The Role of STEMI Communication Network with Major Adverse Cardiac Event Incidence in STEMI Patients Hospitalized in Saiful Anwar General Hospital Malang

Background : Patient with ST-Elevation Myocardial Infarction (STEMI) requires urgent reperfusion either with fibrinolytic or primary Percutaneous Coronary Intervention (PCI). In Malang, a communication network of STEMI has been developed. It connects Saiful Anwar General Hospital with all of the Public Health Centers (PHC) in Malang Raya to shorten system delay since 2015. Objective : To elucidate Malang’s communication network’s role in decreasing Major Adverse Cardiac Event (MACE) in STEMI patients. Methods : This is a retrospective cohort study. Study sample was taken from medical record. Non-network: 96 patients and 88 network patients. Statistical tests using SPSS version 20.0 software. Results : Bivariate analysis showed network-group has a significantly lower MACE (p=0.001). Door-to-balloon time was also lower in network-group (p=0.026). Multivariate analysis without confounder showed that network-group had significantly shorter door-to-reperfusion time (p=0.032) and lower MACE (p=0.035) compared to non-network group. But multivariate analysis with confounder door-to-balloon and door-to-needle failed to explain lower MACE incidence. Network-group (p=0.005) and reperfusion with primary PCI (p=0.05) significantly decreased MACE incidence. Conclusion : Malang’s STEMI communication network and reperfusion with primary PCI reduced MACE in STEMI patients in Saiful Anwar General Hospital Malang.

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A Retrospective Observational Study of Patients with Dilated Cardiomyopathy Undergoing Non-Cardiac Surgery

Anaesthesia and Intensive Care ◽

10.1177/0310057x1704500513 ◽

2017 ◽

Vol 45 (5) ◽

pp. 619-623

Author(s):

K. A. Cook ◽

P. A. MacIntyre ◽

J. R. McAlpine

Keyword(s):

Cardiovascular Disease ◽

Cardiac Surgery ◽

High Risk ◽

Dilated Cardiomyopathy ◽

Major Adverse Cardiac Event ◽

Cardiac Event ◽

Adverse Outcome ◽

Adverse Cardiac Event ◽

Low Risk ◽

Surgical Risk

The perioperative risks and factors associated with adverse cardiac outcomes in patients with dilated cardiomyopathy undergoing non-cardiac surgery are unknown. Interrogation of the Nelson Hospital transthoracic echocardiogram database identified 127 patients with dilated cardiomyopathy who satisfied the study criteria and underwent non-cardiac surgery between June 1999 and July 2013. Demographic and clinical data along with postoperative death within 30 days or a major adverse cardiac event were retrieved and analysed. The mean age was 75.9 years. Seventy-one percent of the patients had severe impairment of left ventricular function and 35% had a severely dilated left ventricle. A major adverse cardiac event occurred in 18.1% of patients and 5.5% of patients died within 30 days of surgery. Increased surgical risk and absence of cerebrovascular disease were associated with adverse outcome (P <0.001, P <0.05, respectively). Forty-three and a half percent (43.5%) of patients undergoing high-risk surgery had an adverse outcome compared to 36.1% and 5.9% for moderate and low-risk surgery, respectively. A major adverse cardiac event was observed in 26.7% of patients with cardiovascular disease compared to 9.8% of patients without cardiovascular disease. We were unable to exclude an influence of other potential risk factors due to the retrospective observational nature of the study. These findings highlight a potential increase in complications with moderate or high surgical risk, whilst are reassuring in demonstrating the relative safety of low-risk surgery in this group of high-risk patients.

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A COMPARISON OF THE HEART, TIMI AND GRACE SCORES IN THE PREDICTION OF A MAJOR ADVERSE CARDIAC EVENT (MACE) IN PATIENTS PRESENTING WITH UNDIFFERENTIATED CARDIAC CHEST PAIN: A PROSPECTIVE COHORT STUDY IN A UK POPULATION.

Emergency Medicine Journal ◽

10.1136/emermed-2016-206402.34 ◽

2016 ◽

Vol 33 (12) ◽

pp. 916.2-917 ◽

Cited By ~ 1

Author(s):

PD Reaney ◽

H Elliott ◽

J Cooper

Keyword(s):

Cohort Study ◽

Chest Pain ◽

Prospective Cohort Study ◽

Major Adverse Cardiac Event ◽

Prospective Cohort ◽

Cardiac Event ◽

Adverse Cardiac Event

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Acute Surgical Anemia Influences the Cardioprotective Effects of β-Blockade

Anesthesiology ◽

10.1097/aln.0b013e3181c5dd81 ◽

2010 ◽

Vol 112 (1) ◽

pp. 25-33 ◽

Cited By ~ 72

Author(s):

W Scott Beattie ◽

Duminda N. Wijeysundera ◽

Keyvan Karkouti ◽

Stuart McCluskey ◽

Gordon Tait ◽

...

Keyword(s):

Beta Blocker ◽

Major Adverse Cardiac Event ◽

Cardiac Event ◽

Propensity Scores ◽

Beta Blockers ◽

Adverse Cardiac Event ◽

Beta Blockade ◽

Cardiac Events ◽

Cardioprotective Effects ◽

The Relationship

Background Despite decreasing cardiac events, perioperative beta-blockade also increases perioperative stroke and mortality. Major bleeding and/or hypotension are independently associated with these outcomes. To investigate the hypothesis that beta-blockade limits the cardiac reserve to compensate for acute surgical anemia, the authors examined the relationship between cardiac events and acute surgical anemia in patients with and without beta-blockade. Methods The records of all noncardiac, nontransplant surgical patients between March 2005 and June 2006 were retrospectively retrieved. The primary outcome was a composite that comprised myocardial infarction, nonfatal cardiac arrest, and in-hospital mortality (major adverse cardiac event). The lowest recorded hemoglobin in the first 3 days defined nadir hemoglobin. Propensity scores estimating the probability of receiving a perioperative beta-blocker were used to match (1:1) patients who did or did not receive beta-blockers postoperatively. The relationship between nadir hemoglobin and major adverse cardiac event was then assessed. Results This analysis identified 4,387 patients in whom nadir hemoglobin could be calculated; 1,153 (26%) patients were administered beta-blockers within the first 24 h of surgery. Propensity scores created 827 matched pairs that were well balanced for all measured confounders. Major adverse cardiac event occurred in 54 (6.5%) beta-blocked patients and in 25 (3.0%) beta-blocker naive patients (relative risk 2.38; 95% CI 1.43-3.96; P = 0.0009). The restricted cubic spline relationship demonstrated that this difference was restricted to those patients in whom the hemoglobin decrease exceeded 35% of the baseline value. Conclusions beta-Blocked patients do not seem to tolerate surgical anemia when compared with patients who are naive to beta-blockers. Prospective studies are required to validate these findings.

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The Roles of Pentraxin-3 to Predict In-Hospital and Three Months Major Adverse Cardiac Event in Acute Myocardial Infarction

ACI (Acta Cardiologia Indonesiana) ◽

10.22146/jaci.v6i2.627 ◽

2020 ◽

Vol 6 (2) ◽

pp. 111-120

Author(s):

Adi Bestara ◽

Trisulo Wasyanto ◽

Niniek Purwaningtyas

Keyword(s):

Myocardial Infarction ◽

Major Adverse Cardiac Event ◽

Cardiac Event ◽

Vascular Inflammation ◽

Adverse Cardiac Event ◽

Pentraxin 3 ◽

Ptx3 Level ◽

St Elevation ◽

The Relationship

Background: Pentraxin-3 (PTX3) was a useful marker for localized vascular inflammation and damage in the cardiovascular system. Recent studies have shown that plasma PTX3 is elevated in patients with myocardial infarction; however, its prognostic value still remains unclear. Aims: This study aimed to investigate the relationship between PTX3 and in-hospital and three months of a major adverse cardiac event (MACE) in acute ST-elevation and non-ST-elevation myocardial infarction patients. Methods: This cohort study conducted from September 1st, 2018 to October 31st, 2019 in Dr. Moewardi Hospital. A 144 patient were observed during hospitalization and 130 survived patient were follow up for three months. The admission PTX3 was compared between the patient with and without MACE. Higher levels of PTX3 were defined as concentrations greater than the optimal cut-off value derived from the Receiver Operating Characteristic (ROC) curve. Results: Among patients, 43.75% was anterior STEMI, 35.42% was inferior STEMI, and 20.38% was NSTEMI with median PTX3 level was 8.16 (0.21-69.35) ng/mL. The in-hospital MACE occurred in 52% of patients, while three months of MACE occurred in 17% patient. Patients with MACE had a higher level of PTX3 compared without MACE (p<0.001) during hospitalization, but not in three months follow up (p=0.408). Multivariate analysis also shown PTX3 was as a predictor of in-hospital MACE (OR 1.127; p=0.001), along with heart rate (OR 1.025; p=0.015). There are different of in-hospital MACE between the patient with high (≥8.247 ng/mL) and low (<8.225 ng/mL) PTX3 level with a hazard ratio (HR) 2.142 (95%CI 1.315-3.487; p=0.002), but the result did not similar after three months follow up (p=0.373). Conclusion: The PTX3 can be used as a predictor of in-hospital MACE but not for three months follow up.

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Family History of Atrial Fibrillation and Risk of Cardiovascular Events

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.120.008477 ◽

2020 ◽

Vol 13 (9) ◽

Author(s):

Daniele Pastori ◽

Danilo Menichelli ◽

Gregory Y.H. Lip ◽

Angela Sciacqua ◽

Francesco Violi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Family History ◽

Cardiovascular Mortality ◽

Major Adverse Cardiac Event ◽

Cardiovascular Events ◽

Cardiac Event ◽

Hazard Ratio ◽

Adverse Cardiac Event ◽

Increased Risk ◽

History Of

Background: To investigate the association between family history of atrial fibrillation (AF) with cardiovascular events (CVEs), major adverse cardiac events (MACE), and cardiovascular mortality. Methods: Multicenter prospective observational cohort study including 1722 nonvalvular AF patients from February 2008 to August 2019 in Italy. Family history of AF was defined as the presence of AF in a first-degree relative: mother, father, sibling, or children. Primary outcome was a composite of CVEs including fatal/nonfatal ischemic stroke and myocardial infarction, and cardiovascular death. Second, we analyzed the association with major adverse cardiac event. Results: Mean age was 74.6±9.4 years; 44% of women. Family history of AF was detected in 368 (21.4%) patients, and 3.5% had ≥2 relatives affected by AF. Age of AF onset progressively decreased from patients without family history of AF, compared with those with single and multiple first-degree affected relatives ( P <0.001). During a mean follow-up of 23.7 months (4606 patients/y) 145 CVEs (3.15%/y), 98 major adverse cardiac event (2.13%/y), and 57 cardiovascular deaths (0.97%/y) occurred. After adjustment for cardiovascular risk factors, family history of AF was associated with a higher risk of CVEs (hazard ratio, 1.524 [95% CI, 1.021–2.274], P =0.039), major adverse cardiac event (hazard ratio, 1.917 [95% CI, 1.207–3.045], P =0.006), and cardiovascular mortality (hazard ratio, 2.008 [95% CI, 1.047–3.851], P =0.036). Subgroup analysis showed that this association was modified by age, sex, and prior ischemic heart disease. Conclusions: In a cohort of elderly patients with a high atherosclerotic burden, family history of AF is evident in >20% of patients and was associated with an increased risk for CVEs and mortality. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01882114.

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