scholarly journals Outcomes of Hospitalized Patients with Myocardial Infarction and Immune Thrombocytopenic Purpura: A Cross Sectional Study over 15 Years

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 4977-4977
Author(s):  
Chisom Onuoha ◽  
Marcus Weldon ◽  
Vamsi Kota ◽  
Achuta Kumar Guddati
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Immune Thrombocytopenic Purpura ◽  
Hospitalized Patients ◽  
Blood Transfusions ◽  
Age Group ◽  
Thrombocytopenic Purpura ◽  
Acute Mi

Abstract Background: Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder characterized by low platelet counts and mucocutaneous bleeding. Antiplatelet agents are an essential component in the treatment of acute myocardial infarction (MI). Patients with ITP are not exempt from succumbing to acute myocardial infarction. Myocardial infraction in these patients is rare but poses a significant management challenge. The outcomes of hospitalized patients with ITP and acute MI have not been previously described and may help identify risk factors associated with adverse outcomes in this unique patient population. Methods: The International Classification of Diseases, 9th Edition, Clinical Modification codes were used to identify patients with ITP who were admitted with acute myocardial infarction. All data regarding such hospitalization was extracted from the National Inpatient Database for the years 2000 to 2014. Patient demographics of age, race and gender; hospital characteristics such as geographical location, teaching status, rural vs. urban location and bed size, medical comorbidities such as hypertension, hyperlipidemia, diabetes and coronary artery disease were studied. The Chi square test was used to determine associations with statistical significance and logistic regression was used to determine independent predictors of mortality. Results: A total of 753,732 hospitalized patients with ITP were identified over the time period of 2000 to 2014 of which 37695 patients had both ITP and acute MI. There were more females with ITP in general (60% females vs 40% males), but more males with ITP and acute MI (55.8% males vs 44.2% females; p =0.0000). Caucasians were affected the most (5.5%) amongst all races and the age group of 65-79 years had the highest percentage of patients with ITP and MI (7.3%). While hospitals located in the Northeast region of the country had the highest prevalence of MI in ITP, there was no statistical difference between prevalence in hospitals of different sizes (small vs. medium vs. large). A majority of patients with MI and ITP were covered by Medicare and were discharged home. 5572 patients received a stent and 3353 patients underwent coronary artery bypass grafting. The classical risk factors of hypertension, hyperlipidemia, and diabetes were also noted to be highly prevalent in patients with ITP and MI. 10.05% of patients with ITP and acute MI died during hospitalization, while 4% of all patients with ITP died during hospitalization (p<0.05). Multiple regression showed that stent placement, female gender, blood transfusions, platelet transfusion, 80+ age group and higher Charlson's score were independent predictors of mortality in patients with ITP who have MI (ORs: 0.3, 0.8, 1.9, 1.3, 5.9 and 5.5 respectively). Conclusions: ITP patients with MI have poor outcomes. Known risk factors for acute MI in the general population are also applicable to patients with ITP. Acute MI is associated with an increased rate of in-hospital death in patients with ITP. Both blood transfusions and platelet transfusions adversely affect outcomes and should be considered in the management of MI in ITP patients. Disclosures Kota: Novartis: Honoraria; Xcenda: Honoraria; Incyte: Honoraria; BMS: Honoraria; Pfizer: Honoraria.

scholarly journals Risk-Predictors of Mortality in Hospitalized Patients with Thrombotic Thrombocytopenic Purpura: Nationally Representative Data from 2007-2011

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 4290-4290
Author(s):  
Ruchika Goel ◽  
Paul Ness ◽  
Clifford M. Takemoto ◽  
Karen E. King ◽  
Aaron Tobian
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Thrombotic Thrombocytopenic Purpura ◽  
Arterial Thrombosis ◽  
Hospitalized Patients ◽  
Thrombocytopenic Purpura ◽  
Plasma Infusion ◽  
Multivariable Logistic Regression

Abstract Introduction: Survivors of Thrombotic Thrombocytopenic Purpura (TTP) hospitalizations have been proposed to be at higher risk for long term poor clinical outcomes and premature death. Patients with TTP have a high risk for in-hospital morbidity and mortality as well. However, there is a paucity of data on the predictors of adverse outcomes including death in hospitalized patients with TTP. Methods: A weighted analysis of 5 years (2007-2011) using data from the Nationwide Inpatient Sample, a stratified probability sample of 20% of all hospital discharges among community hospitals in the United States (approximately 1100 hospitals/year), was performed. Hospitalizations with TTP as the primary admitting diagnoses were identified using the ICD-9 discharge code 446.6. Univariate and stepwise multivariable logistic regression analyses with elimination were used for statistical analysis. Based on results of univariate analysis, the significant variables were added in a stepwise manner in a multivariable model. All variables selected for the multivariable model were tested for interaction with a significance threshold level of p<0.2. Except for this, all hypothesis testing was two tailed and p<0.05 was considered significant. Receiver Operator Characteristics (ROC) curve was constructed using risk factors on multivariate analysis. Results: The all-cause mortality rate was 8.7% (918/10615) among admissions with primary diagnosis of TTP (0.5% pediatric, 65.9% female, 58.2% Caucasian, 27.2% African-American). Table 1 lists the risk factors by univariate analysis and includes a) factors with significantly higher odds of mortality and b) other putative factors which were not statistically significant predictors. Table 2: In stepwise multivariable logistic regression analysis: arterial thrombosis (adjOR 5.1 95%CI=1.1-31.7), acute myocardial infarction (adjOR 2.8, 95%CI=1.6-4.9), non-occurrence of either intervention: plasmapheresis or fresh frozen plasma infusion (adjOR 2.0, 95% CI=1.4-2.9) 4) requirement of platelet transfusions during hospitalization (adjOR 2.0, 95%CI= 1.3-3.2) and every ten year increase in age (OR 1.4 95%CI=1.3-1.6) were independently predictive of mortality in TTP patients (area under the curve for ROC 74%, Figure 1). Conclusion: We present a set of independent risk factors that may potentially be used in a predictive model of mortality in TTP. Early and targeted aggressive therapy based on these factors should guide the management of hospitalized patients with TTP for improved outcomes. Table 1.Unadjusted odds of in-hospital mortality.Significant predictors of mortality for TTP on univariate analysisOdds Ratio95% Confidence LimitsArterial Thrombosis 10.92.254.6AMI 3.72.16.2STROKE 4.93.07.9Platelet Transfusion 2.31.53.6Bleeding event 1.71.12.6Plasmapheresis (No vs. Yes)1.61.22.3plasmapheresis or plasma infusion (not performed)2.21.53.1Every 10 years increase in age1.51.31.6PRBC transfusion1.71.22.3Caucasian versus African American1.91.32.8Asian versus African American3.31.29.1V ariables not significant predictors of mortality for TTP on univariate analysis.Odds Ratio95% Confidence LimitsVenous Thrombosis/Thromboembolism1.90.84.4FEMALE versus male gender1.00.71.4Hypertension Yes vs. no0.90.61.2Diabetes Yes vs. no0.90.61.4Chronic Kidney Disease Yes vs. No1.40.92.2End Stage Renal Disease Yes vs. No0.90.41.9Overweight/Obese Yes vs. No0.70.41.5Variables meeting criteria for inclusion in multiple logistic regression model are in boldface type. Table 2. Multivariable Predictors for In Hospital Mortality in patients with primary diagnosis of TTP Adjusted Odds Ratio 95% Confidence Limits Arterial Thrombosis 6.0 1.2 30.5 Acute myocardial infarction 2.8 1.6 4.8 No Plasmapheresis/Plasma infusion 2.0 1.4 2.9 Platelet Transfusion 2.1 1.4 3.2 Age (per 10 year higher) 1.4 1.3 1.6 Female versus Male 1.2 0.8 1.7 TTP = Thrombotic Thrombocytopenic Purpura Step 0: Using arterial thrombosis Figure 1: Receiver- Operator-Characteristic Curve (ROC) overlay curve for the stepwise multivariable logistic regression risk prediction showing incremental AUC with addition of each risk factor for hospital patients with TTP. Figure 1:. Receiver- Operator-Characteristic Curve (ROC) overlay curve for the stepwise multivariable logistic regression risk prediction showing incremental AUC with addition of each risk factor for hospital patients with TTP. Step 1: Adding acute myocardial infarction Step 2: Adding plasmapheresis /fresh frozen plasma infusion Step 3: Adding platelet transfusions Final model: Adding every ten year increase in age. Disclosures Ness: Terumo BCT: Consultancy.

scholarly journals Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction

2019 ◽  
Vol 43 (1) ◽  
pp. 50-59
Author(s):  
Omar Chehab ◽  
Nadine Abdallah ◽  
Amjad Kanj ◽  
Mohit Pahuja ◽  
Oluwole Adegbala ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Immune Thrombocytopenic Purpura ◽  
Thrombocytopenic Purpura

scholarly journals Clinical Study on Characteristics and Risk Factors of Coronary Artery Lesions in Young Patients with Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Hua Liu ◽  
Jiangang Zhang ◽  
Zengcai Ma ◽  
Zesheng Xu
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Collateral Circulation ◽  
Young Patients ◽  
Coronary Artery Lesions ◽  
Dominant Type ◽  
Factors Affecting

Epidemiological evidence suggests that the incidence of acute myocardial infarction (AMI) among people under 40 years of age has an increasing trend in recent years. Smoking, hypertension, diabetes mellitus, family history, and gender (male) are considered as classic risk factors for CHD, but the pathogenesis of CHD in young people is not exactly the same. Moreover, the relationship between the pattern of coronary artery disease and risk factors in young patients with acute myocardial infarction is inconclusive. In this study, we retrospectively studied the clinical data of 150 AMI patients treated in our hospital from January 2020 to May 2021. The patients were divided into the young group and elderly group according to the difference in age. The number of coronary artery lesions, the degree of coronary artery stenosis, the distribution dominance typing, the position of the lesions, and the presence of collateral circulation were observed and compared between the two groups. Multivariate logistic regression analysis was used to investigate the risk factors affecting coronary artery lesions in young patients with AMI. The results showed that the number of coronary lesions in young patients with AMI was mainly single-vessel, and the dominant type of distribution was mainly right dominant type. The stenosis degree is lighter than that of elderly patients, and the incidence of collateral circulation is lower than that of elderly patients, but the position of the lesions has no obvious regular. Smoking, staying up late, HDL-C, and LDL-C/ApoB were independent factors affecting the number of coronary artery lesions, and the changes of HDL-C and LDL-C/ApoB had an important influence on the degree of coronary stenosis in young patients. This provides a new idea for clinical treatment.

Clinical profile of acute myocardial infarction in the young

2021 ◽  
Vol 11 (2) ◽  
pp. 148-150
Author(s):  
Sapkal Harish Barsu ◽  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Epigastric Pain ◽  
Young Patients ◽  
Clinical Profile ◽  
Atypical Symptoms ◽  
Acute Mi ◽  
Rising Incidence ◽  
And Control

Background: There is a rising incidence of acute myocardial infarction (MI) in young adults. It is important to identify and control cardiovascular risk factors at an early age to prevent the incidence in cases of young MI. Aim: To study the clinical profile of acute myocardial infarction in young patients. Material and Methods: Patients aged 40 years or younger admitted to with a diagnosis of acute MI were studied for clinical presentations, risk factors and management outcome. Results: Majority of patients presented with typical chest pain. 5 patients presented with atypical symptoms, one had only sweating, two had heaviness of chest, one had epigastric pain, one had sudden collapse. The most common risk factor was smoking in 68% followed by alcoholism 40%, Obesity 38%, Metabolic syndrome 38%, HTN 28% DM 26%. Of the total 50 patients, 47 (94%) patients survived whereas 3 (6%) patients succumb to death. Conclusion: There is a need to increase awareness among the young population regarding the entity of MI in young hence stressing on modifying life style. This simple measure can make a large difference in preventing the occurrence of MI in young.

Integrin Polymorphisms as Risk Factors for Thrombosis

1999 ◽  
Vol 82 (08) ◽  
pp. 337-344 ◽  
Author(s):  
Paul Bray
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Arterial Thrombosis ◽  
Protein C ◽  
Integrin Αiibβ3 ◽  
Coronary Syndromes ◽  
Artery Disease

IntroductionBy the year 2020, ischemic heart disease will become the number one public health problem on the planet, surpassing lower respiratory infections, diarrheal disease, perinatal problems, and unipolar major depression.1 Acute myocardial infarction, the most feared complication of coronary artery disease, results from the formation of an occlusive thrombus at the site of a ruptured atherosclerotic plaque. The 1990s have seen an increased awareness of the contribution of inherited disorders of hemostasis as risks for coronary thrombosis. Consideration for potential hypercoagulable states in patients with these disorders would seem justified, since, for example, the risk for an acute coronary event is considerably greater with an abnormally elevated fibrinogen level than with an elevated total cholesterol level.2,3 The clinical benefit of thrombolytic therapy in acute myocardial infarction provides further support for the importance of fibrin formation or dissolution in this setting.4,5 An appropriate hypercoagulable evaluation of an unusual arterial thrombosis, particularly in a young patient, would include assays for hyperhomocysteinemia, the lupus anticoagulant, anticardiolipin antibodies, as well as assays for fibrinogen and plasminogen activator inhibitor-1. Currently, less evidence exists to support measurements of tissue plasminogen activator, von Willebrand factor (vWF), factors VII or XIII, or those factors associated with venous thrombosis, such as activated protein C resistance/factor V Leiden or deficiencies of antithrombin III, protein C, or protein S.There is also abundant evidence that platelet thrombi play a crucial role in the development of acute myocardial infarction. In 1974, Chandler et al summarized a series of pathologic studies examining coronary arteries of patients with acute myocardial infarction and reaffirmed the basic understanding that coronary artery thrombi can cause acute ischemia and myocardial infarction.6 DeWood et al provided in vivo evidence to corroborate pathologic data,7 and Trip et al correlated platelet hyperreactivity with coronary events and mortality in patients with established coronary artery disease.8 The clinical arena has also provided additional support for the central role of platelets in the acute ischemic coronary syndromes, myocardial infarction, and unstable angina. Antiplatelet therapy with aspirin, ticlopidine, clopidogrel, and inhibitors of integrin αIIbβ3 (e.g., abciximab and integrilin) has demonstrated beneficial effects in a number of coronary artery disease settings.9-11 Platelet physiology is arbitrarily divided into phases of adhesion, activation, secretion, and aggregation. When arterial subendothelium is exposed, vWF molecules are rapidly localized to these areas, and the initial platelet contact with the wound is a tethering to this insoluble form of vWF via glycoprotein (GP) Ibα.12,13 Stable adhesion and platelet activation is then mediated through integrin α2β1 binding to exposed collagen and integrin αIIbβ3 binding to vWF and fibrinogen.14 Fibrinogen has multiple αIIbβ3 binding sites, and an expanding thrombus ensues when platelets aggregate via the intercellular bridging of fibrinogen and vWF binding to the activated conformation of αIIbβ3. Three platelet membrane glycoprotein receptors, αIIbβ3, α2β1, and GP Ib-IX, have highly interactive and additive adhesive effects, ultimately resulting in stable thrombus formation.Attempts to educate both physicians and the lay public about the so-called “traditional” risk factors for coronary artery disease and acute ischemic coronary syndromes have been successful,15 and there are now established preventive therapies, such as blood pressure control, cessation of cigarette smoking, and cholesterol lowering. Genetic variations confer a potent risk for coronary artery disease in many families, and, although these risks fall outside the domain of preventive medicine, an emerging concept in the field is that targeted genetic testing may be used to direct therapeutic decisions. Although inherited alterations of hemostatic factors are believed to be important in the development of acute ischemic coronary syndromes, until recently, inherited platelet risk factors had not been considered. This review will focus on the potential link between the genetic and platelet components of arterial thrombosis, in particular, coronary artery disease.

Invasive treatment performed for acute myocardial infarction in a patient with immune thrombocytopenic purpura

2008 ◽  
Vol 127 (3) ◽  
pp. e183-e185 ◽  
Author(s):  
Maria Cruz Ferrer Gracia ◽  
Isabel Calvo Cebollero ◽  
Juan Sánchez-Rubio Lezcano ◽  
Gabriel Galache Osuna ◽  
José Antonio Diarte Miguel ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Immune Thrombocytopenic Purpura ◽  
Invasive Treatment ◽  
Thrombocytopenic Purpura

scholarly journals Association between Serum Osteoprotegerin Levels and Severity of Coronary Artery Disease in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 10 (19) ◽  
pp. 4326
Author(s):  
Yves Cottin ◽  
Rany Issa ◽  
Mourad Benalia ◽  
Basile Mouhat ◽  
Alexandre Meloux ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Coronary Artery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Syntax Score ◽  
Acute Mi ◽  
Coronary Lesions ◽  
Artery Disease

Background. Osteoprotegerin (OPG), a glycoprotein of the tumour necrosis factor (TNF) superfamily, is one of the main biomarkers for vascular calcification. Aim. We aimed to evaluate the association between serum OPG levels and extent of coronary lesions in patients with acute myocardial infarction (MI). Methods. Consecutive patients hospitalized for an acute MI who underwent coronary angiography were included. SYNTAX score was calculated to assess the severity of coronary artery disease. The population was analysed in low (5 (3–6)), medium (11 (9–13)) and high (20 (18–23)) tertiles of SYNTAX score. Results. Among the 378 patients included, there was a gradual increase in age, rate of diabetes, anterior wall location, and a reduction in left ventricular ejection fraction across the SYNTAX tertiles. OPG levels significantly increased across the tertiles (962 (782–1497), 1240 (870–1707), and 1464 (1011–2129) pg/mL, respectively (p < 0.001)). In multivariate analysis, OPG [OR(CI95%): 2.10 (1.29–3.49) 0.003], were associated with the high SYNTAX group, beyond hypercholesterolemia, CV history and reduced glomerular filtration rate. Conclusion. We found an association between OPG levels and coronary lesions complexity patients with acute MI.

scholarly journals Evaluation of Serum 25 Hydroxy Vitamin D level in acute myocardial infarction patients in a tertiary care hospital

2016 ◽  
Vol 7 (6) ◽  
pp. 11-15 ◽  
Author(s):  
Debapriya Rath ◽  
Rachita Nanda ◽  
Pramila Kumari Mishra ◽  
Pradeep Kumar Patra
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Acute Myocardial Infarction ◽  
Vitamin D ◽  
Coronary Artery ◽  
Serum Vitamin ◽  
Coronary Risk Factors ◽  
Serum Vitamin D ◽  
Artery Disease

Background: Coronary artery disease is the leading cause of death worldwide with acute myocardial infarction being the most severe manifestation. Recent evidences have linked vitamin D in the pathogenesis of the coronary risk factors like diabetes, hypertension, obesity and smoking.Aims and Objectives: The present study was undertaken with an aim to look for the vitamin D status of the AMI patients and its relation if any with the above mentioned risk factors.Material and Methods: One hundred acute myocardial infarction patients along with one hundred age and sex matched healthy controls were included in the study and the serum 25 (OH) D was estimated in both the groups.Results: Serum 25 (OH) Vit D level was found to be lower in cases (19.6±6.85 ng/ml) than in controls (27.5±6.23 ng/ml) (p<0.001).The decreased vitamin D level was associated with the incidence of AMI after adjusting for other risk factors. The serum vitamin D level was significantly decreased in the patients having risk factors among the AMI group.Conclusion: The present study showed a significantly low serum vitamin D in AMI patients . Given the therapeutic safety and inexpensiveness of vitamin D, further studies may be undertaken to look for the effect of its supplementation on coronary artery disease. Asian Journal of Medical Sciences Vol.7(6) 2016 11-15

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