scholarly journals Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jia-li Wang ◽  
Chun-yan Guo ◽  
Hui Chen ◽  
Hong-wei Li ◽  
Xue-qiao Zhao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Elderly Women ◽  
Medical Group ◽  
Very Elderly ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Elderly Female

Abstract Background Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors which might contribute to the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the very elderly female PCI cohort. Methods Female ACS patients aged ≥ 80 years were consecutively enrolled (n = 729) into the study. All the patients were divided into female PCI group (n = 232) and medical group (n = 497). MACCE was followed up, including non-fatal myocardial infarction (MI), stroke, heart failure requiring hospitalization (HFRH), cardiovascular (CV) death, and the composite of them. After propensity score matching (1:1), the incidences of MACCE were compared between the two groups. Clinical and coronary artery lesion characteristics were compared between the female PCI patients with (n = 56) and without MACCE (n = 176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in the female PCI patients. MACCE of male PCI patients, who aged ≥ 80 years and hospitalized in the same period (n = 264), was also compared with that of the female PCI patients. Results A total of 32% very elderly female ACS patients received PCI in the present study. (1) Compared to female medical group, PCI procedure significantly alleviated the risks of MACCE: non-fatal MI (6.2% vs. 20.2%, P < 0.001), HFRH (10.9% vs. 22.5%, P = 0.012), CV death (12.4% vs. 28.7%, P < 0.001) and the composite MACCE (24.0% vs. 44.2%, P < 0.001) during the median follow-up period of 36 months. (2) Between very elderly female and male PCI patients, there were no significant differences in occurrence of MACCE (P = 0.232) and CV death (P = 0.951). (3) Multivariate Cox analysis revealed that ST-segment elevation myocardial infarction (STEMI) (HR 1.944, 95% CI 1.11–3.403, P = 0.02) and elevated log- N-Terminal pro-brain natriuretic peptide (NT-proBNP) (HR 1.689, 95% CI 1.029–2.773, P = 0.038) were independently associated with the incidence of MACCE in the female PCI patients. Conclusions PCI procedure significantly attenuated the risk of MACCE and improved the long-term clinical outcomes in very elderly female ACS patients. Aggressive PCI strategy may be reasonable in this population.

Clinical outcomes and prognostic factors in very elderly women with ACS treated with successful PCI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S.M Zhao ◽  
J Wang ◽  
H Chen ◽  
H.Q Zhao ◽  
X.Q Zhao ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cox Regression ◽  
Elderly Women ◽  
Medical Group ◽  
Very Elderly ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
P2y12 Receptor Antagonist ◽  
Cox Analysis

Abstract Background Whether elderly women over 80 years old with acute coronary syndrome (ACS) should actively receive PCI treatment is still controversial. Purpose We assessed the effectiveness and long-term clinical outcomes of PCI in very elderly women patients, and detected predictive factors which contributed to the major adverse cardiovascular and cerebrovascular events (MACCE). Methods Female ACS patients aged ≥80 years were continuously enrolled from the hospital database bank (n=729, a mean age of 83.6±3.1 years). All patients were followed up for MACCE: non-fatal MI, stroke, heart failure (HF) re-hospitalization, cardiovascular (CV) death, and the composite of them. Before and after Propensity Score (PS) Matching (1:1), the incidences of MACCE were compared between female PCI group (n=232) and medical group (n=497). Clinical and coronary artery characteristics were analyzed in PCI treatment patients with (n=56) and without MACCE (n=176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in female PCI patients. Results A total of 31.8% women (n=232) received PCI treatment in the retrospective study.Compared to medical group, PCI treatment significantly reduced the incidences of non-fatal MI (6.2%, 20.2%, p&lt;0.001), HF re-hospitalization (10.9%, 22.5%, p=0.012), CV death (12.4%, 28.7%, p&lt;0.001) and the composite MACCE (24.0%, 44.2%, p&lt;0.001) after PS matching (129 patients in PCI group vs 129 patients in medical group)during a follow-up period of 36 (23, 48) months. Meanwhile, there were no significant differences in composite MACCE (24.1% vs 19.7%, p=0.232) and CV death (10.8% vs 10.6%, p=0.951) between very elderly women and men (≥80 years old) treated with PCI during the same period. Multivariate Cox analysis revealed that STEMI (HR 1.944, 95% CI 1.11–3.403, p=0.02) and elevated NT-proBNP (HR 1.689, 95% CI 1.029–2.733, p=0.038) were independently associated with the incidence of composite MACCE, as well as adherence to P2Y12 receptor antagonist (HR 0.119, 95% CI 0.051–0.278, p&lt;0.001) and β-blocker (HR 0.452, 95% CI 0.254–0.805, p=0.007) medications may help to attenuate the risk of MACCE within elderly women treated with PCI. Conclusion In very elderly women with ACS, PCI treatment significantly decreased the risks of MACCE and improves the long-term clinical outcomes.STEMI and elevated NT-proBNP value were independently associated with the increase of the composite MACCE after PCI in this population. Funding Acknowledgement Type of funding source: None

scholarly journals Incidence and Long‐Term Outcomes of Stroke in Patients Presenting With ST‐Segment Elevation–Myocardial Infarction: Insights From the Midwest STEMI Consortium

2021 ◽  
Author(s):  
Michael Megaly ◽  
Mehmet Yildiz ◽  
Edward Tannenbaum ◽  
Brynn Okeson ◽  
Marshall W. Dworak ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Cox Regression ◽  
Cox Regression Analysis ◽  
St Segment Elevation ◽  
Incidence Trends ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Increased Risk

Background Contemporary real‐world data on stroke in patients presenting with ST‐segment–elevation myocardial infarction (STEMI) are scarce. Methods and Results We evaluated the incidence, trends, cause, and predictors of stroke from 2003 to 2019 in 4 large regional STEMI programs in the upper Midwest that use similar transfer and treatment protocols. We also evaluated the long‐term impact of stroke on 5‐year mortality. Multivariate logistic and Cox regression analysis was used to identify variables independently associated with stroke in patients presenting with STEMI and identify variables associated with 5‐year mortality. A total of 12 868 patients presented with STEMI during the study period. Stroke occurred in 98 patients (0.76%). The incidence of stroke remained stable over time (0.5% in 2003, 1.2% in 2019; P ‐trend=0.22). Most (75%) of strokes were ischemic, with a median time to stroke symptoms of 14 hours after primary percutaneous coronary intervention (interquartile range, 4–72 hours), which led to a small minority (3%) receiving endovascular treatment and high in‐hospital mortality (18%). On multivariate regression analysis, age (increment of 10 years) (odds ratio [OR], 1.32; 95% CI, 1.10–1.58; P ‐value=0.003) and preintervention cardiogenic shock (OR, 2.03; (95% CI, 1.03–3.78; P =0.032)) were associated with a higher risk of in‐hospital stroke. In‐hospital stroke was independently associated with increased risk of 5‐year mortality (hazard ratio, 2.01; 95% CI, 1.13–3.57; P =0.02). Conclusions In patients presenting with STEMI, the risk of stroke is low (0.76%). A stroke in patients presenting with STEMI is associated with significantly higher in‐hospital (18%) and long‐term mortality (35% at 5 years). Stroke was associated with double the risk of 5‐year death.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

Abstract 15416: Impact of Acute Hyperglycemia on Microvascular Damage and Long-term Clinical Outcomes in Patients With ST-elevation Myocardial Infarction

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Tetsuo Horimatsu ◽  
Kenichi Fujii ◽  
Masashi Fukunaga ◽  
Machiko Nishimura ◽  
Ten Saita ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Clinical Outcomes ◽  
Glucose Level ◽  
Multivariate Logistic Regression Analysis ◽  
Diabetic Patients ◽  
Microvascular Damage ◽  
Acute Hyperglycemia ◽  
Cox Regression Analysis

Introduction: We have recently reported the cause of microcirculatory damage after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients can be evaluated by analyzing the thermodilution-derived coronary blood flow pattern (CBFP), and only the capillary destruction pattern was associated with poor mid-term clinical outcomes. In this study, we extend our research on the contribution of acute hyperglycemia on microcirculatory damage and long-term clinical outcomes in STEMI patient. Methods: Ninety-seven consecutive STEMI patients undergoing primary PCI were prospectively enrolled. Using a pressure sensor/thermistor-tipped guidewire, CBFP was assessed from the thermodilution-curves immediately after successful PCI. All patients were classified into 3 groups according to the shape of thermodilution curve: no microvascular damaged group (n=47), arteriole microemboli group (n=33), or capillary destruction group (n=17). Blood glucose levels were measured on admission. Major adverse cardiac events (MACE) were defined as a composite of cardiac death, myocardial infarction, and heart failure rehospitalization within 3 years. Results: Mean admission glucose level was significantly higher in the capillary destruction group than in the microemboli and no microvascular damaged groups (259±134, 162±66, and 153±60 mg/dL, respectively, p<0.0001). These findings were similar when the analysis was limited to non-diabetic patients. The incidence of MACE was also higher in the capillary destruction group compared with the microemboli and no microvascular damaged groups (71, 19, and 16%, respectively, p<0.0001). On multivariate Cox regression analysis, the capillary destruction pattern was the independent predictor of MACE (hazard ratio, 9.41; 95%CI 2.28-38.8; p=0.001). In the multivariate logistic regression analysis, higher glucose level on admission remained as an independent risk factor of the capillary destruction pattern (per 10mg/dL increase, odds ratio, 1.10; 95%CI 1.10-1.22; p=0.002). Conclusions: Hyperglycemia on admission increases the risk of microvascular damage secondary to the capillary destruction and subsequent poor long-term clinical outcomes in STEMI patients.

P5362Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y H Kim ◽  
A.-Y Her ◽  
M H Jeong ◽  
B.-K Kim ◽  
S.-Y Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Statin Therapy ◽  
Clinical Outcomes ◽  
Stent Implantation ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
St Segment Elevation ◽  
St Segment

Abstract Background Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI). Purpose The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES. Methods Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n=15002) and the NSTEMI group (n=11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period. Results After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n=15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p=0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1). Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value STEMI NSTEMI Log-rank Propensity score matched patients MACE 532 (7.2) 584 (8.1) 0.092 1.106 (0.984–1.244) 0.092 All-cause death 163 (2.2) 224 (3.1) 0.001 1.386 (1.133–1.696) 0.002 Cardiac death 121 (1.5) 148 (2.0) 0.088 1.232 (0.969–1.566) 0.089 Re-MI 117 (1.6) 107 (1.5) 0.545 0.922 (0.710–1.199) 0.545 Total revascularization 291 (4.1) 307 (4.4) 0.422 1.068 (0.910–1.254) 0.423 TLR 92 (1.3) 89 (1.2) 0.880 0.978 (0.731–1.309) 0.880 TVR 173 (2.4) 184 (2.6) 0.478 1.078 (0.876–1.327) 0.478 Non-TVR 123 (1.7) 130 (1.9) 0.593 1.070 (0.836–1.369) 0.539 Conclusion The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.

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