scholarly journals Outcomes after first percutaneous coronary intervention for acute myocardial infarction according to patient funding source

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Pamela J Bradshaw ◽  
Shauna Trafalski ◽  
Joseph Hung ◽  
Tom G Briffa ◽  
Kristjana Einarsdóttir
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Funding Source ◽  
Percutaneous Coronary

scholarly journals The effect of unguided de-escalation of P2Y12 receptor inhibitor therapy after acute myocardial infarction in patients undergoing percutaneous coronary intervention: a nationwide cohort study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J.S Yeh ◽  
C.Y Hsu ◽  
C.Y Huang ◽  
W.T Chen ◽  
Y.C Hsieh ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Bleeding Complications ◽  
Funding Source ◽  
P2y12 Inhibitor ◽  
Risk Of Death ◽  
Percutaneous Coronary ◽  
Significant Difference

Abstract Aims To examine the effect of de-escalation of P2Y12 inhibitor in dual antiplatelet therapy (DAPT) on major adverse cardiovascular events (MACE) and bleeding complications after acute myocardial infarction (AMI) in Taiwanese patients undergoing percutaneous coronary intervention (PCI). Methods and results We retrospectively evaluated patients who had received PCI during AMI hospitalisation and were initially on aspirin and ticagrelor and without adverse events at 3 months between 2013 and 2016. In total, 1,901 and 8,199 patients were identified as switched DAPT (switched to aspirin and clopidogrel) and unswitched DAPT (continued on aspirin and ticagrelor) cohorts, respectively. With a mean follow-up of 8 months, the incidence rates (per 100 person-year) of death, AMI readmission and MACE were 2.89, 3.68 and 4.91 in the switched cohort and 2.42, 3.28 and 4.72 in the unswitched cohort, respectively based on an inverse probability of treatment weighted method. (Table) After adjustment for patients' clinical variables, two groups were no significant difference in death (A), AMI admission (B) and MACE (C). Additionally, there was no difference in the risk of major (D) or non-major clinically relevant bleeding (E) (Figure 1). Conclusions Unguided de-escalation of P2Y12 inhibitor in DAPT was not associated with higher risk of death, MACE, AMI readmission in Taiwanese patients with AMI undergoing PCI. Figure 1 Funding Acknowledgement Type of funding source: Private hospital(s). Main funding source(s): Taipei Medical University

scholarly journals Gender disparities in management and treatment in acute myocardial infarction – a German nationwide real-life analysis

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Kuehnemund ◽  
J Koeppe ◽  
J Feld ◽  
A Wiederhold ◽  
J Illner ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Hospital Mortality ◽  
Bypass Surgery ◽  
Coronary Bypass ◽  
Coronary Intervention ◽  
Funding Source ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background/Introduction Acute myocardial infarction (AMI) continues to be one of the most frequent diseases worldwide, remaining among the most common causes of mortality in both women and men of industrialised nations. Female sex has been reported to be associated with an unfavourable outcome in AMI. Differences related to patients' sex have been reported for incidence, symptom presentation, pathophysiological characteristics as well as treatment strategies and outcome. Purpose Objective of this routine-data based analysis was to explore sex differences of recent nationwide trends in in-patient healthcare and acute outcome of AMI. Methods The data base provided by the Federal Statistical Offices comprises all in-patient treated patients on a case base per year. We identified all cases with a main diagnosis of ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) between 01.01.2014 and 31.12.2017. Further, data on concomitant diseases, risk constellations and selected cardiovascular procedures were acquired for sex-specific analysis. Results In total, we identified 280,515 STEMI and 595,220 NSTEMI cases over the four-year period. STEMI cases decreased from 72,894 in 2014, to 70,230 in 2015, to 69,178 in 2016, and to 68,213 in 2017 with 70% of STEMI cases assignable to men. Female sex was associated with older age (74 vs. 62 yrs), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.21% vs. 12.5%), diabetes (26.4% vs. 21.7%), left ventricular heart failure (36% vs. 32.1%), or atrial fibrillation (17.6% vs. 13%). However, dyslipidemia (43.9% vs. 49.3%) and smoking (7.4% vs. 12.1%) were more frequent in male STEMI cases than in female STEMI cases. Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI; p<0.0001; s. Figure); coronary bypass surgery was performed in 2.7% of female vs. 4.2% of male cases (p<0.0001). There were 5,125 female and 2,015 male STEMI patients aged 90 years and older. These received less frequent percutaneous coronary intervention (42.5% female vs. 52.8% male; p<0.0001) and coronary bypass surgery (0.1% female vs. 0.4% male; p=0.0063) compared to younger age groups. Observed in-hospital mortality was significantly increased in female patients with STEMI (15% female vs. 9.6% male; p<0.0001) and NSTEMI (8.4% vs. 6.3%; p<0.0001). Conclusion In a nationwide real-world setting, in-patient STEMI cases continue to decrease over the recent past in both, male and female patients. Women with AMI are older and continue to be less likely to receive revascularization therapies than men. In addition, women present with significantly higher observed in-hospital mortality compared to men. It is important to draw attention to the peculiarities of women with AMI and to supply revascularization therapy equally in high risk clientele. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Innovationsfonds des gemeinsame Bundesausschusses

Increasing the Penetration of Primary Angioplasty in Europe

2012 ◽  
Vol 8 (1) ◽  
pp. 60 ◽  
Author(s):  
Zuzana Kaifoszova ◽  
Petr Widimsky ◽  
◽  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Treatment Guidelines ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
Success Factor ◽  
The Balkans ◽  
Life Saving ◽  
Percutaneous Coronary

Primary percutaneous coronary intervention (PPCI) is recommended by the European Society of Cardiology (ESC) treatment guidelines as the preferred treatment for ST-elevation acute myocardial infarction (STEMI) whenever it is available within 90–120 minutes of the first medical contact. A survey conducted in 2008 in 51 ESC countries found that the annual incidence of hospital admissions for acute myocardial infarction is around 1,900 patients per million population, with an incidence of STEMI of about 800 per million. It showed that STEMI patients’ access to reperfusion therapy and the use of PPCI or thrombolysis (TL) vary considerably between countries. Northern, western and central Europe already have well-developed PPCI services, offering PPCI to 60–90 % of all STEMI patients. Southern Europe and the Balkans are still predominantly using TL. Where this is the case, a higher proportion of patients are left without any reperfusion treatment. The survey concluded that a nationwide PPCI strategy results in more patients being offered reperfusion therapy. To address the inequalities in STEMI patients’ access to life-saving PPCI, and to support the implementation of the ESC STEMI treatment guidelines in Europe, the Stent for Life (SFL) Initiative was launched jointly by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and EuroPCR in 2008. National cardiac societies from Bulgaria, France, Greece, Serbia, Spain and Turkey signed the SFL Declaration at the ESC Congress in Barcelona in 2009. The aim of the SFL Initiative is to improve the delivery of, and STEMI patients’ access to, life-saving PPCI and thereby reduce mortality and morbidity. Currently, 10 national cardiac societies support the SFL Initiative in their respective countries. SFL national action programmes have been developed and are being implemented in several countries. The formation of regional PPCI networks involving emergency medical services, non-percutaneous coronary intervention hospitals and PPCI centres is considered to be a critical success factor in implementing PPCI services effectively. This article describes examples of how SFL countries are progressing in implementing their national programmes, thus increasing PPCI penetration in Europe.

Thrombolytic Therapy in the Current ERA: Myocardial Infarction and Beyond

2018 ◽  
Vol 24 (4) ◽  
pp. 414-426 ◽  
Author(s):  
Patrick Proctor ◽  
Massoud A. Leesar ◽  
Arka Chatterjee
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Ischemic Stroke ◽  
Thrombolytic Therapy ◽  
Coronary Intervention ◽  
Evidence Base ◽  
Primary Pci ◽  
Percutaneous Coronary

Thrombolytic therapy kick-started the era of modern cardiology but in the last few decades it has been largely supplanted by primary percutaneous coronary intervention (PCI) as the go-to treatment for acute myocardial infarction. However, these agents remain important for vast populations without access to primary PCI and acute ischemic stroke. More innovative uses have recently come up for the treatment of a variety of conditions. This article summarizes the history, evidence base and current use of thrombolytics in cardiovascular disease.

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