Abstract 17330: Predictors of Acute Myocardial Infarction During Pregnancy

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_1) ◽  
Author(s):  
Byomesh Tripathi ◽  
Varun Kumar ◽  
Purnima Sharma ◽  
Shilpkumar Arora ◽  
Shikha Malhotra ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Nationwide Inpatient Sample ◽  
Electrolyte Imbalance ◽  
High Risk Population ◽  
International Classification Of Disease ◽  
Nationwide Inpatient Sample Database ◽  
Simple Logistic

Introduction: Risk stratification of the pregnant population is critical to improving outcomes associated with pregnancy-related Acute myocardial infarction (AMI). Methods: Pregnancy-related hospitalizations (antepartum as well as postpartum) and AMI were identified using appropriate International classification of disease-Ninth revision (ICD-9) codes from nationwide inpatient sample database (2005-2014). Simple logistic regression was used to calculate predictors of AMI during pregnancy. Results: We identified 3,786 cases of AMI from a total of 43,437,621 pregnancy related hospitalization during study period. Compared to pregnant women <20-year, we noted more than 10-fold risk of AMI among patients ≥ 40 years (OR 10.1, 95% CI 5.3-19.0, p<0.001). Other significant predictors of AMI during pregnancy were black race compared to white ( OR 1.6, 95% CI 1.3-1.9, p<0.001), co-existing comorbidities such as hypertension (OR 1.9, 95% CI 1.5-2.5, p<0.001),, thrombophilia (OR 4.8, 95% CI 2.7-8.5, p<0.001), diabetes milletus (OR 1.4, 95% CI 1.0-1.9, p<0.027),hyperlipidemia (OR 13.2, 95% CI 9.9-17.6, p<0.001),smoking (OR 3.3, 95% CI 2.3-4.6, p<0.001), substance abuse (OR 1.7, 95% CI 1.2-2.6, p=0.007), congestive heart failure (OR 26.0, 95% CI 20.3-33.2 p<0.001), deep venous thrombosis (OR 2.8, 95% CI 1.3-6.2, p=0.010) as well as obstetric condition including postpartum hemorrhage (OR 1.8, 95% CI 1.3-2.4, p<0.001),, transfusion during pregnancy (OR 3.2, 95% CI 2.4-4.2, p<0.001), postpartum infection (OR 2,7, 95% CI 1.9-3.9, p<0.001),, fluid and electrolyte imbalance (OR 5.2, 95% CI 4.2- 6.6, p<0.001), and postpartum depression (OR 1.4, 95% CI 1.1-1.9 p=0.013). Conclusions: We identified certain patient-level characteristics which correlated to high risk of AMI. This information can be utilized to decide resource allocation and the introduction of early multidisciplinary intervention among high-risk population

Incidence of Sinusitis Associated With Endotracheal and Nasogastric Tubes: NIS Database

2018 ◽  
Vol 27 (1) ◽  
pp. 24-31
Author(s):  
Norma A. Metheny ◽  
Leslie J. Hinyard ◽  
Kahee A. Mohammed
Keyword(s):  
Endotracheal Tube ◽  
Nasogastric Tube ◽  
Nationwide Inpatient Sample ◽  
International Classification Of Disease ◽  
Nasogastric Tubes ◽  
Nationwide Inpatient Sample Database ◽  
Nosocomial Sinusitis ◽  
Tube Type ◽  
Low Incidence

Background Endotracheal and nasogastric tubes are recognized risk factors for nosocomial sinusitis. The extent to which these tubes affect the overall incidence of nosocomial sinusitis in acute care hospitals is unknown. Objective To use data for 2008 through 2013 from the Nationwide Inpatient Sample database to compare the incidence of sinusitis in patients with nasogastric tubes with that in patients with an endotracheal tube alone or with both an endotracheal tube and a nasogastric tube. Methods Patients’ data with any of the following International Classification of Disease, Ninth Revision, Clinical Modification codes were abstracted from the database: (1) 96.6, enteral infusion of concentrated nutritional substances; (2) 96.07, insertion of other (naso-)gastric tube; or (3) 96.04, insertion of an endotracheal tube. Sinusitis was defined by the appropriate codes. Weighted and unweighted frequencies and weighted percentages were calculated, categorical comparisons were made by χ2 test, and logistic regression was used to examine odds of sinusitis development by tube type. Results Of 1 141 632 included cases, most (68.57%) had an endotracheal tube only, 23.02% had a nasogastric tube only, and 8.41% had both types of tubes. Sinusitis was present in 0.15% of the sample. Compared with patients with only a nasogastric tube, the risk for sinusitis was 41% greater in patients with an endotracheal tube and 200% greater in patients with both tubes. Conclusion Despite the low incidence of sinusitis, a significant association exists between sinusitis and the presence of an endotracheal tube, especially when a nasogastric tube is also present.

Trends in Incidence and Outcomes of Pregnancy-Related Acute Myocardial Infarction (From a Nationwide Inpatient Sample Database)

2019 ◽  
Vol 123 (8) ◽  
pp. 1220-1227 ◽  
Author(s):  
Byomesh Tripathi ◽  
Varun Kumar ◽  
Anmol Pitiliya ◽  
Shilpkumar Arora ◽  
Purnima Sharma ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nationwide Inpatient Sample ◽  
Nationwide Inpatient Sample Database

Abstract P456: Myocardial Infarction in Patients With Intracerebral Hemorrhage. Prevalence and Impact on Outcome

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Mohammad Rauf Chaudhry ◽  
Hussan Gill ◽  
Saqib Chaudhry ◽  
Baljinder Singh ◽  
Harathi Bandaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Intracerebral Hemorrhage ◽  
Nationwide Inpatient Sample ◽  
Hospital Charges ◽  
Discharge Disposition ◽  
International Classification Of Disease ◽  
Myocardial Infraction ◽  
Discharge Outcomes ◽  
Baseline Characteristics

Introduction/background: Comorbidities can potentially affect outcome of patients with intracerebral hemorrhage (ICH). It is unclear what the prevalence of acute myocardial infarction (AMI) and its impact on outcome are in patients with intracerebral hemorrhage. Methods: We analyzed the data from Nationwide Inpatient Sample (2005-2014) for all intracerebral hemorrhage (ICH) patients. AMI was identified using the International Classification of Disease, 9th Revision, Clinical Modification codes. Baseline characteristics, discharge outcomes (mortality, discharge disposition, length of stay and in-hospital charges) were compared between the two groups. Results: Of the 884379 patients with ICH, 27692 (3.13%) had in-hospital myocardial infraction. ICH patients with AMI order had lower proportion of females (47.8% versus 49.7%, P= 0.0028) and were older (69.7 years versus 67.2 years, P <.0001) compared to ICH patients without MI. The in-hospital mortality was higher (40.9% versus 25.5%, p≤.0001) among ICH patients with AMI in both univariate and multivariate analysis (OR = 1.22 (1.14 -1.31), P<.0001) after adjusting for potential confounders. ICH patients with MI had higher (72.4% versus 58.8%, P <.0001) proportion of moderate to severe disability at discharge compared to ones without. Similarly, mean length of in-hospital stay (12.4 days versus 8.94 days, P <.0001) and mean hospital charges ($129328 versus $ 81984.0, P <.0001) were also higher in ICH patients with MI Conclusions: While only 3.13% of patients with ICH have an AMI, there is a 22% increase in worse outcome among those patients with AMI and ICH.

scholarly journals Abnormal Glucose Tolerance in Prediabetes Patients with Acute Myocardial Infarction: Implications for Therapy

2021 ◽  
Vol 3 (1) ◽  
pp. 16-21
Author(s):  
Nitchakarn Laichuthai ◽  
Ralph A. DeFronzo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Glucose Tolerance ◽  
Cardiovascular Events ◽  
Current Evidence ◽  
Major Adverse Cardiovascular Events ◽  
High Risk Population ◽  
Abnormal Glucose Tolerance ◽  
Glucagon Like Peptide 1

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

scholarly journals Achievement of guideline recommended LDL-C goals in patients with acute myocardial infarction (AMI) in Switzerland

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Hoepli ◽  
K Ahmed ◽  
H Rickli ◽  
F Eberli ◽  
R Kobza ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Risk Group ◽  
The Other ◽  
Lipid Lowering ◽  
High Risk Population ◽  
Risk Population ◽  
Hospital Outcomes ◽  
Very High

Abstract Background In 2016 and subsequently again in 2019 the ESC/EAS Guidelines for the Management of Dyslipidaemia established a more intensive reduction of LDL cholesterol (LDL-C) treatment recommendations. We aim to characterize patients with acute myocardial infarction (AMI) with regards to achievement of recommended LDL-C goals and their current lipid lowering therapy. Methods We retrospectively analysed patients with AMI admitted to Swiss hospitals between 2016 and 2020. Patients were classified as “very high risk” due to prior atherosclerotic cardiovascular disease (ACSVD) events including at least one of the following: Myocardial infarction (MI), stroke, peripheral arterial disease (PAD) and type 2 diabetes mellitus with target organ damage. The remaining patients were classified as “other risk”. LDL-C treatment recommendation goals for the “very high risk” population were set to 1.8mmol/L (2016 ESC/EAS Guidelines) or 1.4mmol/L (2019 ESC/EAS Guidelines) and for the “other risk” population to 2.6mmol/L or 1.8mmol/L. To identify differences between the two groups the Mann-Whitney test was used and for differences within a group the Kruskal-Wallis test. In-hospital outcomes were summarised as major adverse cardiac and cerebrovascular events (MACCE). Results Among 7114 patients included, 18.4% were categorized as “very high risk” and 81.6% as “other risk” (p&lt;0.001). In general, the “very high risk” patients were older (69.2y vs. 63.6y, p&lt;0.001), more likely to be men (78.8% vs. 75.3%, p=0.007), had poorer in-hospital outcomes (6.0% vs. 3.4%, p&lt;0.001) and were more often on lipid lowering treatment (statin/ezetimibe/combination) (LLT) prior to admission (64.8% vs 14.0%, p&lt;0.001). The overall LDL-C median for the “very high risk” population was significantly lower than for the “other risk” population (2.4mmol/L vs. 3.5mmol/L, p&lt;0.001). In addition, median (IQR) LDL-C increased in the “other risk” group over the years from 3.5mmol/L (2.7; 4.2) in 2016 to 3.7mmol/L (3.1; 4.4) in 2020. In contrast, no change in LDL-C was observed in the patients at higher risk (Fig. 1). Patients in the “other risk” group were more likely to miss the recommended LDL-C goals (2016 Guidelines: 80.0% vs. 75.4%, 2019 Guidelines: 94.2% vs. 89.1%). Patients without LLT prior to admission had a higher chance of not reaching the recommendations compared to patients with LLT prior to admission (without LLT: 2016: 85.3% vs. 91.0%, 2019: 96.1% vs. 96.6%), (with LLT: 2016: 50.8% vs. 66.8%, 2019: 83.2% vs.85.2%) (Fig. 2). Conclusion Median LDL-C levels have tended to increase in recent years in patients with very high CV risk and AMI admitted to Swiss hospitals. Despite existing lipid lowering therapies only few patients met guideline recommended LDL-C goals. Our results indicate that clinical implementation of guidelines remains to be optimised with regards to achievement of LDL-C goals to reduce CV risk and improve outcomes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. LDL-C development Figure 2. Recommended LDL-C goal achievement

Novel high-sensitivity troponin assay requires higher cut-off value to separate acute myocardial infarction from non-acute myocardial infarction in a high-risk population

2015 ◽  
Vol 93 (10) ◽  
pp. 873-877 ◽  
Author(s):  
Anthony Wafik Aziz Wassef ◽  
Brett Hiebert ◽  
Mahwash F. Saeed ◽  
James W. Tam
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Troponin T ◽  
High Sensitivity ◽  
High Risk Population ◽  
Diagnostic Utility ◽  
High Sensitivity Troponin ◽  
Highly Sensitive ◽  
High Sensitivity Troponin T

Purpose: The novel high-sensitivity troponin T assay (hs-cTnT) has been validated for diagnosing AMI in the emergency room. However its utility in high-risk in-patient populations is unknown. Methods: We retrospectively reviewed admissions to a general cardiology unit that had 2 hs-cTnT measurements in the first 12 h of presentation. We assessed 8 diagnostic algorithms that used hs-cTnT concentration and changes in concentration (including the 99th percentile cut-off of 14 ng/L) for their diagnostic utility in separating AMI patients from cardiac/nonACS and non-cardiac chest-pain patients. UA was excluded. Results: There were 233 patients (mean age 67 years, 153 were males (66%)) admitted over a 2 month period, with AMI diagnosed in 118 of these patients (51%). The recommended 99th percentile cut-off had modest accuracy (65%), good sensitivity (88%), and poor specificity (25%); a higher cut-off of 75 ng/L had a better diagnostic accuracy of 73%, p < 0.05. While some hs-cTnT algorithms were either highly sensitive or specific, none were both. Conclusion: In high-risk cardiology in-patients, no hs-cTnT concentration cut-off or change more accurately diagnosed and excluded AMI, although higher cut-offs had better diagnostic utility.

Identification of high risk subsets of acute myocardial infarction

1978 ◽  
Vol 41 (2) ◽  
pp. 197-203 ◽  
Author(s):  
Karl T. Weber ◽  
Joseph S. Janicki ◽  
Richard O. Russell ◽  
Charles E. Rackley ◽  
H.J.C. Swan ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk
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