Abstract P73: Comparison of Hospital-Acquired Anemia and TIMI Bleeding for Mortality Prediction in Patients with Acute Myocardial Infarction

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Adam C Salisbury ◽  
Amit P Amin ◽  
Karen P Alexander ◽  
Frederick A Masoudi ◽  
Yan Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Assessment Tool ◽  
Mortality Prediction ◽  
Logistic Regression Models ◽  
Net Reclassification Improvement ◽  
Risk Patients ◽  
Poor Outcomes ◽  
Hospital Acquired

Background: In-hospital bleeding and new onset, hospital acquired anemia (HAA) are both associated with higher mortality in acute myocardial infarction (AMI). Since bleeding is variably defined and often poorly documented, HAA could be a better method to identify at-risk patients, if its prognostic ability were at least as good as documented bleeding. We directly compared the association of HAA and TIMI bleeding with 1-year mortality. Methods: Among 2,803 AMI patients who were not anemic at admission in the 24-center TRIUMPH registry, the presence and severity of HAA and TIMI bleeding were prospectively collected to identify their relative discrimination of 1-year mortality. Logistic regression models, accounting for clustering using generalized estimating equations, were fit for 1) no bleeding, TIMI minimal, minor and major bleeding and 2) no HAA, mild (hemoglobin (Hgb) > 11 g/dl), moderate (Hgb 9 - 11 g/dl) and severe HAA (Hgb < 9 g/dl). Discrimination was compared using c-statistics and reclassification was assessed using the integrated discrimination improvement (IDI), which measures a model's improvement in average sensitivity without sacrificing average specificity vs. another model, and the continuous net reclassification improvement (NRI), to identify the proportion of patients correctly reclassified by the HAA model. Results: HAA was more common (mild: 33%, moderate: 10%, severe 2%) than TIMI bleeding (minimal: 5%, minor: 3%, major 1%). Over 1-year follow-up, 111 patients (4%) died. The HAA model was superior to TIMI bleeding model for 1-year mortality prediction (c-statistic 0.60 vs. 0.51, p<0.001). The IDI of the HAA vs. the bleeding model was 0.009 (95% CI 0.005 - 0.014) and the relative IDI was 0.26 (26% better average discrimination), with a NRI of 0.32 (0.13-0.50) - 17% of patients with events were correctly reclassified to a higher risk while 14% of patients without events were correctly reclassified to a lower risk by the HAA model. Conclusions: HAA is better than TIMI bleeding for identifying 1-year mortality after AMI hospitalization, and may better identify patients without recognized bleeding who are also at risk for poor outcomes. HAA may be useful to identify high-risk patients and as a quality assessment tool.

Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

2020 ◽  
Vol 29 (4) ◽  
pp. 1944-1955 ◽  
Author(s):  
Maria Schwarz ◽  
Elizabeth C. Ward ◽  
Petrea Cornwell ◽  
Anne Coccetti ◽  
Pamela D'Netto ◽  
...  
Keyword(s):  
At Risk ◽  
Allied Health ◽  
Assessment Tool ◽  
Hospital Setting ◽  
Low Risk ◽  
False Negatives ◽  
Exact Agreement ◽  
Risk Patients ◽  
Impact Phase ◽  
Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

scholarly journals Appropriate secondary prevention and clinical outcomes after acute myocardial infarction according to atherothrombotic risk stratification: The FAST-MI 2010 registry

2018 ◽  
Vol 26 (4) ◽  
pp. 411-419 ◽  
Author(s):  
Victoria Tea ◽  
Marc Bonaca ◽  
Chekrallah Chamandi ◽  
Marie-Christine Iliou ◽  
Thibaut Lhermusier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Secondary Prevention ◽  
High Risk Patients ◽  
Risk Patients ◽  
St Elevation ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Full secondary prevention medication regimen is often under-prescribed after acute myocardial infarction. Design The purpose of this study was to analyse the relationship between prescription of appropriate secondary prevention treatment at discharge and long-term clinical outcomes according to risk level defined by the Thrombolysis In Myocardial Infarction (TIMI) Risk Score for Secondary Prevention (TRS-2P) after acute myocardial infarction. Methods We used data from the 2010 French Registry of Acute ST-Elevation or non-ST-elevation Myocardial Infarction (FAST-MI) registry, including 4169 consecutive acute myocardial infarction patients admitted to cardiac intensive care units in France. Level of risk was stratified in three groups using the TRS-2P score: group 1 (low-risk; TRS-2P=0/1); group 2 (intermediate-risk; TRS-2P=2); and group 3 (high-risk; TRS-2P≥3). Appropriate secondary prevention treatment was defined according to the latest guidelines (dual antiplatelet therapy and moderate/high dose statins for all; new-P2Y12 inhibitors, angiotensin-converting-enzyme inhibitor/angiotensin-receptor-blockers and beta-blockers as indicated). Results Prevalence of groups 1, 2 and 3 was 46%, 25% and 29% respectively. Appropriate secondary prevention treatment at discharge was used in 39.5%, 37% and 28% of each group, respectively. After multivariate adjustment, evidence-based treatments at discharge were associated with lower rates of major adverse cardiovascular events (death, re-myocardial infarction or stroke) at five years especially in high-risk patients: hazard ratio = 0.82 (95% confidence interval: 0.59–1.12, p = 0.21) in group 1, 0.74 (0.54–1.01; p = 0.06) in group 2, and 0.64 (0.52–0.79, p < 0.001) in group 3. Conclusions Use of appropriate secondary prevention treatment at discharge was inversely correlated with patient risk. The increased hazard related to lack of prescription of recommended medications was much larger in high-risk patients. Specific efforts should be directed at better prescription of recommended treatment, particularly in high-risk patients.

scholarly journals Incidence, Correlates, and Outcomes of Acute, Hospital-Acquired Anemia in Patients With Acute Myocardial Infarction

2010 ◽  
Vol 3 (4) ◽  
pp. 337-346 ◽  
Author(s):  
Adam C. Salisbury ◽  
Karen P. Alexander ◽  
Kimberly J. Reid ◽  
Frederick A. Masoudi ◽  
Saif S. Rathore ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Acute Hospital ◽  
Hospital Acquired

scholarly journals The Assessment of Area at Risk and Myocardial Salvage After Coronary Revascularization in Acute Myocardial Infarction

2013 ◽  
Vol 6 (3) ◽  
pp. 358-369 ◽  
Author(s):  
Martin Hadamitzky ◽  
Birgit Langhans ◽  
Jörg Hausleiter ◽  
Carolin Sonne ◽  
Adnan Kastrati ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Coronary Revascularization ◽  
Myocardial Salvage ◽  
Area At Risk

scholarly journals Prognostic nutritional index may not be a good prognostic indicator for acute myocardial infarction

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Yisong Cheng ◽  
Hong Li ◽  
Dongze Li ◽  
Lianjing Liang ◽  
Yu Jia ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Characteristic Curve ◽  
Prognostic Nutritional Index ◽  
Prognostic Indicator ◽  
Decision Curve Analysis ◽  
Net Reclassification Improvement ◽  
Nutritional Index ◽  
Integrated Discrimination Improvement

Abstract The prognostic nutritional index (PNI) has been applied in acute myocardial infarction (AMI) recently.However, the application of PNI in AMI needs verification. This was a prospective cohort study. Patients diagnosed with AMI were enrolled. PNI was calculated as (serum albumin (SA in g/L)) + (5 × total lymphocyte count (TLC) × 109/L). Modified PNI (mPNI) was analyzed by logistic regression analysis to reset the proportion of SA and TLC. The primary outcome was all-cause death. A total of 598 patients were enrolled; 73 patients died during follow-up. The coefficient of SA and TLC in the mPNI formula was approximately 2:1. The area under the receiver operating characteristic curve of SA, TLC, PNI, mPNI and GRACE in predicting death for patients with AMI was 0.718, 0.540, 0.636, 0.721 and 0.825, respectively. Net reclassification improvement (NRI) between PNI and mPNI was 0.230 (p < 0.001). Integrated discrimination improvement (IDI) was 0.042 (p = 0.001). Decision curve analysis revealed that mPNI had better prognostic value for patients with AMI than PNI; however, it was not superior to SA. Thus, PNI may not a reliable prognostic predictor of AMI; after resetting the formula, the value of PNI in predicting prognosis of AMI is almost entirely due to SA.

P3391Cholesterol crystals in culprit coronary artery with acute myocardial infarction and their relation to myocardial salvage

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Nunohiro ◽  
S Kuwasaki ◽  
T Fukushima ◽  
S Furudono ◽  
H Suenaga ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Coronary Artery ◽  
Infarct Size ◽  
Myocardial Salvage ◽  
Area At Risk ◽  
Risk Area ◽  
Contrast Enhanced ◽  
Delayed Enhancement Imaging

Abstract The involvement of cholesterol crystals (CCs) in plaque progression and destabilization of atherosclerotic plaques has been recently recognized. However, little is known about CCs and myocardial salvage in the Acute myocardial infarction (AMI) patients. This study aimed to evaluate the association between the existence of CCs at the site of culprit coronary artery and myocardial salvage index (MSI).To investigate, we applied the diagnostic resources of Optical Coherence Tomography (OCT). Methods This study included 53 AMI patients (90% with STEMI) who underwent primary PCI within 24h of onset. 53 STEMI patients underwent magnetic resonance imaging (CMR) of 5th days and 3 months after PCI. Infarct size was measured on delayed-enhancement imaging, and area at risk was quantified on T2-weighted imaging. MSI was calculated as [area at risk − infarct size] × 100/area at risk. 3 months CMR with contrast-enhanced imaging of late gadolinium enhancement-LGE. Patients were divided 2 groups according to the existence of CCs at the site of culprit coronary artery. Results CCs occurs in 26 of 53 (49%). Acute 5th days risk area (13.5±4.1 vs 12.6±4.9, P=0.48) and 3months infarct size (5.3±3.5 vs 7.0±3.2, P=0.066) were not significant between CCs and no CCs group. But salvage index were significantly lower in patients with CCs group (47.7±17.5% vs 60.1±20.2%, P=0.021) Conclusion Salvage index in patients that CCs were found by the OCT analysis, remain low after AMI. This study demonstrates the potential correlation between the myocardial salvage and vulnerable morphological features of culprit lesion to the presence of CCs with AMI patients.

Hemodynamic profile of patients with acute myocardial infarction at risk of infarct expansion

1987 ◽  
Vol 60 (1) ◽  
pp. 5-9 ◽  
Author(s):  
Luc A. Piérard ◽  
Adelin Albert ◽  
Frederic Gilis ◽  
Muriel Sprynger ◽  
Jean Carlier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
At Risk ◽  
Hemodynamic Profile ◽  
Infarct Expansion
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