Abstract 16438: Combined Prognostic Significance of Heart Failure and Chronic Kidney D in Patients With Acute Myocardial Infarction. The Fast-mi Programme

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nicolas Danchin ◽  
Guillaume Cayla ◽  
Yves Cottin ◽  
Pierre COSTE ◽  
Franck ALBERT ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cox Regression ◽  
Prognostic Significance ◽  
Acute Stage ◽  
Prior History ◽  
First Year ◽  
History Of ◽  
One Year

Introduction: We assessed the interplay and potential cumulative effects of heart failure (HF) and chronic kidney disease (CKD) on one-year and 5-year outcomes in patients admitted for acute myocardial infarction (AMI). Methods: FAST-MI consists of 3 nationwide French surveys 5 years apart from 2005 to 2015, consecutively including STEMI and NSTEMI patients over 1-month periods. Using Cox regression, we analysed the association between CKD and non-fatal HF and death during the first year after discharge according to absence of HF, previous HF and acute stage HF. In those alive at 1 year, we also analysed the prognostic significance of admission for non-fatal HF after AMI and CKD on 5-year mortality. Results: Of 12,301 patients discharged alive, 7960 (64.7%) had normal renal function and no HF. Both CKD and type of HF were independent predictors of one-year death: one-year mortality was 3.6%, 14.3% and 24.5% in patients with no HF, acute stage HF, and prior history of HF, respectively. Within each group, mortality increased by increasing degree of CKD. In patients with no history of HF, CKD was a strong independent correlate of hospital admission for HF within one year of discharge: HR (95%CI) 1.33 (1.01-1.74), P=0.04 for CKD-EPI 30-60, and 1.76 (1.16-2.67), P=0.008 for CKD-EPI <30, as was the case in patients with HF at the acute stage (Figure). Finally, in patients alive at 1year, both HF admission during the first year (adjusted HR 1.85, 1.42-2.39, P<0.001) and CKD (HR 1,23, 1.04-1.47, P=0.02 and HR 1.86, 1.41-2.44, P<0.001, respectively for moderate and severe renal dysfunction), were independent predictors of 5-year death. Conclusion: After AMI, CKD and HF are major independent prognostic factors for death and/or subsequent HF admission. Both are likely to be important therapeutic targets to improve long-term outcomes after AMI.

scholarly journals Prognosis of diabetes mellitus and timing of heart failure in patients with acute myocardial infarction. An analysis of a French nationwide hospital database

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L Fauchier ◽  
C Semaan ◽  
G Fauchier ◽  
J Herbert ◽  
T Genet ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Stage ◽  
First Year ◽  
Diabetic Patients ◽  
History Of ◽  
One Year ◽  
Long Term Mortality

Abstract Background Diabetes mellitus (DM) is a factor of increased mortality in patients with acute myocardial infarction (AMI). DM is also associated with a higher risk of heart failure (HF) in patients with coronary artery disease as in the general population. The aim of the present study was to assess the incidence of HF developing at the acute stage of MI and of HF occurring in the year following hospital discharge, according to presence of DM. We also assessed the association between DM, HF and long-term mortality in this AMI population. Methods We used the French administrative hospital-discharge database, including all patients without history of HF admitted for AMI between 2010 and 2019 (n=797,212, mean age 69 years, 66% male). Among them, 520,258 patients (65%) had ST-segment elevation myocardial infarction (STEMI), 276,954 (35%) had non-STEMI, 192,456 patients (24%) had a history of DM. Occurrence of HF during the initial hospital stay was analysed in the whole population. In patients without HF during the index hospitalisation, discharged and alive at day 8 (n=535,813), we collected all hospitalisations for HF occurring during the year after discharge and analysed subsequent long-term mortality in those alive at one year (n=270,534) (length of follow-up 2.0±2.5 years, median 0.9, IQR 0.1–3.5). Results Overall, DM patients were older than non-DM patients (71±12 vs 67±15 years) and had more frequent comorbidities. At the acute stage, DM was associated with a higher risk of HF (28.7% vs 20.5% adjusted OR 1.40, 1.38–1.42, p&lt;0.0001). In patients without HF at the acute stage and discharged alive at day 8, DM was associated with a higher risk of being hospitalised with HF in the first year (5.6% vs 2.8%, adjusted HR 1.52, 1.49–1.56, p&lt;0.0001). In patients alive at one year, rates of all-cause death per year during subsequent follow-up were 2.2% in those without DM or HF during the first year (reference), 3.4% in those with DM and no HF during the first year (adjusted HR 1.22, 1.18–1.25, p&lt;0.0001), 7.7% in those without DM and with HF during the first year (adjusted HR 1.92, 1.83–2.02, p&lt;0.0001) and 8.9% in those with DM hospitalised with HF during the first year (adjusted HR 2.23, 2.09–2.37, p&lt;0.0001) (see figure). Conclusion After AMI, patients with diabetes are at increased risk of heart failure both at the acute stage and in the year following myocardial infarction, compared with non-diabetic patients. Non-fatal HF developing in the year following discharge is associated with noticeably higher subsequent mortality, and the combination of DM and HF is particularly at risk. Improved management is needed in diabetic patients following an AMI to avoid development of heart failure and its longer-term consequences. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

Abstract 11133: The Incidence and Predicting Factors of Heart Failure After First Acute Myocardial Infarction: A Population[[Unable to Display Character: ‐]]Based Study in Taiwan

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Cheng-Han Lee ◽  
Yi-Heng Li ◽  
Ching-Lan Cheng ◽  
Jyh-Hong Chen ◽  
Yea-Huei Kao Yang
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Coronary Revascularization ◽  
Temporal Trends ◽  
Population Based ◽  
Research Database ◽  
Index Hospitalization ◽  
Predicting Factors ◽  
One Year

Background: Early coronary revascularization and medical therapy advancement improve the survival of patients (pts) with acute myocardial infarction (AMI). However, survivors of AMI are at heightened risk of developing heart failure (HF) and there is a paucity of information regarding this issue in Asian countries. This study described the temporal trends in the incidence of HF after the first AMI and the predicting factors of HF development in Taiwan. Methods: We conducted a nationwide population-based cohort study by using 1999 to 2009 National Health Insurance Research Database. Pts aged≧18 years, with no history of HF, who hospitalized with a first AMI between January 2002 and December 2008 were identified and followed up for one year. The primary outcome was HF. We evaluated the incidence of HF during the index hospitalization, 30 days, 6 months, and one year after the discharge. The predicting factors of HF were identified by Cox proportional hazard model. Results: Overall, 42,011 first AMI pts (mean age 64.4 ± 13.8 years; male 75.0%) from 2002 to 2008 were identified. The HF incidence during the index hospitalization was 14.8%. After exclusion of HF during the hospitalization, the overall HF prevalence at 30 days, 6 months, and 1 year was 9.6%, 14.2%, and 16.8%, respectively. The HF prevalence at 1 year declined from 17.9% to 14.9% (p<0.05) from 2002 to 2008. The independent predicting factors of HF after the first AMI were elder age (≧65 years) (adjusted HR 1.81, 95% CI 1.51-2.18), diabetes mellitus (adjusted HR 1.30, 95% CI 1.21-1.41), chronic kidney disease (adjusted HR 1.41, 95% CI 1.20-1.65), use of loop diuretics within 30 days after the discharge (adjusted HR 2.21, 95% CI 2.00-2.43), and recurrent AMI (adjusted HR 2.43, 2.16-2.74). Conclusions: Survivors of AMI without prior HF remain at risk of developing HF in Taiwan and most episodes occur within 6 months after AMI. Five important clinical factors of HF were identified that may help us for risk stratification.

scholarly journals History of Hypertension and Eplerenone in Patients With Acute Myocardial Infarction Complicated by Heart Failure

Hypertension ◽  
2008 ◽  
Vol 52 (2) ◽  
pp. 271-278 ◽  
Author(s):  
Bertram Pitt ◽  
Ali Ahmed ◽  
Thomas E. Love ◽  
Henry Krum ◽  
Jose Nicolau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
History Of

scholarly journals Five‐Year Risk of Acute Myocardial Infarction After Acute Ischemic Stroke in Korea

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Keon‐Joo Lee ◽  
Seong‐Eun Kim ◽  
Jun Yup Kim ◽  
Jihoon Kang ◽  
Beom Joon Kim ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Cumulative Incidence ◽  
Multivariable Analysis ◽  
First Year ◽  
Vessel Occlusion ◽  
History Of ◽  
Annual Risk

Background The long‐term incidence of acute myocardial infarction (AMI) in patients with acute ischemic stroke (AIS) has not been well defined in large cohort studies of various race‐ethnic groups. Methods and Results A prospective cohort of patients with AIS who were registered in a multicenter nationwide stroke registry (CRCS‐K [Clinical Research Collaboration for Stroke in Korea] registry) was followed up for the occurrence of AMI through a linkage with the National Health Insurance Service claims database. The 5‐year cumulative incidence and annual risk were estimated according to predefined demographic subgroups, stroke subtypes, a history of coronary heart disease (CHD), and known risk factors of CHD. A total of 11 720 patients with AIS were studied. The 5‐year cumulative incidence of AMI was 2.0%. The annual risk was highest in the first year after the index event (1.1%), followed by a much lower annual risk in the second to fifth years (between 0.16% and 0.27%). Among subgroups, annual risk in the first year was highest in those with a history of CHD (4.1%) compared with those without a history of CHD (0.8%). The small‐vessel occlusion subtype had a much lower incidence (0.8%) compared with large‐vessel occlusion (2.2%) or cardioembolism (2.4%) subtypes. In the multivariable analysis, history of CHD (hazard ratio, 2.84; 95% CI, 2.01–3.93) was the strongest independent predictor of AMI after AIS. Conclusions The incidence of AMI after AIS in South Korea was relatively low and unexpectedly highest during the first year after stroke. CHD was the most substantial risk factor for AMI after stroke and conferred an approximate 5‐fold greater risk.

scholarly journals Beta-blockers, and real clinical practice in Russia: the gap between the understanding of the doses of beta-blockers and subsequent prognosis in patients with cardiovascular disease

2017 ◽  
Vol 14 (3) ◽  
pp. 36-41
Author(s):  
I V Fomin ◽  
D S Polyakov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Chronic Heart Failure ◽  
Beta Blockers ◽  
Previous History ◽  
Clinical Manifestations ◽  
Population Level ◽  
Cardiovascular Pathology ◽  
History Of

Presents an analysis of the reception beta-blockers in three epidemiological studies sections of the EPOKhA. Respondents in each slice (2002, 2007, 2017) were stratified into 5 subgroups: only suffering from hypertension - AH (subgroup AH), patients with stable angina pectoris, but in history and clinically has no evidence of acute myocardial infarction (AMI) and chronic heart failure (subgroup of coronary heart disease); after myocardial infarction, but do not have clinical manifestations of chronic heart failure (subgroup myocardial infarction); patients with acute myocardial infarction formed for any reason, but with no previous history of AMI (subgroup chronic heart failure), and patients with clinical manifestations of chronic heart failure after suffering AMI in anamnesis (subgroup myocardial infarction + chronic heart failure). During 15 years in the Russian Federation the frequency of administration of beta-blockers increased from 20% in the section of cardiovascular pathology to 30%. The most sensitive to the use of beta-blockers were patients with a history of AMI and chronic heart failure. Prolonged beta-blockers have been used at the population level only in 2007, but the frequency with any cardiovascular pathology does not exceed the 50% threshold, and the achievement of goals (control heart rate) does not exceed 10% of the level at any pathology. This dependence is associated with low-dose beta-blockers. In any case, the dose of beta-blockers did not exceed 50% of recommended that can be a separate cause of cardiovascular mortality at the population level in Russia.

Abstract 572: Hyperglycemia and Poor Outcomes in Patients without Diabetes Mellitus in the Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS): A Propensity Matched Analysis

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Prakash C Deedwania ◽  
Bertram Pitt ◽  
Enrique V Carbajal ◽  
Ali Ahmed
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Propensity Scores ◽  
Cox Regression ◽  
Baseline Serum ◽  
Increased Risk

Background: The effect of hyperglycemia on outcomes in patients with acute MI (AMI) and low LVEF without diabetes mellitus is not well known. Methods: In the EPHESUS trial, of the 4411 non-DM patients, 554 had baseline hyperglycemia (≥140 mg/dL). Propensity scores for hyperglycemia were calculated for each of the 4411 patients based on 63 baseline covariates, and a greedy 1:8 matching protocol was used to match 400 and 2542 patients respectively with and without hyperglycemia. Matched Cox regression models were used to estimate associations between hyperglycemia and outcomes during 16 months of follow up. Results: Patients with hyperglycemia were more likely to be older, have higher heart rate, lower LVEF, and receive nitrates, statins, digoxin, loop diuretics, and PTCA during index admission. Unadjusted hazard ratios {HR} and 95% confidence intervals {CI} for hyperglycemia were: all-cause death (1.51; 1.22–1.87; P<0.001), cardiovascular (CV) death (1.52; 1.21–1.90; P<0.001), heart failure (HF) death (2.19, 1.46–3.29; P<0.001), all-cause hospitalization (1.23; 1.08–1.40; P=0.002), CV hospitalization (1.51, 1.24–1.84; P<0.001) and HF hospitalization (1.75; 1.37–2.25; P<0.001). In the matched cohort, hyperglycemia was significantly associated with CV death (HR=1.25, 95%CI=1.01–1.54; P=0.039), sudden cardiac death (HR=1.33; 95%CI=1.02–1.73, P=0.035) and fatal/nonfatal AMI (HR=1.53, 95%CI=1.07–2.19; P=0.04; Figure ). Conclusions: In non-diabetic post-AMI HF patients, hyperglycemia is a poor prognosticator and is associated with increased risk of fatal and non-fatal AMI, CV death, HF deaths, sudden cardiac death, and CV hospitalization. Figure Fatal or non fatal acute myocardial infarction (AMI) by baseline serum glucose in post-AMI patients with no known history of diabetes mellitus

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