Major adverse cardiovascular events in patients after acute myocardial infarction treated invasively and different patterns of glucometabolic disturbances evaluated at mid-term follow-up

2017 ◽  
Vol 86 (1) ◽  
pp. 17
Author(s):  
Paweł Francuz ◽  
Tomasz Podolecki ◽  
Monika Kozieł ◽  
Zbigniew Kalarus ◽  
Jacek Kowalczyk
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Glucose Tolerance ◽  
Hospital Discharge ◽  
Cardiovascular Events ◽  
Decompensated Heart Failure ◽  
Major Adverse Cardiovascular Events ◽  
Abnormal Glucose Tolerance

Objective:  To assess the impact of glucometabolic status (GS) evaluated at hospital discharge and at mid-term follow-up visit (FU-visit) on major adverse cardiovascular events (MACE) in patients (pts) with acute myocardial infarction (AMI) treated invasively.Material and Methods: Study encompassed 368 AMI-pts treated invasively, in whom GS was assessed by 2-hour post load glycemia at hospital discharge and at FU-visit after 6 months. Patients were divided into two groups with respect to GS at hospital discharge: abnormal glucose tolerance (AGT, n=149), normal glucose tolerance (NGT, n=219). Each of those groups was divided into two subgroups with respect to GS at FU-visit: persistent AGT (pAGT, n=101), transient AGT (tAGT, n=48), newly detected AGT (newAGT, n=114), persistent NGT (pNGT, n=105). Median follow-up duration after FU-visit was 24.5 months.Results: There was a trend towards more subjects with MACE in AGT than NGT group (24.2% vs. 16%; p=0.051). More AGT-pts were hospitalized due to decompensated heart failure (6% vs. 0.5%; p=0.002). However, there were no significant differences in MACE between subjects with pAGT and tAGT, including heart failure hospitalizations. Among NGT-pts there were no significant differences in particular MACE between newAGT-pts and pNGT-pts.Conclusions: In AMI-pts treated invasively, who had abnormal glucose tolerance at hospital discharge, the improvement in glucometabolic status after 6 months was not related to lower risk of hospitalization due to decompensated heart failure.

scholarly journals Abnormal Glucose Tolerance in Prediabetes Patients with Acute Myocardial Infarction: Implications for Therapy

2021 ◽  
Vol 3 (1) ◽  
pp. 16-21
Author(s):  
Nitchakarn Laichuthai ◽  
Ralph A. DeFronzo
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
High Risk ◽  
Glucose Tolerance ◽  
Cardiovascular Events ◽  
Current Evidence ◽  
Major Adverse Cardiovascular Events ◽  
High Risk Population ◽  
Abnormal Glucose Tolerance ◽  
Glucagon Like Peptide 1

Newly discovered abnormal glucose tolerance is common in patients who present with acute myocardial infarction (MI). These individuals are at very high risk for recurrent major adverse cardiovascular events (MACE), cardiovascular (CV) mortality, and all-cause mortality compared to normal-glucose-tolerant individuals who present with acute MI. Early and aggressive intervention with lifestyle and pharmacologic treatment are essential for the prevention of prediabetes progression to diabetes and recurrent cardiovascular events in this high risk population. Management, both with regard to prevention of recurrent cardiovascular events and development of diabetes, has been poorly addressed in current cardiology and diabetes guidelines. In this article, we review current evidence regarding the use of glucagon-like peptide 1 receptor agonists (GLP-1 RAs), sodium glucose cotransporter 2 inhibitors (SGLT2i), and pioglitazone to prevent recurrent cardiovascular events and propose areas of research to be explored in the future.

P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C X Song ◽  
R Fu ◽  
J G Yang ◽  
K F Dou ◽  
Y J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blocker ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

scholarly journals HIGH ADMISSION PLASMA OSMOLALITY VALUE AS IN-HOSPITAL MAJOR ADVERSE CARDIOVASCULAR EVENTS PREDICTOR IN PATIENT WITH ACUTE MYOCARDIAL INFARCTION

2020 ◽  
Vol 7 (11) ◽  
pp. 79-85
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Logistic Regression ◽  
Blood Glucose ◽  
Acute Heart Failure ◽  
Cardiovascular Events ◽  
Plasma Osmolality ◽  
Receiver Operating Curve ◽  
Major Adverse Cardiovascular Events

Background: Elevated blood urea nitrogen (BUN), blood glucose, and alteration sodium levels are common among patients with acute myocardial infarction (AMI). These parameters to be widely investigated to assess the prognosis in AMI patients. However, the combination of these parameters (BUN, blood glucose, and sodium) calculated by a certain formula in the form of plasma osmolality has not been widely studied to assess the prognosis of patients with acute myocardial infarction. This study aims to assess plasma osmolality in predicting hospital major adverse cardiovascular events (MACEs) among AMI patients. Methods: Data were collected from 118 consecutive patients with AMI in Cardiac Centre Haji Adam Malik General Hospital Medan. We measured admission plasma osmolality [1,86 (Na+) + BUN/2,8 + Glucose/18+9]. Then we observed in hospital Major Adverse Cardiovascular Outcomes (MACEs) which consist of cardiovascular mortality, acute heart failure, malignant arrhythmia, and cardiogenic shock. Statistical analysis was performed using mean difference, logistic regression, and receiver operating curve (ROC). Result: Among 118 patients, MACEs were observed in 49 (41.5%) patients with the most common MACEs was acute heart failure (25.4%). Bivariate analysis showed a significant relationship between the plasma osmolality and in hospital MACEs (p < 0.001). The plasma osmolality AUC prediction value was 78.9%. The optimal cut-off value was 279.9 mOsm/kg (sensitivity 81.6%; specificity 75.4%). In multivariate logistic regression analysis, the plasma osmolality was the strongest predictor with an OR value of 10.542 (95% CI 2.694-41.255; p-value <0.001). Conclusions: Among AMI patients, high plasma osmolality value (≥280 mOsm/kg) is a better predictor of in-hospital MACEs than its components separately(BUN, glucose level, sodium).

scholarly journals Long-term outcome of patients with invasive electrophysiology procedure-related cardiac tamponade

EP Europace ◽  
2020 ◽  
Vol 22 (10) ◽  
pp. 1547-1557
Author(s):  
Gesa von Olshausen ◽  
Tara Bourke ◽  
Jonas Schwieler ◽  
Nikola Drca ◽  
Hamid Bastani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Cardiovascular Events ◽  
Control Group ◽  
Risk Of Death ◽  
Increased Risk

Abstract Aims Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analysed the risk of death or serious cardiovascular events in patients suffering from EP-related cardiac tamponade requiring pericardiocentesis during long-term follow-up. Methods and results Out of 19 997 invasive EPs at the Karolinska University Hospital between January 1998 and September 2018, all patients with EP-related periprocedural cardiac tamponade were identified (n = 60) and matched (1:3 ratio) to a control group (n = 180). After a follow-up of 5 years, the composite primary endpoint — death from any cause, acute myocardial infarction, transitory ischaemic attack (TIA)/stroke, and hospitalization for heart failure — occurred in significantly more patients in the tamponade than in the control group [12 patients (20.0%) vs. 19 patients (10.6%); hazard ratio (HR) 2.53 (95% confidence interval, CI 1.15–5.58); P = 0.021]. This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group [HR 3.75 (95% CI 1.01–13.97); P = 0.049]. Death from any cause, acute myocardial infarction, and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group [HR 36.0 (95% CI 4.68–276.86); P = 0.001]. Conclusion Patients with EP-related cardiac tamponade are at higher risk for cerebrovascular events during the first 2 weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events.

scholarly journals Elevated plasma Sirtuin2 level predicts heart failure after acute myocardial infarction

2020 ◽  
Author(s):  
Meili Zheng ◽  
Lei Zhao ◽  
Hao Sun ◽  
Mulei Chen ◽  
Xinchun Yang
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Events ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Low Level ◽  
High Level Group ◽  
High Level ◽  
Level Group

Abstract Background and Objectives: There is currently no evidence regarding the role of plasma Sirtuin2 (SIRT2) level in heart failure after acute myocardial infarction (AMI) yet. This study assessed the relationship between plasma SIRT2 level and AMI, and also investigated the association of plasma SIRT2 level with major adverse cardiovascular events (MACE) and heart failure after AMI. Methods and Results: A total of 129 AMI patients were included in the present study. The major adverse cardiovascular events (MACE) and heart failure were recorded during hospitalization and follow-up (12 months) after discharge. According to the 75th percentile value of plasma SIRT2 level, we divided all the AMI patients into two groups: high level group (plasma SIRT2 level≥109.0pg/ml) and low level group (plasma SIRT2 level <109.0pg/ml). Compared with the low level group, the high level group had higher prercentage of Killip class≥3 (P<0.001), left ventricular ejection fraction(LVEF) <50% (P=0.007) or even <40% (P=0.012), use of breathing machine(P=0.003), and higher plasma brain natriuretic peptide (BNP) level (P=0.006). Multivariate regression analysis showed that there were higher risks of MACE (hazard ratio (HR)=11.20 [95% confidence interval (CI): 3.18-39.52, P<0.001]) and heart failure (HR=27.10 [95%CI 4.65-157.83, P<0.001]) in the high level group. Conclusions: The present study suggested that plasma SIRT2 level is a promising biomarker to predict heart failure and MACE after AMI.

Long-term outcome of patients with invasive electrophysiology procedure related cardiac tamponade

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Von Olshausen ◽  
T Bourke ◽  
J Schwieler ◽  
N Drca ◽  
H Bastani ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Cardiac Tamponade ◽  
Cardiovascular Events ◽  
Control Group ◽  
Funding Source ◽  
Increased Risk

Abstract Aims Iatrogenic cardiac tamponades are a rare but dreaded complication of invasive electrophysiology procedures (EPs). Their long-term impact on clinical outcomes is unknown. This study analyzed the risk of death or serious cardiovascular events in patients suffering from EP related cardiac tamponade requiring pericardiocentesis during long-term follow-up. Methods and results Out of 19997 invasive EPs at our university hospital between January 1998 and September 2018, all patients with EP related periprocedural cardiac tamponade were identified (n=60) and matched (1:3 ratio) to a control group (n=180). After a follow-up of 5 years, the composite primary end point - death from any cause, acute myocardial infarction, TIA/stroke and hospitalization for heart failure – occurred in significantly more patients in the tamponade than in the control group (12 patients (20.0%) vs 19 patients (10.6%); Hazard ratio (HR) 2.53 (95% CI, 1.15–5.58); p=0.021). This was mainly driven by a higher incidence of TIA/stroke in the tamponade than in the control group (HR 3.75 (95% CI, 1.01–13.97); p=0.049). Death from any cause, acute myocardial infarction and hospitalization for heart failure did not show a significant difference between the groups. Hospitalization for pericarditis occurred in significantly more patients in the tamponade than in the control group (HR 36.0 (95% CI, 4.68–276.86); p=0.001). Conclusion Patients with EP related cardiac tamponade are at higher risk for cerebrovascular events during the first two weeks and hospitalization for pericarditis during the first months after index procedure. Despite the increased risk for early complications tamponade patients have a good long-term prognosis without increased risk for mortality or other serious cardiovascular events. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): German Research Foundation

P1954Prognostic value of the CHADS2 score for adverse cardiovascular events in acute myocardial infarction patients without atrial fibrillation: J-MINUET Substudy

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
K Motozato ◽  
K Sakamoto ◽  
K Tsujita ◽  
K Nakao ◽  
Y Ozaki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiovascular Events ◽  
Chads2 Score ◽  
Intermediate Point ◽  
Significant Difference

Abstract Background The CHADS2score has mainly been used to predict the likelihood of cerebrovascular accidents in patients with atrial fibrillation. However, increasing attention is being paid to this scoring system for risk stratification of patients with coronary artery disease. We investigated the value of the CHADS2 score in predicting cardiovascular events in Japanese acute myocardial infarction (AMI) patients without atrial fibrillation. Methods To elucidate the prognostic value of CHADS2score in AMI patients, we analysed data of the Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET). This was a prospective and multicenter registry consisting of 3,283 AMI patients, who were hospitalized within 48-hours of onset from July 2012 to March 2014. We calculated the CHADS2 scores for 3,044 patients without clinical evidence of atrial fibrillation. The presence of heart failure was substituted by Killip classification>2 on admission. Clinical follow-up data was obtained for 3 years. In addition to the in-hospital mortality,we evaluated cardiovascular events, defined as all cause deathor non-fatal MI during 3-year follow up periods. Results In this study, enrolled patients were classified into low- (point 0–1), intermediate- (point 2–3), and high-score (point 4–6) groups by calculating CHADS2 score. Overall patients with low, intermediate and high score were divided into 1,395, 1,393 and 256 patients, respectively. In-hospital mortality among low, intermediate, and high score groups were 2.8%, 7.4% and 14.8%, respectively (P<0.001). The incidence of cardiovascular eventsamong low, intermediate, and high score groups were 7.8%, 16.3%, 29.3%, respectively (P<0.001). Kaplan-Meier analysis showed a significant difference between the groups (Figure). The event rates were significantly higher in both high score and intermediate score group than in low score group (P<0.001). Multivariate Cox hazard analysis identified CHADS2 score (per 1 point) as an independent predictor of cardiovascular events in addition to chronic kidney disease and lower body mass index. (hazard ratio, 1.344; 95% CI, 1.239–1.459; P<0.001). Among the factors constituting CHADS2 score, heart failure and age were identified as independent predictors for in-hospital mortality. With respect to the cardiovascular event during 3 years, heart failure, age, and previous stroke were revealed as significant independent predictors. Conclusion This large cohort study indicated that the CHADS2 score is useful for the prediction of in-hospital mortality and the cardiovascular events during 3-year follow up in Japanese AMI patients without atrial fibrillation.

P6217Managed Care after Acute Myocardial Infarction (MC-AMI) reduces MACE by 45% in 3-month follow-up - results form Poland's National Health Fund program of post-MI care. A single center analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Kulach ◽  
K Wita ◽  
M Wita ◽  
M Wybraniec ◽  
K Wilkosz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
National Health ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Major Adverse Cardiovascular Events ◽  
Control Group ◽  
Single Center ◽  
Post Discharge

Abstract Background Despite progress in the medical and interventional treatment of acute myocardial infarction (AMI) and low in-hospital mortality related to AMI, a post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawal) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve long-term prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), outpatient follow-up, and prevention of SCD. Aims To assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in a 3-month follow-up. Methods In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1:1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. Results MC-AMI has been proved to reduce MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR 0.476, 95% CI 0.283–0.799, p<0.005). Besides, older age, male sex (HR 2.0), history of unstable angina (HR 3.15), peripheral artery disease (HR 2.17), peri-MI atrial fibrillation (HR 1.87) and diabetes (HR 1.5), were significantly associated with the primary endpoint. Comparison of study endpoints between KO Total, n (%) MC-AMI group, n (%) Control Group, n (%) RR 95% CI NNT P n=1058 n=529 n=529 All-cause mortality 19 (1.8%) 7 (1.3%) 12 (2.3%) 0.583 0.232–1.470 105.8 0.247 Hospitalization for HF 31 (2.9%) 12 (2.3%) 19 (3.6%) 0.632 0.310–1.288 75.6 0.202 Myocardial infarction 25 (2.4%) 9 (1.7%) 16 (3.0%) 0.563 0.251–1.262 75.6 0.157 MACE 73 (6.9%) 26 (4.9%)# 47 (8.9%) 0.553 0.348–0.879 25.2 0.012 *Two-tailed Pearson's Chi-square test; MACE, Major Adverse Cardiovascular Events. #Number of patients with at least one MACE; in 2 patients 2 endpoints occurred. This explains why the total number of MACE is lower than the sum of all endpoints. MC-AMI vs. control - MACE in 3 months up Conclusions MC-AMI is the first program of a comprehensive. Participation in MC-AMI – a first comprehensive in-hospital and post-discharge care for AMI patients for AMI patients improves prognosis and reduces MACE rate by 45% as soon as in 3 months.

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