Abstract P041: Cumulative Exposure to Air Pollution, Socioeconomic Status and Post-Myocardial Infarction Outcomes in Central Israel. A Cohort Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Noa Molshatzki ◽  
David Broday ◽  
Silvia Koton ◽  
Yuval . ◽  
Vicki Myers ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Socioeconomic Status ◽  
Cardiac Death ◽  
Fine Particles ◽  
Adverse Outcomes ◽  
Cumulative Exposure ◽  
Exposure Misclassification ◽  
Cox Models ◽  
Clinical Variables

Objective: In a community-based cohort of myocardial infarction (MI) survivors, we examined whether cumulative residential exposure to air pollutants constitutes a risk factor for adverse outcomes. Methods: Patients aged ≤65 years (n=1,428), admitted with first MI in 1992-1993 to the 8 hospitals serving the population of central Israel, were followed up through 2005. Extensive data were collected on socio-demographic, clinical, and environmental factors. Daily measures of nitrogen dioxide (NO 2 ), nitric oxide (NO) and fine particles (PM 2.5 ) recorded at air quality monitoring stations were summarized and cumulative exposure was estimated for each patient based on geo-coded residential location at study entry. Cox models were used to assess the hazard ratios (HRs) for all-cause death, cardiac death, recurrent MI, heart failure and stroke associated with a 10 μ g/m 3 increase in pollutant exposure. Results: Patients residing in more polluted areas had better socioeconomic status at both the individual and neighborhood levels. Exposure to pollutants was inversely associated with outcomes. However, these associations were either removed or reversed upon multivariable adjustment for socioeconomic and clinical variables (HRs [95% CIs] of PM 2.5 are reported in the Table). Conclusions: In this unique setting and in contrast to other reports, better socioeconomic status was associated with higher exposure to pollution. In multivariable models accounting for socioeconomic and clinical variables, we observed a weak positive association between PM 2.5 exposure and post-MI outcomes, consistent with findings in the general population. Considering exposure misclassification, the true association is likely stronger. Unadjusted Multivariable-Adjusted All-Cause Death 0.93 (0.53-1.62) 1.51 (0.85-2.67) Cardiac Death 0.74 (0.38-1.44) 1.37 (0.70-2.68) Recurrent MI 1.06 (0.62-1.81) 1.67 (0.96-2.92) Heart Failure 0.60 (0.32-1.12) 1.39 (0.73-2.62) Stroke 0.64 (0.29-1.40) 1.04 (0.46-2.33)

Abstract P205: Neighborhood Socioeconomic Status and Long-term Incidence of Cancer After Myocardial Infarction

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
Yariv Gerber ◽  
Uri Goldbourt ◽  
Tal Hasin ◽  
Gali Cohen ◽  
Lital Keinan-Boker
Keyword(s):  
Myocardial Infarction ◽  
Socioeconomic Status ◽  
Cancer Incidence ◽  
Case Fatality ◽  
Incidence Rates ◽  
Medical Surveillance ◽  
Subdistribution Hazard ◽  
Cox Models ◽  
Neighborhood Socioeconomic Status ◽  
Clinical Variables

Background: Higher cancer incidence rates in patients with cardiovascular disease compared with the general population were recently documented in several European and North American settings. While different mechanisms were proposed to account for the association, the possibility of differential detection cannot be ruled out. We evaluated cancer incidence and case-fatality according to neighborhood socioeconomic status (NSES) in a cohort of myocardial infarction (MI) survivors. Methods: Patients aged ≤65 years admitted to hospital in central Israel with first MI in 1992-1993 were followed up for cancer (via the National Cancer Registry) and death (via the Population Registry) through 2011. NSES was estimated at baseline through a composite census-derived index (measured on a 1-20 scale) developed by the Israel Central Bureau of Statistics, along with other socio-demographic and clinical variables. Fine and Gray subdistribution hazard regression models were used to assess the hazard ratio (HR) for cancer associated with NSES, with death considered a competing event; Cox models were then used to assess the association with case fatality among incident cancer cases. Results: Among 1380 cancer-free patients at baseline (mean age, 54 years; 81% men), 230 developed cancer during a mean (SD) follow-up of 14 (6) years. The age-adjusted HR for cancer was 1.24 (95% CI: 1.08-1.41) per 1 SD increase in NSES. Further adjustment for individual SES measures and clinical variables (including smoking) did not weaken the association (HR=1.26, 95% CI: 1.09-1.46). Conversely, among patients diagnosed with cancer, NSES was associated with reduced mortality risk (age-adjusted HR=0.78, 95% CI: 0.65-0.93; multivariable-adjusted HR=0.80, 95% CI: 0.64-0.99). Conclusions: Residing in an affluent neighborhood was associated with higher incidence and lower case fatality rate of cancer post-MI, which, to some extent, may reflect detection bias due to increased medical surveillance.

scholarly journals Risk stratification score for acute myocardial infarction and sudden cardiac death in type 2 diabetes mellitus

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Lee ◽  
J Zhou ◽  
CL Guo ◽  
WKK Wu ◽  
WT Wong ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiac Death ◽  
Adverse Outcomes ◽  
Risk Scores ◽  
Diabetic Patients ◽  
Type 2 Diabetic

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Acute myocardial infarction (AMI) and sudden cardiac death (SCD) are major cardiovascular adverse outcomes in patients with type 2 diabetic mellitus. Although there are many risk scores on composite outcomes of major cardiovascular adverse outcomes or cardiovascular mortality for diabetic patients, these existing scores did not account for the difference in pathogenesis and prognosis between acute coronary syndrome and lethal ventricular arrhythmias. Furthermore, recent studies reported that HbA1c and lipid levels, which were often accounted for in these risk scores, have J/U-shaped relationships with adverse outcomes. Purpose The present study aims to evaluate the application of incorporating non-linear J/U-shaped relationships between mean HbA1c and cholesterol levels into risk scores for predicting for AMI and non-AMI related SCD respectively, amongst type 2 diabetes mellitus patients. Methods This was a territory-wide cohort study of patients with type 2 diabetes mellitus above the age 40 and free from prior AMI and SCD, with or without prescriptions of anti-diabetic agents between January 1st, 2009 to December 31st, 2009 at government-funded hospitals and clinics in Hong Kong. Risk scores were developed for predicting incident AMI and non-AMI related SCD. The performance of conditional inference survival forest (CISF) model compared to that of random survival forests (RSF) model and multivariate Cox model. Results This study included 261308 patients (age = 66.0 ± 11.8 years old, male = 47.6%, follow-up duration = 3552 ± 1201 days, diabetes duration = 4.77 ± 2.29 years). Mean HbA1c and high-density lipoprotein-cholesterol (HDL-C) were significant predictors of AMI under multivariate Cox regression and were linearly associated with AMI. Mean HbA1c and total cholesterol were significant multivariate predictors with a J-shaped relationship with non-AMI related SCD. The AMI and SCD risk scores had an area-under-the-curve (AUC) of 0.666 (95% confidence interval (CI)= [0.662, 0.669]) and 0.677 (95% CI= [0.673, 0.682]), respectively. CISF significantly improves prediction performance of both outcomes compared to RSF and multivariate Cox models. Conclusions A holistic combination of demographic, clinical, and laboratory indices can be used for the risk stratification of type 2 diabetic patients against AMI and SCD.

Abstract 13304: Liver Dispersion Predicts Adverse Outcomes in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Yu Hotsuki ◽  
Akiomi Yoshihisa ◽  
Koichiro Watanabe ◽  
Yu Sato ◽  
Yusuke Kimishima ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Death ◽  
Cardiac Event ◽  
Liver Stiffness ◽  
Adverse Outcomes ◽  
Right Atrial ◽  
Gamma Glutamyl Transferase ◽  
Abdominal Ultrasonography ◽  
Patients With Heart Failure ◽  
Glutamyl Transferase

Background: It has been recently reported that liver stiffness assessed by transient elastography reflects right atrial pressure (RAP), and is associated with worse outcome in patients with heart failure (HF). However, the relationship between liver dispersion (LD, a novel indicator of liver viscosity) determined by abdominal ultrasonography and RAP, and prognostic impacts of LD on HF patients have not been fully examined. We aimed to clarify associations of LD with parameters of liver functional test (LFT) and right-heart catheterization (RHC), and cardiac event such as cardiac death and worsening HF in patients with HF. Methods and Results: We performed abdominal ultrasonography, LFT, RHC, and followed up cardiac events including cardiac death and unplanned hospitalization due to HF in patients with HF (n=157). We examined associations of LD with parameters of LFT and RHC. There were significant correlations between LD and circulating levels of gamma-glutamyl transferase (R=0.197, P=0.018), cholinesterase (R=-0.301, P=0.001), and 7S domain of collagen type IV (P4NP 7S, a marker of fibrosis, R=0.334, P<0.001), but not with RAP (R=0.067, P=0.514) or cardiac index (R=-0.038, P=0.667). During the follow up period (median 305 days), 6 cardiac deaths and 18 unplanned hospitalization due to HF occurred. In the Kaplan-Meier analysis ( Figure ), cardiac event rate was significantly higher in the high LD group (LD ≥10.0 (m/s)/kHz, n=79) than in the low LD group (LD < 10.0 (m/s)/kHz, n=78; log-rank, P=0.007). In the multivariable Cox proportional hazard analysis, high LD was found to be an independent predictor of cardiac event (hazard ratio 3.274, 95% confidence interval 1.203-8.912, P=0.020). Conclusions: LD assessed by abdominal ultrasonography reflects liver fibrosis rather than liver congestion, and is associated with adverse prognosis in HF patients.

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

Management of Cardiovascular Disease in Dialysis Patients

2017 ◽  
Author(s):  
John K. Roberts ◽  
John P. Middleton
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Volume Overload ◽  
Current Evidence ◽  
Dialysis Patients ◽  
Esrd Patients

Cardiovascular disease is a common cause of death and disease in patients with end-stage renal disease (ESRD). Registry data show that 41% of deaths in ESRD patients are due to a variety of cardiovascular causes, such as acute myocardial infarction, congestive heart failure, arrhythmia/sudden cardiac death, and stroke. In the general population, each of these disease entities in isolation can be effectively managed according to evidence from large clinical trials and evidence-based guidelines. However, many of these trials did not include patients with ESRD, limiting the transferability of this evidence to the care of patients on dialysis. To complicate matters, cardiovascular events in ESRD patients are likely augmented from a unique interplay of cardiac risk due to both reduced kidney function and the necessity for artificial renal replacement therapies. In this light, the patient on dialysis is subjected to a series of unique factors: the continued presence of the metabolic perturbations of uremia and the peculiar environment of the dialysis treatment itself. Since the ESRD heart is under a considerable amount of strain due to chronic volume overload, rapid electrolyte and fluid shifts, and accelerated vascular calcification, management can be complex and outcomes multifactorial. In this review, we summarize the current evidence regarding management of acute myocardial infarction, heart failure, sudden cardiac death, and atrial fibrillation. We also address modifiable risk factors related to the dialysis procedure itself and highlight recent randomized controlled trials that included dialysis patients and measured important cardiovascular outcomes. 

scholarly journals Systematic Review of Compound Danshen Dropping Pill: A Chinese Patent Medicine for Acute Myocardial Infarction

2013 ◽  
Vol 2013 ◽  
pp. 1-15 ◽  
Author(s):  
Jing Luo ◽  
Hao Xu ◽  
Keji Chen
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiac Death ◽  
Data Extraction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Quality Of Evidence

Objective. This paper systematically evaluated the efficacy and safety of compound Danshen dropping pill (CDDP) in patients with acute myocardial infarction (AMI).Methods. Randomized controlled trials (RCTs), comparing CDDP with no intervention, placebo, or conventional western medicine, were retrieved. Data extraction and analyses were conducted in accordance with the Cochrane standards. We assessed risk of bias for each included study and evaluated the strength of evidence on prespecified outcomes.Results. Seven RCTs enrolling 1215 patients were included. CDDP was associated with statistically significant reductions in the risk of cardiac death and heart failure compared with no intervention based on conventional therapy for AMI. In addition, CDDP was associated with improvement of quality of life and impaired left ventricular ejection fraction. Nevertheless, the safety of CDDP was unproven for the limited data. The quality of evidence for each outcome in the main comparison (CDDP versus no intervention) was “low” or “moderate.”Conclusion. CDDP showed some potential benefits for AMI patients, such as the reductions of cardiac death and heart failure. However, the overall quality of evidence was poor, and the safety of CDDP for AMI patients was not confirmed. More evidence from high quality RCTs is warranted to support the use of CDDP for AMI patients.

scholarly journals 56. Long-Term Cardiovascular Outcomes After Drug-Related vs Non-Drug-Related Infective Endocarditis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S39-S40
Author(s):  
Brandon Muncan ◽  
Aikaterini Papamanoli ◽  
Hal A Skopicki ◽  
Andreas Kalogeropoulos
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Ischemic Stroke ◽  
Drug Use ◽  
Cardiac Death ◽  
First Episode ◽  
Kaplan Meier ◽  
Icd 10

Abstract Background Drug use-related infective endocarditis (IE) has nearly doubled in the past two decades in the United States, largely due to the current opioid crisis. Although there are robust data on surgical outcomes for people who use drugs (PWUD) vs. non-PWUD patients after an initial encounter for IE, long-term comparative data on post-IE outcomes are relatively sparse. Methods Using data from the TriNetX electronic health records network, we identified (1) a cohort of patients 16 to 64 years old who had a first encounter for IE (captured with ICD-10 codes I33, I38, or I39) and history of drug use (captured with ICD-10 codes F11, F13-F16, F18, F19, O99.32, or T40) preceding the IE episode and (2) a propensity score-matched cohort of patients age 16-64 who had a first episode of IE and no documented drug use. We compared the post-IE incidence of (1) mortality; (2) ischemic stroke; (3) intracranial hemorrhage; (4) myocardial infarction; (5) heart failure; and (6) sudden cardiac death (cardiac arrest or ventricular fibrillation or tachycardia) between the 2 cohorts over a 5-year follow up period. We matched the cohorts for demographic data and clinically relevant medical history. We used Kaplan-Meier estimates and Cox models to compare incidence. Results We identified 6,578 PWUD patients and 6,578 matched non-PWUD patients 16-64 years old with a first episode of IE. The baseline characteristics are summarized in Table 1. Standardized mean differences of characteristics were generally &lt; 0.1, indicating adequate matching. The 5-year Kaplan-Meier rates of outcomes of interest are summarized in Table 2. Mortality did not differ between cohorts. However, the incidence of ischemic stroke and intracranial hemorrhage was consistently higher among PWUD throughout the 5-year follow-up. Rates of myocardial infarction were also higher among PWUD; however, the difference was more pronounced later during follow-up. Rates of heart failure and sudden cardiac death did not differ. Conclusion Cardiovascular events after IE were common among both PWUD and non-PWUD patients over a 5-year follow-up period. However, rates of ischemic and hemorrhagic stroke were consistently higher among PWUD. Further investigation is needed to elucidate the sources of elevated stroke risk among PWUD and identify targets for intervention. Disclosures All Authors: No reported disclosures

P1876Atrial fibrillation related symptoms and cardiovascular outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
P Krisai ◽  
S Blum ◽  
S Aeschbacher ◽  
J H Beer ◽  
G Moschovitis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Primary Endpoint ◽  
Cox Proportional Hazards ◽  
Cardiovascular Outcomes ◽  
Adverse Outcomes ◽  
Secondary Endpoint ◽  
Study Cohort ◽  
Inverse Association ◽  
The Impact

Abstract Background Comprehensive information on the impact of atrial fibrillation (AF)-related symptoms and quality of life (QoL) on adverse outcomes is sparse. Purpose We aimed to investigate whether AF-related symptoms and/or QoL are associated with cardiovascular outcomes in a large cohort of AF patients. Methods A total of 3902 participants with documented AF from two nationwide prospective cohort studies in Switzerland were included. Information on AF-related symptoms was assessed yearly by standardized questionnaires, QoL was quantified using a visual analog scale (0–100, with higher scores indicating better QoL). The primary endpoint was a composite of stroke and systemic embolism. The secondary endpoint was a composite of cardiovascular death, hospitalization for heart failure and myocardial infarction. We assessed associations using multivariable, time-updated Cox proportional-hazards models including age, sex, study cohort, history of heart failure, hypertension, diabetes, prior stroke, prior myocardial infarction, vascular disease and prior catheter ablation for AF as covariates. Results Mean age was 72 years, and 72% were male. The median QoL score was 75 points, and 2572 (66%) participants had AF-related symptoms. Symptomatic individuals were younger (71 vs 75 years) and had more often paroxysmal AF (29 vs 23%) (p for both <0.001). The most frequent symptoms were palpitations (42%), dyspnea (25%) and fatigue (18%). In multivariable, time-updated models, the hazard ratio (HR) was 1.24 (95% confidence intervals (CI) 0.72; 2.11, p=0.43) for the primary endpoint and HR 0.83 (95% CI 0.65; 1.06, p=0.14) for the secondary endpoint in symptomatic vs non-symptomatic individuals. There was a significant, inverse association for a 5-point increase in the QoL score with both the primary (HR 0.94 (95% CI 0.88; 0.99), p=0.04) and secondary (HR 0.91 (95% CI 0.88; 0.93), p<0.0001) endpoints. Conclusions AF-related symptoms are not associated with adverse cardiovascular events in AF patients. In contrast, QoL is inversely associated with to adverse cardiovascular outcomes.

Abstract 15224: Importance of Beta Blocker Subtype for the Risk of Perioperative Adverse Events in Patients Without Heart Failure and Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Mads E Jørgensen ◽  
Gunnar H Gislason ◽  
Christian Torp-Pedersen ◽  
Mark Hlatky ◽  
C harlotte Andersson
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Cardiovascular Death ◽  
Adverse Outcomes ◽  
Major Adverse Cardiovascular Events ◽  
Blocker Therapy ◽  
Beta Blocker Therapy ◽  
Increased Risk

Objective: Beta blocker therapy in patients undergoing surgery is being revisited. Previous studies have demonstrated increased risks of perioperative adverse outcomes associated with beta blocker therapy, but whether some beta blocker subtypes may be superior to others remains unknown. Methods: Using nationwide Danish registries we included all non-cardiac surgeries in patients without heart failure or myocardial infarction in 2005-2011. Patients were grouped according to beta blocker use prior to surgery. Risks of 30-day MACE (major adverse cardiovascular events; non-fatal myocardial infarction, non-fatal stroke or cardiovascular death) were estimated using logistic regression models adjusted for gender, age, body mass index, pharmacotherapy, comorbidities, type of surgery and surgery risk. Results: We included 607,338 patients in the study. Patients on beta blockers (n=50,480) were older with similar gender distribution (mean age 66 years [sd=12.9], 45%male) compared with patients not on beta blockers (n=556,858) (mean age 52 years [sd=17.6], 44%male). Patients on beta blockers had more comorbidities and received more pharmacotherapy (all p<0.001). Unadjusted absolute risks of MACE were increased with all beta blocker subtypes (range 1.7% for propranolol to 4.2% for sotalol) compared with untreated patients (0.8%). Odds ratios for the risk of 30-day MACE are shown in the Figure Conclusion: Patients without chronic heart failure and prior myocardial infarction were at increased risk of 30-day perioperative MACE when treated with beta blockers, with the exception of bisoprolol. Patients treated with carvedilol seemed to be at especially high risk.

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