Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy

2020 ◽  
pp. 204887261989620
Author(s):  
Batric Popovic ◽  
Emmanuel Sorbets ◽  
Jeremie Abtan ◽  
Marc Cohen ◽  
Charles V Pollack ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Patients With Heart Failure ◽  
Early Invasive Strategy

Background Previous studies published before the era of systematic early invasive strategy have reported a higher mortality in non-ST-segment elevation myocardial infarction patients with heart failure. The aim of our study was to compare the clinical characteristics, outcomes and causes of death of patients according to their heart failure status at admission in a large non-ST-segment elevation myocardial infarction population with planned early invasive management. Methods We performed a post-hoc analysis of the Treatment of Acute Coronary Syndrome with Otamixaban randomised trial which included non-ST-segment elevation myocardial infarction patients with systematic coronary angiography within 72 h. Patients were categorised according to presence or absence of heart failure (Killip grade ≥2) at admission. Results A total of 13,172 patients were enrolled, of whom 944 (7.2%) had heart failure. At day 30, death occurred in 213 patients (1.6%) and cardiovascular death was the dominant cause of death in both groups ((with vs without heart failure) 78.8% vs 78.4%, p = 0.94). At six months, death occurred in 90/944 (9.5%) patients with heart failure and 258/12228 patients without heart failure (2.1%) ( p < 0.001). After adjustment on Global Registry of Acute Coronary Events risk score, heart failure was an independent predictor of all-cause mortality at day 30 (odds ratio: 1.58; 95% confidence interval, 1.06–2.36, p = 0.02) and at day 180 (odds ratio: 1.77; 95% confidence interval, 1.3–2.42, p < 0.001) as well as of ischaemic complications (cardiovascular death, myocardial infarction, stent thrombosis or stroke at day 30 (odds ratio: 1.28; 95% confidence interval, 1.01–1.62, p = 0.04). Conclusion Non-ST-segment elevation myocardial infarction patients with heart failure at admission still have worse outcomes than those without heart failure, even with systematic early invasive strategy. Further efforts are needed to improve the prognosis of these high risk patients.

scholarly journals The effect of early invasive strategy on mortality outcome in patients with chronic kidney disease presenting with non-ST segment elevation myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Sharon ◽  
B Fishman ◽  
E Itelman ◽  
P Fefer ◽  
I Barbash ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Mortality Data ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Risk Of Death ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Early Invasive Strategy

Abstract Background Current guidelines recommend an early invasive strategy for patients with non-ST segment elevation myocardial infarction (NSTEMI). Purpose To evaluate whether early invasive strategy is associated with better outcome among patients with chronic kidney disease (CKD). Methods Retrospective cohort analysis of consecutive patients with NSTEMI between 2008 and 2021. Glomerular filtration rate (eGFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) creatinine equation. Invasively treated patients were dichotomized into early (&lt;24 hours) and non-early groups. Mortality data was available for all patients from a national registry. Multivariate Cox regression models with interaction analysis were applied. Results Final study population comprised 7,107 NSTEMI patients, of whom 3,172 (45%) had eGFR &lt;60 ml/min/1.73m2. 1,988 (28%) and 973 (14%) patients had eGFR under 45 and 30 ml/min/1.73m2, respectively. 3,529 (50%) patients were treated invasively, among them 1837 (52%) underwent early invasive strategy. Patients in the early invasive group were younger (64 vs. 68 years, p&lt;0.001) and were less likely to have comorbidities including kidney disease. During a median follow-up of 3 years (IQR 1.2–5.2), 2,552 (36%) patients died. Kaplan Meier survival analysis demonstrated that the cumulative probability of death was 50%, 15%, and 6% among patients in the conservative, non-early, and early invasive groups respectively (p Log-rank &lt;0.001). Subgroup analysis of invasively managed patients showed that early invasive strategy was associated with a significant 32% reduced risk of death in a multivariate model (95% CI 0.56–0.82, p&lt;0.001), but this associated benefit was modified by eGFR (p for interaction 0.045). The modification effect of CKD on the association of early invasive strategy with outcome was most pronounced among invasively treated patients with eGFR &lt;45 ml/min/1.73m2, with no survival benefit for early invasive approach in these patients (HR 0.8, 95% CI 0.57–1.14, p=0.221 vs. HR 0.6 95% CI 0.45–0.72, p&lt;0.001; p for interaction=0.046). Conclusion Among invasively treated NSTEMI patients, the benefit of early invasive strategy is modified by CKD, and limited to those with eGFR ≥45 ml/min/1.73m2. FUNDunding Acknowledgement Type of funding sources: None.

Abstract 17267: Outcomes of Patients With Non-ST-Segment Elevation Myocardial Infarction and High Degree Atrioventricular Block Treated With Early vs Delayed Invasive Strategy

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Raj Patel ◽  
Harsh P Patel ◽  
Samarthkumar J Thakkar ◽  
Fadee Kutom ◽  
Dipesh Ludhwani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrioventricular Block ◽  
Linear Regression Analysis ◽  
Pacemaker Implantation ◽  
Invasive Strategy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Early Invasive Strategy ◽  
High Degree

Introduction: High degree atrioventricular block (HDAVB) is an uncommon complication of non-ST-segment elevation myocardial infarction (NSTEMI), frequently necessitating pacemaker implantation. Hypothesis: This contemporary analysis compares the need for pacemaker implantation based on the timing of intervention in acute NSTEMI complicated by HDAVB. Methods: We used 2016-2017 National Inpatient Sample (NIS) database to identify all admissions with NSTEMI. Those without HDAVB were excluded from the study. Time to coronary intervention from initial admission was used to segregate the admissions into two groups: early invasive strategy (EIS) (<24 hours) and delayed invasive strategy (DIS)(>24 hours). A multivariate logistic and linear regression analysis was performed to compare in-hospital outcomes among both groups. Results: Out of 949,984 NSTEMI related admissions, coexistent HDAVB was present in 0.7% (n=6725) patients which were subsequently included in the study. Amongst those, 55.61% (n=3740) hospitalization included invasive intervention (EIS=1320, DIS=2420) (Figure1). Patients treated with EIS were younger (69.95 vs 72.38, p= <0.05) and had a concomitant cardiogenic shock. Contrarily the prevalence of chronic kidney disease (CKD), heart failure (HF), and pulmonary hypertension was higher in DIS group. EIS was associated with lower length of stay and total hospitalization cost. Although statistical significance was not achieved, a trend towards higher in-hospital mortality and lower pacemaker implantation rates were seen in hospitalizations involving EIS (Table1). Conclusions: HDAVB is a rare complication of NSTEMI and it is associated with significant mortality. The timing of revascularization does not appear to influence the rate of pacemaker placement in NSTEMI complicated by HDAVB. Further studies are needed to assess if all patients presenting with HDAVB should be treated with an early invasive strategy.

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