Abstract 245: Risk of Readmission With Recurrent Myocardial Infarction After Index Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Moses Anabila ◽  
Jeevanantham Rajeswaran ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Patient Outcomes ◽  
Treatment Strategy ◽  
Medical Center ◽  
Parametric Method ◽  
Treatment Strategies ◽  
Recurrent Myocardial Infarction ◽  
Acute Mi ◽  
Increasing Risk ◽  
Considerable Morbidity

Background: Recurrent Myocardial Infarction (MI) after an index MI is a cause for considerable morbidity and mortality. However, the underlying factors that precipitate patients for a recurrent MI remain unclear. We aimed to assess the effect of index MI treatment strategy on the risk of developing a recurrent MI. Methods: We reviewed all cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 and identified all cases of recurrent MI within 90 days after index MI. Readmissions were further stratified depending on the treatment strategy undertaken during index MI into medically managed and revascularized patients. The instantaneous risk of readmission following each of these treatment strategies was estimated by the parametric method. Results: We identified 6,626 patients admitted with an index MI, of which 168 patients were readmitted with a recurrent MI within 90 days. Among the index admissions, 4354 (66%) patients underwent revascularization and 2272 (34%) patients underwent medical management. Time-varying instantaneous risk of readmission analysis showed an early peaking risk followed by a late increasing risk in the revascularization group whereas, in the medically managed group, the analysis yielded an early peaking followed by a late almost constant risk of readmission for MI. Conclusion: Patients with acute MI who are medically treated are at a higher risk of developing a recurrent MI than patients who undergo revascularization. Defining the characteristics and underlying factors contributing to these readmissions can be pivotal in improving patient outcomes.

Abstract 15371: Risk of Early Recurrent Myocardial Infarction After Index Myocardial Infarction Stratified by Index Treatment Strategy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Jeevanantham Rajeswaran ◽  
Moses Anabila ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Treatment Strategy ◽  
Medical Management ◽  
Focal Point ◽  
Medical Center ◽  
Standard Of Care ◽  
Increased Risk ◽  
Significant Difference ◽  
Acute Mi ◽  
Index Treatment

Introduction: Survivors of Myocardial Infarction (MI) remain at increased risk for another cardiovascular event. The purpose of our study was to assess the role of index treatment strategy in developing early recurrent MI after acute MI. Methods: We analyzed all cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017, and identified all cases of recurrent MI within 90 days of index MI. Early recurrent MI cases were further stratified depending on the treatment strategy for index MI. Reinfarctions were also stratified according to the time of readmission into early (0-30 days after discharge) and late (30-90 days after discharge) time periods. Results: We identified 6,626 patients admitted with an acute MI and 168 cases of recurrent MI within 90 days of discharge. Among the index MI patients, 4354 (66%) patients underwent revascularization whereas 2272 (34%) underwent medical management. An unadjusted comparison of the risk of readmission among the 3 different revascularization strategies showed that the CABG group appeared to have the lowest risk of readmission with a recurrent MI, and there was no significant difference in the late risk of readmission between PCI and CABG groups (P=0.8). The medically managed group had the highest late risk of readmission with a recurrent MI. Conclusions: The risk of readmission with a recurrent MI is higher in patients who undergo medical management for index MI. Aiming to improve the standard of care in these patients should be the focal point of interest to curb these reinfarctions.

T786C eNOS polymorphism as risk factor for recurrent myocardial infarction in young and middleaged patients

2020 ◽  
pp. 17-21
Author(s):  
E. A. Shishkina ◽  
O. V. Khlynova ◽  
A. V. Tuev ◽  
A. V. Krivtsov
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Coronary Intervention ◽  
Middle Aged ◽  
Aged Patients ◽  
Recurrent Myocardial Infarction ◽  
Enos Polymorphism ◽  
Acute Mi ◽  
Oxide Synthase ◽  
Endothelial Nitric Oxide

Objective. To determine the possible role of the endothelial nitric oxide synthase (eNOS) polymorphism T786C (rs 2070744) in developing of recurrent myocardial infarction (MI) in young and middle-aged patients. Materials and methods. 114 patients with acute MI treated with percutaneous coronary intervention and thrombolysis that were admitted to Clinical cardiologic dispensary (Perm city, Russia) were enrolled into a study. Among them there were 28 patients with recurrent MI. The eNOS T786C polymorphism were determined by real-time PCR. Results. In T786C polymorphism of eNOS, compared with the T/T genotype, it was determined that those with T/C has 2,27 fold (95 % CI: 1.01–5.49), and those with the CC genotype has 2.22 times (95 % CI: 1.30–8.53) (p = 0.034) greater risk of developing recurrent MI. Patients with severe coronary arteries atherosclerosis more frequently had eNOS T786C polymorphism of T/C genotype (OR = 4,67; 95 % CI: 1,38–15,37; p = 0,031). Conclusion. The eNOS T786C variants could be evaluated as recurrent MI risk factor in young and middle-aged patients.

Latest Strategies and Patient Outcomes in the Treatment of ST-segment-elevation Myocardial Infarction

2010 ◽  
Vol 6 (1) ◽  
pp. 80
Author(s):  
Pedro L Sánchez ◽  
Isaac Pascual Calleja ◽  
Héctor Bueno ◽  
Francisco Fernández-Avilés ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Patient Outcomes ◽  
Treatment Strategies ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Appropriate Treatment ◽  
St Segment

The goal of treatment strategies for patients with ST-segment-elevation myocardial infarction (STEMI) is to reperfuse the occluded coronary artery as rapidly and safely as possible. This article discusses evidence in terms of the latest appropriate treatment strategies for patients with STEMI, taking into consideration timing and logistical barriers. We also present the reperfusion pathway we use.

Abstract 357: Comparison of Comorbidities Between Patients Admitted With Index Myocardial Infarction and Recurrent Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Moses Anabila ◽  
Jeevanantham Rajeswaran ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Risk Factor ◽  
Medical Center ◽  
Modifiable Risk Factors ◽  
Risk Factor Management ◽  
Recurrent Myocardial Infarction ◽  
Artery Disease ◽  
The Relationship ◽  
Risk Factor Burden

Background: Several comorbidities are known to increase the risk of coronary artery disease. However, the relationship between modifiable risk factors and recurrent Myocardial Infarction (MI) has not been clearly defined. The purpose of our study was to assess if there were certain comorbidities that increase the risk of recurrent myocardial infarction. Methods: We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 (29% STEMI, 71% NSTEMI), and we identified all cases of readmission with a recurrent MI within 90 days after index MI. All patients with index MI were screened for accompanying comorbidities and compared with patients with recurrent MI. Results: There were a total of 2051 readmissions (31%) within 90-days of index MI, of which 168 readmissions were for recurrent MI. Hypertension and Dyslipidemia appeared to be the most prominent modifiable risk factors in patients with index MI and recurrent MI (86%, 94% for HTN & 81%, 93% for DLP). All comorbidities were substantially more prevalent in patients with recurrent MI than in patients with index MI. Conclusion: Patients with recurrent MI have a higher risk factor burden than the general population with MI. This highlights the importance of risk factor management in patients with acute Myocardial infarction.

Abstract 383: Effect of Race on Risk of Recurrent Myocardial Infarction After Index Myocardial Infarction

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Raunak Nair ◽  
Michael Johnson ◽  
Kathleen A Kravitz ◽  
Moses Anabila ◽  
Jeevanantham Rajeswaran ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
African Americans ◽  
Medical Center ◽  
White Americans ◽  
Recurrent Myocardial Infarction ◽  
Increased Risk ◽  
Artery Disease ◽  
Racial Factors ◽  
White Patients

Background: Though the prevalence of coronary artery disease is known to be highest in African Americans, it is unclear if there are any racial factors predisposing patients for a recurrent Myocardial Infarction (MI) after index MI. Methods: We reviewed 6,626 cases of MI at a single quaternary care medical center from January 1 st , 2010 to January 1 st , 2017 (29% STEMI, 71% NSTEMI), and we identified all cases of recurrent MI within 90 days of discharge after index MI. The patients were categorized according to their corresponding races into White Americans, African Americans, and Others. Result: Out of the 6626 initial cases of MI, 72% were white patients, 25% were African Americans and 3% belonged to other races. A total of 2051 patients were readmitted within 90 days of index admission, of which 168 patients were readmitted with an MI. Only 2.1% of White patients developed a recurrent MI whereas 4% of African Americans were readmitted with a recurrent MI (P=0.003). Conclusion: We observed that African Americans were more likely to be readmitted with a recurrent MI than White Americans. Understanding the reasons for this increased risk in MI can translate into improved care for African Americans.

Prevention of Recurrent Myocardial Infarction and Sudden Death with Aspirin Therapy

1987 ◽  
Vol 21 (12) ◽  
pp. 961-969 ◽  
Author(s):  
Martha M. Rumore ◽  
George S. Goldstein
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Clinical Practice ◽  
Sudden Death ◽  
Secondary Prevention ◽  
Aspirin Therapy ◽  
Initial Event ◽  
Current State ◽  
Recurrent Myocardial Infarction ◽  
Acute Mi

In October 1985, the Food and Drug Administration approved a new indication of aspirin for the secondary prevention of recurrent myocardial infarction (MI) and death in patients with MI or unstable angina. Clinical trials have demonstrated the efficacy of this drug, especially when treatment is begun soon after the initial event. The antiplatelet actions of aspirin seem to be the most plausible explanation for its efficacy in reducing mortality and the rate of reinfarction. A single daily 325-mg tablet is effective and produces side-effect incidences of only zero to two percent above those produced by placebo. This article assesses the current state of knowledge regarding the value of aspirin therapy in survivors of acute MI and the implications for clinical practice.

P1004Atrial fibrillation during acute myocardial infarction : a prospective multicenter study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
S Grigoryan ◽  
L G Hazarapetyan ◽  
A A Ter-Markaryan ◽  
M F Drampyan
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analyses ◽  
Past History ◽  
Medical Center ◽  
Statistical Significance ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Acute Mi

Abstract   New-onset atrial fibrillation (AF) frequently complicates acute myocardial infarction (AMI) and is associated with higher in-hospital and 1-year mortality, particularly in patients with ST-segment elevation AMI. In this clinical setting the occurrence of AF is of particular importance since irregular ventricular rates during AF may cause further impairment of the coronary circulation and left ventricular function in addition to the adverse consequences of neuro-hormonal activation. However, incidence and risk factors contributing to the occurrence of AF in AMI are still not well-known. The purpose of this study is to evaluate prospectively some risk factors contributing the incidence of AF in the setting of AMI. Methods This was a three-center prospective study, conducted in the coronary care unit of our medical center during the period of January 2017 to June 2018. This study included 976 patients with acute MI of different localization. AF was found in 82 patients of whom 68 experienced this arrhythmia anew. Onset, duration and mode of termination of AF, clinical and risk factors associated with its presentation and its relation with patient outcome were evaluated. Anamnesis, clinical and functional state of the heart (according to the results of instrumental and laboratory data) was studied in all patients. The data was analyzed for statistical significance using multivariate analyses by SPSS 16. Results   The obtained results showed that in acute MI AF was registered in 9.4% of patients, among which new episodes of AF have been identified in 82.9% of patients. All the patients who developed AF after AMI were more than 60 years of age. Moreover, 68% of patients with AF have arterial hypertension, 27% - diabetes mellitus and 67% patients have higher heart rate. There is a relationship between developed AF and other supraventricular arrhythmias in the past history.  In 62% of patients with AF, anterior MI was detected and accompanied by more severe hemodynamic disorders. Multivariate analyses showed that AF correlated weakly with age (r = 0.249) and strongly with left atrial diameter (r = 0.478) and left ventricular dysfunction (r = 0.419) especially with higher Killip class. Conclusions The results of the present study revealed that in the presence of identified certain risk factors in patients with acute MI, AF may develop. There is the link between identified risk factors and the occurrence of AF

RESULTS OF ENDOVASCULAR MYOCARDIAL REVASCULARIZATION AND QUALITY OF LIFE IN SUCH PATIENTS AGED UNDER 40

2020 ◽  
pp. 44-57
Author(s):  
F.Z. Abdullaev ◽  
F.E. Abbasov ◽  
N.M. Babaev ◽  
L.S. Shikhieva ◽  
G.A. Amrakhova
Keyword(s):  
Quality Of Life ◽  
Myocardial Infarction ◽  
Coronary Artery ◽  
Stable Angina ◽  
Myocardial Revascularization ◽  
Overweight And Obesity ◽  
Panic Attacks ◽  
Recurrent Myocardial Infarction ◽  
Stent Diameter

The aim of the paper is to correlate the results of endovascular myocardial revascularization (EMR) in patients under 40 years of age with acute coronary syndrome (ACS) / stable angina, primary EMR age ≤35/36–40 and stent diameter. Materials and Methods. The authors examined 208 patients (24–40 years of age) with coronary artery disease: 157 patients (75.5 %) aged 36–40; 51 patients (24.5 %) aged ≤35. All in all, 165 (79.3 %) patients underwent EMR; 32 patients (15.4 %) underwent coronary artery bypass grafting; 11 patients (5.3 %) refused medical intervention. EMR results and the quality of life were studied in 126 patients (76.4 %) at 10–107 months of observation (62.5±2.6 months). Results. 84 patients with ACS (50.9 %) and 81 patients with stable angina (49.1 %) underwent EMR. There were no any peri-procedural complications. The authors observed 0 % hospital and 30-day mortality. The survival rate of patients for the period up to 9 years was 99.2 %; long-term mortality was 0.8 %; the constancy of results up to 1, 2 and 3 years of follow-up was 90.5 %, 84.1 % and 81.7 %, respectively, and up to 5–9 years it was 79.4 %. An active lifestyle was verified in 74.6 % of patients; a sparing lifestyle was observed in 25.4 %; 86.5 %, of patients returned to work; transient sexual disorders were found in 28.6% of patients. 83.3 % and 27.8 % of patients kept to drug therapy and dietary regimen. 34.1 % and 23.8 % of patients kept smoking and taking power drinks; overweight and obesity were observed in 23.8 % and 19 % of patients. Recurrent myocardial infarction (MI) / angina was verified in 23 % of patients; 20.6 % of patients underwent second EMR. 23 % of patients got depressed due to recurrent myocardial infarction / angina, while 18.3 % of patients were down due to the quarantine (COVID-19); 6.3 % suffered from panic attacks, for fear of recurrent anginous pain. Conclusion. Predictors of recurrent EMR and stability of results were: 1) ACS; 2) patients’ age (≤35); 3) history of MI, ejection fraction ≤35–40 %, diabetes; 4) stent diameter (<28 mm); 5) smoking and taking power drinks. The leading predictor was the aggressiveness of atherosclerosis and diabetes in persons under 40, causing: a) early stent dysfunction; b) native and “protected” coronary vessels damage in case of intact stents patency. Keywords: ischemic heart disease, young patients, risk profile, semiotics of coronary arteries, endovascular myocardial revascularization, quality of life. Цель. Корреляция результатов эндоваскулярных реваскуляризаций миокарда (ЭВРМ) у больных моложе 40 лет с острым коронарным синдромом (ОКС) / стабильной стенокардией, возрастом при первичной ЭВРМ ≤35 лет / 36–40 лет и диаметром стентов. Материалы и методы. Обследовано 208 больных ИБС в возрасте 24–40 лет: 157 (75,5 %) чел. – в возрасте 36–40 лет, 51 (24,5 %) – ≤35 лет. ЭВРМ выполнена 165 (79,3 %) больным, коронарное шунтирование – 32 (15,4 %), 11 (5,3 %) пациентов отказались от вмешательства. Исходы ЭВРМ и качество жизни изучены у 126 (76,4 %) больных на сроках 10–107 мес. (62,5±2,6 мес.) наблюдения. Результаты. ЭВРМ выполнена 84 (50,9 %) больным ОКС и 81 (49,1 %) больному стабильной стенокардией. Перипроцедурных осложнений не выявлено. Госпитальная и 30-дневная летальность составила 0 %. Выживаемость пациентов на сроках до 9 лет – 99,2 %; отдаленная летальность – 0,8 %; сохранность результатов до 1, 2 и 3 лет наблюдения составила соответственно 90,5, 84,1 и 81,7 %, до 5–9 лет – 79,4 %. Активный образ жизни верифицирован у 74,6 % обследованных, щадящий – у 25,4 %, возврат к работе – у 86,5 %, транзиторные сексуальные нарушения – у 28,6 %. Медикаментозную терапию и диетический режим питания соблюдали 83,3 и 27,8 % пациентов. Продолжали курить и принимать энергетические напитки 34,1 и 23,8 % обследованных; избыточный вес и ожирение сохранялись у 23,8 и 19 %. Рецидив инфаркта миокарда (ИМ) / стенокардии отмечен у 23 % пациентов; повторные ЭВРМ выполнены 20,6 % больным. Депрессию из-за рецидива ИМ / стенокардии отмечали 23 % пациентов, ввиду карантина (COVID-19) – 18,3 %; 6,3 % страдали паническими атаками, боясь повторения ангинозных болей. Выводы. Предикторами повторных ЭВРМ и стабильности результатов являются: 1) ОКС; 2) возраст ≤35 лет; 3) анамнез ИМ, фракция выброса ≤35–40 %, диабет; 4) диаметр стентов <28 мм; 5) курение и прием энергетических напитков. Ведущий предиктор – агрессивность атеросклероза и диабета у лиц не старше 40 лет, обусловливающих: а) раннюю дисфункцию стентов; б) при сохранной проходимости стентов – поражение нативных и «защищенных» коронарных сосудов. Ключевые слова: ишемическая болезнь сердца, молодые больные, профиль риска, семиотика коронарных артерий, эндоваскулярная реваскуляризация миокарда, качество жизни.

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