scholarly journals Acute myocardial infarction in post COVID-19 patients

2021 ◽  
Vol 9 (5) ◽  
pp. 286-288
Author(s):  
Moisés Andrés Lombana Salas ◽  
◽  
María Camila Miranda Jiménez ◽  
Michelle Bedoya Coronel ◽  
Wendy Yulieth Herazo Madera ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Literature Search ◽  
Different Populations ◽  
Over Time

The SARS-CoV-2 infection has caused mortality in different populations; in addition, morbidity withimmunological, hematological and/or cardiovascular compromises has been reported, with acutemyocardial infarction (AMI) standing out. A literature search was conducted in databases todetermine existing evidence regarding AMI in post-COVID-19 patients. It was found that initially AMIwas described in some patients during the disease; however, a recently published case seriesshowed that it could occur in recovered patients, secondary to systemic and procoagulantinflammation over time, suggesting further research in this area.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

scholarly journals Risk of Ischemic Stroke After Acute Myocardial Infarction in Patients Undergoing Coronary Artery Bypass Graft Surgery

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
André Åström ◽  
Lars Söderström ◽  
Thomas Mooe
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Ischemic Stroke ◽  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Incidence Rates ◽  
P2y12 Inhibitors ◽  
Over Time

AbstractOnly sparse epidemiological data are available regarding the risk of ischemic stroke (IS) after coronary artery bypass surgery (CABG). Here we aimed to describe the incidence and predictors of IS associated with CABG performed after acute myocardial infarction (AMI), as well as trends over time. We analyzed data for 248,925 unselected AMI patients. We separately analyzed groups of patients who underwent CABG early or late after the index infarction. IS incidence rates per year at risk were 15.8% (95% confidence interval, 14.5–17.1) and 10.9% (10.6–11.2), respectively, among patients with and without CABG in the early cohort, and 4.0% (3.5–4.5) and 2.3% (2.2–2.3), respectively, among patients with and without CABG in the late cohort. Predictors of post-AMI IS included prior IS, CABG, prior atrial fibrillation, prior hemorrhagic stroke, heart failure during hospitalization, older age, diabetes mellitus, and hypertension. Reduced IS risk was associated with use of statins and P2Y12 inhibitors. IS incidence markedly decreased among patients who did not undergo CABG, while no such reduction over time occurred among those who underwent CABG. This emphasizes the need to optimize modifiable risk factors and to consistently use treatments that may reduce IS risk among CABG patients.

Abstract P274: Physical Activity Patterns and Determinants Following Acute Myocardial Infarction: Insights From the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young Acute Myocardial Infarction Patients)

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Karl E Minges ◽  
Kelly M Strait ◽  
Sarah Camhi ◽  
Judith H Lichtman ◽  
Rachel P Dreyer ◽  
...  
Keyword(s):  
Physical Activity ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Activity Patterns ◽  
Estimating Equation ◽  
Vigorous Activity ◽  
Targeted Interventions ◽  
Factors Associated ◽  
Wide Range ◽  
Over Time

Introduction: Despite the benefits of participation in regular physical activity (PA) following acute myocardial infarction (AMI), little is known about the habitual patterns of PA for young AMI patients, especially expanding beyond findings for those engaged in cardiac rehabilitation. We assessed patterns and determinants in levels of PA over a period of 12-months following AMI. Methods: A 2:1 (women:men) observational study design enrolled 3,572 AMI patients (2,397 women, 67.1%) aged 18-55 years from 103 US, 24 Spanish, and 3 Australian hospitals (2008-2012). Data were obtained by medical record abstraction and patient interviews at baseline (pre-AMI), 1- and 12-months post-AMI. Patients were assigned to AHA defined levels of PA based on self-reported frequency, duration, and intensity, as follows: Active (≥ 150 min/wk moderate or ≥ 75 min/wk vigorous activity), Insufficient (10-149 min/wk moderate or 10-74 min/wk vigorous activity), or Inactive (< 10 min/wk moderate or vigorous activity). We used a generalized estimating equation model to examine the factors associated with insufficient/inactive PA levels over time. Results: At baseline, 1- and 12-months post-AMI, 36.7%, 37.6%, and 40.0% of patients were considered active. There were 27 PA patterns observed from baseline to 12-months (Table). The most frequent were those with no change in PA over time (14% staying active, 7% insufficient, and 13% inactive). Additionally, 25% of patients had an increase (at least a one category change) in PA, while 19% had a decrease between baseline and 12-months post-AMI. Female sex, non-white race, non-active workplaces, smoking, diabetes, hypertension, and obesity were independently associated with being insufficient/inactive over time (all p<.05). Conclusions: Despite clinical recommendations, young adults recovering from AMI experience a wide range of PA patterns. By identifying factors associated with insufficient/inactive PA during recovery, targeted interventions can be introduced prior to hospital discharge.

scholarly journals Advanced cardiovascular risk prediction in the emergency department: updating a clinical prediction model – a large database study protocol

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Charles Reynard ◽  
Glen P. Martin ◽  
Evangelos Kontopantelis ◽  
David A. Jenkins ◽  
Anthony Heagerty ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Prediction Models ◽  
Predictive Performance ◽  
Modern Medicine ◽  
Clinical Prediction ◽  
Electronic Data ◽  
Cardiovascular Risk Prediction ◽  
Predicted Probability ◽  
Over Time

Abstract Background Patients presenting with chest pain represent a large proportion of attendances to emergency departments. In these patients clinicians often consider the diagnosis of acute myocardial infarction (AMI), the timely recognition and treatment of which is clinically important. Clinical prediction models (CPMs) have been used to enhance early diagnosis of AMI. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid is currently in clinical use across Greater Manchester. CPMs have been shown to deteriorate over time through calibration drift. We aim to assess potential calibration drift with T-MACS and compare methods for updating the model. Methods We will use routinely collected electronic data from patients who were treated using TMACS at two large NHS hospitals. This is estimated to include approximately 14,000 patient episodes spanning June 2016 to October 2020. The primary outcome of acute myocardial infarction will be sourced from NHS Digital’s admitted patient care dataset. We will assess the calibration drift of the existing model and the benefit of updating the CPM by model recalibration, model extension and dynamic updating. These models will be validated by bootstrapping and one step ahead prequential testing. We will evaluate predictive performance using calibrations plots and c-statistics. We will also examine the reclassification of predicted probability with the updated TMACS model. Discussion CPMs are widely used in modern medicine, but are vulnerable to deteriorating calibration over time. Ongoing refinement using routinely collected electronic data will inevitably be more efficient than deriving and validating new models. In this analysis we will seek to exemplify methods for updating CPMs to protect the initial investment of time and effort. If successful, the updating methods could be used to continually refine the algorithm used within TMACS, maintaining or even improving predictive performance over time. Trial registration ISRCTN number: ISRCTN41008456

Abstract 14971: Impact of Medicare Diagnosis Code Expansion and Inclusion of Outpatient Data on Risk-adjusted 30-day Mortality and Readmission Rates After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Lauren Gilstrap ◽  
Rishi Wadhera ◽  
Andrea Austin ◽  
Stephen A Kearing ◽  
Karen Joynt Maddox ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Risk Adjustment ◽  
Average Increase ◽  
Diagnosis Code ◽  
Readmission Rates ◽  
Medicare Data ◽  
Diagnosis Codes ◽  
The Impact ◽  
Over Time

Introduction: In January 2011, the Center for Medicare and Medicaid Services increased the number of billing codes allowed per admission from 9 to 25. This caused an artificial increase in comorbidity burdens. Some have argued including outpatient data mitigates this problem. The aim of this study was to explore the impact of diagnosis code expansion, using inpatient and inpatient+outpatient data and evaluate potential solutions for conducting longitudinal studies of 30-day risk-adjusted outcome rates after acute myocardial infarction (AMI). Hypothesis: Limiting diagnosis codes and including outpatient data would produce the most stable estimates of risk-adjusted outcomes over time. Methods: We used 100% Medicare data to create a cohort of beneficiaries with AMI between 2008 and 2013. We used 4 methods to calculate the hierarchical condition categories/patient (HCC/pt) necessary for risk adjustment: 1) inpatient-only data, limited codes after 2011; 2) inpatient-only data, unlimited codes; 3) inpatient+ outpatient data, limited codes; 4) inpatient+outpatient data, unlimited codes. Results: Using inpatient-only data, expanding diagnosis codes increased the average HCC/pt by +0.23 HCC/pt. Using inpatient+outpatient data, the average increase was only +0.11 HCC/pt. (relatively 109% less, Figure A ). Between 2009-2013, AMI mortality was flat while readmissions declined ( Figure B ). For mortality, all 4 methods produced estimates that were, on average, +0.7% higher than unadjusted (raw) rates. For readmission, the closest to unadjusted and most stable over time was inpatient+outpatient data with limited codes. Conclusion: For studies that span January 2011, diagnosis codes should be limited to 9 after 2011 when using inpatient or combined inpatient and outpatient data.

Abstract P091: Temporal Trends in Incidence of Acute Myocardial Infarction and Revascularization in People With and Without Mental Illness

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Lauren Bresee ◽  
Marcello Tonelli ◽  
Braden Manns ◽  
Brenda Hemmelgarn
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Mental Illness ◽  
Mood Disorder ◽  
Psychotic Disorder ◽  
Mentally Ill ◽  
Artery Bypass ◽  
Temporal Trends ◽  
Relative Decrease ◽  
Over Time

Objective: The objective of this study was to evaluate the temporal trends in the incidence of acute myocardial infarction (AMI) and receipt of revascularization procedures in people with and without mental illness. Hypothesis: Individuals with mental illness will have higher rates of AMI, and lower rates of revascularization compared to people without mental illness. Methods: We did a population-based study using provincial administrative data from April 1, 1998 until March 31, 2009. We identified individuals 20 years of age and older as having mental illness (psychotic disorder [PD] or mood disorder [MD]) based on physician billing claims and hospitalization data, and compared them to those without mental illness by this definition. We identified incident AMI using a validated algorithm applied to hospitalization data. We used procedure codes to identify receipt of cardiac catheterization, coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA) in those with incident AMI. Rates were age-adjusted using the 2001 Canadian census population to perform direct standardization. Relative change over time was calculated by comparing rates in 2009 to rates in 1998. Results: A total of 3,639,480 subjects were included, of whom 576,411 (15.8%) had a mood disorder only, 38,116 (1.0%) had a psychotic disorder only, and 72,430 (2.0%) had both a MD and PD. People with MD were more likely to be female, whereas those with PD were older, than the other mentally ill and non-mentally ill populations. Incidence of AMI was highest in people with PD (210 per 100,000 in 2009) and lowest in people without mental illness (160 per 100,000 in 2009), however, incidence of AMI decreased over time in all groups. Use of catheterization decreased over time in people with MD (19% relative decrease) and PD (25% relative decrease), while increasing in people without mental illness (10.8% relative increase). Use of PTCA increased in all groups except people with PD (21.1% relative decrease). Conclusions: Incidence of AMI decreased over time in people with and without mental illness, however, people with mental illness consistently had a higher incidence of AMI compared to individuals without mental illness. Use of catheterization and PTCA increased in people without mental illness while decreasing in people with PD over the study period.

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