scholarly journals A retrospective study of an invasive versus conservative strategy in patients aged ≥80 years with acute ST-segment elevation myocardial infarction

2019 ◽  
Vol 47 (9) ◽  
pp. 4431-4441
Author(s):  
Yong-Gang Sui ◽  
Si-Yong Teng ◽  
Jie Qian ◽  
Yuan Wu ◽  
Ke-Fei Dou ◽  
...  
Keyword(s):  
Treatment Group ◽  
Conservative Treatment ◽  
Treatment Strategy ◽  
Hospital Death ◽  
Invasive Treatment ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Invasive Intervention

Objective To investigate what is the most appropriate strategy for patients with ST-segment elevation myocardial infarction (STEMI) aged ≥80 years in China. Methods This cohort study retrospectively enrolled patients with STEMI aged ≥80 years old and grouped them according to the treatment strategy that was used: a conservative treatment strategy or an invasive treatment strategy. Factors associated with whether to perform an invasive intervention, in-hospital death and a good prognosis were investigated using logistic regression analyses. Results A total of 232 patients were enrolled: conservative treatment group ( n = 93) and invasive treatment group ( n = 139). Patients in the invasive treatment group had a better prognosis and lower incidence of adverse events compared with the conservative treatment group. Advanced age, creatinine level and a higher Killip class were inversely correlated with whether to perform an invasive intervention, while the use of beta-receptor-blocking agents was a favourable factor for invasive treatment. Hypertension and a higher Killip class were risk factors for in-hospital death, while the use of beta-receptor-blocking agents and diuretics decreased the risk of in-hospital death. Conclusions An invasive treatment strategy was superior to a conservative treatment strategy in patients with STEMI aged ≥80 years.

Abstract 16476: Safety Profile of Bivalirudin in the Treatment of ST-Segment Elevation Myocardial Infarction Patients in Clinical Practice - Results From the Bremen STEMI Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Robert Zabrocki ◽  
Eduard Fiehn ◽  
Harm Wienbergen ◽  
Susanne Seide ◽  
Johannes Schmucker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Safety Profile ◽  
Real World Data ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Heart Center ◽  
Current Guidelines

Introduction: Previous studies demonstrated that treatment of patients (pts) being affected by ST-segment elevation myocardial infarction (STEMI) with bivalirudin (biv) instead of heparin (hep) reduced rates of major bleedings. Results regarding a reduction in all-cause mortality are inconclusive, stent thromboses however were slightly increased. Real world data in pts with STEMI treated with biv in the era of new anti-thrombotic treatment are still spare. The aim of this study was to evaluate safety of biv for all-comers. Methods: All pts with STEMI from the metropolitan area of Bremen (Germany) are admitted to the Bremen heart center and documented in the Bremen STEMI-registry (BSR) since 2006. In May 2013 we adapted our anticoagulation strategy to the current guidelines from hep with glycoprotein IIb/IIIa inhibitors (GPI) to biv with provisional use of GPI. Pts receiving biv were compared to all pts until April 2013 in the BSR without chronic renal failure. Results: Baseline and interventional characteristics of 530 consecutive pts treated with biv and 5197 pts treated with hep are shown in table 1. Despite a higher portion of pts after resuscitation (10.3% vs 8.6%; p<0.01) and a higher incidence of Killip class 3 or 4 (15% vs 8%; p<0.001) in the biv group inhospital all-cause mortality showed no difference (biv: 6.8% vs hep: 7.3%, p=0.66). However pts treated with biv demonstrated highly significant lower bleeding rates (TIMI major/minor bleedings: 0.8% vs 3.7%, p<.01). Stent-thromboses showed a trend towards an increased event rate with biv (1.3%, 7pts vs 1.0%, 52pts, p=0.07). Conclusions: In one of the largest all-comers registries treatment with biv was associated with significantly lower minor and major bleedings. There is only a trend for a higher rate of stent thromboses in the biv group. Therefore, data from our all-comers registry support the beneficial safety profile of biv observed in clinical studies.

scholarly journals Difference in the in-hospital prognosis between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction with high Killip class: Data from the Japan Acute Myocardial Infarction Registry

2020 ◽  
pp. 204887262092668
Author(s):  
Motoki Fukutomi ◽  
Kensaku Nishihira ◽  
Satoshi Honda ◽  
Sunao Kojima ◽  
Misa Takegami ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Short Term ◽  
Term Outcome ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Significant Difference

Background ST-segment elevation myocardial infarction is known to be associated with worse short-term outcome than non-ST-segment elevation myocardial infarction. However, whether or not this trend holds true in patients with a high Killip class has been unclear. Methods We analyzed 3704 acute myocardial infarction patients with Killip II–IV class from the Japan Acute Myocardial Infarction Registry and compared the short-term outcomes between ST-segment elevation myocardial infarction ( n = 2943) and non-ST-segment elevation myocardial infarction ( n = 761). In addition, we also performed the same analysis in different age subgroups: <80 years and ≥80 years. Results In the overall population, there were no significant difference in the in-hospital mortality (20.0% vs 17.1%, p = 0.065) between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction groups. Patients <80 years of age also showed no difference in the in-hospital mortality (15.7% vs 15.2%, p = 0.807) between ST-segment elevation myocardial infarction ( n = 2001) and non-ST-segment elevation myocardial infarction ( n = 453) groups, whereas among those ≥80 years of age, ST-segment elevation myocardial infarction ( n = 942) was associated with significantly higher in-hospital mortality (29.3% vs 19.8%, p = 0.001) and in-hospital cardiac mortality (23.3% vs 15.0%, p = 0.002) than non-ST-segment elevation myocardial infarction ( n = 308). After adjusting for covariates, ST-segment elevation myocardial infarction was a significant predictor for in-hospital mortality (odds ratio 2.117; 95% confidence interval, 1.204–3.722; p = 0.009) in patients ≥80 years of age. Conclusion Among cases of acute myocardial infarction with a high Killip class, there was no marked difference in the short-term outcomes between ST-segment elevation myocardial infarction and non-ST-segment elevation myocardial infarction in younger patients, while ST-segment elevation myocardial infarction showed worse short-term outcomes in elderly patients than non-ST-segment elevation myocardial infarction. Future study identifying the prognostic factors for the specific anticipation intensive cares is needed in this high-risk group.

scholarly journals Gender differences in clinical characteristics and in-hospital and one-year outcomes of young patients with ST-segment elevation myocardial infarction under the age of 40

2021 ◽  
Vol 13 (2) ◽  
pp. 116-124
Author(s):  
Bektas Murat ◽  
Eylem Kivanc ◽  
Rafet Dizman ◽  
Gurbet Ozge Mert ◽  
Selda Murat
Keyword(s):  
Myocardial Infarction ◽  
Gender Differences ◽  
Young People ◽  
Clinical Characteristics ◽  
Left Ventricular Ejection ◽  
Killip Class ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
One Year

Introduction: Although the incidence of acute ST-segment elevation myocardial infarction (STEMI) in the elderly population has decreased in recent years, this is not the case for young people. At the same time, no reduction in hospitalization rate after STEMI was shown in young people. Clinical characteristics, risk factors, angiographic findings, in-hospital and one-year outcomes of patients under the age of 40 and their gender differences were investigated. Methods: This study has been performed retrospectively in two centers. Between January 2015 and April 2019, 212 patients aged 18-40 years with STEMI and who underwent reperfusion therapy were included. The gender differences were compared. Results: The median age of (male 176; 83.0% and female 36; 17.0%) patients included in the study was 36 (33-38) for men and 36 (34-38) for women. Chest pain was the most common complaint for both genders (96.0% vs. 94.4%; P = 0.651). While men presented more often with Killip class 1,women presented more often with Killip class 2. The anterior myocardial infarction (MI) was the most common MI type and it was higher in women than in man (P = 0.027). At one year of follow-up, the prevalence of all-cause hospitalization was 24%, MI 3.8%, coronary angiography 15.1%, cardiovascular death 1.4%, and all-cause death 0.47%, there was no gender difference. Conclusion: Anterior MI was the most common type of MI and it was more common in women than in men. Left anterior descending artery was the most common involved coronary artery. The most common risk factor is smoking. In terms of in-hospital outcome, left ventricular ejection fraction was significantly lower in women. There was no significant difference in one-year outcomes between both genders.

scholarly journals Use of the Thrombolysis in Myocardial Infarction Risk Index for Elderly Patients With ST-Segment Elevation Myocardial Infarction

2021 ◽  
Vol 8 ◽  
Author(s):  
Bingqi Fu ◽  
Xuebiao Wei ◽  
Qi Wang ◽  
Zhiwen Yang ◽  
Jiyan Chen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
Assessment Tool ◽  
Risk Index ◽  
Area Under The Curve ◽  
Kidney Injury ◽  
Hospital Death ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Thrombolysis in Myocardial Infarction (TIMI) Risk Index (TRI) is a simple risk assessment tool for patients with ST-segment elevation myocardial infarction (STEMI). However, its applicability to elderly patients with STEMI undergoing percutaneous coronary intervention (PCI) is uncertain.Methods: This was a retrospective analysis of elderly (≥60 years) patients who underwent PCI for STEMI from January 2010 to April 2016. TRI was calculated on admission using the following formula: heart rate × (age/10)2/systolic blood pressure. Discrimination and calibration of TRI for in-hospital events and 1 year mortality were analyzed.Results: Totally 1,054 patients were divided into three groups according to the tertiles of the TRI: &lt;27 (n = 348), 27–36 (n = 360) and &gt;36 (n = 346). The incidence of acute kidney injury (AKI; 7.8 vs. 8.6 vs. 24.0%, p &lt; 0.001), AHF (3.5 vs. 6.6 vs. 16.2%, p &lt; 0.001), in-hospital death (0.6 vs. 3.3 vs. 11.6%, p &lt; 0.001) and MACEs (5.2 vs. 5.8 vs. 15.9%, p &lt; 0.001) was significantly higher in the third tertile. TRI showed good discrimination for in-hospital death [area under the curve (AUC) = 0.804, p &lt; 0.001; Hosmer-Lemeshow p = 0.302], which was superior to its prediction for AKI (AUC = 0.678, p &lt; 0.001; Hosmer-Lemeshow p = 0.121), and in-hospital MACEs (AUC = 0.669, p &lt; 0.001; Hosmer-Lemeshow p = 0.077). Receiver-operation characteristics curve showed that TRI &gt; 42.0 had a sensitivity of 64.8% and specificity of 82.2% for predicting in-hospital death. Kaplan-Meier analysis showed that patients with TRI &gt; 42.0 had higher 1 year mortality (Log-rank = 79.2, p &lt; 0.001).Conclusion: TRI is suitable for risk stratification in elderly patients with STEMI undergoing PCI, and is thus of continuing value for an aging population.

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