Cardiac and Other Presentation and Clinical Outcomes of COVID-19 Pandemic among Different Ethnic and Religious Populations in The City of Jerusalem

Abstract Background: The COVID‑19 pandemic is an ongoing global pandemic. Jerusalem with its 919,400 inhabitants has a wide variety of populations, of which 62% are Jews (36% ultra-orthodox; 64% non-ultraorthodox) and 38% Arabs which were largely affected by the pandemic. The aim of our study was to understand the different presentations, course and clinical outcomes in these different ethnical and cultural groups in Jerusalem in the COVID-19 pandemic. Methods: We performed a cohort study of all COVID-19 patients admitted between March 9 - July 16, 2020 to the two university medical centers in Jerusalem. Patients were divided according to their religion and ethnicity into 3 main groups: 1) Ultra-Orthodox Jews; 2) other (non-Ultra-Orthodox) Jews and 3) Arabs. Results: Six hundred and two patients comprised the study population. Of them the 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. The Arab patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old vs. 57±21 and 59±19, respectively, p<0.01), but suffered from significantly more co-morbidities. Moreover, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared the other groups of patients. Being an Ultra-Orthodox was independently associated with significantly higher rate of Major Adverse Cardiovascular Events (MACE) [OR=1.96; 95% CI (1.03-3.71), p<0.05]. Age was the only independent risk factor associated with increased mortality rate [OR=1.10; 95% CI (1.07 - 1.13), p<0.001]. Conclusions: The COVID-19 first phase in Jerusalem, affected different ethnical and cultural groups differently, with the Ultra-Orthodox Jews mostly affected by admission rates, presenting symptoms clinical course and MACE (Acute coronary syndrome, shock, cerebrovascular event or venous thromboembolism). It is conceivable that vulnerable populations need special attention and health planning in time of pandemic, to prevent rapid distribution and severe morbidity.

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Cardiac and other Presentation and Clinical Outcomes of COVID-19 Pandemic among different ethnic and religious populations in the city of Jerusalem

10.22541/au.162506999.99797857/v1 ◽

2021 ◽

Author(s):

Elad Asher ◽

Tal Y Samuel ◽

Oren Yagel ◽

Arik Wolak ◽

Rivka Farkash ◽

...

Keyword(s):

Clinical Outcomes ◽

Health Planning ◽

Orthodox Jews ◽

Major Adverse Cardiovascular Events ◽

Cerebrovascular Event ◽

Cultural Groups ◽

Admission Rates ◽

Presenting Symptoms ◽

Coronary Syndrome ◽

Religion And Ethnicity

Background: The COVID‑19 pandemic is an ongoing global pandemic. Jerusalem with its 919,400 inhabitants has a wide variety of populations, of which 62% are Jews (36% ultra-orthodox; 64% non-ultraorthodox) and 38% Arabs which were largely affected by the pandemic. The aim of our study was to understand the different presentations, course and clinical outcomes in these different ethnical and cultural groups in Jerusalem in the COVID-19 pandemic. Methods: We performed a cohort study of all COVID-19 patients admitted between March 9 - July 16, 2020 to the two university medical centers in Jerusalem. Patients were divided according to their religion and ethnicity into 3 main groups: 1) Ultra-Orthodox Jews; 2) other (non-Ultra-Orthodox) Jews and 3) Arabs. Results: Six hundred and two patients comprised the study population. Of them the 361 (60%) were Ultra-Orthodox Jews; 166 (27.5%) non-Ultra-Orthodox Jews and 75 (12.5%) Arabs. The Arab patients were younger than the Ultra-Orthodox Jews and the non-Ultra-Orthodox Jews (51±18 year-old vs. 57±21 and 59±19, respectively, p<0.01), but suffered from significantly more co-morbidities. Moreover, hemodynamic shock, ischemic ECG changes and pathological chest x-ray were all more frequent in the Ultra-Orthodox patients as compared the other groups of patients. Being an Ultra-Orthodox was independently associated with significantly higher rate of Major Adverse Cardiovascular Events (MACE) [OR=1.96; 95% CI (1.03-3.71), p<0.05]. Age was the only independent risk factor associated with increased mortality rate [OR=1.10; 95% CI (1.07 - 1.13), p<0.001]. Conclusions: The COVID-19 first phase in Jerusalem, affected different ethnical and cultural groups differently, with the Ultra-Orthodox Jews mostly affected by admission rates, presenting symptoms clinical course and MACE (Acute coronary syndrome, shock, cerebrovascular event or venous thromboembolism). It is conceivable that vulnerable populations need special attention and health planning in time of pandemic, to prevent rapid distribution and severe morbidity.

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Abstract 11526: Intraprocedural Thrombotic Events During PCI for ACS Are Associated With Increased Adverse Ischemic Events at 30 Days: A Meta-Analysis of Randomized Trials

Circulation ◽

10.1161/circ.130.suppl_2.11526 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Ramez Nairooz ◽

Partha Sardar ◽

Saurav Chatterjee ◽

Zubair Ahmed ◽

Dmitriy N Feldman

Keyword(s):

Clinical Outcomes ◽

Stent Thrombosis ◽

Literature Search ◽

Randomized Trials ◽

Meta Analysis ◽

Major Adverse Cardiovascular Events ◽

Repeat Revascularization ◽

Coronary Syndrome ◽

Reported Data ◽

Ischemic Events

Background: Data regarding intraprocedural thrombotic events (IPTE) including slow reflow or no reflow, distal embolization, intraprocedural stent thrombosis and abrupt vessel closure during PCI for acute coronary syndrome (ACS) are scarce. Their association with subsequent adverse ischemic events needs further investigation. Aim: To evaluate effect of IPTE on in-hospital and at 30-days clinical outcomes after PCI for ACS. Hypothesis: IPTE during PCI are associated with adverse ischemic events while in-hospital and at 30 days. Methods: We performed a literature search of all published full-length articles of randomized trials that reported data on patients with IPTE compared with no IPTE during PCI for patients with ACS. We calculated odd ratios via random effects model for in-hospital ischemic outcomes and 30 day outcomes. Results: Our literature search yielded 3 randomized trials reporting clinical outcomes with IPTE and no IPTE for ACS patients undergoing PCI: ACUITY, HORIZONS-AMI and EARLY-ACS trials. We report clinical outcomes (in-hospital and at 30 days) in 8,043 patients in total, of those 673 had IPTE. At 30 days, patients with IPTE had more major adverse cardiovascular events (MACE) (Odds ratio (OR) 3.97, 95% Confidence interval (CI) [1.81-8.69]; p=0.0006), mortality (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), myocardial infarction (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), repeat revascularization (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003), total stent thrombosis (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) and non-CABG related major bleeding (OR 4.54, 95% CI [1.99, 10.39]; p=0.0003) than those with no IPTE. Similarly, in-hospital clinical outcomes were all significantly higher in patients with IPTE than those without. Conclusion: IPTE during PCI is associated with more adverse ischemic events, including mortality, both in-hospital and at 30 days.

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Morphological Plaque Characteristics and Clinical Outcomes in Patients With Acute Coronary Syndrome and a Cancer History

Journal of the American Heart Association ◽

10.1161/jaha.120.020243 ◽

2021 ◽

Author(s):

Kosuke Tanimura ◽

Hiromasa Otake ◽

Hiroyuki Kawamori ◽

Takayoshi Toba ◽

Akira Nagasawa ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Cardiovascular Events ◽

Morphological Characteristics ◽

Major Adverse Cardiovascular Events ◽

Optical Coherence ◽

Cancer History ◽

Coronary Syndrome ◽

Plaque Erosion

Background Although patients with a cancer history have a 2 to 3 times higher risk for acute coronary syndrome (ACS), the morphological characteristics of ACS culprit plaque in those patients and their relations with clinical outcomes remain unknown. Methods and Results This retrospective, multicenter, observational cohort study included consecutive patients with ACS who underwent optical coherence tomography‐guided emergent percutaneous coronary intervention. Patients were categorized into those without a cancer history, those with a cancer history, and those currently receiving cancer treatment. ACS culprit lesions were classified as plaque rupture, plaque erosion, or calcified nodule using optical coherence tomography. Plaque erosion frequency was significantly higher in culprit lesions of patients with current cancer and patients with cancer history than in those of patients without cancer history (56.3% versus 61.7% versus 36.5%). Calcified nodule incidence was significantly higher in patients without cancer history than in patients with current cancer and patients without cancer history (patients with current cancer: 12.4% versus patients without cancer history: 25.5% versus patients without cancer history: 12.6%, P <0.001). Cancer history was independently associated with nonplaque rupture (plaque erosion or calcified nodule) in ACS culprit lesions (odds ratio, 4.00; P <0.001). Cancer history was independently associated with major adverse cardiovascular events (hazard ratio [HR], 1.98; P =0.002). Nonplaque rupture in ACS culprit lesions was independently associated with major adverse cardiovascular events (HR, 1.60; P =0.011). Conclusions Patients with a cancer history had significantly worse clinical outcomes after ACS than those without a cancer history. Those with a cancer history had significantly higher plaque erosion and calcified nodule incidences in the ACS culprit lesions, which might partly explain their worse clinical outcomes. Registration URL: www.umin.ac.jp/ctr/index.htm . Unique Identifier: UMIN000038442.

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De-Escalation of Antiplatelet Therapy in Patients With Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Clinical Trials

Journal of Cardiovascular Pharmacology and Therapeutics ◽

10.1177/1074248418809098 ◽

2018 ◽

Vol 24 (2) ◽

pp. 153-159

Author(s):

Babikir Kheiri ◽

Mohammed Osman ◽

Ahmed Abdalla ◽

Adam Chahine ◽

Sahar Ahmed ◽

...

Keyword(s):

Clinical Trials ◽

Percutaneous Coronary Intervention ◽

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Randomized Clinical Trials ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

Coronary Syndrome ◽

Increased Risk ◽

Percutaneous Coronary

Aims: Patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI) are recommended to be placed on potent P2Y12 blockade. However, the long-term bleeding risk is high. Therefore, despite no definitive evidence, switching to clopidogrel beyond the acute phase is common. We aimed to evaluate the clinical outcomes of antiplatelet de-escalation compared with continuation in patients treated with PCI. Methods: We searched databases for randomized clinical trials (RCTs) that evaluated the safety and efficacy of antiplatelet de-escalation compared with continuation in patients treated with PCI. Pooled summary estimates were calculated. Results: We included 3 RCTs with 3391 patients (median follow-up: 12 months). Compared with the continued group, the net clinical outcome (composite of bleeding or thrombotic events) was significantly reduced in the group switched to clopidogrel (8.7% vs 12.1%; risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.43-0.97; P = .03). However, there were similar clinical outcomes between groups for major adverse cardiovascular events (MACE; RR: 0.78; 95% CI: 0.55-1.11; P = .17), all Bleeding Academic Research Consortium (BARC) types bleeding (RR: 0.61; 95% CI: 0.33-1.11; P = .10), or BARC types ≥2 bleeding (RR: 0.49; 95% CI: 0.19-1.26; P = .14). Conclusions: Our results suggest a net clinical benefit of de-escalation therapy shortly after PCI, without increased risk of MACE. Larger randomized trials will be necessary to confirm these findings.

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Abstract 17007: Does Age Modify Gender-based Differences in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI)

Circulation ◽

10.1161/circ.130.suppl_2.17007 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Kleanthis Theodoropoulos ◽

Jennifer Yu ◽

Melisssa Aquino ◽

Usman Baber ◽

Swathi Roy ◽

...

Keyword(s):

Myocardial Infarction ◽

Percutaneous Coronary Intervention ◽

Clinical Outcomes ◽

Coronary Intervention ◽

Bleeding Complications ◽

Major Adverse Cardiovascular Events ◽

Complication Rates ◽

Coronary Syndrome ◽

Percutaneous Coronary ◽

Gender Based

Introduction: Women experience higher complication rates and mortality after PCI than men but it remains unknown whether these differences are sustained among younger and older patients. Hypothesis/Objectives: To investigate if previously reported gender-based disparities in outcome following percutaneous coronary intervention (PCI) are modified by age in a large and racially-diverse cohort in the drug eluting stent (DES) era. Methods: A total of 23,400 patients (7942 female, 34%) underwent PCI of de novo lesion(s) from 01/2005 to 12/2012 at Mount Sinai Hospital. We compared demographics, procedural characteristics, and 1-year rates of death, myocardial infarction, and major adverse cardiovascular events (MACE), by sex in younger (≤65 years old, n=11,381) and older (>65 years old, n= 12,019) patients. Results: Regardless of age, compared to males, females had higher body mass index (BMI), better renal function, smoked less, but were more hypertensive and diabetic. Women had higher HDL and LDL cholesterol levels. More women presented with an unstable coronary syndrome and required left anterior descending artery PCI. Women had more vascular and bleeding complications post-PCI but the 30-day readmission rate did not differ between genders within age groups. At 1 year women, in both age categories, were at higher risk for death or myocardial infarction than men. Among younger patients, women had more MACE than men, but formal interaction testing was negative (Figure). Conclusion: Females undergoing PCI have more comorbidities and are at higher risk for unfavorable outcomes than males. The substantial gender-based differences in clinical outcomes following PCI were independent of age suggesting that preventive strategies should be promoted amongst women.

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Association between cytochrome P450 2C19 polymorphism and clinical outcomes in clopidogrel-treated Uygur population with acute coronary syndrome: a retrospective study

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-02201-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Luhai Yu ◽

Tingting Wang ◽

Huidong Bai ◽

Weijiang Zhu ◽

Yanju Li ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Outcomes ◽

Genetic Polymorphisms ◽

Cardiovascular Events ◽

Minority Groups ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Uygur Population

Abstract Background Acute coronary syndrome (ACS) has become a vital disease with high mortality in the Uygur populations. Clopidogrel plays an important role in reducing the risk of recurrent cardiovascular events after ACS; however, it is a prodrug that requires biotransformation by cytochrome P450 (CYP450). Objectives To determine the effect of genetic polymorphisms in CYP2C19*2, *3, and *17, and along with clinical, demographic factors, on variation in response to clinical outcomes in Uygur patients. Methods A total of 351 patients with ACS were treated with clopidogrel and aspirin for at least 12 months; we recorded major adverse cardiovascular events (MACE) or bleeding within 1 year. Multivariable logistic regression analyses were carried out to identify factors associated with MACE or bleeding. Results We analyze risk factors include age, BMI (body mass index), smoking, alcohol intake, NSTEMI (non-ST-segment elevation myocardial infarction), hypertension, dyslipidemia, concomitant medication, CYP2C19*2 carriers, CYP2C19*17 carriers and metabolizer phenotype. CYP2C19*2 carriers had an odds of having MACE of 2.51 (95% CI: 1.534–4.09) compared with noncarriers (P < .001). However, no factors were significantly associated with bleeding (P > 0.05). Conclusion The CYP2C19*2 gene polymorphism contributes to the risk of MACE in dual clopidogrel—treated Uygur population with ACS with or without PCI (percutaneous coronary intervention). These data may provide valuable insights into the genetic polymorphisms affecting clopidogrel metabolism among minority groups in China.

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Prognostic Significance of Relative Hyperglycemia after Percutaneous Coronary Intervention in Patients with and without Recognized Diabetes

Current Vascular Pharmacology ◽

10.2174/1570161118666200317145540 ◽

2020 ◽

Vol 19 (1) ◽

pp. 91-101 ◽

Cited By ~ 1

Author(s):

Qi Zhao ◽

Ting-Yu Zhang ◽

Yu-Jing Cheng ◽

Yue Ma ◽

Ying-Kai Xu ◽

...

Keyword(s):

Prognostic Significance ◽

Coronary Intervention ◽

Major Adverse Cardiovascular Events ◽

St Segment Elevation ◽

Glycemic Level ◽

Prognostic Effect ◽

Coronary Syndrome ◽

St Segment ◽

Diabetic Population ◽

Shape Curve

Background: The research on the association between the relative glycemic level postpercutaneous coronary intervention (PCI) and adverse prognosis in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients is relatively inadequate. Objective: The study aimed to identify whether the glycemic level post-PCI predicts adverse prognosis in NSTE-ACS patients. Methods: Patients (n=2465) admitted with NSTE-ACS who underwent PCI were enrolled. The relative glycemic level post-procedure was calculated as blood glucose level post-PCI divided by HbA1c level, which was named post-procedural glycemic index (PGI). The primary observational outcome of this study was major adverse cardiovascular events (MACE) [defined as a composite of all-cause death, non-fatal myocardial infarction (MI) and any revascularization]. Results: The association between PGI and MACE rate is presented as a U-shape curve. Higher PGIs [hazard ratio (HR): 1.669 (95% confidence interval (CI): 1.244-2.238) for the third quartile (Q3) and 2.076 (1.566-2.753) for the fourth quartile (Q4), p<0.001], adjusted for confounding factors, were considered to be one of the independent predictors of MACE. The association between the PGI and the risk of MACE was more prominent in the non-diabetic population [HR (95%CI) of 2.356 (1.456-3.812) for Q3 and 3.628 (2.265-5.812) for Q4, p<0.001]. There were no significant differences in MACE risk between PGI groups in the diabetic population. Conclusion: Higher PGI was a significant and independent predictor of MACE in NSTE-ACS patients treated with PCI. The prognostic effect of the PGI is more remarkable in subsets without pre-existing diabetes than in the overall population. The predictive value of PGI was not identified in the subgroup with diabetes.

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