Abstract 153: Rural Systems of Care: Real World Observations and Trends in ST Elevation Myocardial Infarction Patient Characteristics, and Correlations of Arrival Mode to Outcomes

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Scott Mikesell ◽  
Jeffrey Sather ◽  
John Gallagher ◽  
Richard Mullvain ◽  
Tomasz Stys ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Arrest ◽  
Systems Of Care ◽  
St Elevation Myocardial Infarction ◽  
Lv Function ◽  
Direct Transfer ◽  
St Elevation ◽  
Transfer Group

Background: Minnesota, North Dakota and South Dakota have been enhancing statewide systems through infrastructure and clinical education regarding ST-elevation myocardial infarction (STEMI) since 2010 in an attempt to equalize access to timely reperfusion in rural areas. A trend in faster time to reperfusion has been observed for STEMI patients who transfer directly to Percutaneous Coronary Intervention (PCI) capable facilities via Emergency Medical Services (EMS) and receive a pre-hospital 12-lead ECG in comparison to those who first present to a non PCI capable facility. This improved time to STEMI recognition and reperfusion may be associated with improved outcomes. Methods: Data was collected via ACTION Registry-GWTG from 2012-2015. The cohort was defined as STEMI patients who received PPCI with interfacility transfer (n=1010) and without (n=376) and who receive a pre-hospital 12-lead ECG (n=1078) and do not (n=308). The association between mode of transport, time to PPCI, and outcomes including LV function, in hospital clinical events, and in-hospital mortality were analyzed by unadjusted association. Multivariable adjustment was performed using covariates from the previously developed and validated ACTION mortality model to determine the independent association between arrival mode and outcomes. Results: The direct transfer group demonstrated shorter cumulative times (79 vs. 145 min., p=<0.001) to coronary reperfusion as compared to the interfacility transfer group. The pre-hospital ECG group experienced a shorter time to transfer (40 vs. 55 min., p=<0.001) to a PPCI center consistent with earlier system recognition and activation for a STEMI patient. The direct transfer and pre-hospital ECG groups had a statistically significant less risk of in-hospital cardiogenic shock, congestive heart failure, cardiac arrest and death as a composite end-point, p=0.011 & <0.001 respectively. During the years of 2012 to 2015, the performance of pre-hospital ECGs has increased. Conclusion: Implementation of Mission Lifeline programming was associated with significantly lower risk of in-hospital shock, congestive heart failure, cardiac arrest and death in STEMI patients presenting via EMS through increased utilization of pre hospital ECG, education, and hospital triage and procedural PPCI streamlining.

Abstract 360: Association Between Door-To-Balloon Time on Mortality in Patients With ST-Elevation Myocardial Infarction and Cardiac Arrest

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Chetan P Huded ◽  
Michael J Johnson ◽  
Venu Menon ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Systems Of Care ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Caucasian Race ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Door To Balloon

Background: Door-to-balloon-time (D2BT) is a national hospital metric for quality of care among patients with ST-elevation myocardial infarction (STEMI) but STEMI patients with cardiac arrest (CA) are excluded from D2BT public reporting metrics. The association of D2BT with mortality in STEMI patients with cardiac arrest (CA) in the contemporary era of rapid primary PCI is unknown. We assessed the association of D2BT and outcomes in patients with STEMI+CA. Methods: We reviewed consecutive cases of STEMI and CA, defined as loss of pulse requiring cardiopulmonary resuscitation and/or defibrillation, treated with percutaneous coronary intervention (PCI) at our center from 1/1/11-12/31/16.We assessed characteristics and outcomes among these patients by quartile of D2BT (Q1: 21-82 minutes, Q2: 83-106 minutes, Q3: 109-139 minutes, Q4: 141-489 minutes). Results: We identified 145 patients with STEMI+CA. Increasing quartiles of D2BT were associated with higher proportion of female sex (p=0.040), Caucasian race (p=0.001), and dyslipidemia (p=0.008). The use of guideline-directed medical therapy prior to PCI (aspirin, P2Y12 inhibitor, and anticoagulant) and the occurrence of in-hospital post-PCI adverse events were similar between groups. We observed a trend toward increased in-hospital mortality associated with increasing D2BT (Q1: 8.3%, Q2: 10.8%, Q3: 19.4%, Q4: 22.2%, p=0.059, Figure). Conclusion: D2BT is associated with in-hospital mortality among patients with STEMI+CA. Efforts should be made to implement systems of care to reduce disparities in D2BT among appropriate patients within this population.

Abstract 337: Prognostic Impact of Cardiac Arrest Among Patients With ST-Elevation Myocardial Infarction

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Anirudh Kumar ◽  
Chetan P Huded ◽  
Michael J Johnson ◽  
Venu Menon ◽  
Stephen G Ellis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Cardiac Arrest ◽  
Troponin T ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Prognostic Impact ◽  
History Of ◽  
St Elevation ◽  
The Impact

Background: ST-elevation myocardial infarction (STEMI) is a potentially fatal condition that may be complicated by cardiac arrest (CA). However, the impact of CA complicating STEMI on prognosis in the contemporary era of rapid primary PCI is uncertain. Methods: We reviewed consecutive cases of STEMI treated with percutaneous coronary intervention (PCI) at our center between January 1, 2011 and December 31, 2016. Baseline clinical characteristics and in-hospital long-term outcomes were compared between patients with and without CA. Results: Among 1,272 patients with STEMI, 148 (11.6%) had CA (30.4% out-of-hospital, 69.6% after ED arrival). Compared to patients without CA, patients with STEMI+CA were more likely to have a history of heart failure, valve surgery, peripheral and cerebrovascular disease, and chronic kidney disease with a trend towards increased prevalence of left main or left anterior descending culprit vessel. Patients with STEMI+CA had greater creatinine (1.28±0.92 vs. 1.07±0.67, p=0.013, infarct size (CK-MB 171.6±131.6 vs. 139.2±117.0 ng/mL, p=0.010; troponin T 6.2±6.2 vs. 5.0±4.8 ng/mL, p=0.024), door-to-balloon-time (118.1±63.6 vs. 106.8±64.0, p=0.045), and incidence of cardiogenic shock (48.0% vs. 5.9%, p<0.0001) and intra-aortic balloon pump need (36.5% vs. 8.3%, p<0.0001). Patients with STEMI+ CA had higher rates of major bleeding (25.0% vs. 9.4%, p<0.0001) and post-PCI heart failure (13.5% vs. 8.1%, p=0.042). Patients with STEMI+CA had significantly greater mortality in-hospital (14.9% vs. 3.6%, p<0.0001) and at 1-year (22.9% vs. 9.3%, p<0.0001) (Figure). Conclusions: CA is a complication in >1 in 10 patients with STEMI and is associated with significantly higher morbidity and mortality compared with STEMI without CA. Strategies to improve the care and outcomes of STEMI patients with CA are needed.

scholarly journals CILOSTAZOL DID NOT INDUCE ANY ADVERSE REACTIONS IN CORONARY ARTERIAL DISEASE (NON-ST ELEVATION MYOCARDIAL INFARCTION) WITH CONGESTIVE HEART FAILURE COMORBIDITY: A CASE REPORT

2016 ◽  
Vol 10 (1) ◽  
pp. 1 ◽  
Author(s):  
Yedy Purwandi Sukmawan
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Adverse Reaction ◽  
Case Report ◽  
Adverse Reactions ◽  
Arterial Disease ◽  
St Elevation Myocardial Infarction ◽  
Coronary Arterial Disease ◽  
St Elevation

A 63 year-old males with dyspnea, had recently begun using cilostazol after switched from aspirin caused by asthma related to aspirin. Cilostazol contraindicated for congestive heart failure and possess adverse reactions related to the heart such as cardiac arrhytmia, palpitation, tachycardia and oedema. But however, 10 days monitoring for adverse reaction of cilostazol used, revealed there was no adverse reaction to be related to cilostazol.

scholarly journals GWTG-HF score and acute coronary syndrome

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
M Santos ◽  
H Santos ◽  
I Almeida ◽  
H Miranda ◽  
S Paula ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Logistic Regression ◽  
Roc Curve ◽  
Curve Analysis ◽  
St Elevation Myocardial Infarction ◽  
Lv Function ◽  
Roc Curve Analysis ◽  
St Elevation ◽  
Excellent Accuracy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Post-hospitalization (PH) risk stratification is crucial. The Get With The Guidelines Heart Failure score (GWTG-HFS) predicts in-hospital mortality (M) of patients (P) admitted with acute heart failure. Objective To validate GWTG-HFS as predictor of PH early and late M and readmission (RA) rates, in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/20168 and 11/12/2019. Patients who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA). Statistical analysis used non-parametric tests, logistic regression and ROC curve analysis. Results 268 patients with ACS, mean age was 66.4 ± 12.5 years old and 59.7% were male. The diagnosis was unstable angina in 2.6%, non-ST elevation myocardial infarction (NSTEMI) in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. 41.8% of the P were or had been smokers, 68.5% had hypertension, 34.5% were diabetic and 50.9% had dyslipidaemia. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis &lt;50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the P had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 1mM rate was 1.9% and 1yM rate was 7.8%. Age (p = 0.034), diabetes (p = 0.031), KKC (p &lt; 0.001), BUN (p = 0.003) and LV function (p &lt; 0.001) were predictors of 1mM. Age (p &lt; 0.001), HR (p = 0.009), KKC (p = 0.032), BUN (p &lt; 0.001), sodium (p &lt; 0.001), creatinine (p &lt; 0.001), Hb (p &lt; 0.001), LV function (p &lt; 0.001), de novo AF (p &lt; 0.001) and number of arteries with significant disease (p = 0.044) were predictors of 1yM. Logistic regression and ROC curve analysis showed that GWTG-HFS was able to predict 1mM (Odds ratio (OR) 1.18, p = 0.005, confidence interval (CI) 1.05-1.33; area under curve (AUC) 0.872) and 1yM (OR 1.16, p = 0.001, CI 1.09-1.24, AUC 0.838) with excellent accuracy, and 1mRA (OR 1.10, p = 0.006, CI 1.03-1.18, AUC 0.677) and 1yRA (OR 1.04, p = 0.024, CI 1.01-1.08, AUC 0.580) with poor accuracy. A sub-analysis regarding NSTEMI P showed that GWTG-HFS was able to predict 1mM (OR 1.20, p = 0.010, CI 1.05-1.39, AUC 0.902) and 1yM (OR 1.15, p &lt; 0.001, CI 1.07-1.23, AUC 0.817) with excellent accuracy. On the other hand, sub-analysis regarding STEMI showed that GWTG-HFS was not able to predict 1mM (p = 0.495) but was accurate at predicting 1yM (OR 1.18, p = 0.048, CI 1.00-1.39, AUC 0.881). Conclusion This study confirms that, in our population, GWTG-HFS is a valuable tool in PH risk score stratification in ACS, particularly NSTEMI.

scholarly journals Association of Interleukin 8 and Myocardial Recovery in Patients with ST-Elevation Myocardial Infarction Complicated by Acute Heart Failure

PLoS ONE ◽  
2014 ◽  
Vol 9 (11) ◽  
pp. e112359 ◽  
Author(s):  
Trygve Husebye ◽  
Jan Eritsland ◽  
Harald Arnesen ◽  
Reidar Bjørnerheim ◽  
Arild Mangschau ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Heart Failure ◽  
Interleukin 8 ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Recovery ◽  
St Elevation
Sign in / Sign up

Export Citation Format

Share Document