scholarly journals The importance of chronic kidney disease for the assessment of risk of adverse outcomes after myocardial infarction

2017 ◽  
Vol 95 (6) ◽  
pp. 563-570 ◽  
Author(s):  
V. N. Karetnikova ◽  
V. V. Kalaeva ◽  
Maria V. Evseeva ◽  
O. V. Gruzdeva ◽  
M. V. Zykov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Renal Dysfunction ◽  
Acute Phase ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Group I ◽  
Time Of Admission

Renal dysfunction (RD) in the acute phase of myocardial infarction (MI) is pivotal for the risk stratification of adverse long-term outcomes after myocardial infarction and, therefore, requires further study. Purpose. To determine the role of CKD and renal dysfunction (in the acute phase of MI) in the adverse long-term post-MI prognosis. Material and methods. 954 patients with ST-segment elevation myocardial infarction (STEMI) were enrolled in a registry study, performed in the period from 2008 to 2010 at the Kemerovo Cardiology Dispensary. All patients were assigned to two groups according to the presence of concomitant CKD. Serum creatinine levels were measured at the time of admission and on 10-12th days, with further calculation of glomerular filtration rate (GFR) using the CKD-EPI equation. Patients without CKD were assigned to Group I (n = 616 (64.5%), and STEMI patients with CKD to Group II (n=338 (35.4%). Observations during the three-year follow-up period were evaluated from the end-points. Results. The factors associated with mortality among patients with CKD were as follows: left ventricular ejection fraction (LVEF) < 40% at the time of admission (OR 2.1; 95% CI 1.0-4.4), signs of RD at the time of discharge (OR 2.5, 95% CI 1.0-5.9), non-performance of myocardial revascularization (OR 3.1, 95% CI 1.4-6.8). The long-term prognosis in the group of patients without CKD depended on the following factors: non-performance of PCI (OR 2.1, 95% CI 1.0-4.3), severe AHF (Killip class) (OR 3.5, 95% CI 1.9-6.7), LVEF < 40% (OR 2.0, 95% CI 1.0-3.8), and older age (OR 2.0, 95% CI 1.0-3.9). Conclusion. Renal dysfunction (regardless of the presence of CKD) diagnosed in the acute phase of MI as well as left ventricular dysfunction (EF < 40%) were found to affect long-term mortality risk in the post-MI period.

scholarly journals Outcomes of long-term observation period in patients with myocardial infarction undergone radiopaque interventions in the acute period of the disease.

2018 ◽  
Vol 96 (7) ◽  
pp. 648-657
Author(s):  
V. N. Karetnikova ◽  
V. V. Kalaeva ◽  
M. V. Evseeva ◽  
O. V. Gruzdeva ◽  
A. A. Shilov ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Roc Curve ◽  
Fatal Outcome ◽  
Myocardial Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Acute Period ◽  
Observation Period

Introduction. Currently, the importance of various factors in the acute period of myocardial infarction (MI) for the risk stratification of unfavourable course ofpost-infarction period is continued to be studied. Purpose. We aimed to identify the factors, affecting the formation of adverse outcomes of in-hospital and long-term postinfarction period in patients with ST-elevated MI (STEMI) undergone radiopaque interventions (ROI). Material and methods. The study included 954 STEMI patients admitted to the Kemerovo Cardiology Dispensary in the period from 2008 to 2010. Diagnostic coronary angiography was performed in 725 (76%) patients, and 557 (76.8%) of cases undergone myocardial revascularization (isolated balloon angioplasty, angioplasty with stenting). Results. The in-hospital mortality in STEMI patients was associated with the age older than 60 years (OR 2.4 95% CI 1.4-3.9, p<0.001), decrease in left ventricular ejection fraction (LVEF) less than 40% on admission (OR 1.9 95% CI 1.1-2.9) and contrast-induced nephropathy (CIN) (OR 1.9 95% CI 1.0-3.5). The area under the ROC-curve was 0.744 (0.693-0.796; р<0.001). Fatal outcomes within a year after MI were associated with the decrease of glomerular filtration rate (GFR) less than 60 ml/min/1.73 m (OR 1.4 95% CI 1.0-2.0), LVEF less than 40% (OR 1.7 95% CI 1.1-2.7), development of CIN (OR 2.3 95% CI 1.3-4.1). The area under the ROC-curve was 0.707 (0.665-0.749, р<0.001). The risk offatal outcome within a three-year observation period was shown to increase 6.8-fold in the presence of acute heart failure (AHF) Killip > II on admission (OR 6.8 95% CI 2.1-21.8), 3.4-fold (OR 3.4 95% CI 1.1-11.0) in patients of the older age category (>60 years), 4.1-fold in development of CIN (OR 4.1 95% CI 1.1-14.3). The area under the ROC-curve was 0.744 (0.632-0.856, р=0.001). Conclusion. The independent risk factors of fatal outcome development within the in-hospital period in STEMI patients undergone ROI were: the age older than 60years, LVEF reduce less than 40% and the presence of CIN. Fatal outcomes within a year after MI were associated with GFR decrease less than 60 ml/min/1.73 m, LVEF less than 40% and CIN development, and within three years - AHF Killip class II and greater, age older than 60 years, as well as CIN after ROI.

scholarly journals Electrical storm reveals worse prognosis compared to myocardial infarction complicated by ventricular tachyarrhythmias in ICD recipients

2021 ◽  
Author(s):  
Julian Müller ◽  
Michael Behnes ◽  
Tobias Schupp ◽  
Dominik Ellguth ◽  
Gabriel Taton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Electrical Storm ◽  
Ventricular Tachyarrhythmias ◽  
Ventricular Ejection Fraction ◽  
St Segment ◽  
All Cause Mortality ◽  
Worse Prognosis

AbstractBoth acute myocardial infarction complicated by ventricular tachyarrhythmias (AMI–VTA) and electrical storm (ES) represent life-threatening clinical conditions. However, a direct comparison of both sub-groups regarding prognostic endpoints has never been investigated. All consecutive implantable cardioverter-defibrillator (ICD) recipients were included retrospectively from 2002 to 2016. Patients with ES apart from AMI (ES) were compared to patients with AMI accompanied by ventricular tachyarrhythmias (AMI–VTA). The primary endpoint was all-cause mortality at 3 years, secondary endpoints were in-hospital mortality, rehospitalization rates and major adverse cardiac event (MACE) at 3 years. A total of 198 consecutive ICD recipients were included (AMI–VTA: 56%; ST-segment elevation myocardial infarction (STEMI): 22%; non-ST-segment myocardial infarction (NSTEMI) 78%; ES: 44%). ES patients were older and had higher rates of severely reduced left ventricular ejection fraction (LVEF) < 35%. ES was associated with increased all-cause mortality at 3 years (37% vs. 19%; p = 0.001; hazard ratio [HR] = 2.242; 95% CI 2.291–3.894; p = 0.004) and with increased risk of first cardiac rehospitalization (44% vs. 12%; p = 0.001; HR = 4.694; 95% CI 2.498–8.823; p = 0.001). This worse prognosis of ES compared to AMI–VTA was still evident after multivariable adjustment (long-term all-cause mortality: HR = 2.504; 95% CI 1.093–5.739; p = 0.030; first cardiac rehospitalization: HR = 2.887; 95% CI 1.240–6.720; p = 0.014). In contrast, the rates of MACE (40% vs. 32%; p = 0.326) were comparable in both groups. At long-term follow-up of 3 years, ES was associated with higher rates of all-cause mortality and rehospitalization compared to patients with AMI–VTA.

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

scholarly journals Long-term clinical prognosis predictors in patients with chronic heart failure and reduced left ventricular ejection fraction

2019 ◽  
Vol 26 (5) ◽  
pp. 33-43 ◽  
Author(s):  
L. G. Voronkov ◽  
К. V. Voitsekhovska ◽  
S. V. Fedkiv ◽  
T. I. Gavrilenko ◽  
V. I. Koval
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Left Atrium ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
C Reactive Protein ◽  
Ventricular Ejection Fraction ◽  
Reactive Protein ◽  
Vasodilator Response

The aim – to identify prognostic factors for the development of adverse cardiovascular events (death and hospitalization) in patients with chronic heart failure (CHF) and left ventricular ejection fraction (LVEF) ≤ 35 % after long-term observation. Materials and methods. 120 stable patients with CHF, aged 18–75, II–IV functional classes according to NYHA, with LVEF ≤ 35 % were examined. Using multiple logistic regression according to the Cox method, we analyzed independent factors that affect the long-term prognosis of patients with heart failure. Results and discussion. During the observation period, out of 120 patients, 61 patients reached combined critical point (CCР). In the univariate regression model, predictors of CCР reaching were NYHA functional class, weigh loss of ≥ 6 % over the past 6 months, systolic and diastolic blood pressure, patient’s history of myocardial infarction, angina pectoris, anemia, number of hospitalizations over the past year and parameters reflecting the functional state of the patient (6-minute walk distance, number of extensions of the lower limb). The risk of CCP developing is significantly higher in patients with lower body mass index, shoulder circumference of a tense and unstressed arm, hip, thickness of the skin-fat fold over biceps and triceps, estimated percentage of body fat. Рredictors CCP reaching are higher levels of uric acid and C-reactive protein. Echocardiographic predictors of CCP onset were LVEF, size of the left atrium, TAPSE score, as well as its ratio to systolic pressure in the pulmonary artery, index of final diastolic pressure in the left ventricle. Also, the risk of CCP reaching is greater at lower values of the flow-dependent vasodilator response. Independent predictors of CCP onset were the circumference of the shoulder of an unstressed arm, the level of C-reactive protein in the blood, and the rate of flow-dependent vasodilator response. When analyzing the indices in 77 patients, who underwent densitometry, it was revealed that the E/E´ index, the index of muscle tissue of the extremities, the index of fat mass, and the ratio of fat mass to growth affect CCP reaching. In a multivariate analysis, taking into account densitometry indices, independent predictors of CCP onset were the size of the left atrium, the index of muscle mass of the extremities, the rate of flow-dependent vasodilator response and the presence of myocardial infarction in anamnesis. Conclusions. Independent predictors of CCP reaching in patients with CHF and LVEF ≤ 35 % are myocardial infarction in anamnesis, lower arm circumference of the arm, limb muscle mass index, flow-dependent vasodilator response, higher levels of C-reactive protein, sizes of the left atrium.

P1868Risk of arrhythmias after myocardial infarction in patients with left ventricular systolic dysfunction according to mode of revascularization: a CARISMA substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Thomsen ◽  
S Pedersen ◽  
P K Jacobsen ◽  
H V Huikuri ◽  
P E Bloch Thomsen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Loop Recorder ◽  
Ventricular Ejection Fraction ◽  
New Onset

Abstract Introduction The CARISMA trial was the first study to use continuous monitoring for documentation of long-term arrhythmias in post-infarction patients with left ventricular dysfunction. During the study duration (2000–2005), primary PCI (pPCI) as treatment of acute myocardial infarction was introduced approximately midway (2002) on the enrolling centres. Purpose The aim of this study was to describe the influence of mode of revascularization after myocardial infarction (AMI) on long-term risk of risk of new onset atrial fibrillation, ventricular tachyarrhythmias and brady arrhythmias. Methods The study is a sub-study on the CARISMA study population that consisted of patients with AMI and left ventricular ejection fraction ≤40%, which received an implantable loop recorder and was followed for 2 years. After exclusion of 15 patients who refused device implantation and 26 with pre-existing arrhythmias, 268 of the 312 patients were included. Choice of revascularization was made by the treating team independently of the trial and was retrospectively divided into primary percutaneous intervention (pPCI), subacute PCI (24 hours to 2 weeks after AMI), primary thrombolysis or no revascularization. Endpoints were new-onset of arrhythmias and major cardiovascular events (MACE). The Kaplan-Meier (figure 1) and Mantel-Byar methods were used for time to first event risk analysis. Results A total of 77 patients received no revascularization, whereas 49 received thrombolysis only and 142 received PCI. At two-years follow up patients treated with any PCI had a significant lower risk (0.40, n=63) of any arrhythmia compared to patients treated with trombolysis (0.60, n=30) or no revascularization (0.68, n=16) (p<0.001, unadjusted) (figure 1). Risk of MACE was significant higher in patients with any arrhythmia (0.25, n=76) compared to no arrhythmia (0.11, n=93) at two years follow-up (p=0.004, unadjusted). Figure 1 Conclusion(s) The long-term risk of new onset arrhythmias after AMI was significantly lower in patients treated with any PCI compared to patients not revascularized or treated with thrombolysis. Risk of MACE was significantly higher in patients with new onset arrhythmias compared to patients with no arrhythmias.

scholarly journals The diagonal branches and outcomes in patients with anterior ST- elevation myocardial infarction

2019 ◽  
Author(s):  
Shuning Zhang ◽  
Xin Deng ◽  
Wenlong Yang ◽  
Liping Xia ◽  
Kang Yao ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Left Ventricular ◽  
Cox Proportional Hazards ◽  
Left Ventricular Ejection ◽  
Primary Pci ◽  
Ventricular Ejection Fraction ◽  
Timi Grade ◽  
Short And Long Term ◽  
The Impact

Abstract Background: To detect the impact of loss of main diagonal branch (D) flow on cardiac function and clinical outcomes in patients with anterior ST-segment elevation myocardial infarction (STEMI).Methods: Patients with anterior STEMI undergoing primary percutaneous coronary intervention (PCI)at our clinic between October 2015 and October 2018were reviewed. Anterior STEMI due to left anterior descending artery (LAD) occlusion with or without loss of the main D flow (TIMI grade 0-1 or 2-3) was enrolled in the analysis. The short- and long-term incidence of major adverse cardiac events (MACEs, a composite of all-cause death, target vessel revascularization and reinfarction) and left ventricular ejection fraction (LVEF) were analyzed.Results: A total of 392 patients (mean age of 63.9years) with anterior STEMI treated with primary PCI was enrolled in the study. They were divided into two groups, loss (TIMI grade 0-1, n=69) and no loss (TIMI grade2-3, n=323) of D flow, before primary PCI. Compared with the group without loss of D flow, the group with loss of D flow showed a lower LVEF post PCI (41.0% vs. 48.8%, p=0.003). Meanwhile, loss of D flow resulted in the higher in-hospital, one-month, and 18-month incidence of MACEs, especially in all-cause mortality (all p<0.05). Landmark analysis further indicated that the significant differences in 18-month outcomes between the two groups mainly resulted from the differences during the hospitalization. In addition, multivariate Cox proportional hazards analysis found that D flow loss before primary PCI was independent factor predicting short- and long-term outcomes in patients with anterior STEMI.Conclusion: Loss of the main D flow in anterior STEMI patients was independently associated with the higher in-hospital incidences of MACEs and all-cause death as well as the lower LVEF.

P3619Incidence of progressively reduced LVEF during long-year follow-up after myocardial infarction: impact for mid-term outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Yoshioka ◽  
Y Shibata ◽  
K Node ◽  
N Watanabe ◽  
N Kuriyama ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Phase ◽  
Cardiac Death ◽  
Chronic Phase ◽  
Left Ventricular ◽  
Clinical Impact ◽  
Left Ventricular Ejection ◽  
Secondary Outcome ◽  
Ventricular Ejection Fraction

Abstract Background Severely reduced left ventricular ejection fraction (LVEF≤35%) is commonly seen in approximately 5% of the myocardial infarction (MI) survivors in its acute-phase, which is recognized as a risk factor of post-MI cardiac death. However, clinical impact of the progressively reduced LVEF in the chronic-phase after MI has not been clarified. Purpose To evaluate clinical impact of the progressively reduced LVEF in the chronic-phase after MI. Method We evaluated 1659 consecutive patients with acute MI by serial echocardiography. Primary outcome was severely reduced LVEF. And secondary outcome was all cause death and cardiac death. Result During follow-up (median: 1097 days), severely reduced LVEF newly developed in 8.6% of AMI survivors. These patients had significantly higher incidence of all cause death (20.7% vs. 4.4%, p<0.01) and cardiac death (10.6% vs. 1.2%, p<0.01) than those with LVEF>35%. Severely reduced LVEF progressed in the chronic-phase associated with all cause death and cardiac death as well as those with severely reduced EF in the acute-phase. Figure 1 Conclusions Progressively reduced LVEF during chronic-phase occurred 8.6% per 10-year in MI survivors. Careful long-term follow-up after MI should be needed to identify possible candidate for the implantable cardioverter-defibrillator.

scholarly journals Long-term Performance of Epic and PERIMOUNT Mitral Bioprostheses in Young Rheumatics

2021 ◽  
Vol 04 (06) ◽  
pp. 01-12
Author(s):  
Ujjwal Chowdhury
Keyword(s):  
Survival Data ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Mechanical Prosthesis ◽  
Actuarial Survival ◽  
Ventricular Ejection Fraction ◽  
Group I ◽  
Group Ii ◽  
Term Performance

Objective: We compared the long-term cossmposites of valve-related reoperation, morbidity and mortality following two types of mitral bioprostheses in young rheumatics aged <45 years. Methods: Retrospective comparative analysis of structural valve-related reoperations, and survival data were performed on 260 propensity matched patients, undergoing bioprosthetic MVR between 2000 and 2019, using Epic (Group I, n=130) or PERIMOUNT bioprostheses (Group II, n=130). Results: The median age was 34.5 (IQR: 28-39) and 34 (IQR: 29-40) years for group I and II respectively. Hazard regression for mortality included HR (95% CI) preoperative congestive heart failure (CHF) 4.70 (1.76-12.56), p=0.002; renal failure 66.91 (12.88-347.59), p<0.0001; low left ventricular ejection fraction <0.25, 3.76 (1.72-7.27), p=0.004; and valve-related reoperations 3.82 (1.81-9.56), p=0.001. Although the structural valve degeneration (SVD)-related reoperations were more among the perimount group, propensity score matching did not exhibit any difference between the groups [8.5% (Group I) vs 14.6% (Group II), SMD -0.23, p=0.5]. At a median follow-up of 134 (IQR: 99.5-178.5) months, actuarial survival was 96.36%±0.01% (93.11-98.10), and there was no difference in survival between the groups (Log rank p=0.70). Conclusions: Both Epic and PERIMOUNT mitral bioprostheses provide similar long-term clinical outcomes and are an appealing alternative to mechanical prosthesis in younger rheumatics.

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