scholarly journals A kórelőzményben szereplő revascularisatiós műtét rövid és hosszú távú prognosztikai jelentősége szívinfarktus miatt kezelt betegekben

2021 ◽  
Vol 162 (5) ◽  
pp. 177-184
Author(s):  
András Jánosi ◽  
Tamás Ferenci ◽  
András Komócsi ◽  
Péter Andréka
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation

Összefoglaló. Bevezetés: A szívinfarktust megelőző revascularisatiós beavatkozások prognosztikai jelentőségével kapcsolatban kevés elemzés ismeretes, hazai adatokat eddig nem közöltek. Célkitűzés: A szerzők a Nemzeti Szívinfarktus Regiszter adatait felhasználva elemezték a koszorúér-revascularisatiós szívműtétet (CABG) túlélt betegek prognózisát heveny szívinfarktusban. Módszer: Az adatbázisban 2014. 01. 01. és 2017. 12. 31. között 55 599 beteg klinikai és kezelési adatait rögzítették: 23 437 betegnél (42,2%) ST-elevációval járó infarktus (STEMI), 32 162 betegnél (57,8%) ST-elevációval nem járó infarktus (NSTEMI) miatt került sor a kórházi kezelésre. Vizsgáltuk a CABG után fellépő infarktus miatt kezelt betegek klinikai adatait és prognózisát, amelyeket azon betegek adataival hasonlítottunk össze, akiknél nem szerepelt szívműtét a kórelőzményben (kontrollcsoport). Eredmények: A betegek többsége mindkét infarktustípusban férfi volt (62%, illetve 59%). Az indexinfarktust megelőzően a betegek 5,33%-ánál (n = 2965) történt CABG, amely az NSTEMI-betegeknél volt gyakoribb (n = 2357; 7,3%). A CABG-csoportba tartozó betegek idősebbek voltak, esetükben több társbetegséget (magas vérnyomás, diabetes mellitus, perifériás érbetegség) rögzítettek. Az indexinfarktus esetén a katéteres koszorúér-intervenció a kontrollcsoport STEMI-betegeiben gyakoribb volt a CABG-csoporthoz viszonyítva (84% vs. 71%). Az utánkövetés 12 hónapja során a betegek 4,7–12,2%-ában újabb infarktus, 13,7–17,3%-ában újabb katéteres koszorúér-intervenció történt. Az utánkövetés alatt a CABG-csoportban magasabbnak találtuk a halálozást. A halálozást befolyásoló tényezők hatásának korrigálására Cox-féle regressziós analízist, illetve ’propensity score matching’ módszert alkalmaztunk. Mindkét módszerrel történt elemzés azt mutatta, hogy a kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a túlélést. Amennyiben a beteg kórelőzményében szerepelt a koszorúérműtét, az indexinfarktus nagyobb eséllyel volt NSTEMI, mint STEMI (HR: 1,612; CI 1,464–1,774; p<0,001). Következtetés: A kórelőzményben szereplő koszorúér-revascularisatiós műtét nem befolyásolta a szívinfarktus miatt kezelt betegek életkilátásait. Orv Hetil. 2021; 162(5): 177–184. Summary. Introduction: Little analysis is known about the prognostic significance of revascularization interventions before myocardial infarction; no domestic data have been reported so far. Method: The authors use data from the Hungarian Myocardial Infarction Registry to analyze the prognosis of patients with acute myocardial infarction who had previous coronary artery bypass grafting (CABG). Between 01. 01. 2014. and 31. 12. 2017, 55 599 patients were recorded in the Registry: 23 437 patients (42.2%) had ST-elevation infarction (STEMI) and 31 162 patients (57.8%) had non-ST-elevation infarction (NSTEMI). The clinical data and prognosis of patients treated for infarction after CABG were compared with those of patients without a CABG history. Results: The majority of patients were male (59% and 60%, respectively). Prior to index infarction, CABG occurred in 5.33% of patients (n = 2965), which was more common in NSTEMI (n = 2357; 7.3%). The CABG patients were older and had more comorbidities (hypertension, diabetes mellitus, peripheral vascular disease). For index infarction, percutaneous coronary intervention was more common in STEMI patients in the control group compared to CABG (84% vs. 71%). At 12 months of follow-up, 4.7–12.2% of patients had reinfarction, and 13.7–17.3% had another percutaneous coronary intervention. During the full follow-up, the CABG group had higher mortality. Cox regression analysis and propensity score matching were used to correct for the effect of other factors influencing mortality. Both analyses showed CABG did not affect survival. In the CABG group, the index infarction was more likely to be NSTEMI than STEMI (HR: 1.612; CI 1.464–1.774; p<0.001). Conclusion: The history of CABG does not affect the life expectancy of patients treated for an acute myocardial infarction. Orv Hetil. 2021; 162(5): 177–184.

scholarly journals Long-term survival after a pharmacoinvasive strategy in patients with ST-elevation myocardial infarction and long distances to primary percutaneous coronary intervention – a prospective cohort study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K M Kvakkestad ◽  
J M Gran ◽  
S Halvorsen
Keyword(s):  
Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Propensity Score ◽  
Lower Risk ◽  
Coronary Intervention ◽  
Term Survival ◽  
Percutaneous Coronary ◽  
St Elevation

Abstract Background In patients with ST-elevation myocardial infarction (STEMI), a pharmacoinvasive (PI) strategy is the recommended reperfusion method if primary percutaneous coronary intervention (pPCI) cannot be performed within 120 minutes from diagnosis. Long-term prognosis for STEMI patients with long transfer distances to pPCI is sparsely documented. Purpose To compare short- and long-term survival, and cardiovascular (CV) death in STEMI patients treated with PI or pPCI strategy. Methods Consecutive STEMI patients admitted to our cardiac invasive centre were registered prospectively during 2005–2011 in a local quality registry. Follow-up data throughout 2013 were provided by the Norwegian Cause of death registry. Effects of treatment strategy were determined using a propensity score weighted analysis, adjusting for treatment-outcome confounding. Outcomes were 30-day mortality, overall survival and CV death during follow-up. Results Of 4762 STEMI patients, 543 (11.4%) were treated with thrombolysis before admission for rescue- or early coronary angiography (PI strategy), and 4044 (84.9%) were admitted for a pPCI strategy (3,7% excluded due to unspecified treatment strategy). Median age was 60 and 63 years in the PI and pPCI groups (19.5% and 24.1% women, respectively). Median time to reperfusion was 110 minutes (25–75th percentile: 75–163; symptom-to-thrombolysis) versus 230 minutes (149–435; symptom-to-balloon). Crude 30-day mortality was 3.9% and 6.6% in the PI- and pPCI groups. Median follow-up was 4.5 years (max 8.3 years). The overall 8-year survival was 84.6% (95% CI 79.4–88.4) in the PI group and 72.6% (95% CI 70.1–74.9) in the pPCI group (crude hazard ratio [HR] 0.56 (95% CI 0.43–0.72, p&lt;0.0001). After propensity score weighting (based on age, gender, smoking, previous hypertension, stroke, diabetes, myocardial infarction, angina pectoris and peripheral artery disease, kidney function and pre-hospital resuscitation), patients had estimated 25% lower risk of long-term mortality with a PI strategy (weighted HR 0.75; 95% CI 0.53–1.07, p=0.113, Figure 1A). Cumulative incidence rate of CV death was 12.8 (PI strategy) and 27.8 (pPCI strategy) pr 1000 person-years (crude incidence rate ratio 0.46; 95% CI 0.32–0.68, p&lt;0.0001), and was significantly lower in the PI group after weighting on the propensity score (p=0.048, Figure 1B). Conclusions There was a non-significant 25% lower risk of mortality up to 8 years with a PI versus pPCI strategy in STEMI patients with long transfer distances to PCI, after adjustment for treatment-outcome confounding. Importantly, long-term incidence of CV death was significantly lower in the PI group. These findings from real life practice support the use of a PI strategy in STEMI patients without contraindications to thrombolysis, when pPCI within 120 minutes from diagnosis is not possible. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funded by grant form the Scientific Board of the Southeastern Norway Regional Health Authority, Hamar, Norway.

scholarly journals Transradial Percutaneous Coronary Intervention in Patients with ST-Elevation Acute Myocardial Infarction

2012 ◽  
Vol 20 (3) ◽  
pp. 282-287 ◽  
Author(s):  
Clarissa Campo Dall’Orto ◽  
Rubens Pierry Ferreira Lopes ◽  
Luiz Daniel Silva de Oliveira ◽  
Giovanni Cisari ◽  
Alexandre de Souza Marques ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
St Elevation ◽  
Elevation Acute Myocardial Infarction

scholarly journals Longitudinal Evaluation of Mitral Valve Leaflet Remodeling After Acute Myocardial Infarction

2020 ◽  
Vol 13 (12) ◽  
Author(s):  
Shun Nishino ◽  
Nozomi Watanabe ◽  
Toshihiro Gi ◽  
Nehiro Kuriyama ◽  
Yoshisato Shibata ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Mitral Valve ◽  
Primary Percutaneous Coronary Intervention ◽  
Complex Geometry ◽  
Coronary Intervention ◽  
Mitral Valve Leaflet ◽  
Percutaneous Coronary

Background: Recent animal studies have suggested that mitral valve (MV) leaflet remodeling can occur even without significant tethering force and that the postinfarct biological reaction would contribute to the histopathologic changes of the leaflet. We serially evaluated the MV remodeling in patients with anterior and inferior acute myocardial infarction (MI), by using 2- and 3-dimensional transthoracic echocardiography. Additional histopathologic examinations were performed to assess the leaflet pathology. Methods: Sixty consecutive first-onset acute MI (anterior MI, n=30; inferior MI, n=30) patients who underwent successful primary percutaneous coronary intervention were examined (1) before primary percutaneous coronary intervention, (2) at 6-month follow-up, and (3) at follow-up 1 year or later after onset. MV complex geometry including MV leaflet area and thickness was analyzed using dedicated software. Additional histopathologic study compared 18 valves harvested during surgery for ischemic mitral regurgitation (MR). Results: MV area and thickness incrementally increased during the follow-up period. MV leaflet area significantly increased (anterior MI: 5.59 [5.28–5.98] to 6.54 [6.20–7.26] cm 2 /m 2 , P <0.001; inferior MI: 5.60 [4.76–6.08] to 6.32 [5.90–6.90] cm 2 /m 2 , P <0.001), and leaflet thickness also increased (anterior MI: 1.09 [0.92–1.24] to 1.45 [1.28–1.60] mm/m 2 , P <0.001; inferior MI: 1.15 [1.03–1.25] to 1.44 [1.27–1.59] mm/m 2 , P <0.001); data represent onset versus ≥1 year. Larger annuls, larger tenting, and a reduced leaflet area/annular ratio with smaller coaptation index were observed in patients with persistent ischemic MR compared with those without significant ischemic MR. Histopathologic examinations revealed that MV thickness was significantly greater in chronic ischemic MR compared with acute ischemic MR (1432.6±490.5 versus 628.7±278.7 μm; P =0.001), with increased smooth muscle cells and fibrotic materials. Conclusions: MV leaflet remodeling progressed both in area and thickness after MI. This is the first clinical study to record the longitudinal course of MV leaflet remodeling by serial echocardiography.

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