scholarly journals TEN-YEAR STATIN ADHERENCE IN SURVIVORS OF ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: INSIGHTS FROM THE AMI-QUEBEC STUDY

2018 ◽  
Vol 25 (2) ◽  
pp. e63-e77
Author(s):  
T Huynh ◽  
P Lecca ◽  
M Montigny ◽  
R Gagnon ◽  
M Eisenberg ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Statin Adherence ◽  
Optimal Adherence ◽  
Over Time

Background Adherence to statins is often sub-optimal and declines over time. Direct costs incurred by patients are often cited as responsible for inadequate statin adherence. To determine whether patients with ST-segment elevation myocardial infarction (STEMI) who benefit from low or no-cost drug dispensation have optimal long-term adherence to statins, we aimed to evaluate 10-year adherence to statin in a cohort of STEMI survivors. Methods The AMI-QUEBEC Study follows a cohort of STEMI patients hospitalized at 17 hospitals in Quebec, Canada during the year 2003. We obtained 10-year data on lipid lowering therapy (LLT) consumption in STEMI survivors with drug coverage by the Quebec Provincial Health Board (i.e., Régie de l’Assurance Maladie du Québec – RAMQ). Optimal adherence was defined as the proportion of days covered (PDC) of ≥80%. We used multivariate logistic regression to determine factors independently associated with optimal adherence to statins. Results Complete 10-year data on statin dispensation was available for 524 patients. Optimal adherence remained stable over time at 80% and more during the 10-year follow-up period. During the last 5 years, despite being STEMI patients at very high-risk and therefore requiring some LLT therapy, 12% of patients did not use any LLT. Patients between the age of 60 and 80 years had the most optimal PDC. Older age (up to 80 years), living in less socially deprived areas, concomitant use of angiotensin-converting-enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB), and admission to percutaneous coronary interventions (PCI)-hospitals were associated with improved statin adherence. Conclusion Future studies are needed to explore the potential factors associated with concomitant use of ACEI/ARB, and admission to PCI-hospitals that may have optimized statin adherence. As for socially deprived patients (single, widow, single-parent family member, and those who lived alone), they may benefit from more support and encouragement to enhance their long-term statin adherence.

Aggressive lipid lowering therapy with pitavastatin and ezetimibe improve cardiovascular outcomes in patients with ST segment elevation myocardial infarction: insights from the HIJ-PROPER Study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Otsuki ◽  
H Arashi ◽  
M Nakazawa ◽  
Y Inagaki ◽  
S Ebihara ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Lowering Therapy ◽  
St Segment

Abstract Aims The purpose of this study was to evaluate the effect of aggressive lipid-lowering therapy with pitavastatin and ezetimibe in patients with ST-segment elevation myocardial infarction (STEMI) as compared with those with other classification of an acute coronary syndrome (ACS) including non-STEMI (NSTEMI) and unstable angina pectoris (UA). Methods This is a post hoc sub-analysis of the HIJ-PROPER study. In the original study, ACS patients with dyslipidemia were randomized to either pitavastatin + ezetimibe therapy or pitavastatin monotherapy. In the present analysis, we divided HIJ-PROPER participants into the STEMI group (n=880) and NSTEMI + UA group (n=841). Cardiovascular events were analyzed between the two groups. The primary endpoint was a composite of major advanced cardiovascular events (MACE; all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina pectoris, and ischemia-driven revascularization) Result During median follow-up period of 3.4 years, the cumulative incidence of the primary endpoint in STEMI group was 31.9% in the pitavastatin+ezetimibe therapy, compared with 39.7% in the pitavastatin-monotherapy (HR, 0.77; 95% CI, 0.62–0.97; p=0.02). However, there was no effect of pitavastatin+ezetimibe therapy on the primary endpoint in the NSTEMI + UA group. Concerning the individual components of the primary endpoint in STEMI group, the percentage of occurrence of all-cause death was significantly lower in the pitavastatin+ezetimibe therapy compared to pitavastatin mono-therapy (14 patients (3.2%) vs. 31 patients (6.9%), respectively; HR, 0.45; 95% CI, 0.23–1.84, p=0.01). Multivariate analysis revealed that use of ezetimibe and prevalence of diabetes mellitus at baseline were independent predictors of primary endpoints in STEMI group (HR, 0.79; 95% CI, 0.63–0.99; p=0.04 for use of ezetimibe, HR 1.54; 95% CI, 1.22–1.94, p=0.0003 for diabetes mellitus). Conclusion Patients with pitavastatin+ezetimibe therapy as compared with pitavastatin-monotherapy had lower cardiovascular event in patients with ST-segment elevation myocardial infarction. Kaplan-Meier curves for primary endpoint Funding Acknowledgement Type of funding source: None

Hospital and long-term prognosis of patients with non-ST-segment elevation myocardial infarction

2008 ◽  
Vol 149 (45) ◽  
pp. 2115-2119 ◽  
Author(s):  
András Jánosi ◽  
Dániel Várnai ◽  
Zsófia Ádám ◽  
Adrienn Surman ◽  
Katalin Vas
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Long Term Prognosis

A szerzők 139, nem ST-elevációs infarktus miatt kezelt betegük adatait elemzik. Vizsgálják a betegek kórházi és késői prognózisát, egyes echokardiográfiás adatok prognózissal való összefüggését, valamint a kórházból elbocsátott betegek esetén a szekunder prevenció szempontjából ajánlott gyógyszeres kezelés gyakoriságát. Az utánkövetés a betegek 98%-ában sikeres volt, a bekövetkezett eseményekről, illetve az utánkövetés idején alkalmazott gyógyszeres kezelésről postai kérdőív útján szereztek adatokat. A nők átlagéletkora 78,6, a férfiaké 71,4 év volt. A kezelt betegeknél gyakori volt a társbetegségek (hypertonia, diabetes mellitus, korábbi ischaemiás szívbetegség) előfordulása. A kórházi kezelés időszakában 30 betegnél (22%) történt koronarográfia, és 29 betegnél revascularisatiós beavatkozásra is sor került. A kórházi halálozás 15% volt, az utánkövetés háromnegyed éve alatt 17%-os halálozást észleltek. A kórházban, illetve az utánkövetési idő alatt meghalt betegek szignifikánsan idősebbek voltak azoknál, akik életben maradtak. Egyes echokardiográfiás adatok (ejekciós frakció, végszisztolés átmérő, szegmentális falmozgászavar és a mitralis insufficientia nagysága) prognosztikus jelentőségűnek bizonyultak, mivel szignifikánsan különböztek az életben maradt és a meghalt betegek esetén. A kórházból elbocsátott betegek igen magas arányban részesültek a másodlagos prevenció szempontjából fontosnak ítélt gyógyszeres kezelésben (aszpirin, béta-blokkoló, ACE-gátló, statin). Az utánkövetés idején sem csökkent ezen gyógyszerek használatának aránya, ami a betegek jó compliance-ét igazolja.

Patient survival after acute myocardial infarction treated with primary percutaneous coronary intervention within the left main coronary artery according to time of admission

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Januszek ◽  
K Bujak ◽  
M Gasior ◽  
D Dudek ◽  
S Bartus
Keyword(s):  
Myocardial Infarction ◽  
Left Main Coronary Artery ◽  
Left Main ◽  
Night Time ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Coronary Syndromes ◽  
Overall Mortality

Abstract Background Previously published studies assessing the time effect of primary percutaneous intervention (PCI) on long-term clinical outcomes in an overall group of patients with acute coronary syndromes has been widely investigated. It has been suggested that night-time admission may negatively influence long-term overall mortality. Patients treated within the left main coronary artery (LMCA) belong a narrow group of high-risk procedures that require an operator and a team with high skills. Purpose The aim of the presented study was to assess the relationship between the time of pPCI (day- vs. night-time) and overall mortality among patients treated due to AMI within the LMCA. Methods This observational study was performed on 443,805 patients hospitalised due to non-ST segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI). Patients were prospectively enrolled between January 2006 and December 2018 in the ongoing Polish Registry of Acute Coronary Syndromes (PL-ACS). From the overall group of patients, the authors selected 5,404 patients treated within the LMCA. After taking exclusion criteria into consideration, the patients were divided according to time of PCI treatment: daytime hours (7:00 a.m.-10:59 p.m.) – 2,809 patients and night-time hours (11:00 p.m. - 6.59 a.m.) – 473 patients. Results Patients treated during night-time and daytime did not differ significantly in age (70.79 [61.52–79.73] vs. 69.73 [60.8–78.82] years, p=0.13) or gender – males (67.6% vs. 67.0%, p=0.79). Patients treated during daytime presented with significantly higher rate of STEMIs (67.2% vs. 49.9%) and lower rate of NSTEMIs (32.8% vs. 50.1%) in comparison to those treated during night-time (p<0.001). The 30-day and 12-month overall mortality rates were significantly greater among patients treated during night-time hours (20.3% vs. 14.9%, p=0.003) and (31.7% vs. 26.2%, p=0.001). Kaplan-Maier survival curves confirmed this relationship (p=0.001). Multiple regression analysis did not confirm that the time of pPCI (day- vs. night-time) is significantly related to survival (hazard ratio [HR]: 1.22; 95% confidence interval [CI]: 0.96–1.55, p=0.099). However, significance was achieved for the left ventricle ejection fraction (HR: 0.95; 95% CI: 0.94–0.95, p<0.001), systolic blood pressure on admission (HR: 0.995; 95% CI: 0.991–0.998, p=0.005), age (HR: 1.04; 95% CI: 1.03–1.05, p<0.001), the use of intra-aortic balloon counterpulsation (HR: 1.04; 95% CI: 1.03–1.05, p<0.001) and diagnosed peripheral artery disease (HR: 1.55; 95% CI: 1.2–2.01, p<0.001). Conclusions The time of pPCI (day- vs. night-time) in patients with AMI and treated within the LMCA is related to the overall 30-day and 12-month survival which is poorer in those treated during the night-time. However, this relationship was not confirmed by multiple regression analysis and was not found to be significant among other stronger predictors. Funding Acknowledgement Type of funding source: None

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