI and to describe the role of heart failure (HF) as complication affecting prognoses. Methods Retrospective nationwide cohort study based on administrative data on patients with AMI admitted in all Italian hospitals from 2007 to 2017. Index admission mortality rate (I-MR), 30-day and 1-year post-discharge mortality rate (PD-MR), and 30-day and 1-year total mortality rate (T-MR) were analysed; mortality average annual changes (AC) and their 95% CI were calculated; the Cox model, adjusting for age, sex, comorbidities and length of stay, was used to analyse 1-year PD-MR Results 1,148,820 patients were considered. From 2007 to 2017, both I-MR and T-MR up to 1 year decreased significantly (from 10.9 to 8.4%; AC: -0.28%; CI: -0.31 to -0.25 and from 20.2% to 17.1%: AC: -0.33%; CI: -0.39 to -0.28, respectively). From 2010, also the rate of PD-MR decreased significantly from 11.7% to 10.4%, with such favourable trend confirmed at multivariable analyses. The HF diagnosis at the index admission is always associated with a significant increase in the risk of death (1-year T-MR average: 43% and 12% in patients with or without HF, respectively; both patients with and without HF show a constant improvement in I-MR, T-MR and PD-MR over time. Conclusions In the last decade, the remarkable improvements in the in-hospital treatment of patients with AMI and in the overall prognosis up to 1 year are confirmed by a constant decrease in both early and long-term mortality. Since complication from HF remains a dangerous condition that significantly worsens the prognosis of the AMI patient, appropriate management strategies must be identified and implemented to guarantee best results from both clinic and public health perspective. Key messages Remarkable improvements achieved in overall prognosis after AMI over the past 10 years. HF confirms to be a condition able to worsen AMI patients’ prognosis.

Sign in / Sign up

Export Citation Format

Share Document