scholarly journals Treatment Outcomes of Clopidogrel in Patients With ACS and Diabetes Undergoing PCI-analysis of Beijing Medicare Database

2020 ◽  
Author(s):  
Weihao Wang ◽  
Xiaoxia Wang ◽  
Lina Zhang ◽  
Jie Zhang ◽  
Fuli Man ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Large Scale ◽  
Coronary Intervention ◽  
Chinese Patients ◽  
Increased Risk ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
One Year ◽  
Medicare Database

Abstract Background There are several clinical trials that proved the efficacy of clopidogrel treatment for patients with percutaneous coronary intervention. There are few large-scale research to explore the mortality associated with different duration use of clopidogrel in patients with diabetes and ACS undergoing PCI in the Chinese population. Objectives The objective of this analysis was to determine the efficacy of long-term clopidogrel therapy(≥ 12 months) versus short-term use(< 12 months) in Chinese patients with diabetes after PCI. Methods Using the Beijing Medicare database provided by Beijing Medical Security Bureau. The Beijing Medicare database contains medical data of about 16 million people, including about 990,000 patients with diabetes and a history of taking antidiabetic medicines. Patients were divided into two groups, one group of 9,116 patients receiving consecutive clopidogrel for one year or more, and another group of 3290 patients receiving consecutive clopidogrel less than one year. The primary of this analysis was the risk of all-cause death, myocardial infarction and revascularization. Results In patients with diabetes after PCI, long-term clopidogrel treatment was associated with a reduced risk of all-cause death(HR, 0.57[95%CI, 0.49–0.67], P < 0.0001), myocardial infarction(HR, 0.79[95%CI, 0.68–0.93], P = 0.0035) and an increased risk of angina(HR, 1.18[95%CI, 1.10–1.27], P < 0.0001]) and revascularization(HR, 1.07[95%CI, 1.01–1.13], P = 0.02]). There was no significant difference in the incidence of all-cause re-hospitalization(P = 0.7529), diabetes-related re-hospitalization and cerebrovascular re-hospitalization. Conclusion The present study concluded that long-term dual anti-platelet therapy including clopidogrel and aspirin could decrease the risks of all-cause death, myocardial infarction. But it could increase the risks of angina and revascularization. Further studies should interpret the cause of this question.

scholarly journals Treatment and Prognosis of Myocardial Infarction Outside Cardiology Departments

2020 ◽  
Vol 10 (1) ◽  
pp. 106
Author(s):  
Anton Gard ◽  
Bertil Lindahl ◽  
Nermin Hadziosmanovic ◽  
Tomasz Baron
Keyword(s):  
Myocardial Infarction ◽  
Coronary Intervention ◽  
Cardiology Department ◽  
Percutaneous Coronary ◽  
All Cause Mortality ◽  
Short And Long Term ◽  
Long Term Prognosis ◽  
One Year

Aim: Our aim was to investigate the characteristics, treatment and prognosis of patients with myocardial infarction (MI) treated outside a cardiology department (CD), compared with MI patients treated at a CD. Methods: A cohort of 1310 patients diagnosed with MI at eight Swedish hospitals in 2011 were included in this observational study. Patients were followed regarding all-cause mortality until 2018. Results: A total of 235 patients, exclusively treated outside CDs, were identified. These patients had more non-cardiac comorbidities, were older (mean age 83.7 vs. 73.1 years) and had less often type 1 MIs (33.2% vs. 74.2%), in comparison with the CD patients. Advanced age and an absence of chest pain were the strongest predictors of non-CD care. Only 3.8% of non-CD patients were investigated with coronary angiography and they were also prescribed secondary preventive pharmacological treatments to a lesser degree, with only 32.3% having statin therapy at discharge. The all-cause mortality was higher in non-CD patients, also after adjustment for baseline parameters, both at 30 days (hazard ratio (HR) 2.28; 95% confidence interval (CI) 1.62–3.22), one year (HR 1.82; 95% CI 1.39–2.36) and five years (HR 1.62; 95% CI 1.32–1.98). Conclusions: MI treatment outside CDs is associated with an adverse short- and long-term prognosis. An improved use of percutaneous coronary intervention (PCI) and secondary preventive pharmacological treatment might improve the long-term prognosis in these patients.

6110OCT guidance during primary PCI may increase long-term risk of device oriented events: subanalysis of ROBUST study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Jakl ◽  
P Cervinka ◽  
P Kala ◽  
J Kanovsky ◽  
A Kupec ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Stent Implantation ◽  
Statistical Power ◽  
Imaging System ◽  
Coronary Intervention ◽  
Study Groups ◽  
Cardiovascular Death ◽  
Increased Risk

Abstract Background Optical coherence tomography (OCT) guidance in primary percutaneous coronary intervention (pPCI) is expected to be safe in short and mid-term follow-up. Long term merits or risks of OCT guidance are unknown. Purpose To assess the possible merits of OCT guidance in pPCI in long-term follow-up. Methods 201 patients with ST-elevation myocardial infarction (STEMI) were enrolled in this study. Patients were randomized either to pPCI alone (angio-guided group, n=96) or to pPCI with OCT guidance (OCT-guided group, n=105) and also either to biolimus A9 or to everolimus-eluting stent implantation. The OCT study was performed after PCI with C7-XRTM intravascular imaging system employing a non-occlusive technique. Incidence of Device-oriented Composite Endpoints (DoCE) was compared in both study groups. DoCE were defined as composite of definite or possible cardiovascular death, myocardial infarction and target vessel revascularization. The search for DoCE was performed by means of medical check-ups, repeated telephone contacts, analysis of medical records and search in national population registry. Results Mean follow-up was 6.5 (6.5–7.1 years). Of these patients, 2 (1.0%) patients died of cardiovascular reason, 4 patients (2%) suffered myocardial infarction and 7 (3.5%) patients underwent target lesion revascularization. In OCT guided group, number of stents per patient was higher (1.4 vs. 1.2, p=0.03). Risk of DoCE was significantly higher in OCT-guided group (7.6% vs. 2.1%, p=0.023). Event-free survival in study groups Conclusion Our data suggest increased risk of adverse events related to OCT guided tailoring of stent implantation performed after pPCI. These findings should be confirmed by further randomised trials with higher statistical power. Acknowledgement/Funding The work was supported by a long-term organization development plan 1011 (FMHS)

scholarly journals Predictive Value of N-Terminal Prohormone of Brain Natriuretic Peptide in Long-Term Remodeling of the Left Ventricle in Diabetic Patients of Young and Middle Age With Acute Coronary Syndrome After Percutaneous Coronary Intervention

2021 ◽  
Vol 9 (4) ◽  
pp. 511-520
Author(s):  
Z. Wang ◽  
E. A. Asaphyeva ◽  
T. I. Makeeva
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Middle Age ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patients With Diabetes ◽  
Long Term Prognosis

Abstract. Recently, quantitative analysis of the level of the N-terminal prohormone of the brain naturetic peptide (NT-proBNP) has been widely used to diagnose heart failure (HF). A statistically significant correlation was found between the serum NT-proBNP concentration and HF stage. It was found that in patients with high cardiovascular risk, NT-proBNP has the highest predictive value in relation to mortality. In young and middle-aged patients with diabetes mellitus (DM) with myocardial infarction (MI) and stents of an infarct-associated artery, the frequency of unfavorable remodeling (UR) of the left ventricle (LV) in the long-term prognosis was studied. The frequency of atherosclerotic lesions of the coronary arteries (CA) in patients with diabetes in acute coronary syndrome (ACS) was determined, the results of echocardiographic parameters were presented in the follow-up dynamics, the value of serum NT-proBNP in predicting LV UR 12 months after myocardial infarction (MI) was determined.Aim of study. To assess the diagnostic capabilities of NT-proBNP in the long-term prediction of the development of LV infarction in patients with MI with diabetes in young and middle age after percutaneous coronary intervention (PCI).Design. Prospective controlled non-randomized trial. The patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months after AMI. The study included 191 patients with ACS with / without ST-segment elevation, who were divided into two groups. The main group included 76 patients with ACS with diabetes mellitus, the comparison group included 115 patients with ACS without diabetes mellitus. Patients in both groups were comparable in age, gender, comorbidity, and complications of AMI. The duration of diabetes was, on average, 6 years (from one to 12 years).Material and methods. All patients underwent electrocardiography, echocardiography, tests for the content of troponin I, NT-proBNP, glycosylated hemoglobin, lipids, determined the level of creatinine in the blood and the glomerular filtration rate according to the Modification of diet in renal disease (MDRD). All patients were examined twice: on the first day of ACS after PCI with stenting of infarct-associated coronary artery and 12 months later.Results. In 69% of diabetic patients with anterior myocardial infarction and in 63% of patients with posterolateral MI 12 months after PCI, signs of LV inferiority were revealed in the form of an increase in the indices of end-diastolic and systolic volumes of the LV and low ejection fraction (≤45%). In patients without diabetes, these figures were 18% and 31%, respectively. High concentrations of NT-proBNP on the first day of myocardial infarction after PCI were of the greatest value in the diagnosis and prognosis of LV UR after 12 months.Conclusion. The NT-proBNP level of more than 776 pg/ml on the first day after PCI is an indicator of an unfavorable long-term prognosis in patients with young and middle-aged diabetes in terms of the development of LV systolic dysfunction.

scholarly journals Acute Occlusion of the Infarct-Related Artery as a Predictor of Very Long-Term Mortality in Patients with Acute Myocardial Infarction

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Nikola Kos ◽  
Ivan Zeljković ◽  
Tomislav Krčmar ◽  
Karlo Golubić ◽  
Fran Šaler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Coronary Intervention ◽  
Long Term Outcomes ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Significant Difference ◽  
Infarct Related Artery ◽  
Long Term Mortality

Aim. The survey’s aim was to examine the significance of infarct-related artery (IRA) occlusion (verified angiographically) on very long-term outcomes of patients with acute myocardial infarction, within the STEMI and NSTEMI diagnosis. Methods. A single-center, nonrandomized, registry-based study on patients treated for acute coronary syndrome with percutaneous coronary intervention between June 2011 and December 2016 was conducted. Patients with angiographically proven IRA occlusion (100% stenosis with TIMI flow 0 distal to occlusion) were categorized as occlusive myocardial infarction (OMI) and patients with patent IRA (50–99% stenosis with TIMI 1–3 flow) were categorized as nonocclusive myocardial infarction (NOMI) and very long-term outcomes were analyzed. Data were collected prospectively from the hospital’s PCI registry and the database of the Croatian Institute of Public Health. Results. A total of 2450 patients were included in the study. 796 (32.5%) patients had NOMI and 1654 patients (67.5%) had OMI. According to ECG changes, 1534 patients presented with STEMI (62,6%) and 916 with NSTEMI (37,8%). 88% of STEMI patients presented with OMI and 12% with NOMI, while patients with NSTEMI in 33,8% presented with OMI and in 66,81% with NOMI. A median follow-up was 4.7 years. There was no significant difference in cardiovascular mortality between the groups (14.8% vs 13.1%; OMI vs NOMI, respectively; p = 0.374 ) neither in all-cause mortality (19% vs 21.5%; OMI vs NOMI, respectively; p = 0.374 ). Patients with NSTEMI had a significantly higher very long-term mortality (21.6% vs 18.1%; NSTEMI vs STEMI, respectively; p = 0.029 ). Conclusion. The main findings of the study are as follows: (1) total IRA occlusion was not associated with higher long-term mortality; (2) NSTEMI was associated with a higher mortality rate compared with STEMI, independent of angiographic presentation (OMI/NOMI); (3) IRA occlusion was not associated with significantly higher mortality rates in patients with STEMI and NSTEMI, respectively.

scholarly journals Angiographic Complete versus Clinical Selective Incomplete Percutaneous Revascularization in Heart Failure Patients with Multivessel Coronary Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Chieh-Yu Chang ◽  
Chun-Chi Chen ◽  
I-Chang Hsieh ◽  
Ming-Jer Hsieh ◽  
Cheng-Hung Lee ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Intervention ◽  
Complete Revascularization ◽  
Cardiac Events ◽  
Long Term Outcomes ◽  
Increased Risk ◽  
Significant Difference ◽  
Incomplete Revascularization ◽  
Percutaneous Revascularization

Background. Patients with multivessel disease (MVD) often pursue complete revascularization (CR) during percutaneous coronary intervention (PCI) to improve prognosis. However, angiographic CR is not always feasible and is associated with some procedure-related complications in heart failure (HF) patients with MVD. Clinical selective incomplete revascularization (IR) may be reasonable for these high-risk patients, but its role in long-term outcomes remains uncertain. Methods. Six hundred patients with HF and MVD submitted to PCI were enrolled. Major adverse cardiac events (MACEs) were defined as a composite of recurrent myocardial infarction, any revascularization, and all-cause mortality at 5 years. Results. During a mean follow-up period of 3.7 ± 1.9 years, there was no significant difference in 5-year MACEs between selective IR and successful angiographic CR in HF patients with MVD. However, patients who failed CR had a significantly greater incidence of 5-year MACEs than those in the other two groups (failed CR: 46.4% vs. selective IR: 27.7% vs. successful CR: 27.8%, p<0.001). Conclusions. Long-term outcomes of selective IR were comparable with those of successful angiographic CR in HF patients with MVD. However, patients that failed CR showed 2.53-fold increased risk of MACEs compared to patients undergoing either selective IR or successful angiographic CR. A more comprehensive planning strategy should be devised before PCI in HF patients with MVD.

scholarly journals Survival Benefit of the Late Percutaneous Coronary Intervention in the Patients after Acute Myocardial Infarction Who Are Or Who Are Not Treated with Thrombolysis

2009 ◽  
Vol 9 (1) ◽  
pp. 54-58
Author(s):  
Božidarka Knežević ◽  
Nebojša Bulatović ◽  
Nataša Belada ◽  
Vesna Ivanović ◽  
Siniša Dragnić ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Percutaneous Coronary ◽  
One Year ◽  
The Impact

The impact of late percutaneous coronary intervention (PCI) in the patients after acute myocardial infarction (AMI) on long term mortality remains to be established. At currently, thrombolysis is accepted as standard therapy when PCI is not immediately available. However, PCI is often performed in stable patients with AMI who are/are not received thrombolysis .We performed the trial that enrolled myocardial infarction patients treated with thrombolysis, late PCI and medically to assess the potential benefits of delayed PCI. We follow up 164 consecutive patients after AMI one year. The patients are divided in two groups; first group-66 patients who received reperfusion (37 patients received only thrombolysis, 10 patients received thrombolysis and PCI 7-9 days after thrombolysis and 19 patients underwent only PCI after 7-9 days) and second group-98 patients medically treated. One year mortality was 3% in the reperfusion group (2/66) and 14,3% in the medical group (14/98) (p=0,016). There were not significant differences between groups about other end points-reinfarctus, coronary artery bypass surgery and PCI performed later after discharge. The major predictors of one year mortality were ages (p<0,001) and ejection fraction (p=0,003). Also, therapy with beta-blockers (p=0,002), statins (p=0,001) and ACE-inhibitors (p=0,024) was associated with better survival. Delayed PCI performed 7-9 days after AMI in the patients who underwent thrombolysis or those did not improves outcome at long-term follow-up

Microparticles during long-term follow-up after acute myocardial infarction

2017 ◽  
Vol 117 (08) ◽  
pp. 1571-1581 ◽  
Author(s):  
Christina Christersson ◽  
Åsa Thulin ◽  
Agneta Siegbahn
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Whole Blood ◽  
Cardiovascular Events ◽  
Time Period ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Long Term Follow Up

SummaryMicroparticles (MPs) are formed from platelets (PMPs), endothelial cells (EMPs) and monocytes (MMPs), and in acute myocardial infarction (MI), there is an increase of MPs in the culprit artery. In this study MPs were evaluated in whole blood in 105 patients with MI at five time-points during a two-year follow-up (FU). Patients with non-ST-elevated MI had higher concentrations of CD41+MPs compared to ST-elevated MI patients (p=0.024). The concentrations of PMPs in whole blood increased during the time period (p<0.001), but no significant change over time was found for EMPs and MMPs. CD62P+MP counts were higher in MI patients with diabetes (p=0.020), and patients with hypertension had increased levels of CD14+MPs (p=0.004). The amount of CD62P+TF+MPs increased significantly during FU (p<0.001). Patients with atherosclerosis in three arterial beds, i. e. coronary, carotid and peripheral arteries, had lower concentrations of CD62P+TF+MPs (p=0.035) and CD144+TF+MPs (p=0.004) compared to patients with atherosclerosis in one or two arterial beds. Higher concentrations of CD62P+MPs early after MI were associated with an increased risk of cardiovascular events during FU, hazard ratio 3.32 (95%CI1.20–9.31). Only small variations in PMP, EMP and MMP concentrations were found during long-term FU after MI and their levels seem to reflect the underlying cardiovascular disease rather than the acute MI. PMPs expressing P-selectin might be a promising biomarker for predicting future cardiovascular events, but further studies are needed to confirm these results.Supplementary Material to this article is available online at www.thrombosis-online.com.

scholarly journals Changes over Time in Hemoglobin A1C (HbA1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus

2021 ◽  
Vol 10 (15) ◽  
pp. 3232
Author(s):  
Ygal Plakht ◽  
Harel Gilutz ◽  
Arthur Shiyovich
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hemoglobin A1c ◽  
Prognostic Significance ◽  
Diabetic Patients ◽  
Term Survival ◽  
Patients With Diabetes ◽  
One Year ◽  
Hba1c Levels

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA1C < 5.5–7% and ∆HbA1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C < 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p < 0.001). Additionally, ∆HbA1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <−2.5% and ≥2.5% ∆HbA1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p < 0.001). A rapid increase in HbA1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored.

scholarly journals Outcomes of Coronary Angioplasty in Diabetic Patients – A Retrospective Study

2016 ◽  
Vol 01 (02) ◽  
pp. 005-010
Author(s):  
Galla Kishore ◽  
Chandragiri Susmitha ◽  
P Rao
Keyword(s):  
Statistical Significance ◽  
Chronic Stable Angina ◽  
Coronary Intervention ◽  
Diabetic Patients ◽  
Coronary Syndrome ◽  
Major Cardiovascular Events ◽  
Number Of Patients ◽  
Significant Difference ◽  
Patients With Diabetes ◽  
One Year

AbstractAims: We want to study the effect of diabetes Mellitus (DM) on the outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) comparing those with non diabetics, with reference to gender.Methods: We retrospectively evaluated the consecutive patients undergoing PCI either with acute coronary syndrome (ACS) or chronic stable angina (CSA) in our institute between March 2014 to March 2015. We followed them up to one year for the major cardiovascular events (MACES) and other complications. We compared the rate of events between diabetic and non diabetic patients along with gender subgroups and tested for the significance.Results: In 645 patients undergone PCI in our institute, 326(50.5%) were diabetics, of them 104(31.9%) were females. Patients with diabetes with CAD were older with more incidence of hypertension and kidney derangement than non diabetics. History of CAD and previous procedure are definitely more in diabetics as is multi vessel disease (p=0.02) and LV dysfunction (p=0.003). Total number of patients presenting with complications within one year of PCI is 18(0.02%). Of them 14 are males and 4 are females, 14 were diabetics and 4 were non diabetics. There was no statistical significance in the outcomes between female & males (p=0.7), diabetics females & diabetic males (p=0.48) and non diabetics females & nondiabetic males(p=0.7). Male patients with diabetes had significantly more complications than non diabetic males (p=0.05) but there is no significant difference between diabetic and non diabetic females (p=0.59).Conclusion: Patients with DM undergoing PCI had more complications than non diabetics with significant difference between male diabetics and non diabetic males. This difference is not significant between diabetic and non diabetic females.

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