Abstract T3: Type 2 Myocardial Infarction Predicts Outcome In Hypertensive Crisis Patients: Nationwide Analysis

Background: Type 2 Myocardial infarction (T2MI) can occur in hypertensive crisis patients. The impact of T2MI in this population is poorly understood due to limited available data. Objective: To assess the impact of T2MI on patients admitted to the hospital with hypertensive crisis. Methods: We queried National Readmission Database (NRD) of year 2018 for adult patients admitted with a primary diagnosis of hypertensive crisis. Patients were excluded if they had type 1 myocardial infarction (T1MI), septic shock, or bleeding in the index admission. Primary outcome was 90-day readmission due to T1MI. Secondary outcome was in-hospital mortality. Subgroup analysis was done according to urgency and emergency presentation. Multivariate regression was done to account for confounders. Results: A total of 101211 patients were included in our cohort of whom 3644 (3.6%) were diagnosed with T2MI and 24471 (24.2%) were readmitted within 90 days of discharge. Of those, 912 (3.7%) were diagnosed with T1MI on readmission. T2MI was independently associated with increased odds of 90-day readmission with T1MI (Adjusted odds ratio (aOR): 2.67, 95% CI [1.91-3.75], P=0.000). T2MI effect was observed in hypertensive urgency, and in hypertensive emergency. T2MI was associated with increased in-hospital mortality in hypertensive urgency population (aOR: 4.21, 95% [1.58-11.25], P=0.004) but not in hypertensive emergency (table 1). Conclusion: In hypertensive crisis patients, T2MI was associated with increased 90-day readmission with T1MI. Aggressive management of cardiovascular risk factors and risk stratification should be considered at the time of diagnosis.

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Abstract 17382: Gender Difference in Presentation, Management and Outcome of Patients With Acute Myocardial Infarction: A Sub-analysis of J-MINUET Study

Circulation ◽

10.1161/circ.132.suppl_3.17382 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yasuharu Nakama ◽

Masaharu Ishihara ◽

Masashi Fujino ◽

Hisao Ogawa ◽

Koichi Nakao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Gender Difference ◽

Hospital Mortality ◽

Current Smoking ◽

Killip Class ◽

Universal Definition ◽

The Impact

Purpose: Several studies have reported gender difference in presentation, management and outcome in patients with acute myocardial infarction (AMI). In this study, we focused the impact of age on gender difference in mortality after AMI. Methods: Between July 2012 and March 2014, 3283 patients were admitted to the 28 hospitals participating to the J-MINUET group within 48 hours after the onset of AMI. AMI was diagnosed by universal definition (type 1 or type 2). Patients were divided into 5 strata according to their age: those with age <55 years, 55-64 years, 65-74 years, 75-84 years and ≥85 years. Results: There were 813 women (24.8%). Women were significantly older than men (74.5±11.8 years vs 66.6±12.3 years, P<0.001). Women had longer time from onset to admission, more NSTEMI, atypical symptom other than chest pain, Killip class ≥2, CKD and type 2 MI. They also had less diabetes and current smoking habits. Although most of the patients received urgent angiography (93.1%), it was less frequent in women (90.4% vs 94.0%, P<0.001). Among patients who underwent primary PCI (85.1%), achievement of final TIMI-3 flow was similar (91.2% vs 92.0%, P=0.53). In-hospital mortality was significantly higher in women than men (9.6% vs 5.5%, P<0.001). When patients were stratified according to their age, there was a liner increase in the prevalence of women as age advanced: 10.6% in <55 years, 15.1% in 55-64 years, 19.8% in 65-74 years, 35.6% in 75-84 years and 53.6% in ≥85 years (P<0.001). There was no significant gender difference in mortality in each stratum (Figure). Multivariate analysis showed that women was no more an independent predictor of death after adjusting age (OR 1.29, 95%CI 0.95-1.75, P=0.10), or age and other variables (OR 1.19, 95%CI 0.79-1.76, P=0.40). Conclusions: Women had higher in-hospital mortality than men after AMI even in the contemporary troponin era. However, their high mortality was mostly explained by their advanced age.

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Cardiovascular-related deaths at the beginning of the COVID-19 outbreak: a prospective analysis based on the UK Biobank

BMJ Open ◽

10.1136/bmjopen-2020-046931 ◽

2021 ◽

Vol 11 (6) ◽

pp. e046931

Author(s):

Junren Wang ◽

Jianwei Zhu ◽

Huazhen Yang ◽

Yao Hu ◽

Yajing Sun ◽

...

Keyword(s):

Primary Diagnosis ◽

Secondary Outcome ◽

Hospital Inpatient ◽

Reference Period ◽

Stress Reactions ◽

Uk Biobank ◽

The Uk ◽

The Impact ◽

Distinct Increase ◽

Related Mortality

ObjectiveTo assess the impact of the COVID-19 outbreak on cardiovascular disease (CVD) related mortality and hospitalisation.DesignCommunity-based prospective cohort study.SettingThe UK Biobank.Participants421 372 UK Biobank participants who were registered in England and alive as of 1 January 2020.Primary and secondary outcome measuresThe primary outcome of interest was CVD-related death, which was defined as death with CVD as a cause in the death register. We retrieved information on hospitalisations with CVD as the primary diagnosis from the UK Biobank hospital inpatient data. The study period was 1 January 2020 to June 30 2020, and we used the same calendar period of the three preceding years as the reference period. In order to control for seasonal variations and ageing of the study population, standardised mortality/incidence ratios (SMRs/SIRs) with 95% CIs were used to estimate the relative risk of CVD outcomes during the study period, compared with the reference period.ResultsWe observed a distinct increase in CVD-related deaths in March and April 2020, compared with the corresponding months of the three preceding years. The observed number of CVD-related deaths (n=218) was almost double in April, compared with the expected number (n=120) (SMR=1.82, 95% CI 1.58 to 2.07). In addition, we observed a significant decline in CVD-related hospitalisations from March onwards, with the lowest SIR observed in April (0.45, 95% CI 0.41 to 0.49).ConclusionsThere was a distinct increase in the number of CVD-related deaths in the UK Biobank population at the beginning of the COVID-19 outbreak. The shortage of medical resources for hospital care and stress reactions to the pandemic might have partially contributed to the excess CVD-related mortality, underscoring the need of sufficient healthcare resources and improved instructions to the public about seeking healthcare in a timely way.

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Impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular infarction

Sao Paulo Medical Journal ◽

10.1590/s1516-31802006000400003 ◽

2006 ◽

Vol 124 (4) ◽

pp. 186-191 ◽

Cited By ~ 6

Author(s):

Afonso Celso Pereira ◽

Roberto Alexandre Franken ◽

Sandra Regina Schwarzwälder Sprovieri ◽

Valdir Golin

Keyword(s):

Myocardial Infarction ◽

Hospital Mortality ◽

Right Ventricular ◽

Left Ventricular ◽

Hospital Death ◽

Inferior Wall ◽

Mortality And Morbidity ◽

Killip Class ◽

Increased Risk ◽

The Impact

CONTEXT AND OBJECTIVE: There is uncertainty regarding the risk of major complications in patients with left ventricular (LV) infarction complicated by right ventricular (RV) involvement. The aim of this study was to evaluate the impact on hospital mortality and morbidity of right ventricular involvement among patients with acute left ventricular myocardial infarction. DESIGN AND SETTING: Prospective cohort study, at Emergency Care Unit of Hospital Central da Irmandade da Santa Casa de Misericórdia de São Paulo. METHODS: 183 patients with acute myocardial infarction participated in this study: 145 with LV infarction alone and 38 with both LV and RV infarction. The presence of complications and hospital death were compared between groups. RESULTS: 21% of the patients studied had LV + RV infarction. In this group, involvement of the dorsal and/or inferior wall was predominant on electrocardiogram (p < 0.0001). The frequencies of Killip class IV upon admission and 24 hours later were greater in the LV + RV group, along with electrical and hemodynamic complications, among others, and death. The probability of complications among the LV + RV patients was 9.7 times greater (odds ratio, OR = 9.7468; 95% confidence interval, CI: 2.8673 to 33.1325; p < 0.0001) and probability of death was 5.1 times greater (OR = 5.13; 95% CI: 2.2795 to 11.5510; p = 0.0001), in relation to patients with LV infarction alone. CONCLUSIONS: Patients with LV infarction with RV involvement present increased risk of early morbidity and mortality.

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Hypertensive Emergency and Type 2 Myocardial Infarction Resulting From Pheochromocytoma and Concurrent Capnocytophaga Canimorsus Infection

The Open Cardiovascular Medicine Journal ◽

10.2174/1874192401408010043 ◽

2014 ◽

Vol 8 (1) ◽

pp. 43-47 ◽

Cited By ~ 6

Author(s):

Graham J Fent ◽

Hazlyna Kamaruddin ◽

Pankaj Garg ◽

Ahmed Iqbal ◽

Nicholas F Kelland ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Presentation ◽

Plaque Rupture ◽

Interesting Case ◽

Hypertensive Emergency ◽

Cardiac Biomarkers ◽

Dog Bite ◽

Capnocytophaga Canimorsus ◽

Review Current

A diagnosis of myocardial infarction is made using a combination of clinical presentation, electrocardiogram and cardiac biomarkers. However, myocardial infarction can be caused by factors other than coronary artery plaque rupture and thrombosis. We describe an interesting case presenting with hypertensive emergency and type 2 myocardial infarction resulting from Pheochromocytoma associated with Capnocytophaga canimorsus infection from a dog bite. We also review current literature on the management of hypertensive emergency and Pheochromocytoma.

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160 The Impact of the Dependent Coverage Provision on Neurosurgical Population

Neurosurgery ◽

10.1093/neuros/nyx417.160 ◽

2017 ◽

Vol 64 (CN_suppl_1) ◽

pp. 240-240

Author(s):

Matthew Decker ◽

John David Mayfield ◽

Paul Kubilis ◽

Maryam Rahman

Keyword(s):

Hospital Mortality ◽

Age Groups ◽

Primary Diagnosis ◽

Cost Of Care ◽

Hospital Length Of Stay ◽

Control Cohort ◽

Neurosurgical Patients ◽

Comorbidity Index ◽

Dependent Coverage ◽

The Impact

Abstract INTRODUCTION The Dependent Coverage Provision (DCP), a provision of the Patient Protection and Affordable Care Act (ACA), enables dependents aged 19 25 to remain on parental insurance without restrictions. This increased access to health insurance for the population with the highest uninsured rate. Its impact has not been studied in neurosurgical population where the cost of care is disproportional based on insurance status. METHODS A National Inpatient Sampling database query was performed comparing an experimental (ages 19–25) and a control cohort (ages 27–33) and metrics before (January 2007 March 2009) and after DCP implementation (October 2011 December 2014). Those with a primary diagnosis of traumatic brain injury (TBI), ischemic or hemorrhagic stroke (Stroke) or primary brain tumor (Tumor) had the following metrics obtained: uninsured rate, comorbidity index, hospital length of stay (LOS), in-hospital mortality rates, and disposition status home. A difference-in-difference analysis was performed comparing the cohorts to assess direct effects of DCP. RESULTS >There was a significant decrease in the uninsured rate for TBI (p <.0001) and Stroke (p = .0019) patients but not for Tumor (p = .6663) patients after implementation of the DCP. There was no significant change in the comorbidity index, LOS, or in-hospital mortality for any diagnosis over the study period. An improvement occurred in these metrics in both age groups, however, the differences were insignificant. Lastly, there was an increase for the TBI control cohort to be discharged home (p = .0288) that was not observed elsewhere. CONCLUSION The DCP did decrease the uninsured rate in most neurosurgical patients. Other quality metrics were not different between the pre-DCP and post-DCP cohorts although both groups showed improvement in these metrics over time. The impact of the ACA on quality of care for neurosurgical patients should be further investigated.

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P1515Female sex is an independent predictor of mortality in patients with STEMI in Spain: a study in 325,017 episodes over 11 years (2005–2015)

European Heart Journal ◽

10.1093/eurheartj/ehz748.0277 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Anguita ◽

A Sambola Ayala ◽

J Elola ◽

J L Bernal ◽

C Fernandez ◽

...

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Hospital Mortality ◽

Independent Predictor ◽

National Health System ◽

Anterior Myocardial Infarction ◽

Female Sex ◽

Spanish National Health System ◽

History Of ◽

The Impact

Abstract Background Recent studies reported a decrease in the mortality of ST-elevation myocardial infarction (STEMI) patients. This favorable evolution could not extend to women. The interaction between gender and mortality in STEMI remains controversial. Purpose To assess the impact of female sex on mortality of patients with STEMI through of period of 11 years. Methods We conducted a retrospective longitudinal study using information provided by the minimal database system of the Spanish National Health System to identify all hospitalizations in patients aged 35–94 years with the principal diagnosis of STEMI from 2005–2015. Results A total of 325,017 STEMI were identified. Of them, 273,182 were included, and 106,277 (38.8%) were women. Women were older than men and had more comorbidities. Through the study period 53% men vs 37.2% underwent PTCA; women presented more frequently heart failure, shock and stroke than men (p<0.001, respectively). The mean crude in-hospital mortality rate for the whole study period was higher in women (OR: 2.18; 95% CI: 2.12.-2.23, p<0.0001). Female sex was independently associated with higher in-hospital mortality (adjusted OR: 1.18; 95% CI: 1.14–1.22, p<0.001) (Table 1). The risk was maintained through the whole study period (lower OR: 1.14 in 2014; higher OR: 1.28 in 2006). Table 1. Variables independently associated with in-hospital mortality adjusted by risk in a multilevel logistic regression model, 2005–2015 STEMI In-hospital mortality Odds Ratio P 95% CI Woman 1.18 <0.001 1.14 1.22 Age 1.06 <0.001 1.06 1.06 History of PTCA 1.58 <0.001 1.40 1.77 Congestive heart failure 1.26 <0.001 1.22 1.30 Acute Myocardial Infarction 1.84 <0.001 1.54 2.20 Anterior myocardial infarction 1.47 <0.001 1.23 1.76 Cardio-respiratory failure or shock 15.25 <0.001 14.78 15.75 Hypertension 0.81 <0.001 0.79 0.84 Stroke 5.76 <0.001 5.18 6.42 Cerebrovascular disease 0.86 <0.001 0.79 0.93 Renal failure 1.95 <0.001 1.88 2.02 Vascular disease and complications 7.03 <0.001 5.72 8.63 CI, Confidence Interval. Conclusions Female sex is an independent predictor of mortality in patients with STEMI in Spain, maintaining through a period of the 11 years.

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P2769Racial differences in outcomes among acute pulmonary embolism patients: a nationwide analysis

European Heart Journal ◽

10.1093/eurheartj/ehz748.1086 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Shi

Keyword(s):

Pulmonary Embolism ◽

Regression Analysis ◽

Length Of Stay ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Primary Diagnosis ◽

Total Cost ◽

Rehabilitation Facilities ◽

The Impact ◽

White Patients

Abstract Background Limited data is available regarding racial disparities in patients admitted for acute pulmonary embolism. Purpose We aimed to examine the impact of racial differences on outcomes in patients admitted for acute pulmonary embolism. Methods We used the Nationwide Inpatient Sample, which represents 20% of community hospital discharges in the US, to identify adult patients who were discharged with the primary diagnosis of acute pulmonary embolism in 2016 with ICD-10 codes. Logistic regression analysis and linear regression analysis were used to compare patients with different races. Outcomes were focused on in-hospital mortality, total cost, length of stay and disposition, adjusting gender, age, Charlson comorbid index and socioeconomic variables. Results In 2016, 35,526 patients were admitted with a primary diagnosis of acute pulmonary embolism. White patients were more likely to be older and with higher income. After adjusting for the above variables, white patients had lower total cost of hospitalization (p<0.0001), shorter length of stay (p<0.0001), lower in-hospital mortality (adjusted odds ratio = 0.79, p=0.001), and more likely to be discharged to rehabilitation facilities compared to being discharged home. Outcomes in white vs non-white patients Conclusion Among acute pulmonary embolism hospitalizations, white patients generally had better outcomes despite being older in age, and were more likely to be transferred to rehabilitation facilities after discharge.

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P2653Seasonal variations of myocardial infarction and sex-specific differences in Germany

European Heart Journal ◽

10.1093/eurheartj/ehz748.0974 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Keller ◽

L Hobohm ◽

T Munzel ◽

M A Ostad

Keyword(s):

Myocardial Infarction ◽

Seasonal Variation ◽

Mortality Rate ◽

Hospital Mortality ◽

Seasonal Variations ◽

The United States ◽

Summer Season ◽

Recurrent Event ◽

Acute Mi ◽

The Impact

Abstract Background Ischemic heart disease (IHD) is the most common cause of death with an increasing frequency worldwide. It accounts for approximately 20% of all deaths in Europe and the United States of America. Approximately 1/3 of the IHD patients present with sudden cardiac death. The acute presentation of IHD myocardial infarction (MI) is a life-threatening, serious health problem, which causes substantially morbidity and mortality. It is well established that the onset of MI follows a circadian and seasonal periodicity. Seasonal variation regarding the incidence and the short-term mortality of acute MI was frequently reported, but data about sex-specific differences are sparse. Purpose Thus, our objectives were to investigate seasonal variations of myocardial infarction. Methods We analyzed the impact of seasons on incidence and in-hospital mortality of patients with acute MI in Germany from 2005 to 2015. We included all MI patients (ICD code I21) with an acute MI (, but not those MI patients with a recurrent event in the first 28 days after a previous MI (ICD code I22)), who were hospitalized in Germany between 2005 and 2015, in this analysis (source: RDC of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2015, own calculations). Results The nationwide sample comprised 3,008,188 hospitalizations of patients with MI (2005–2015). The annual incidence was 334.7 per 100.000 population. Incidence inclined from 316.3 to 341.6 per 100.000 population per year (β 0.17 [0.10 to 0.24], P<0.001), while in-hospital mortality rate decreased from 14.1% to 11.3% (β −0.29 [−0.30 to −0.28, P<0.001). Overall, 377,028 (12.5%) patients died in-hospital. Seasonal variation of both incidence and in-hospital mortality were of substantial magnitude. Seasonal incidence (86.1 vs. 79.0 per 100.000 population per year, P<0.001) and in-hospital mortality (13.2% vs. 12.1%, P<0.001) were higher in the winter than in the summer saeson. Risk to die in winter was elevated (OR 1.080 (95% CI 1.069–1.091), P<0.001) compared to summer season independently of sex, age and comorbidities. Reperfusion treatment with drug eluting stents and coronary artery bypass graft were more often used in summer. We observed sex-specific differences regarding the seasonal variation of in-hospital mortality: males showed lowest mortality in summer, while females during fall. Low temperature dependency of mortality seems more pronounced in males. Conclusions Incidence of acute MI increased 2005–2015, while in-hospital mortality rate decreased. Seasonal variations of incidence and in-hospital mortality were of substantial magnitude with lowest incidence and lowest mortality in the summer season. Additionally, we observed sex-specific differences regarding the seasonal variation of the in-hospital mortality. Acknowledgement/Funding This study was supported by the German Federal Ministry of Education and Research (BMBF 01EO1503)

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Interleukin-18 Promoter Gene Polymorphisms are not Associated with Myocardial Infarction in Type 2 Diabetes in Slovenia

Balkan Journal of Medical Genetics ◽

10.2478/v10034-011-0011-6 ◽

2011 ◽

Vol 14 (1) ◽

pp. 3-9 ◽

Cited By ~ 9

Author(s):

S Kariž ◽

D Petrovič

Keyword(s):

Myocardial Infarction ◽

Type 2 Diabetes ◽

Gene Polymorphisms ◽

Serum Levels ◽

Control Group ◽

Interleukin 18 ◽

Significant Difference ◽

Promoter Gene ◽

The Impact

Interleukin-18 Promoter Gene Polymorphisms are not Associated with Myocardial Infarction in Type 2 Diabetes in SloveniaType 2 diabetes is a major risk factor for myocardial infarction (MI) and chronic inflammation may play a central role in both diseases. Interleukin (IL)-18 is a potent proinflammatory cytokine, which is considered important in acute coronary syndromes and type 2 diabetes. We investigated the association of the -137 (G>C), polymorphism (rs187238) and the -607 (C<A) polymorphism (rs1946518) of the IL-18 gene promoter region in 495 Caucasians with type 2 diabetes, of whom 169 had MI and 326 subjects had no clinically evident coronary artery disease (controls). We also investigated the impact of these polymorphisms on the serum IL-18 level in subsets of both groups and in a normal group. Genotype distributions of the polymorphisms showed no significant difference between cases and controls. However, IL-18 serum levels were significantly lower in diabetics with the137 CC genotype than in those with other genotypes (241.5 ± 132.7 ng/Lvs.340.2 ± 167.4 ng/L; p <0.05). High sensitivity C-reactive protein and IL-18 serum levels were higher in diabetics in the MI group than in the control group. We conclude that these IL-18 promoter gene polymorphisms are not risk factors for MI in Caucasians with type 2 diabetes.

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