scholarly journals Association between Natriuretic Peptides and Mortality among Patients Admitted with Myocardial Infarction: A Report from the ACTION Registry®–GWTG™

2013 ◽  
Vol 59 (8) ◽  
pp. 1205-1214 ◽  
Author(s):  
Benjamin M Scirica ◽  
Mitul B Kadakia ◽  
James A de Lemos ◽  
Matthew T Roe ◽  
David A Morrow ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Natriuretic Peptides ◽  
Left Ventricular ◽  
Blood Concentrations ◽  
Clinical Model ◽  
St Segment Elevation ◽  
C Statistic ◽  
St Segment

BACKGROUND Patients with increased blood concentrations of natriuretic peptides (NPs) have poor cardiovascular outcomes after myocardial infarction (MI). The objectives of this analysis were to evaluate the utilization and the prognostic value of NP in a large, real-world MI cohort. METHODS Data from 41 683 patients with non–ST-segment elevation MI (NSTEMI) and 27 860 patients with ST-segment elevation MI (STEMI) at 309 US hospitals were collected as part of the ACTION Registry®–GWTG™ (Acute Coronary Treatment and Intervention Outcomes Network Registry–Get with the Guidelines) (AR-G) between July 2008 and September 2009. RESULTS B-type natriuretic peptide (BNP) or N-terminal pro-BNP (NT-proBNP) was measured in 19 528 (47%) of NSTEMI and 9220 (33%) of STEMI patients. Patients in whom NPs were measured were older and had more comorbidities, including prior heart failure or MI. There was a stepwise increase in the risk of in-hospital mortality with increasing BNP quartiles for both NSTEMI (1.3% vs 3.2% vs 5.8% vs 11.1%) and STEMI (1.9% vs 3.9% vs 8.2% vs 17.9%). The addition of BNP to the AR-G clinical model improved the C statistic from 0.796 to 0.807 (P < 0.001) for NSTEMI and from 0.848 to 0.855 (P = 0.003) for STEMI. The relationship between NPs and mortality was similar in patients without a history of heart failure or cardiogenic shock on presentation and in patients with preserved left ventricular function. CONCLUSIONS NPs are measured in almost 50% of patients in the US admitted with MI and appear to be used in patients with more comorbidities. Higher NP concentrations were strongly and independently associated with in-hospital mortality in the almost 30 000 patients in whom NPs were assessed, including patients without heart failure.

scholarly journals B-type natriuretic peptide levels and its correlation with left ventricular functions and heart failure in patients of acute coronary syndromes

2021 ◽  
Vol 9 (4) ◽  
pp. 1112
Author(s):  
Rajinder Kumar ◽  
Muzaffar Majeed Khujwal ◽  
Isha Sharma ◽  
Amit Varma
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Coronary Syndromes ◽  
Left Ventricular ◽  
Entire Spectrum ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Clinical Heart Failure

Background: This study was designed to measure levels of B-type natriuretic peptide (BNP) across entire spectrum of acute coronary syndrome (ACS) and to find its correlation with left ventricular functions and heart failure.Methods: We measured BNP levels at baseline in 100 consecutive patients between 24-96 hours after the onset of ischemic symptoms in patients of ACS. Echocardiography was performed in all patients between day 2-5 after the index diagnosis and stabilizing the patients.Results: The BNP levels were raised across the entire spectrum of ACS, with levels (>80 pg/ml) in 32.2% of patients with ST segment-elevation myocardial infarction (STEMI), in 24% with non-ST segment-elevation myocardial infarction (NSTEMI), and in 16.6% with unstable angina (UA) respectively. High BNP levels were associated with greater increase in LV end-systolic volumes (r=+0.545, p<0.001) (LVESV) and end-diastolic volumes (LVEDV) (r=+0.336, p<0.001). There was a negative correlation between BNP levels and left ventricular ejection fraction (LVEF) (r=-0.394, p<0.002). BNP levels were significantly raised (156.0±45.1 vs 57.7±18.3 pg/ml, p<0.02) in patients developing symptomatic clinical heart failure, irrespective of LVEF ≤40%.Conclusions: Integrated use of echocardiography and BNP levels provide powerful incremental assessment of cardiac functions, clinical status, and outcome across the entire spectrum of acute coronary syndromes (ACS). Increased BNP levels are associated with progressive ventricular dilatation, LV-dysfunction, development of clinical heart failure and is associated with poor prognosis in patients of ACS.

Impact of Clinical Profile on Hospital Mortality in Patients with Acute Heart Failure and Acute Myocardial Infarction with ST-Segment Elevation

2014 ◽  
Vol 20 (8) ◽  
pp. S117
Author(s):  
Ricardo Mourilhe-Rocha ◽  
Marcelo L.S. Bandeira ◽  
Nathalia F. Araujo ◽  
Ana Rafaela M. Santos ◽  
Roberta Ribeiro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Clinical Profile ◽  
St Segment Elevation ◽  
St Segment

scholarly journals Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Arshad A. Khan ◽  
Mohammed S. Al-Omary ◽  
Nicholas J. Collins ◽  
John Attia ◽  
Andrew J. Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction (TIMI) II study. Methods A total of 3339 patients were randomized to either an invasive (n = 1681) or a conservative (n = 1658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) (p = 0.01) from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis. Graphic abstract

scholarly journals Comparison of in Hospital Outcome of Patients with and without Distorted Terminal Portion of QRS Complex on Initial Electrocardiogram in ST Segment Elevation Myocardial Infarction

2016 ◽  
Vol 11 (1) ◽  
pp. 30-35
Author(s):  
Khandaker Aisha Siddika ◽  
Md Abu Siddique ◽  
Shamim Ahsan ◽  
Arif Hossain ◽  
Sohel Mahmud ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
P Value ◽  
Qrs Complex ◽  
Terminal Portion ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Background: Distorted terminal portion of QRS complex on initial electrocardiogram in ST segment elevation myocardial infarction is a strong predictor of inhospital adverse outcome.Objectives: Our purpose of this study was to analyse admission ECG in patients of STEMI based on terminal portion of QRS complex and find out inhospital death, heart failure, cardiogenic shock and recurrent MI.Methods: We evaluated 60 patients of STEMI admitted within 12 hours and receiving thrombolytic therapy. We defined two ECG groups according to absence of distortion of terminal QRS (Group-I) and presence of distorted terminal QRS (Group-II) in two or more adjacent leads. Group-II further divided into pattern-A – J point originating at ?50% of height of R wave in leads with qR configuration and pattern B- S wave is absent in leads with RS configuration.Results: Out of 60 patients of STEMI, 30(50.0%) patients had distortion of QRS. There were 7(11.6%) deaths, 16(26.7%) heart failure, 3(5.0%) cardigenic shock and no recurrent myocardial infarction. Hospital mortality and heart failure were found to be significantly higher in distorted QRS group (3.3% vs. 20.0%, p=0.04; 13.3% vs. 40.0%, p=0.02; respectively), cardiogenic shock of both groups did not show significant difference (0.0% vs. 10.0%, p=0.075). Multiple logistic regression analysis using hospital mortality as dependable variable and all studied risk factors were independent variables, QRS distortion on admission ECG and Killip class were only variable found to be statistically significant (OR=7.25, p value < 0.05 ; OR=16.25, p value < 0.05 respectively).Conclusion: Careful analysis of ECG which is simple, cheap, universally available bed side investigation may offer important prognostic information in patients with STEMI and would help in deciding which patients should go urgent myocardial revascularization procedure.University Heart Journal Vol. 11, No. 1, January 2015; 30-35

scholarly journals Natural History and Prognostic Implications of Left Ventricular End-Diastolic Pressure in Reperfused ST-Segment Elevation Myocardial Infarction – An Analysis of the Thrombolysis in Myocardial Infarction (TIMI) II Randomized Controlled Trial.

2021 ◽  
Author(s):  
Arshad A Khan ◽  
Mohammed S Al-Omary ◽  
Nicholas J Collins ◽  
John Attia ◽  
Andrew Boyle
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Natural History ◽  
Hospital Discharge ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Timi Flow Grade ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

Abstract Background The aim of the current study is to assess the natural history and prognostic value of elevated left ventricular end-diastolic pressure (LVEDP) in patients with ST-segment elevation myocardial infarction (STEMI) after reperfusion with thrombolysis; we utilize data from the Thrombolysis in Myocardial Infarction II study. Methods A total of 3,339 patients were randomized to either an invasive (n = 1,681) or a conservative (n = 1,658) strategy in the TIMI II study following thrombolysis. To make the current cohort as relevant as possible to modern pharmaco-invasively managed cohorts, patients in the invasive arm with TIMI flow grade ≥ 2 (N = 1201) at initial catheterization are included in the analysis. Of these, 259 patients had a second catheterization prior to hospital discharge, and these were used to define the natural history of LVEDP in reperfused STEMI. Results The median LVEDP for the whole cohort was 18 mmHg (IQR: 12–23). Patients were divided into quartiles by LVEDP measured during the first cardiac catheterization. During a median follow up of 3 (IQR: 2.1–3.2) years, quartile 4 (highest LVEDP) had the highest incidence of mortality and heart failure admissions. In the cohort with paired catheterization data, the LVEDP dropped slightly from 18 mmHg (1QR: 12–22) to 15 mmHg (IQR: 10–20) [p = 0.01] from the first to the pre-hospital discharge catheterization. Conclusions LVEDP remains largely stable during hospitalisation post-STEMI. Elevated LVEDP is a predictor of death and heart failure hospitalization in STEMI patients undergoing successful thrombolysis.

Impact of Clinical Profile on Hospital Mortality in Patients with Acute Myocardial Infarction with ST-Segment Elevation and Acute Heart Failure

2013 ◽  
Vol 19 (8) ◽  
pp. S31
Author(s):  
Ricardo Mourilhe-Rocha ◽  
Marcelo L.S. Bandeira ◽  
Nathalia F. Araujo ◽  
Ana R.M. Santos ◽  
Roberta Ribeiro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Acute Heart Failure ◽  
Clinical Profile ◽  
St Segment Elevation ◽  
St Segment

scholarly journals HEART FAILURE PREDICTION MARKERS IN PATIENTS OF ACUTE MYOCARDIAL INFARCTION

2020 ◽  
Vol 76 (4) ◽  
pp. 56-61
Author(s):  
E.V. Khorolets ◽  
◽  
S.V. Shlyk ◽  
L.A. Khaisheva ◽  
◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Growth Factor ◽  
Left Ventricular ◽  
Ventricular Failure ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment

The article is devoted to the study of the patients with acute ST-segment elevation myocardial infarction (STEMI) complicated by acute heart failure (AHF). Clinical data were assessed, including the level of stimulating growth factor (ST-2) and growth differentiation factor (GDF-15), depending on the degree of AHF classification of T. Killip. It has been established that ST-2 is a marker of AHF prognosis in STEMI patients at the hospital stage of treatment. GDF-15 reaches high valuesт in acute left ventricular failure.

First-degree atrioventricular block in acute anterior myocardial infarction

2020 ◽  
pp. 021849232097148
Author(s):  
Arvin Zabeh ◽  
Masoumeh Jahanafrouz ◽  
Babak Kazemi ◽  
Leili Pourafkari ◽  
Ghiti Davarmoin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Atrioventricular Block ◽  
Left Ventricular ◽  
Hospital Death ◽  
Anterior Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Pr Interval

Background There is paucity of data regarding the prognostic implications of first-degree atrioventricular block in patients with acute anterior myocardial infarction as a distinct group. The aim of this study was to elucidate the association of prolonged PR interval with hospital clinical outcomes in patients with treated with thrombolysis. Methods Three hundred consecutive patients with a first acute anterior ST-segment elevation myocardial infarction undergoing thrombolysis between October 2017 and March 2018, were retrospectively enrolled in this study. They were divided into two groups based on PR interval on admission: PR interval ≤200 ms, and PR interval > 200 ms. Hospital mortality and complications were compared between the 2 groups. Results Of the 300 patients, 26 (8.66%) had first-degree atrioventricular block on initial presentation. Overall, hospital death occurred in 20 (6.66%) patients. Patients with PR interval > 200 ms had a higher hospital mortality rate (26.9%) than those without (4.7%, p < 0.001). In multivariate Cox regression analysis, only left ventricular systolic function and PR interval were independent predictors of hospital mortality (odds ratio = 1.031; 95% confidence interval: 1.008–1.056, p = 0.009 for PR interval). Conclusion In patients with a first acute anterior ST-segment elevation myocardial infarction treated with thrombolysis, first-degree atrioventricular block was associated with increased hospital mortality and a worse prognosis.

scholarly journals Sex-based associations with microvascular injury and outcomes after ST-segment elevation myocardial infarction

Open Heart ◽  
2019 ◽  
Vol 6 (1) ◽  
pp. e000979 ◽  
Author(s):  
Annette Marie Maznyczka ◽  
David Carrick ◽  
Jaclyn Carberry ◽  
Kenneth Mangion ◽  
Margaret McEntegart ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Sex Differences ◽  
Microvascular Obstruction ◽  
Left Ventricular ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Flow Reserve ◽  
St Segment ◽  
Heart Failure Hospitalisation

ObjectivesWe aimed to assess for sex differences in invasive parameters of acute microvascular reperfusion injury and infarct characteristics on cardiac MRI after ST-segment elevation myocardial infarction (STEMI).MethodsPatients with STEMI undergoing emergency percutaneous coronary intervention (PCI) were prospectively enrolled. Index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) were measured in the culprit artery post-PCI. Contrast-enhanced MRI was used to assess infarct characteristics, microvascular obstruction and myocardial haemorrhage, 2 days and 6 months post-STEMI. Prespecified outcomes were as follows: (i) all-cause death/first heart failure hospitalisation and (ii) cardiac death/non-fatal myocardial infarction/urgent coronary revascularisation (major adverse cardiovascular event, MACE) during 5- year median follow-up.ResultsIn 324 patients with STEMI (87 women, mean age: 61 ± 12.19 years; 237 men, mean age: 59 ± 11.17 years), women had anterior STEMI less often, fewer prescriptions of beta-blockers at discharge and higher baseline N-terminal pro-B-type natriuretic peptide levels (all p < 0.05). Following emergency PCI, fewer women than men had Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion grades ≤ 1 (20% vs 32%, p = 0.027) and women had lower corrected TIMI frame counts (12.94 vs 17.65, p = 0.003). However, IMR, CFR, microvascular obstruction, myocardial haemorrhage, infarct size, myocardial salvage index, left ventricular remodelling and ejection fraction did not differ significantly between sexes. Female sex was not associated with MACE or all-cause death/first heart failure hospitalisation.ConclusionThere were no sex differences in microvascular pathology in patients with acute STEMI. Women had less anterior infarcts than men, and beta-blocker therapy at discharge was prescribed less often in women.Trial registration numberNCT02072850.

Sign in / Sign up

Export Citation Format

Share Document