scholarly journals Impact of ST‐Segment–Elevation Myocardial Infarction Regionalization Programs on the Treatment and Outcomes of Patients Diagnosed With Non–ST‐Segment–Elevation Myocardial Infarction

2021 ◽  
Vol 10 (3) ◽  
Author(s):  
Juan Carlos C. Montoy ◽  
Yu‐Chu Shen ◽  
Ralph G. Brindis ◽  
Harlan M. Krumholz ◽  
Renee Y. Hsia
Keyword(s):  
Myocardial Infarction ◽  
Myocardial Infarctions ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
Segment Elevation Myocardial Infarction ◽  
Risk Of Mortality ◽  
St Segment ◽  
Changes In Risk ◽  
The Impact ◽  
Improve Access

Background Many communities have implemented systems of regionalized care to improve access to timely care for patients with ST‐segment–elevation myocardial infarction. However, patients who are ultimately diagnosed with non–ST‐segment–elevation myocardial infarctions (NSTEMIs) may also be affected, and the impact of regionalization programs on NSTEMI treatment and outcomes is unknown. We set out to determine the effects of ST‐segment–elevation myocardial infarction regionalization schemes on treatment and outcomes of patients diagnosed with NSTEMIs. Methods and Results The cohort included all patients receiving care in emergency departments diagnosed with an NSTEMI at all nonfederal hospitals in California from January 1, 2005 to September 30, 2015. Data were analyzed using a difference‐in‐differences approach. The main outcomes were 1‐year mortality and angiography within 3 days of the index admission. A total of 293 589 patients with NSTEMIs received care in regionalized and nonregionalized communities. Over the study period, rates of early angiography increased by 0.5 and mortality decreased by 0.9 percentage points per year among the overall population (95% CI, 0.4–0.6 and −1.0 to −0.8, respectively). Regionalization was not associated with early angiography (−0.5%; 95% CI, −1.1 to 0.1) or death (0.2%; 95% CI, −0.3 to 0.8). Conclusions ST‐segment–elevation myocardial infarction regionalization programs were not statistically associated with changes in guideline‐recommended early angiography or changes in risk of death for patients with NSTEMI. Increases in the proportion of patients with NSTEMI who underwent guideline‐directed angiography and decreases in risk of mortality were accounted for by secular trends unrelated to regionalization policies.

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

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

Abstract 380: Gender Differences in Glucose Metabolism Profile in Patients with ST Segment Elevation Myocardial Infarction

2014 ◽  
Vol 7 (suppl_1) ◽  
Author(s):  
Gautam V Shah ◽  
Bhuvnesh Aggarwal ◽  
Mandeep Randhawa ◽  
Sachin S Goel ◽  
A. Micheal Lincoff ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Insulin Resistance ◽  
Gender Differences ◽  
Cleveland Clinic ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Difference ◽  
The Impact

Background: Presence of insulin resistance has been known to be a strong independent risk factor for coronary artery disease. However, there is limited data on gender differences in metabolic profile of patients that present with an acute ST segment elevation myocardial infarction (STEMI). Methods: All patients (N = 1,652) who underwent primary PCI for STEMI at the Cleveland Clinic Foundation between January 2005 to December 2012 were included. Insulin Resistance (IR) was defined as presence of diabetes mellitus (DM) or pre-DM. Further DM was identified if there was a known history of DM or hypoglycaemic therapy or if admission glycated hemoglobin (HbA1c) was ≥ 6.5 and pre-DM was defined for admission HbA1c ≥ 5.7 and < 6.5. Lastly, prevalence of IR in women was compared with similarly aged men presenting with STEMI at our institution. Results: IR was identified in 70% (n= 1,163/1,652) and DM in 30% (n = 487/1,652) of patients presenting with STEMI. Prevalence of IR was significantly higher in post menopausal women (age > 50 years) when compared with similarly aged men (79%; 344/435 vs. 69%; 603/871; p <0.0001) with majority of the difference contributed by difference in incidence of DM (38%; 163/435 in females vs 29%; 257/871 in males; p<0.0001; Figure 1). Conclusions: Our results indicate that prevalence of IR including diabetes mellitus may be higher in women as compared to similarly aged men who present with STEMI and the difference increases with increasing age. We also noted that Pre-DM contributes significantly to the high prevalence of IR in subjects with STEMI irrespective of gender. Larger studies are required to assess the impact of Pre-DM on adverse cardiovascular events in men as well as women.

Abstract 13993: Impact of Prasugrel Pretreatment and Timing of Coronary Artery Bypass Grafting on Clinical Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction: From the Accoast Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Dariusz Dudek ◽  
Petr Widimsky ◽  
Leonardo Bolognese ◽  
Patrick Goldstein ◽  
Christian Hamm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Clinical Outcomes ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Cabg Patients ◽  
The Impact

Objectives: We evaluated the impact of prasugrel pretreatment and timing of coronary artery bypass grafting (CABG) on clinical outcomes of patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing CABG based on data from ACCOAST. Methods: We evaluated the impact of troponin, prasugrel pretreatment and CABG timing on clinical outcomes of NSTEMI patients undergoing CABG through 30 days from ACCOAST. Results: CABG patients versus PCI or medically managed patients were more often male, diabetic, had peripheral arterial disease and a higher GRACE score. By randomization assignment, 157 patients received a 30-mg loading-dose of prasugrel before CABG; 157 patients did not. CABG patients were grouped by tertiles of time from randomization to CABG; baseline characteristics in the Table. Patients in the lowest tertile had significantly more events (cardiovascular death, MI, stroke, urgent revascularization or glycoprotein IIb/IIIa bailout) and all TIMI major bleeds than those in the other 2 groups (p<0.045, p<0.002 respectively), but the patients in the higher 2 groups were not significantly different from each other. No difference was detected in all cause death among the 3 groups (p>0.39). A multivariate model evaluated 5 possible predictors of the composite endpoint of all cause death, MI, stroke and TIMI major bleeding. Time from randomization to CABG (HR 0.84 for each 1 hour of delay), left main disease presence (HR 1.76), and region of enrollment (Eastern Europe vs other, HR 3.83) were significant predictors but not prasugrel pretreatment or baseline troponin level ≥3xULN. Conclusions: In this group of high-risk patients presenting with NSTEMI, early surgical revascularization carried an increased risk of bleeding and ischemic complications, without impact on all-cause mortality. No impact of baseline troponin or prasugrel pretreatment (important factors influencing time of CABG) on clinical outcomes was confirmed.

scholarly journals Risks and Benefits of Thrombolytic, Antiplatelet, and Anticoagulant Therapies for ST Segment Elevation Myocardial Infarction: Systematic Review

2014 ◽  
Vol 2014 ◽  
pp. 1-11 ◽  
Author(s):  
Bruno Ramos Nascimento ◽  
Marcos Roberto de Sousa ◽  
Fábio Nogueira Demarqui ◽  
Antonio Luiz Pinho Ribeiro
Keyword(s):  
Myocardial Infarction ◽  
Multivariate Regression ◽  
Randomized Trials ◽  
Primary Angioplasty ◽  
Medline Search ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Risks And Benefits ◽  
St Segment ◽  
The Impact

Objectives. Assess the impact of associating thrombolytics, anticoagulants, antiplatelets, and primary angioplasty (PA) on death, reinfarction (AMI), and major bleeding (MB) in STEMI therapy. Methods. Medline search was performed to identify randomized trials comparing these classes in STEMI treatment, at least 500 patients, providing death, AMI, and MB rates. Similar arms were grouped. Correlation between number of drugs and PA and the outcomes was evaluated, as well as correlation between the year of the study and the outcomes. Results. Fifty-nine papers remained after exclusions. 404.556 patients were divided into 35 groups of arms. There was correlation between the number of drugs and rates of death (r=-0.466, P=0.005) and MB (r=0.403, P=0.016), confirmed by multivariate regression. This model also showed that PA is associated with lower mortality and increased MB. Year and period of publication correlated with the outcomes: death (r=-0.380, P<0.001), MB (r=0.212, P=0.014), and AMI (r=-0.231, P=0.009). Conclusion. The increasing complexity of STEMI treatment has resulted in significant reduction in mortality along with increased rates of MB. Overall, however, the benefits of treatment outweigh the associated risks of MB.

scholarly journals The impact of obesity on mortality in UA/non-ST-segment elevation myocardial infarction

2007 ◽  
Vol 28 (14) ◽  
pp. 1694-1701 ◽  
Author(s):  
H. J. Buettner ◽  
C. Mueller ◽  
M. Gick ◽  
M. Ferenc ◽  
J. Allgeier ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
The Impact
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