scholarly journals Prime time for the sweet spot in timing of coronary invasive approach in patients with non-ST elevation myocardial infarction

2018 ◽  
Vol 10 (1) ◽  
pp. 17-20
Author(s):  
Eliano P. Navarese ◽  
Bernhard Wernly ◽  
Michael Lichtenauer ◽  
Martino Pepe ◽  
Wojciech Wanha ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Elevation Myocardial Infarction ◽  
Prime Time ◽  
Sweet Spot ◽  
Invasive Approach ◽  
St Elevation

scholarly journals Consensus statement: improvement in care and outcomes for patients with ST‐elevation myocardial infarction with timely reperfusion therapy: a pharmaco-invasive approach

2020 ◽  
Vol 7 (12) ◽  
pp. 1889
Author(s):  
Arup Dasbiswas ◽  
Abhijeet Shelke ◽  
Anurag Singhal ◽  
Bhupesh Shah
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Reperfusion Therapy ◽  
St Elevation Myocardial Infarction ◽  
Myocardial Salvage ◽  
Invasive Approach ◽  
Mortality And Morbidity ◽  
St Elevation ◽  
Clinically Significant ◽  
Timely Delivery

The prevalence of cardiovascular diseases continues to increase in India, with a rapid epidemiological transition. Timely management of ST-elevation myocardial infarction (STEMI)is the key to decrease mortality and morbidity rates. In India, patients most often do not receive optimal therapy owing to a number of factors such as socio-economic constraints, lack of knowledge, geographical restrictions etc, leading to suboptimal outcomes. The timely delivery of optimal reperfusion strategy for STEMI patients is immensely challenging for physicians, due to several reasons. Primary percutaneous coronary Intervention (PCI) is still a global gold standard for the treatment of STEMI. Delayed case presentation is a significant challenge, especially in Indian tier towns/cities, because of prolonged transportation time or traffic delays with regards to reaching a PCI facility. Keeping in mind the accessibility to PCI facility because of geographical locations as well as affordability concerns especially in smaller Indian towns, pharmaco-invasive approach is almost as effective and a practical approach for reduction of morbidity and mortality rates. Timely establishment of reperfusion therapy is critical for improving myocardial salvage in patients with STEMI. There is an urgent need for developing strategies for efficient STEMI management, such as timely delivery of reperfusion therapy; reinforcement of health system and professionals, implementation of guideline-based interventions, streamlined insurance policy and greater emphasis on patient awareness for detection of symptoms. In addition to the timely reperfusion therapy and other standard care drugs, statins and potassium channel activators have demonstrated clinically significant improvements in the outcome of STEMI management.

Abstract 354: Non-ST-Elevation Myocardial Infarction: Admissions, Rate, and Timing of Revascularization in The United States

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Brian C Case ◽  
Charan Yerasi ◽  
Yanying Wang ◽  
Brian J Forrestal ◽  
Joshua Hahm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Trials ◽  
Hospital Mortality ◽  
The United States ◽  
Mortality Rates ◽  
St Elevation Myocardial Infarction ◽  
Invasive Approach ◽  
Diagnostic Angiography ◽  
St Elevation ◽  
Cabg Patients

Objectives: This study aimed to evaluate non-ST-elevation myocardial infarction (NSTEMI) rates, revascularization timing, and mortality rates using the Nationwide Readmissions Database (NRD). Background: Clinical trials have shown improved outcomes with reduced mortality with an early invasive approach for NSTEMI. However, real-world data are lacking. Methods: The study cohort was obtained from the 2016 NRD dataset. We used the International Classification of Diseases, Tenth Revision, to identify patients who underwent diagnostic angiography and subsequently received either percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Finally, revascularization timing and mortality rates (in-hospital and 30-day) were extracted. Results: Our analysis included 748,463 NSTEMI admissions in 2016. Of these admissions, 50.1% (374,988) underwent diagnostic angiography with 38.9% (253,492) revascularized: 77.6% (197,945) PCI and 22.4% (57,254) CABG. Patients with more comorbidities tended to have more delayed revascularization. PCI was most commonly performed on the day of admission, 32.9% (65,155). This differs from CABG, which was most commonly performed on Day 3 after admission, 13.7% (7,823). The in-hospital mortality rate increased after Day 1 for PCI patients and after Day 4 for CABG patients, whereas 30-day in-hospital mortality for both populations increased as revascularization was delayed (Figure 1). Conclusions: Our study shows that mortality generally increased as revascularization was delayed, while sicker patients tended to have longer delays until revascularization. However, confounding variables prevent definite causal attribution. Randomized clinical trials are needed to evaluate whether very early revascularization (<90 minutes) is associated with improved long-term outcomes in high-risk patients.

scholarly journals Invasive management in elderly patients with non-ST elevation myocardial infarction is beneficial regardless of frailty status

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
B Fishman ◽  
A Sharon ◽  
E Itelman ◽  
A M Tsur ◽  
P Fefer ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Elderly Patients ◽  
St Elevation Myocardial Infarction ◽  
Sensitivity Analyses ◽  
Cumulative Probability ◽  
Invasive Approach ◽  
Frailty Status ◽  
Risk Of Death ◽  
St Elevation ◽  
Invasive Management

Abstract Introduction Elderly patients are underrepresented in clinical trials evaluating the management of non-ST elevation myocardial infarction (NSTEMI) patients. Moreover, frailty status is often not reported in these trials. Purpose To evaluate the association of invasive management with outcome among elderly (≥80) patients presenting with NSTEMI by frailty status. Methods Retrospective cohort of consecutive elderly patients who were hospitalized with NSTEMI as a primary clinical diagnosis between 2008 to 2019. Primary outcome was all-cause mortality. Frailty status was estimated as a continuous variable as well as categorized to low, medium, and high. Cox regression models were applied with stratification by frailty status. Additional sensitivity analyses were conducted including propensity score matching (PSM) and inverse probability treatment weighting (IPTW) models. Results Study population included 2,317 patients with median age of 86 years (IQR 83–90) of whom 1,243 (54%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs. 44%, p&lt;.001). During the follow up (median of 19 months, [IQR 4–41]), 1,599 (69%) patients died. Kaplan Meier survival curves (Figure 1) show that the cumulative probability of death at 19 months was 50% among patients who were managed conservatively compared with 21% among invasively managed patients (p Log rank &lt;.001). In the multivariable Cox model, invasive approach was associated with a significant 39% decrease in the risk of death (95% CI 0.53–0.71). The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 [0.58–0.93], 0.65 [0.50–0.85] and 0.52 [0.34–0.78], respectively; p for interaction NS). Results were consistent with PSM and IPTW analyses (HR of 0.6 [0.50–0.71] and 0.67 [0.55–0.82], respectively). Additional sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results. Conclusions Invasive approach is associated with improved survival among elderly patients with NSTEMI irrespective of frailty status. Our results support and extend recent ESC recommendations for the management of elderly patients with NSTEMI FUNDunding Acknowledgement Type of funding sources: None. Figure 1

scholarly journals Experts’ consensus: pharmaco-invasive therapy for ST‐elevation myocardial infarction along with focus on secondary prevention and cardiac rehabilitation in India

2021 ◽  
Vol 8 (2) ◽  
pp. 325
Author(s):  
Arup Dasbiswas ◽  
Samir Kubba ◽  
Jossy Chacko
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Cardiac Rehabilitation ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Treatment Protocols ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
Care Systems ◽  
St Elevation

In India, patients with acute coronary syndrome (ACS) tend to present with higher percentage of ST-elevation myocardial infarction (STEMI). Numerous existing challenges like patient unawareness, lack of structured STEMI care systems, inadequacy of promptly available facilities and unequipped ambulances for patient transport make it difficult to achieve optimal STEMI treatment. Also, due to socio-economic diversities prevailing in India, a large proportion of the entire population has access to only basic primary healthcare and are unable to afford proper medical facilities. Judicious and timely reperfusion strategy has been the mainstay of STEMI management. Even though, percutaneous coronary intervention (PCI) continues to be the gold standard for treating STEMI worldwide, it is not the ideal strategy in many Indian settings, especially in villages and smaller towns/cities. In such scenarios, pharmaco-invasive approach has proved to be a better reperfusion therapeutic strategy for improving treatment outcomes and subsequently reducing morbidity and mortality. The purpose of this consensus article is to highlight the clinical perspectives of Indian cardiologists at identifying and addressing the need gaps currently existing in India for optimization of STEMI treatment approaches. The experts shared their views on the rationale of pharmaco-invasive approach and highlighted the significance of commonly used thrombolytic agents, STEMI treatment protocols, secondary prevention and cardiac rehabilitation.

Sign in / Sign up

Export Citation Format

Share Document