Abstract 16632: Clinical Characteristics and In-Hospital Outcomes of Covid-19 Patients With Ecg St Segment Elevation: A System Wide Analysis

Myocardial injury is seen in approximately 20% of COVID-19 patients and ST elevation myocardial infarction may be the presenting clinical manifestation. Recent data suggest that the ST-segment elevation (STE) may be due to myopericarditis. We assessed the clinical characteristics, electrocardiographic patterns, incidence, management and outcomes of COVID-19 pts with STE. Methods: We analyzed 23,406 ECGs (10,018 pts) admitted to 13 New York City area hospitals between March 1 and April 30, 2020. Results: After manual adjudication, 51 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 did not have STE. Baseline clinical characteristics were similar among the three groups, albeit a higher percentage of pts with low ejection fraction in the diffuse STE group. Cardiac catheterization was performed on 10 pts. Three pts did not have obstructive disease. Pts with focal STE were more likely to require inotropes and die during index hospitalization. Kaplan-Meier estimated overall survival rates were 31%, 33% and 6% in patients without STE, focal and diffuse STE, respectively (p < 0.0001) (Figure). By stepwise logistic regression analysis, focal STE was the strongest predictor of death (OR=7.0; CI 3.8-13.0, p<0 .0001) followed by age > 65 years (OR=3.5; CI 3.1-3.9; p<0.0001) and diffuse STE (OR=2.9; CI 1.1-7.2; p<0.0001). Female gender was associated with a decreased risk (OR 0.72; CI, 0.65-0.79; p<0.0001). Conclusions: In this large retrospective analysis of 10,018 COVID-19 pts, we observed that: 1) a very small percentage (0.7%) presented with STE; 2) 70% had focal STE and 30% had diffuse STE; 3) a minority underwent coronary angiography; 4) in-hospital mortality rates were very high for pts with STE, and even more so for those with focal STE (63% vs 46%) and; 5) focal STE was the strongest predictor of in-hospital mortality and female gender was a predictor of survival.

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P5502Comparison of clinical characteristics and prognosis between non-octogenarians and octogenarians with cardiac troponin positive acute myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz746.0452 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Soeda ◽

M Ishihara ◽

F Fujino ◽

H Ogawa ◽

K Nakao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Cardiac Troponin ◽

Clinical Characteristics ◽

St Segment Elevation ◽

The Poor ◽

St Segment ◽

Universal Definition ◽

Multicenter Registry

Abstract Background Cardiac troponin (cTn) is the preferred biomarker for the diagnosis of acute myocardial infarction (AMI). Octogenarians who presented cTn positive AMI are not usually recruited in clinical trials. Therefore, their clinical characteristics and prognosis are rarely investigated. Objective To study the characteristics and prognosis in octogenarians who presented cTn positive AMI. Methods and results The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective and multicenter registry. A total of 3,283 consecutive AMI patients who were diagnosed by cTn-based criteria were included. The patients were divided into non-octogenarians (n=2,593) and octogenarians (n=690). Compared with non- octogenarians, octogenarians showed significantly lower incidence of diabetes mellitus (37.6% and 31.9%, p=0.006) and dyslipidemia (53.6% and 45.6%, p<0.001), and significantly higher incidence of hypertension (64.1% and 75.3%, p<0.001) and chronic kidney disease (38.7% and 68.7%, p<0.001). Octogenarians showed significantly longer onset to door time (p<0.001) and longer door to device time (p<0.001). Though, compared with non-octogenarians, octogenarians showed lower peak CK (2,506 and 1,926, p<0.001), LVEF was significantly lower in octogenarians (54.6% and 52.6%, p=0.005). The presentation of AMI was different between the two group. The incidence of ST-segment elevation MI (STEMI) was 70.7% in non-octogenarians and 62.0% in octogenarians. Non-STEMI with CK elevation and without CK elevation were 16.2% and 13.1% in non- octogenarians, and 20.9% and 17.1% in octogenarians. In-hospital mortality was higher in octogenarians (4.7% and 13.2%, P<0.001). Especially, octogenarians with STEMI and non-STEMI with CK elevation showed the highest in-hospital mortality. And octogenarians without CK elevation showed similar in hospital mortality with non-octogenarians with STEMI (Figure). Conclusions J-MINUET showed the poor prognosis of octogenarians who were diagnosed as AMI based on cTn. Acknowledgement/Funding None

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Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

VASA ◽

10.1024/0301-1526/a000512 ◽

2016 ◽

Vol 45 (2) ◽

pp. 169-174 ◽

Cited By ~ 10

Author(s):

Eva Freisinger ◽

Nasser M. Malyar ◽

Holger Reinecke

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Real World ◽

Large Scale ◽

Female Gender ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Cardiovascular Morbidity And Mortality

Abstract. Background: Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular morbidity and mortality. The objective of this nationwide analysis was to explore the association of PAD with in-hospital mortality in patients hospitalized for acute myocardial infarction (AMI). Patients and methods: Data on all in-patient hospitalizations in Germany are continuously transferred to the Federal Statistical Office (DESTATIS), as required by federal law. These case-based data on AMI in the years 2005, 2007 and 2009 were analyzed regarding ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) as the primary diagnoses and concomitant PAD as the secondary diagnosis with respect to age and gender related disparity. Results: We analyzed 619,103 AMI cases, including 270,026 (43.6 %) with STEMI and 349,077 (56.4 %) with NSTEMI. The PAD ratio was 3.4 % in STEMI and 5.7 % in NSTEMI. In STEMI, in-hospital mortality was 15.6 % in cases with PAD vs. 12.0 % without, and 12.0 % vs. 9.8 % in NSTEMI, respectively (P < 0.001; 2009). Although female gender was associated with a significantly higher in-hospital mortality, the presence of PAD particularly negatively affected in-hospital mortality in men (+ 60 % male vs - 11 % female in STEMI; + 33 % male vs - 3 % female in NSTEMI). Conclusions: Our data demonstrate the adverse impact of concomitant PAD on in-hospital mortality in AMI, in a large-scale, real-world scenario. Further research, particularly with a focus on gender, is needed to identify diagnostic and therapeutic measures to reduce the remarkably high in-hospital mortality of AMI patients with concomitant PAD.

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Abstract P31: Long-Term Outcomes Among Nonagenarians with Non--ST-Segment Elevation Myocardial Infarction

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_2.ap31 ◽

2011 ◽

Vol 4 (suppl_2) ◽

Author(s):

Renato D Lopes ◽

DaJuanicia N Holmes ◽

Tracy Y Wang ◽

Matthew T Roe ◽

Eric D Peterson ◽

...

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Mortality Rates ◽

P Value ◽

Elderly Adults ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Kaplan Meier ◽

St Segment ◽

Mortality Table

Background: Age is a key determinant of adverse acute events following non-ST-segment elevation myocardial infarction (NSTEMI), but the influence of age on longer-term outcomes in hospital survivors has yet to be explored. Methods: Our population included NSTEMI patients aged ≥65 years in the CRUSADE registry who were treated from 2/2003-12/2006 and linked to Medicare claims data for longitudinal follow-up. In-hospital and 1-year mortality rates (among hospital survivors calculated using the Kaplan-Meier method) are shown for nonagenarians and younger elderly-aged groups. Cox proportional hazard modeling was used to adjust for baseline characteristics, discharge medications, and procedures. Results: Of 36,711 NSTEMI hospital survivors aged ≥65 years, 58.8% (21586/36711) were 65-79 years old, and 7.6% (2794/36711) were ≥90 years old. Compared with younger elderly adults (ages 65-79), nonagenarians had lower prevalence of diabetes but higher prevalence of congestive heart failure, hypertension, prior stroke, and renal insufficiency (all p<0.0001). The qualifying NSTEMI was more likely to be a first cardiac event (no prior MI, PCI, or CABG) for nonagenarians than for younger elderly adults (59.7% [1669/2794] vs. 51.0% [11002/21586], p<0.0001). Nonagenarians were less likely to receive revascularization (10.3% [289/2794] vs. 56.7% [12238/21586], p<0.0001) and evidence-based discharge medicine, and had high mortality (Table). One-year mortality remained higher for nonagenarians after adjustment (HR 2.15, 95% CI 1.99-2.32, reference age 65-79). Conclusions: Nonagenarians with NSTEMI experience 2-fold higher mortality following discharge compared with younger elderly adults, with a mortality rate approaching 50% at 1 year. This hazard persists after adjustment, suggesting the role of unmeasured competing risks in this vulnerable population. Table. Discharge medication, in-hospital mortality, and 1-year mortality rates by age category Discharge medications (%) 65-79 Years 80-84 Years 85-89 Years ≥90 Years P-value Aspirin 94.9 19085/21586 93.2 6166/7324 92.6 4118/5007 91.2 2198/2794 <0.001 Clopidogrel 71.5 13677/21586 67.8 4205/7324 64.0 2643/5007 58.2 1220/2794 <0.001 Beta-blocker 92.1 18352/21586 91.7 6119/7324 92.3 4131/5007 92.2 2229/2794 0.942 Statin 80.9 16514/21586 74.2 5018/7324 67.1 2998/5007 56.0 1297/2794 <0.001 ACE inhibitor or ARBs 66.4 13624/21586 65.9 4493/7324 64.2 2891/5007 61.4 1477/2794 <0.001 In-hospital mortality 4.4 996/22582 7.1 560/7784 9.2 509/5516 11.1 348/3141 <0.001 1-year mortality 13.2 2853/21586 23.8 1740/7324 33.5 1676/5007 45.6 1275/2794 –

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P1955The CHADS-VASc score is a predictor of No-Reflow in patients with NSTEMI

European Heart Journal ◽

10.1093/eurheartj/ehz748.0702 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

H A Barman ◽

S K Kahyaoglu ◽

E D Durmaz ◽

A A Atici ◽

E O Okuyan ◽

...

Keyword(s):

Hospital Mortality ◽

Multivariate Regression ◽

Female Gender ◽

Coronary Intervention ◽

Multivariate Regression Analysis ◽

St Segment Elevation ◽

No Reflow ◽

St Segment ◽

Percutaneous Coronary ◽

The Relationship

Abstract Introduction No-reflow (NR) is one of the major complications associated with primary percutaneous coronary intervention (PCI) in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to elucidate the relationship between the CHA2DS2-VASc score and NR phenomena in patients with NSTEMI. Methods A total number of 428 consecutive patients with NSTEMI were assessed for this study. Patients were divided into 2 groups, those with NR, NR(+) (n=84), and those without NR, NR(−) (n=307), according to their post-PCI, no-reflow status. The thrombus burden was classified according to the TIMI thrombus grade (TTG). CHA2DS2-VASc scores were calculated for all patients. Results The CHA2DS2-VASc score was significantly higher in the NR(+) group compared to the NR(−) (3.48±1.19 vs 1.81±0.82, p<0.001). After a multivariate regression analysis, a higher CHA2DS2-VASc score (OR: 6.52, 95% CI: 3.51–12.14, p<0.001), hs-Troponin (OR: 1.077, 95% CI: 1.056–1.099, p<0.001) and TTG (OR: 1.563, 95% CI: 1.134–2.154, p=0.006) were independent predictors of NR. In-hospital mortality rates were significantly higher in the NR(+) group compared to the NR(−) (15% vs. 5%, p<0.001). Table 1. Demographic, clinical, and angiographic characteristic of the patients Variables NR(−) (n=307) NR(+) (n=84) p Age, years, mean ± SD 55.50±8.95 56.67±8.80 0.248 Female gender, n (%) 83 (%27) 25 (%30) 0.536 CHF, n (%) 30 (%10) 17 (%20) 0.019 HT, n (%) 116 (%38) 45 (%54) 0.004 DM, n (%) 67 (%22) 30 (%36) 0.009 Previous stroke/TIA, n (%) 9 (%3) 9 (%11) <0.001 CHA2DS2-VASc score, mean ± SD 1.81±0.82 3.48±1.19 <0.001 LVEF (%), mean ± SD 56.11±9.31 51.15±11.32 <0.001 hs-troponin (pg/ml) (NRI <14pg/ml) 56.59±11.83 114.23±26.42 <0.001 Serum creatinine, mean ± SD, mg/dl 0.89±0.13 0.91±0.22 0.852 Hemoglobin (g/dl) 14.16±1.76 14.10±1.74 0.782 TTG, median 1 (0–3) 3 (1–5) <0.001 TTG(4,5), n (%) 70 (%23) 36 (%42) <0.001 In-hospital mortality, n (%) 16 (%5) 13 (%15) <0.001 Conclusions In conclusion, CHA2DS2-VASc score is associated with higher risk of no-reflow in patients with NSTEMI undergoing PCI. Acknowledgement/Funding None

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On- vs off-hours primary percutaneous coronary intervention: a single-centre experience

European Heart Journal ◽

10.1093/eurheartj/ehab724.1438 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

F G Mane ◽

R Flores ◽

R Silva ◽

I Conde ◽

C Rodrigues ◽

...

Keyword(s):

Percutaneous Coronary Intervention ◽

Hospital Mortality ◽

Coronary Intervention ◽

St Segment Elevation ◽

Admission Time ◽

Funding Sources ◽

Kaplan Meier ◽

St Segment ◽

Percutaneous Coronary ◽

One Year

Abstract Introduction In ST-segment elevation myocardial infarction (STEMI) patients, emergency medical system delays importantly affect outcomes. The effect of admission time in STEMI patients is dubious when percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. Aims The authors aimed to retrospectively describe the association between admission time and STEMI patient's care standards and outcomes. Methods Characteristics and outcomes of 1222 consecutive STEMI patients treated in a PCI-centre were collected. On-hours were defined as admission on non-national-holidays from Monday to Friday from 8 AM to 6 PM. Time delays, in-hospital and one-year all-cause mortality were assessed. Results A total of 439 patients (36%) were admitted on-hours and 783 patients (64%) were admitted off-hours. Baseline characteristics were well-balanced between groups, including the percentage of patients admitted in cardiogenic shock (on-hours: 4.6% vs off-hours 4%; p=0.62). Median emergency system dependent time to reperfusion (i.e. first-medical contact to reperfusion) did not differ between the two groups (on-hours: 120 min vs. off-hours 123 min, p=0.54). The authors observed no association between admission time and in-hospital mortality (on-hours: 5% vs. off-hours 4.9%, p=0.90) or 1-year mortality (on-hours: 10% vs. off-hours 10%, p=0.97). In patients admitted directly in the PCI-centre, median time from first-medical contact to reperfusion (on-hours: 87 min vs off-hours: 88 min, p=0.54), in-hospital mortality (on-hours: 4% vs off-hours: 7%, p=0.30) and 1 year mortality (on-hours: 9% vs off-hours: 13%, p=0.27) did not differ between the two groups. Survival analysis showed no survival benefit of on-hours PCI over off-hours PCI (HR 1.01; 95% CI [0.77–1.46], p=0.95). Conclusion In a contemporary well-organized emergency network, STEMI patients admission time in the PCI-centre was not associated with reperfusion delays or increased mortality. FUNDunding Acknowledgement Type of funding sources: None. Kaplan-Meier curve

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Abstract 16509: Incidence, Risk Factors and Prognostic Implications of Covid-19 St-segment Elevation Across a Large Health System in New York

Circulation ◽

10.1161/circ.142.suppl_3.16509 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Arvind Devanabanda ◽

Eitezaz Mahmood ◽

Ibrahim Ali ◽

Avneet SINGH ◽

Perwaiz Meraj ◽

...

Keyword(s):

Risk Factors ◽

New York ◽

Length Of Stay ◽

Survival Rates ◽

Multivariate Regression Analysis ◽

Cumulative Probability ◽

St Segment Elevation ◽

Kaplan Meier ◽

Presentation Time ◽

St Elevation

Introduction: There is limited evidence on ST elevation myocardial Infarction (STEMI) in COVID-19 patients. The aim of this study is to demonstrate the incidence of STEMI, clinical and angiographic outcomes, risk factors of COVID-19 patients among focal STEMIs, diffuse ST-elevation (STE), and no-STE. Methods: We retrospectively identified COVID-19 patients at 13 different hospitals from March 1 to April 30, 2020. All ECGs were analyzed for focal, diffuse or no-STE. Outcomes examined were death, ventilation, ICU admission, pressor and inotrope use and length of stay. Kaplan-Meier method estimated cumulative probability of death by STEMI status. Multivariate regression analysis identified association of STEMI and death. Results: There were 10,018 patients with 23,406 ECGs, of which 55 (0.5%) had focal STE, 22 (0.2%) had diffuse STE and 9,945 patients had no-STE. Death, length of stay, ICU stay, ventilator use, inotrope use, and pressor use were all statistically significant (p<0.0001) among no-STE, focal STE and diffuse STE groups. Cardiac catheterization performed on 10 STE patients, showed culprit lesions were left anterior descending artery 30%, right coronary artery 40% and no obstructive disease 30% of the time. Median symptom onset to ER presentation time in COVID STEMI was 12 hours. Figure 1 demonstrates the overall survival rates of 31%, 33%, and 6% in the no-STE, diffuse STE, and focal STE group, respectively ( P < .0001). Table 1 shows the strongest cardiac and ECG predictors of death in COVID-19 population. Conclusions: COVID-19 patients with focal STEMI and diffuse STE elevations are associated with worse survival and clinical outcomes.

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Prevalence, Clinical Characteristics, and Predictors of Patients with Thromboembolic Events in Takotsubo Cardiomyopathy

Clinical Medicine Insights Cardiology ◽

10.4137/cmc.s38151 ◽

2016 ◽

Vol 10 ◽

pp. CMC.S38151 ◽

Cited By ~ 21

Author(s):

Ibrahim El-Battrawy ◽

Michael Behnes ◽

Dennis Hillenbrand ◽

Darius Haghi ◽

Ursula Hoffmann ◽

...

Keyword(s):

Right Ventricular ◽

Clinical Significance ◽

Takotsubo Cardiomyopathy ◽

Clinical Characteristics ◽

Anticoagulation Therapy ◽

Thromboembolic Events ◽

St Segment Elevation ◽

Reactive Protein ◽

Kaplan Meier ◽

St Segment

Background Several acute complications related to takotsubo cardiomyopathy (TTC) have been documented recently. However, the incidence and clinical significance of acute thromboembolic events in TTC is not well established. Methods A detailed investigation of the clinical characteristics and in-hospital complications of 114 consecutive patients diagnosed with TTC between January 2003 and September 2015 was carried out. This study was initiated to reveal the predictors, clinical significance, and short-term and long-term outcomes of patients with TTC associated with acute thromboembolic events on index presentation. Results The incidence of acute thromboembolic events related to TTC was around 12.2%, and these included ventricular thrombi, cerebrovascular events, retinal and brachial artery pathologies, renal, splenic, and aortic involvement. The most frequent complication on initial presentation was cardiogenic shock (20%) accompanied with pulmonary congestion (20%). Interestingly, patients experiencing thromboembolic events had higher C-reactive protein (CRP) levels as compared to the non-thromboembolic group ( P = 0.02). Certain thromboembolic events were characterized by the presence of ST-segment elevation in electrocardiogram ( P 0.02). Chest pain was the primary symptom in these patients ( P 0.09). Furthermore, there was significant right ventricular involvement (as assessed by transthoracic echocardiography) in patients presenting with an acute thromboembolic event ( P 0.08). A Kaplan–Meier analysis indicated a significantly higher mortality rate over a mean follow-up of three years in the thromboembolic group than the non-thromboembolic group (log-rank, P = 0.02). Conclusions Our results confirmed the relative common occurrence of thromboembolic events in the setting of TTC. Inflammation might play an important role in the development of thromboembolic events, and a right ventricular involvement and ST-segment elevation could be positive predictors for this occurrence. In order to circumvent the risk of a negative outcome, it is recommended that an anticoagulation therapy be initiated in all high-risk patients.

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Nutritional risk index is an independent predictor of one-year mortality after primary angioplasty for ST-segment elevation myocardial infarction, regardless of age, frailty and clinical severity

European Heart Journal ◽

10.1093/ehjci/ehaa946.2855 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Arroyo-Espliguero ◽

A Silva-Obregon ◽

M.C Viana-Llamas ◽

A Estrella-Alonso ◽

S Saboya-Sanchez ◽

...

Keyword(s):

Risk Index ◽

Female Gender ◽

Primary Angioplasty ◽

Clinical Severity ◽

Nutritional Risk ◽

St Segment Elevation ◽

Kaplan Meier ◽

St Segment ◽

Nutritional Risk Index ◽

One Year

Abstract Background Undernutrition is a common feature of elderly and hospitalized patients with cardiovascular diseases and is associated with adverse events. Purpose Assess the impact of nutritional risk index (NRI) in one-year mortality in ST-segment elevation myocardial infarction (STEMI) patients following primary angioplasty (PA). Methods Cohort of 319 consecutive patients (64.4 years [54.3–75.2]; 21.9% women) admitted to a general ICU after a PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Patients were dichotomized in no to mild (NRI ≥97.5) and moderate to severe (NRI <97.5) nutritional risk. We used Kaplan-Meier and Cox survival models. Results Patients with NRI <97.5 were older, mainly women, had a higher GRACE 2.0 and required more inotropic agents (P=0.001) and mechanical ventilation (P=0.002) during admission. They had lower CK and higher BNP levels, despite the lack of differences in LVEF and MI location (P=0.164) (Table 1). One-year mortality rate was higher in patients with NRI <97.5 (P<0.001), mainly from cardiogenic shock (P<0.001) (Table). After Cox regression analysis, moderate to severe nutritional risk showed a 3.10-fold higher risk of one-year mortality (95% confidence interval [CI], 1.21 to 7.90, P=0.018), independently of age, female gender, frailty (Clinical Frailty Scale ≥4), GRACE 2.0 and LVEF (Figure 1). Conclusion Moderate to severe NRI was associated with one-year all-cause mortality in patients undergoing PA for STEMI, regardless of age, female gender, frailty and clinical severity. The prognostic impact of NRI in mortality suggests the need to include its assessment in clinical examination of STEMI patients. Figure 1. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

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Cardiac Rupture—The Most Serious Complication of Takotsubo Syndrome: A Series of Five Cases and a Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm10051066 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1066

Author(s):

Małgorzata Zalewska-Adamiec ◽

Hanna Bachórzewska-Gajewska ◽

Sławomir Dobrzycki

Keyword(s):

Female Gender ◽

Left Ventricular ◽

Cardiac Rupture ◽

Control Group ◽

Mechanical Complication ◽

Takotsubo Syndrome ◽

St Segment Elevation ◽

Glucose Levels ◽

Risk Of Death ◽

St Segment

Background: The most serious complication of the acute Takotsubo phase is a myocardial perforation, which is rare, but it usually results in the death of the patient. Methods: In the years 2008–2020, 265 patients were added to the Podlasie Takotsubo Registry. Cardiac rupture was observed in five patients (1.89%), referred to as the Takotsubo syndrome with complications of cardiac rupture (TS+CR) group. The control group consisted of 50 consecutive patients with uncomplicated TS. The diagnosis of TS was based on the Mayo Clinic Criteria. Results: Cardiac rupture was observed in women with TS aged 74–88 years. Patients with TS and CR were older (82.20 vs. 64.84; p = 0.011), than the control group, and had higher troponin, creatine kinase, aspartate aminotransferase, and blood glucose levels (168.40 vs. 120.67; p = 0.010). The TS+CR group demonstrated a higher heart rate (95.75 vs. 68.38; p < 0.0001) and the Global Registry of Acute Coronary Events (GRACE) scores (186.20 vs. 121.24; p < 0.0001) than the control group. In patients with CR, ST segment elevation was recorded significantly more often in the III, V4, V5 and V6 leads. Left ventricular free wall rupture was noted in four patients, and in one case, rupture of the ventricular septum. In a multivariate logistic regression, the factors that increase the risk of CR in TS were high GRACE scores, and the presence of ST segment elevation in lead III. Conclusions: Cardiac rupture in TS is rare but is the most severe mechanical complication and is associated with a very high risk of death. The main risk factors for left ventricular perforation are female gender, older age, a higher concentration of cardiac enzymes, higher GRACE scores, and ST elevations shown using electrocardiogram (ECG).

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Malnutrition and biological frailty are independent and complementary predictors of one-year mortality in women after primary angioplasty for ST-segment elevation myocardial infarction

European Heart Journal ◽

10.1093/ehjci/ehaa946.3167 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

R Arroyo-Espliguero ◽

M.C Viana-Llamas ◽

A Silva-Obregon ◽

A Estrella-Alonso ◽

C Marian-Crespo ◽

...

Keyword(s):

Myocardial Infarction ◽

Mortality Rate ◽

Primary Angioplasty ◽

Prognostic Impact ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Kaplan Meier ◽

St Segment ◽

One Year ◽

The Impact

Abstract Background Malnutrition and sarcopenia are common features of frailty. Prevalence of frailty among ST-segment elevation myocardial infarction (STEMI) patients is higher in women than men. Purpose Assess gender-based differences in the impact of nutritional risk index (NRI) and frailty in one-year mortality rate among STEMI patients following primary angioplasty (PA). Methods Cohort of 321 consecutive patients (64 years [54–75]; 22.4% women) admitted to a general ICU after PA for STEMI. NRI was calculated as 1.519 × serum albumin (g/L) + 41.7 × (actual body weight [kg]/ideal weight [kg]). Vulnerable and moderate to severe NRI patients were those with Clinical Frailty Scale (CFS)≥4 and NRI<97.5, respectively. We used Kaplan-Meier survival model. Results Baseline and mortality variables of 4 groups (NRI-/CFS-; NRI+/CFS-; NRI+/CFS- and NRI+/CFS+) are depicted in the Table. Prevalence of malnutrition, frailty or both were significantly greater in women (34.3%, 10% y 21.4%, respectively) than in men (28.9%, 2.8% y 6.0%, respectively; P<0.001). Women had greater mortality rate (20.8% vs. 5.2%: OR 4.78, 95% CI, 2.15–10.60, P<0.001), mainly from cardiogenic shock (P=0.003). Combination of malnutrition and frailty significantly decreased cumulative one-year survival in women (46.7% vs. 73.3% in men, P<0.001) Conclusion Among STEMI patients undergoing PA, the prevalence of malnutrition and frailty are significantly higher in women than in men. NRI and frailty had an independent and complementary prognostic impact in women with STEMI. Kaplan-Meier and Cox survival curves Funding Acknowledgement Type of funding source: None

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