Abstract 19771: Persistent Thrombocytopenia after Myocardial Infarction is Associated with Increased Short- and Long-Term Mortality

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Salim Virani ◽  
Scott Bassett ◽  
Mahboob Alam ◽  
Ravi Hira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Bleeding Complications ◽  
Group Differences ◽  
Long Term Outcomes ◽  
Post Discharge ◽  
Short And Long Term ◽  
The Impact ◽  
Long Term Mortality

Background: Thrombocytopenia (TCP) occurs commonly in patients hospitalized with acute myocardial infarction (AMI). It is unclear whether persistent TCP after discharge among AMI survivors is associated with worse outcomes. Methods: We examined the impact of persistent post-discharge TCP on outcomes in a registry of consecutive AMI patients hospitalized between January 2004 and December 2007. In-hospital (IH) TCP was defined by a nadir platelet count < 150 x 109/L. Resolved TCP was defined as IH TCP which resolved within 3 months after discharge while persistent TCP was defined as IH TCP which did not resolve within 3 months. Results: Of 842 patients hospitalized for a first AMI, we examined data on 617 hospital survivors who had follow-up within 3 months of discharge and documented long-term outcomes. Of those, 474 (76.8%) patients did not experience IH TCP while 42 (6.8%) and 101 (16.4%) had persistent and resolved TCP, respectively (Table). Patients with persistent TCP were older, had worse comorbidities, and were more likely to have TCP at baseline and discharge. There were no inter-group differences in infarct size, major bleeding complications, revascularization, or ejection fraction at discharge. Mortality following discharge was higher at all time-points among AMI patients with persistent TCP compared to patients with resolved or without IH TCP (Figure). Patients with resolved TCP had comparable mortality to those without IH TCP. Conclusion: Persistent TCP within 3 months after hospital discharge for AMI is associated with significantly increased short- and long-term mortality compared to patients with recovered TCP or without IH TCP.

scholarly journals Patients with rheumatoid arthritis have impaired long-term outcomes after myocardial infarction: a nationwide case-control registry study

Rheumatology ◽  
2021 ◽  
Author(s):  
Antti Palomäki ◽  
Anne M Kerola ◽  
Markus Malmberg ◽  
Päivi Rautava ◽  
Ville Kytö
Keyword(s):  
Myocardial Infarction ◽  
Real Life ◽  
Stroke Rate ◽  
Long Term Outcomes ◽  
Antirheumatic Drugs ◽  
Serological Status ◽  
The Impact ◽  
Long Term Mortality

Abstract Objective To investigate the long-term outcomes of patients with RA after myocardial infarction (MI). Methods All-comer, real-life MI patients with RA (n = 1614, mean age 74 years) were retrospectively compared with propensity score (1:5) matched MI patients without RA (n = 8070) in a multicentre, nationwide, cohort register study in Finland. The impact of RA duration and the usage of corticosteroids and antirheumatic drugs on RA patients’ outcomes were also studied. The median follow-up was 7.3 years. Results RA was associated with an increased 14-year mortality risk after MI compared with patients without RA [80.4% vs 72.3%; hazard ratio (HR) 1.25; CI: 1.16, 1.35; P &lt;0.0001]. Patients with RA were at higher risk of new MI (HR 1.22; CI: 1.09, 1.36; P =0.0001) and revascularization (HR 1.28; CI: 1.10, 1.49; P =0.002) after discharge from index MI. Cumulative stroke rate after MI did not differ between RA and non-RA patients (P =0.322). RA duration and corticosteroid usage before MI, but not use of methotrexate or biologic antirheumatic drugs, were independently associated with higher mortality (P &lt;0.001) and new MI (P =0.009). A higher dosage of corticosteroids prior to MI was independently associated with higher long-term mortality (P =0.002) and methotrexate usage with lower stroke rate (P =0.034). Serological status of RA was not associated with outcomes. Conclusion RA is independently associated with poorer prognosis after MI. RA duration and corticosteroid usage and dosage were independent predictors of mortality after MI in RA. Special attention is needed for improvement of outcomes after MI in this vulnerable population.

scholarly journals Impact of Admission Hyperglycemia on Short and Long-Term Prognosis in Acute Myocardial Infarction: MINOCA versus MIOCA

2021 ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract BackgroundThe prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients.MethodsMulticenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality.ResultsaHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality.ConclusionsaHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy.Trial Registrationdata were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

Impact of high bleeding risk criteria on short- and long-term outcomes in patients with acute myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Dai ◽  
A.O Okada ◽  
Y.H Hyodo ◽  
T.N Nakano ◽  
S.T Tomomori ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Bleeding Risk ◽  
Long Term Outcomes ◽  
Kaplan Meier ◽  
Short And Long Term ◽  
High Bleeding Risk ◽  
Minor Criteria ◽  
The Impact

Abstract Background The Academic Research Consortium (ARC) proposed the new definition of high bleeding risk (HBR) criteria. It remains unknown about the prevalence and the impact of HBR on clinical outcome after acute myocardial infarction (AMI). Purpose To assess the prevalence and the impact of HBR on short- and long-term outcomes in patients with AMI. Methods Between January 2015 and January 2018, 412 patients with AMI underwent coronary angiography within 24 hours after the onset of chest pain. According to HBR criteria proposed by ARC, we divided patients into 2 groups; HBR and non-HBR group. We considered a patient HBR if the patient met at least 1 major criteria or 2 minor criteria. Major criteria included severe CKD (eGFR&lt;30 ml/min), severe anemia (Hgb&lt;11 g/dl), active cancer, and the use of oral anticoagulant drug. Minor criteria included high age (≥75), moderate CKD (eGFR 30–59 ml/min), moderate anemia (Hgb 11–12.9 g/dl for men and 11–11.9 g/dl for women). Kaplan-meier method was used to compare long-term outcome of HBR and non-HBR group. Major adverse cardiovascular events (MACE) were defined as all-cause death, non-fetal MI, and stroke. Results Patients with HBR were found in 37% of patients with AMI. In-hospital mortality (11.3% vs 4.2%, p=0.008) and MACE rate was significantly higher in HBR than non-HBR group (Figure). HBR group was associated with higher all-cause death (15.7% vs 2.5%, p&lt;0.0001) and intracranial bleeding (4.8% vs 0.5%, p=0.02) than non-HBR group, although the incidence of non-fetal MI was comparable between two groups (7.6% vs 8.5%, p=0.76). Conclusions AMI patients with HBR were associated with worse outcomes both short- and long-term. Kaplan-Meier curves for MACE Funding Acknowledgement Type of funding source: None

scholarly journals Predictions and outcomes of atrial fibrillation in the patients with acute myocardial infarction

Open Medicine ◽  
2017 ◽  
Vol 12 (1) ◽  
pp. 115-124 ◽  
Author(s):  
Mihailo Vukmirović ◽  
Aneta Bošković ◽  
Irena Tomašević Vukmirović ◽  
Radoje Vujadinovic ◽  
Nikola Fatić ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Odds Ratio ◽  
Logistic Regression Model ◽  
Epidemiological Studies ◽  
Short And Long Term ◽  
Long Term Mortality

AbstractThe large epidemiological studies demonstrated that atrial fibrillation is correlated with high mortality and adverse events in patients with acute myocardial infarction. The aim of this study was to determinate predictors of atrial fibrillation develop during the hospital period in patients with acute myocardial infarction as well as short- and long-term mortality depending on the atrial fibrillation presentation. The 600 patients with an acute myocardial infarction were included in the study and follow-up 84 months. Atrial fibrillation develops during the hospital period was registered in 48 patients (8%). After adjustment by logistic regression model the strongest predictor of atrial fibrillation develop during the hospital period was older age, particularly more than 70 years (odds ratio 2.37, CI 1.23-4.58, p=0.010), followed by increased of Body Mass Index (odds ratio 1.17, CI 1.04-1.33, p=0.012), enlarged diameter of left atrium (LA) (odds ratio 1,18, CI 1,03-1,33, p=0,015) presentation of mitral regurgitation (odds ratio 3.56, CI 1.25-10.32, p=0.018) and B-type natriuretic peptide (odds ratio 2.12, CI 1.24-3.33, p=0.048).Patients with atrial fibrillation develop during the hospital period had a higher mortality during the hospital course (10.4% vs. 5.6%) p=0.179. as well as follow-up period of 84 months than patients without it (64.6% vs. 39.1%) p=0.569, than patients without it, but without statistically significance. Patients with AF develop during the hospital period had higher mortality during the hospital course as well as follow up period of 84 months than patients without it, but without statistically significance.

scholarly journals Impact of admission hyperglycemia on short and long-term prognosis in acute myocardial infarction: MINOCA versus MIOCA

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Pasquale Paolisso ◽  
Alberto Foà ◽  
Luca Bergamaschi ◽  
Francesco Angeli ◽  
Michele Fabrizio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Coronary Arteries ◽  
Hospital Death ◽  
Diabetic Patients ◽  
Long Term Outcomes ◽  
Short And Long Term ◽  
The Impact

Abstract Background The prognostic role of hyperglycemia in patients with myocardial infarction and obstructive coronary arteries (MIOCA) is acknowledged, while data on non-obstructive coronary arteries (MINOCA) are still lacking. Recently, we demonstrated that admission stress-hyperglycemia (aHGL) was associated with a larger infarct size and inflammatory response in MIOCA, while no differences were observed in MINOCA. We aim to investigate the impact of aHGL on short and long-term outcomes in MIOCA and MINOCA patients. Methods Multicenter, population-based, cohort study of the prospective registry, designed to evaluate the prognostic information of patients admitted with acute myocardial infarction to S. Orsola-Malpighi and Maggiore Hospitals of Bologna metropolitan area. Among 2704 patients enrolled from 2016 to 2020, 2431 patients were classified according to the presence of aHGL (defined as admission glucose level ≥ 140 mg/dL) and AMI phenotype (MIOCA/MINOCA): no-aHGL (n = 1321), aHGL (n = 877) in MIOCA and no-aHGL (n = 195), aHGL (n = 38) in MINOCA. Short-term outcomes included in-hospital death and arrhythmias. Long-term outcomes were all-cause and cardiovascular mortality. Results aHGL was associated with a higher in-hospital arrhythmic burden in MINOCA and MIOCA, with increased in-hospital mortality only in MIOCA. After adjusting for age, gender, hypertension, Killip class and AMI phenotypes, aHGL predicted higher in-hospital mortality in non-diabetic (HR = 4.2; 95% CI 1.9–9.5, p = 0.001) and diabetic patients (HR = 3.5, 95% CI 1.5–8.2, p = 0.003). During long-term follow-up, aHGL was associated with 2-fold increased mortality in MIOCA and a 4-fold increase in MINOCA (p = 0.032 and p = 0.016). Kaplan Meier 3-year survival of non-hyperglycemic patients was greater than in aHGL patients for both groups. No differences in survival were found between hyperglycemic MIOCA and MINOCA patients. After adjusting for age, gender, hypertension, smoking, LVEF, STEMI/NSTEMI and AMI phenotypes (MIOCA/MINOCA), aHGL predicted higher long-term mortality. Conclusions aHGL was identified as a strong predictor of adverse short- and long-term outcomes in both MIOCA and MINOCA, regardless of diabetes. aHGL should be considered a high-risk prognostic marker in all AMI patients, independently of the underlying coronary anatomy. Trial registration data were part of the ongoing observational study AMIPE: Acute Myocardial Infarction, Prognostic and Therapeutic Evaluation. ClinicalTrials.gov Identifier: NCT03883711.

P5734The outcome of intra-aortic balloon pumping support for acute myocardial infarction with extracorporeal membrane oxygenation therapy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Kida ◽  
S Hikoso ◽  
D Nakatani ◽  
S Suna ◽  
T Dohi ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Extracorporeal Membrane Oxygenation ◽  
Coronary Insufficiency ◽  
Membrane Oxygenation ◽  
Iabp Support ◽  
Short And Long Term ◽  
Long Term Mortality

Abstract Background It has been reported that intra-aortic balloon pumping (IABP) support for acute myocardial infarction (AMI) with cardiogenic shock did not reduce short and long-term mortality. However, the significance of IABP support for AMI patients with extracorporeal membrane oxygenation (ECMO) therapy remains unclear. The aim of this study was to investigate the effect of IABP support for the short and long-term outcome in AMI patients who received ECMO. Methods Using the database of the Osaka Acute Coronary Insufficiency Study (OACIS), 12,093 consecutive AMI patients were enrolled in this analysis. Among these, we analyzed 520 patients with ECMO. We classified the patients into two groups, patients who received IABP support [IABP group (n=460)] and patients who did not [no IABP group (n=60)]. Primary outcome was all-cause death. Results Study patients had following baseline clinical characteristics, age: 66.8±12.0 year old, male: 78.3%, diabetes mellitus: 41.0%, Killip class≥II: 66.2%, multi-vessel disease: 72.3%, peak creatine phosphokinase >3000IU/L: 68.1%. During a mean follow-up period of 349±625 days, Kaplan-Meier analysis revealed that the all-cause death was significantly lower in IABP group than no IABP group for 30-day (45.5% vs 72.7%, log-rank p<0.001) and long-term (66.2% vs 78.4%, Log rank p=0.005) follow-up period. Cox multivariate analysis revealed that IABP support was significantly associated with a reduced risk of mortality (Hazard ratio 0.445, 95% confidence interval 0.289 to 0.687, p<0.001). Conclusions IABP support for AMI patients with ECMO was significantly associated with reduced risks of the short and long-term mortality, suggesting that IABP support might contribute to improvement of the survival in AMI patients with ECMO.

scholarly journals Does Diabetes Mellitus Increase the Short- and Long-Term Mortality in Patients With Critical Acute Myocardial Infarction? Results From American MIMIC-III and Chinese CIN Cohorts

2021 ◽  
Vol 12 ◽  
Author(s):  
Shiqun Chen ◽  
Zhidong Huang ◽  
Liling Chen ◽  
Xiaoli Zhao ◽  
Yu Kang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Harmful Effect ◽  
The United States ◽  
Short And Long Term ◽  
The Impact ◽  
Mimic Iii ◽  
Long Term Mortality

BackgroundThe harmful effect of diabetes mellitus (DM) on mortality in patients with acute myocardial infarction (AMI) remains controversial. Furthermore, few studies focused on critical AMI patients. We aimed to address whether DM increases short- and long-term mortality in this specific population.MethodsWe analyzed AMI patients admitted into coronary care unit (CCU) with follow-up of ≥1 year from two cohorts (MIMIC-III, Medical Information Mart for Intensive Care III; CIN, Cardiorenal ImprovemeNt Registry) in the United States and China. Main outcome was mortality at 30-day and 1-year following hospitalization. Kaplan-Meier curves and Cox proportional hazards models were constructed to examine the impact of DM on mortality in critical AMI patients.Results1774 critical AMI patients (mean age 69.3 ± 14.3 years, 46.1% had DM) were included from MIMIC-III and 3380 from the CIN cohort (mean age 62.2 ± 12.2 years, 29.3% had DM). In both cohorts, DM group was older and more prevalent in cardio-renal dysfunction than non-DM group. Controlling for confounders, DM group has a significantly higher 30-day mortality (adjusted odds ratio (aOR) (95% CI): 2.71 (1.99-3.73) in MIMIC-III; aOR (95% CI): 9.89 (5.81-17.87) in CIN), and increased 1-year mortality (adjusted hazard ratio (aHR) (95% CI): 1.91 (1.56-2.35) in MIMIC-III; aHR (95% CI): 2.62(1.99-3.45) in CIN) than non-DM group.ConclusionsTaking into account cardio-renal function, critical AMI patients with DM have a higher 30-day mortality and 1-year mortality than non-DM group in both cohorts. Further studies on prevention and management strategies for DM are needed for this population.Clinical Trial Registrationclinicaltrials.gov, NCT04407936.

Abstract 3518: High Remnant Lipoprotein Levels Adversely Affect Short- and Long-term Outcomes for Patients with Acute Myocardial Infarction and Type 2 Diabetes Mellitus

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Takamitsu Nakamura ◽  
Mitsumasa Hirano ◽  
Yoshinobu Kitta ◽  
Yasushi Kodama ◽  
Akira Mende ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Long Term Outcomes ◽  
Remnant Lipoprotein ◽  
Type 2 Dm ◽  
Short And Long Term

Diabetes mellitus (DM) adversely affects prognosis in patients with acute myocardial infarction (AMI). Evidence shows that lipids-lowering therapy rather than glycemic control reduces macrovascular events in these patients, but it remains unclear which lipoprotein fractions contribute to negative effects. We previously showed that high levels of remnant lipoprotein, a triglyceride-rich lipoprotein, were an independent risk of future coronary events in patients with chronic coronary artery disease and DM. This study examined the hypothesis that remnant lipoproteinemia may adversely affect short- and long-term prognosis in patients with AMI and DM. Methods and Results: A prospective study was performed in 268 consecutive patients with Type 2 DM who were enrolled on day 5 after AMI. Fasting serum levels of remnant lipoproteins (remnant-like lipoprotein particles cholesterol; RLP-C) on day 5 after AMI were measured by an immunoseparation method. Adverse events, a composite of cardiac death, nonfatal MI, or recurrent unstable myocardial ischemia leading to unplanned revascularization therapy, were assessed during follow-up periods of 30 days and 1 year after AMI. Events rates were higher in patients with than without higher RLP-C levels (≥ 5.5 mg/dL, 50 th percentile of the distribution) during both short- and long-term follow-up periods (30 days post-MI, 8.2% [11/134 patients] vs. 2.2% [3/134 patients], p <0.05; 1 year post-MI, 15% [20] vs. 7.5% [10], p <0.05). In multivariate Cox hazard analyses, higher RLP-C levels were a significant predictor of adverse events during 30 days and 1 year independently of enrollment levels of glucose, LDL-C, and non-HDL-C (hazard ratios 2.1 and 1.7, 95% CI 1.8 – 3.9 and 1.3 – 4.0, respectively, both p<0.01). RLP-C levels were significantly correlated with C-reactive protein levels and intimal thickening of carotid artery at enrollment (r =0.30 and 0.39, respectively, both p<0.01). Conclusions: High remnant lipoprotein levels adversely affect short- and long-term outcomes in patients with AMI and Type 2 DM. The pro-inflammatory and pro-atherothrombogenic effects of remnant lipoprotein may contribute to coronary plaques instability in patients with AMI and Type 2 DM.

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