scholarly journals Prognostic impact of percutaneous coronary intervention in octogenarians with non-ST elevation myocardial infarction: A report from SWEDEHEART

2019 ◽  
Vol 9 (5) ◽  
pp. 480-487 ◽  
Author(s):  
Sebastian Völz ◽  
Petur Petursson ◽  
Oskar Angerås ◽  
Jacob Odenstedt ◽  
Dan Ioanes ◽  
...  
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Coronary Intervention ◽  
Prognostic Impact ◽  
Entire Study ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
One Year

Aims: Percutaneous coronary intervention (PCI) improves outcomes in non-ST elevation acute coronary syndromes (NSTE-ACSs). Octogenarians, however, were underrepresented in the pivotal trials. This study aimed to assess the effect of PCI in patients ≥80 years old. Methods and results: We used data from the SWEDEHEART registry for all hospital admissions at eight cardiac care centres within Västra Götaland County. Consecutive patients ≥80 years old admitted for NSTE-ACS between January 2000 and December 2011 were included. We performed instrumental variable analysis with propensity score. The primary endpoint was all-cause mortality at 30 days and one year after index hospitalization. During the study period 5200 patients fulfilled the inclusion criteria. In total, 586 (11.2%) patients underwent PCI, the remaining 4613 patients were treated conservatively. Total mortality at 30 days was 19.4% (1007 events) and 39.4% (1876 events) at one year. Thirty-day mortality was 20.7% in conservatively treated patients and 8.5% in the PCI group (adjusted odds ratio 0.34; 95% confidence interval 0.12–0.97, p = 0.044). One-year mortality was 42.1% in the conservatively treated group and 16.3% in the PCI group (adjusted odds ratio 0.97; 95% confidence interval 0.36–2.51, p = 0.847). Conclusions: PCI in octogenarians with NSTE-ACS was associated with a lower risk of mortality at 30 days. However, this survival benefit was not sustained during the entire study-period of one-year.

scholarly journals The Clinical Prediction Factors for Non-Culprit Lesion Progression in Patients with Acute ST Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention

2021 ◽  
Author(s):  
jian wang ◽  
Cheng-ying Yan
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background To investigate the relationship between the clinical features and progression of non-culprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods A total of 480 patients (57.1 ± 9.2 y) with STEMI who underwent PPCI between January 2016 and December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as a treatment for culprit lesions. Clinical and angiographic follow-up were performed for 12 months. All patients were divided into a non-culprit lesions (NCL) progression group (205 cases) and a control group (275 cases) based on angiographic follow-up outcomes at 12 months. The clinical and angiographic features were analyzed. Results Body mass index (BMI), serum creatinine (Scr), fasting blood glucose (FBG), glycated serum albumin, glycated hemoglobin and homocysteine levels in the NCL progression group were significantly higher than those in the control group (P < 0.05). A logistic regression analysis showed that FBG (odds ratio = 1.274, 95% confidence interval: 1.077–1.505, P = 0.005) and Scr (odds ratio = 1.020, 95% confidence interval: 1.002–1.038, P = 0.027) were independent predictors of NCL progression. A partial correlation analysis showed that FBG was positively correlated with NCL progression (r = 0.231, P = 0.001). A receiver operating characteristic curve showed that the boundary point of FBG to predict NCL progression was 5.715 mmol/L, and the sensitivity was 74.4% and the specificity was 46.4%. Conclusions FBG is a valuable predictor for NCL progression in patients with STEMI after PPCI.

Clinical impact and predictors of complete ST segment resolution after primary percutaneous coronary intervention: A subanalysis of the ATLANTIC Trial

2017 ◽  
Vol 8 (3) ◽  
pp. 208-217 ◽  
Author(s):  
Enrico Fabris ◽  
Arnoud van ’t Hof ◽  
Christian W Hamm ◽  
Frédéric Lapostolle ◽  
Jens F Lassen ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
St Segment ◽  
Percutaneous Coronary ◽  
St Elevation

Background: In the ATLANTIC (Administration of Ticagrelor in the catheterization laboratory or in the Ambulance for New ST elevation myocardial Infarction to open the Coronary artery) trial the early use of aspirin, anticoagulation, and ticagrelor coupled with very short medical contact-to-balloon times represent good indicators of optimal treatment of ST-elevation myocardial infarction and an ideal setting to explore which factors may influence coronary reperfusion beyond a well-established pre-hospital system. Methods: This study sought to evaluate predictors of complete ST-segment resolution after percutaneous coronary intervention in ST-elevation myocardial infarction patients enrolled in the ATLANTIC trial. ST-segment analysis was performed on electrocardiograms recorded at the time of inclusion (pre-hospital electrocardiogram), and one hour after percutaneous coronary intervention (post-percutaneous coronary intervention electrocardiogram) by an independent core laboratory. Complete ST-segment resolution was defined as ≥70% ST-segment resolution. Results: Complete ST-segment resolution occurred post-percutaneous coronary intervention in 54.9% ( n=800/1456) of patients and predicted lower 30-day composite major adverse cardiovascular and cerebrovascular events (odds ratio 0.35, 95% confidence interval 0.19–0.65; p<0.01), definite stent thrombosis (odds ratio 0.18, 95% confidence interval 0.02–0.88; p=0.03), and total mortality (odds ratio 0.43, 95% confidence interval 0.19–0.97; p=0.04). In multivariate analysis, independent negative predictors of complete ST-segment resolution were the time from symptoms to pre-hospital electrocardiogram (odds ratio 0.91, 95% confidence interval 0.85–0.98; p<0.01) and diabetes mellitus (odds ratio 0.6, 95% confidence interval 0.44–0.83; p<0.01); pre-hospital ticagrelor treatment showed a favorable trend for complete ST-segment resolution (odds ratio 1.22, 95% confidence interval 0.99–1.51; p=0.06). Conclusions: This study confirmed that post-percutaneous coronary intervention complete ST-segment resolution is a valid surrogate marker for cardiovascular clinical outcomes. In the current era of ST-elevation myocardial infarction reperfusion, patients’ delay and diabetes mellitus are independent predictors of poor reperfusion and need specific attention in the future.

scholarly journals The clinical prediction factors of nonculprit lesions progression in patients with acute ST elevation myocardial infarction after primary percutaneous coronary intervention

2020 ◽  
Author(s):  
jian wang ◽  
Xue-Jie WANG
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
Control Group ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Objective :To investigate the relationship between the clinical features and progression of nonculprit lesions in patients with ST-elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI). Methods: A total of 192 patients (57.1 ± 9.2 years) with STEMI who underwent PPCI from January 2016 to December 2017 in Beijing Anzhen Hospital were enrolled in this study. All patients underwent PPCI as treatment for culprit lesions.Clinical and angiographic follow-up were performed in 12 months. All patients were divided into Nonculprit lesions(NCL) progression group ( 82 cases) and the control group (110 cases) according to angiographic follow-up outcome in 12 months. The clinical and angiographic features were analyzed.Results: Levels of body mass index（BMI）,serum creatinine（Scr）,fasting blood glucose（FBG）,glycated serum albumin（GSA）,glycated hemoglobin(GHb) and homocysteine (Hcy) in NCL progression group were significantly higher than those in the control group( P < 0. 05,respectively).Logistic regression showed that FBG( odds ratio = 1. 274,95% confidence interval: 1. 077-1. 505,P = 0. 005) and Scr ( odds ratio =1. 020,95% confidence interval:1. 002-1. 038,P=0. 027) were independent predictors of NCL progression.Partial correlation analysis showed that FBG was positively correlated with NCL progression( r = 0. 231,P = 0. 001) .Receiver operating characteristic(ROC) curve showed that the boundary point of FBG to predict NCL progression was 5. 715 mmol /L, the sensitivity was 74. 4% and the specificity was 46. 4%.Conclusion: FBG is an valuable predictor for NCL progression in patients with STEMI after PPCI.

P960Association of peri-procedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction treated by percutaneous coronary intervention: systematic review and meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
R Batchelor ◽  
D Liu ◽  
J Bloom ◽  
S Noaman ◽  
W Chan
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Percutaneous Coronary Intervention ◽  
Clinical Outcomes ◽  
Odds Ratio ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Increased Risk ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background Morphine analgesia may affect absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of peri-procedural intravenous (IV) morphine administration on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is not well defined. Purpose To conduct a systematic review and meta-analysis exploring clinical outcomes with peri-procedural IV morphine in patients undergoing PPCI for STEMI. Methods Analysis of the electronic databases MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI IV morphine use with myocardial infarction (MI) and mortality. Primary and secondary outcomes were in-hospital or 30-day MI and all-cause mortality respectively. Results Eleven studies (1 randomised controlled trial; 10 cohort studies) were included for systematic review. Five studies, including 3,748 patients were included in meta-analysis of the primary outcome. Of 3,748 patients, 2,239 were treated concurrently with ticagrelor, 1,256 treated with clopidogrel and 253 with prasugrel. As shown in the Figure, there was a trend towards increased risk of myocardial infarction with IV morphine (odds ratio 1.88; 95% CI 0.87–4.09, I2 0%). Across seven studies and 6585 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70, 95% CI 0.40–1.23, I2 19%). Figure 1. MI in hospital or at 30 days Conclusion Based on current literature, evidence of an association between IV morphine and myocardial infarction in patients undergoing PPCI for STEMI is limited by observational methodology and conflicting results. There is no evidence of an association between intravenous peri-procedural morphine and mortality. Clinical trial evidence with strong documentation of adverse events data is required to demonstrate association or causality. Acknowledgement/Funding None

scholarly journals Incidence, predictors and outcomes of stress hyperglycemia in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

2019 ◽  
Vol 17 (1) ◽  
pp. 147916411988398 ◽  
Author(s):  
Mohamed Khalfallah ◽  
Randa Abdelmageed ◽  
Ehab Elgendy ◽  
Yasser Mostafa Hafez
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Primary Percutaneous Coronary Intervention ◽  
Odds Ratio ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Diabetic Patients ◽  
Stress Hyperglycemia ◽  
Percutaneous Coronary ◽  
St Elevation

Background: Stress hyperglycemia is a common finding during ST elevation myocardial infarction in diabetic patients and is associated with a worse outcome. However, there are limited data about stress hyperglycemia in non-diabetic patients and its outcome especially in patients undergoing primary percutaneous coronary intervention. Methods: The study was conducted on 660 patients with ST elevation myocardial infarction who were managed with primary percutaneous coronary intervention. Patients were classified into two groups according to the presence of stress hyperglycemia: group I (patients with stress hyperglycemia) and group II (patients without stress hyperglycemia). Patients were analysed for clinical outcome including mortality and the occurrence of major adverse cardiac events. Results: Incidence of stress hyperglycemia was 16.8%, multivariate regression analysis identified the independent predictors of stress hyperglycemia, that were family history of diabetes mellitus odds ratio 1.697 (95% confidence interval: 1.077–2.674, p = 0.023), body mass index >24 kg/m2 odds ratio 1.906 (95% confidence interval: 1.244–2.922, p = 0.003) and cardiogenic shock on admission odds ratio 2.517 (95% confidence interval: 1.162–5.451, p = 0.019). Mortality, cardiogenic shock, contrast induced nephropathy and no reflow phenomenon were significantly higher in stress hyperglycemia group with p value = 0.027, 0.001, 0.020 and 0.037, respectively. Conclusion: Stress hyperglycemia in non-diabetic patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention is associated with increased incidence of no reflow phenomenon, contrast induced nephropathy, cardiogenic shock and higher mortality.

scholarly journals Cardiac rehabilitation after percutaneous coronary intervention: Results from a nationwide survey

2017 ◽  
Vol 17 (3) ◽  
pp. 273-279 ◽  
Author(s):  
Siv JS Olsen ◽  
Henrik Schirmer ◽  
Kaare H Bønaa ◽  
Tove A Hanssen
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Odds Ratio ◽  
Bypass Graft ◽  
Participation Rate ◽  
Coronary Intervention ◽  
Lower Probability ◽  
Coronary Syndrome ◽  
Percutaneous Coronary

Aim: The purpose of this study was to estimate the proportion of Norwegian coronary heart disease patients participating in cardiac rehabilitation programmes after percutaneous coronary intervention, and to determine predictors of cardiac rehabilitation participation. Methods: Participants were patients enrolled in the Norwegian Coronary Stent Trial. We assessed cardiac rehabilitation participation in 9013 of these patients who had undergone their first percutaneous coronary intervention during 2008–2011. Of these, 7068 patients (82%) completed a self-administered questionnaire on cardiac rehabilitation participation within three years after their percutaneous coronary intervention. Results: Twenty-eight per cent of the participants reported engaging in cardiac rehabilitation. Participation rate differed among the four regional health authorities in Norway, varying from 20%–31%. Patients undergoing percutaneous coronary intervention for an acute coronary syndrome were more likely to participate in cardiac rehabilitation than patients with stable angina (odds ratio 3.2; 95% confidence interval 2.74–3.76). A multivariate statistical model revealed that men had a 28% lower probability ( p<0.001) of participating in cardiac rehabilitation, and the odds of attending cardiac rehabilitation decreased with increasing age ( p<0.001). Contributors to higher odds of cardiac rehabilitation participation were educational level >12 years (odds ratio 1.50; 95% confidence interval 1.32–1.71) and body mass index>25 (odds ratio 1.19; 95% confidence interval 1.05–1.36). Prior coronary artery bypass graft was associated with lower odds of cardiac rehabilitation participation (odds ratio 0.47; 95% confidence interval 0.32–0.70) Conclusion: The estimated cardiac rehabilitation participation rate among patients undergoing first-time percutaneous coronary intervention is low in Norway. The typical participant is young, overweight, well-educated, and had an acute coronary event. These results varied by geographical region.

Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey

2020 ◽  
pp. 147451512094053
Author(s):  
Ji-Su Kim ◽  
Gwang S Kim ◽  
Seok-Min Kang ◽  
Sang H Chu
Keyword(s):  
Percutaneous Coronary Intervention ◽  
Confidence Interval ◽  
Cardiac Rehabilitation ◽  
Health Behaviour ◽  
Odds Ratio ◽  
Health Belief ◽  
Coronary Intervention ◽  
Education Programme ◽  
Symptom Experience ◽  
Percutaneous Coronary

Background: Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. Aims: The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. Methods: A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. Results: Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45–8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28–6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08–1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02–1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00–1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. Conclusion: This study provides evidence that educational programmes to help improve patients’ perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.

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