The impact of complete atrioventricular block on in-hospital and long-term mortality in patients treated with primary percutaneous coronary intervention

Objective: To analyze the incidence and the prognostic impact of complete AV block on in-hospital and 6-year mortality in STEMI patients treated with pPCI. Method: Study included 3044 consecutive STEMI patients. Results: Complete AV block was registered only at admission in 144 (4.73%) patients; 125 (86.8%) patients with complete AV block had inferior infarction. Temporary pacemaker was implanted in 72 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9%vs3.6%, respectively, p<0.001. In patients with heart block and inferior infarction inhospital mortality was 13%, whereas in patients with heart block and anterior infarction inhospital mortality was 53%. When we analyzed patients who were discharged alive from the hospital, we also found significantly higher long-term (6-year) mortality rate in those with complete AV block vs patients without AV block: 7.8%v 3.4% respectively, p<0.001. Complete AV block was an independent predictor for in-hospital and 6-year mortality: inhospital mortality OR 2.94 95%CI 1.23-5.22; six year mortality HR 1.61, 95%CI 1.10- 2.37. When subanalysis was performed, in patients with inferior STEMI, complete AV block was an independent predictor of in-hospital and 6-year mortality, while in patients with anterior STEMI, complete AV block was an independent predictor of in-hospital mortality. Conclusion: In analyzed STEMI patients complete AV block was transitory and was registered only at hospital admission. Although transitory, complete AV block remained a strong independent predictor of in-hospital and long-term mortality.

Download Full-text

The impact of complete atrioventricular block on in-hospital and long-term mortality in patients with ST-elevation myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.125 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

L Savic ◽

I Mrdovic ◽

M Asanin ◽

G Krljanac

Keyword(s):

Heart Failure ◽

Hospital Mortality ◽

Heart Block ◽

Independent Predictor ◽

Av Block ◽

St Elevation ◽

Complete Atrioventricular ◽

Complete Av Block ◽

Long Term Mortality

Abstract Funding Acknowledgements Type of funding sources: None. Background/aim: Complete atrioventricular (AV) block is associated with worse in-hospital outcome in patients with ST-elevation myocardial infarction (STEMI), while whether it has an impact on long-term outcome is uncertain. The majority of previous studies that analyzed this issue are performed before introduction primary percutaneous coronary intervention (pPCI). The aim of this study was to analyse the incidence and the prognostic impact of complete AV block at admission on in-hospital and 6-year mortality in STEMI patients treated with pPCI. Method we analyzed 2863 consecutive STEMI patients without cardiogenic shock at admission. Clinical, laboratory and echocardiographic characteristics and prognosis were compared between patients with and without complete AV block at admission. Results Complete AV block at admission was registered in 134 (4.6%) patients; 117 (87.3%) patients with complete AV block had inferior infarction. In comparison without complete AV block, patients with complete AV block were older; they were more likely to have heart failure, lower blood pressure and lower creatinine clearance at admission, multi-vessel disease on initial coronary angiogram and lower pre-discharge left ventricular ejection fraction (EF). Temporary pacemaker was implanted in 68 (50%) patients with complete AV block. No patient underwent permanent pacemaker implantation. In-hospital mortality was significantly higher in patients with complete AV block than in patients without complete AV block: 17.9% vs 3.6%, respectively, p < 0.001. In patients with heart block and inferior infarction in-hospital mortality was 13%, whereas in patients with heart block and anterior infarction in-hospital mortality was 53%. When we analyze patients who were discharged alive from the hospital, we also find significantly higher long-term (6-year) mortality rate in those with complete AV block at admission vs patients without AV block: 7.8% vs 3.4% respectively, p < 0.001 (Figure 1). The causes of death in patients with complete AV block during long-term follow up were cardiovascular, e.g. sudden death, reinfarction or worsening of heart failure. In Cox regression model complete AV block was an independent predictor for in-hospital and 6-year mortality: in-hospital mortality HR 2.54 85%CI 1.93-5.22, p = 0.011; six year mortality HR 1.61, 95CI 1,09-2.37, p = 0.017. Other independent predictors for both short- and long-term mortality were age, heart failure at admission, lower creatinine clearance at admission, EF and post-procedural flow TIMI <3 thorugh infarct-related artery. Conclusion Complete AV block at admission is an independent predictor for in-hospital and long-term mortality in STEMI patients treated with primary PCI. Abstract Figure 1

Download Full-text

Long-term prognostic benefit of beta-blockers use after discharge in patients with Tako-Tsubo syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1817 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Jamhour-Chelh ◽

S Raposeiras-Roubin ◽

I Nunez-Gil ◽

E Abu-Assi ◽

D Aritza Conty ◽

...

Keyword(s):

Large Scale ◽

Beta Blockers ◽

Funding Source ◽

Prognostic Impact ◽

Private Company ◽

Cox Analysis ◽

The Impact ◽

Long Term Mortality

Abstract Background Tako-tsubo Syndrome (TS) seems to be associated with a catecholamine-mediated mechanism. However, the impact of beta-blockers (BB) in-hospital and after discharge still remain uncertain. Objectives: The purpose of the study was to examine whether BB use after discharge in patients with TS, was associated with lower long-term mortality and recurrence. Methods Using a national multicentre large-scale inpatient database (RETAKO Registry), we analysed patients with a definitive TS diagnosis. Results A total of 970 patients were analysed (568 with BB therapy and 402 no-BB therapy). After discharge and over a median of follow-up of 1.1 years, treatment with BB have no shown prognostic effectiveness in terms of mortality and TS recurrence in unadjusted and adjusted Cox analysis (HR 0.86; 95% CI: 0.59 to 1.27; and 0.95; 95% CI: 0.57–1.13, respectively). Conclusions This data suggests that use of beta-blockers after hospital discharge has not shown long-term prognostic benefit in patients with Tako-tsubo Syndrome. Prognostic impact of BB in TS. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Retako webpage was funded by a non-conditioned Astrazeneca scholarship.

Download Full-text

De-Ritis Ratio Improves Long-Term Risk Prediction after Acute Myocardial Infarction

Journal of Clinical Medicine ◽

10.3390/jcm7120474 ◽

2018 ◽

Vol 7 (12) ◽

pp. 474 ◽

Cited By ~ 3

Author(s):

Matthias Steininger ◽

Max-Paul Winter ◽

Thomas Reiberger ◽

Lorenz Koller ◽

Feras El-Hamid ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cox Regression ◽

Independent Predictor ◽

Troponin T ◽

Hazard Analysis ◽

Entire Study ◽

The Impact ◽

Long Term Mortality

Background: Recent evidence suggested levels of aspartate aminotransferase (AST), alanine transaminase (ALT), and AST/ALT ratio (De-Ritis ratio) were associated with a worse outcome after acute myocardial infarction (AMI). However, their value for predicting long-term prognosis remained unknown. Therefore, we investigated the prognostic potential of transaminases on patient outcome after AMI from a long-term perspective. Methods: Data of a large AMI registry including 1355 consecutive patients were analyzed. The Cox regression hazard analysis was used to assess the impact of transaminases and the De-Ritis ratio on long-term mortality. Results: The median De-Ritis ratio for the entire study population was 1.5 (interquartile range [IQR]: 1.0–2.6). After a median follow-up time of 8.6 years, we found that AST (crude hazard ratio (HR) of 1.19 per 1-SD [95% confidence interval (CI): 1 .09–1.32; p < 0.001]) and De-Ritis ratio (crude HR of 1.31 per 1-SD [95% CI: 1.18–1.44; p < 0.001]), but not ALT (p = 0.827), were significantly associated with long-term mortality after AMI. After adjustment for confounders independently, the De-Ritis ratio remained a strong and independent predictor for long-term mortality in the multivariate model with an adjusted HR of 1.23 per 1-SD (95% CI: 1.07–1.42; p = 0.004). Moreover, the De-Ritis ratio added prognostic value beyond N-terminal pro-B-Type Natriuretic Peptide, Troponin T, and Creatine Kinase. Conclusion: The De-Ritis ratio is a strong and independent predictor for long-term mortality after AMI. As a readily available biomarker in clinical routine, it might be used to identify patients at risk for fatal cardiovascular events and help to optimize secondary prevention strategies after AMI.

Download Full-text

99 New onset atrial fibrillation in STEMI patients: main prognostic factors and clinical outcome

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Beatrice Dal Zotto ◽

Lucia Barbieri ◽

Gabriele Tumminello ◽

Massimo Saviano ◽

Domitilla Gentile ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hospital Mortality ◽

Independent Predictor ◽

Left Ventricular ◽

Left Ventricular Ejection ◽

Short And Long Term ◽

Long Term Mortality ◽

New Onset

Abstract The treatment of patients with known atrial fibrillation (AF) undergoing percutaneous coronary intervention has clear indications in the actual guidelines. Remarkable lack of evidence regarding new-onset AF (NOAF) in particular during STEMI is the reason for this study. We retrospectively analysed 1455 consecutive STEMI patients. The primary outcomes are in-hospital, 1-year and long-term follow-up mortality. Cerebral ischaemic events and major bleedings were considered clinical endpoints at 1 year. NOAF was detected in 102 subjects, 62.7% males, mean age 74.8 ± 10.6 years. Mean left ventricular ejection fraction (LVEF) was 43.5 ± 12.1% and left atrial enlargement (58 ± 20.9 ml) was observed. Anterior STEMI accounted for the majority (46%). NOAF has been predominantly recorded in the acute phase (mean duration of 8.1 ± 12.5 h). CHA2DS2-VASc score >2 was recorded in 83% of cases, while HAS-BLED score of 2 or 3 was the most represented. All patients acutely received enoxaparin, but only 21.6% were discharged on oral anticoagulation (OAC). In-hospital mortality was 14.2%, while 1-year and long-term mortality were 17.2% and 32.1%, respectively. We identified age as an independent predictor of short- and long-term mortality, while LVEF was the only other independent predictor for in-hospital mortality and arrhythmia duration for 1-year mortality. After 1-year of follow-up we recorded three ischaemic events and no major bleeding. In conclusion, STEMI patients who present NOAF are a very high-risk population with increased short- and long-term mortality. Our data suggest that the indication for OAC should be always driven by CHA2DS2-VASC and HAS-BLEED score, even in patients with a single episode indeed. 99 Figure 1Kaplan-Meier curve representing the long-term survival of the entire population from hospital admission up to the maximum follow-up time was performed

Download Full-text

Impact of telemedicine interventions on mortality in patients with acute myocardial infarction: a systematic review and meta-analysis

Heart ◽

10.1136/heartjnl-2018-314539 ◽

2019 ◽

Vol 105 (19) ◽

pp. 1479-1486 ◽

Cited By ~ 12

Author(s):

Milena Soriano Marcolino ◽

Luciana Marques Maia ◽

João Antonio Queiroz Oliveira ◽

Laura Defensor Ribeiro Melo ◽

Bruno Leonardo Duarte Pereira ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Usual Care ◽

Risk Of Bias ◽

Cochrane Central Register ◽

The Impact ◽

Quality Evidence ◽

Long Term Mortality

BackgroundDespite the promise of telemedicine to improve care for ischaemic heart disease, there are significant obstacles to implementation. Demonstrating improvement in patient-centred outcomes is important to support development of these innovative strategies.ObjectiveTo assess the impact of telemedicine interventions on mortality after acute myocardial infarction (AMI).MethodsArticles were searched in MEDLINE, Cochrane Central Register of Controlled Trials, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados de Enfermagem (BDENF), Indice Bibliográfico Español en Ciencias de la Salud (IBECs), Web of Science, Scopus and Google Scholar, from January 2004 to January 2018. Study selection and data extraction were performed by two independent reviewers. In-hospital mortality (primary outcome), and door-to-balloon (DTB) time, 30-day mortality and long-term mortality (secondary outcomes) were assessed. Random effects models were applied to estimate pooled results.ResultsThirty non-randomised controlled and seven quasi-experimental studies were included (16 960 patients). They were classified as moderate or serious risk of bias by ROBINS-I (Risk Of Bias In Non-randomized Studies–of Interventions tool). In 31 studies, the intervention was prehospital ECG transmission. Telemedicine was associated with reduced in-hospital mortality compared with usual care (relative risk (RR) 0.63(95% confidence interval[CI] 0.55 to 0.72); I2 <0.001%). DTB time was consistently reduced (mean difference −28 (95% CI −35 to –20) min), but showed large heterogeneity (I2=94%). Thirty-day mortality (RR 0.62;95% CI 0.43 to 0.85) and long-term mortality (RR 0.61(95% CI 0.40 to 0.92)) were also reduced, with moderate heterogeneity (I2=52%).ConclusionsThere is moderate-quality evidence that telemedicine strategies, in particular ECG transmission, combined with the usual care for AMI are associated with reduced in-hospital mortality and very-low quality evidence that they reduce DTB time, 30-day mortality and long-term mortality.

Download Full-text

Reperfusion in high-risk acute pulmonary embolism: can the PESI score predict outcomes?

European Heart Journal ◽

10.1093/eurheartj/ehab724.1898 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Martinho ◽

R Cale ◽

S Alegria ◽

F Ferreira ◽

M J Loureiro ◽

...

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Hospital Mortality ◽

Acute Pulmonary Embolism ◽

Cardiovascular Outcomes ◽

Early Mortality ◽

Prognostic Impact ◽

Long Term Outcomes ◽

The Impact

Abstract Introduction Acute pulmonary embolism (PE) is one of the leading causes of cardiovascular death worldwide. Haemodynamic (HD) instability defines high risk (HR) of early mortality and reperfusion treatment is the standard of care for rapid relieve of right ventricle (RV) overload in these situations. The impact of reperfusion in long-term outcomes is not well established. The PE Severity Index (PESI) score is used to stratify the risk of early death in HD stable patients (pts) and was not validated to predict outcomes in HR-PE. Purpose Estimate the prognostic performance of the PESI score in HR-PE and study its possible interaction in acute and long-term outcomes of reperfusion in HR-PE pts. Methods Retrospective single-centre study of consecutive HR-PE pts, defined by the 2019 ESC guidelines criteria, between 2008–2018. Logistic regression analysis was performed to test for an interaction between tertiles of the PESI score and reperfusion in early-mortality (during hospitalization and at 30 days) as well as 1-year MACE (a composite of cardiovascular mortality, PE recurrence or chronic thromboembolic pulmonary hypertension). Results Of a total of 1955 PE pts, 102 fulfilled the inclusion criteria (72.5% pts initially presented with HD instability with the remaining developing HR-PE after hospital admission). Mean age was 68±15 years and 60% were females. In-hospital and 30-day mortality were 39.6% and 43.0%, respectively. At one-year follow-up, MACE was 55.0%. Mean PESI at the time of HR-PE diagnosis was 200±39 and showed significant differences for in-hospital mortality (189±38 vs 217±34; OR 1.02, 95% CI 1.00–1.03, p<0.001), 30-day mortality (191±38 vs 214±36; OR 1.02, 95% CI 1.00–1.03, p=0.004) and 1y-MACE (186±41 vs 214±32; OR 1.02, 95% CI 1.01–1.03, p<0.001). Total reperfusion rate was 57.8% and was also associated with lower in-hospital mortality (OR 0.45, 95% CI 0.20–1.02; p=0.057), 30-day mortality (OR 0.35, 95% CI 0.15–0.80; p=0.012) and 1y-MACE (OR 0.35, 95% CI 0.15–0.80; p=0.014). The benefit of reperfusion was significantly influenced by the PESI score categorized by tertiles (figure 1). Conclusions Although the PESI score stratifies HD stable pts, in this population it was able to predict cardiovascular outcomes in HR-PE pts. Furthermore, it showed a significant interaction with the prognostic impact of reperfusion in early and late cardiovascular outcomes. FUNDunding Acknowledgement Type of funding sources: None. Figure 1. Interaction between PESI and reperfusion

Download Full-text

The impact of comorbidities and their stacking on short- and long-term prognosis of patients over 50 with community-acquired pneumonia

BMC Infectious Diseases ◽

10.1186/s12879-021-06669-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

E. Blanc ◽

G. Chaize ◽

S. Fievez ◽

C. Féger ◽

E. Herquelot ◽

...

Keyword(s):

Hospital Mortality ◽

Community Acquired Pneumonia ◽

Admission Diagnosis ◽

Prognostic Impact ◽

Logistic Regression Models ◽

Hospital Stays ◽

Short And Long Term ◽

Long Term Prognosis ◽

The Impact

Abstract Background The prognosis of patients hospitalized with community-acquired pneumonia (CAP) with regards to intensive care unit (ICU) admission, short- and long-term mortality is correlated with patient’s comorbidities. For patients hospitalized for CAP, including P-CAP, we assessed the prognostic impact of comorbidities known as at-risk (AR) or high-risk (HR) of pneumococcal CAP (P-CAP), and of the number of combined comorbidities. Methods Data on hospitalizations for CAP among the French 50+ population were extracted from the 2014 French Information Systems Medicalization Program (PMSI), an exhaustive national hospital discharge database maintained by the French Technical Agency of Information on Hospitalization (ATIH). Their admission diagnosis, comorbidities (nature, risk type and number), other characteristics, and their subsequent hospital stays within the year following their hospitalization for CAP were analyzed. Logistic regression models were used to assess the associations between ICU transfer, short- and 1-year in-hospital mortality and all covariates. Results From 182,858 patients, 149,555 patients aged ≥ 50 years (nonagenarians 17.8%) were hospitalized for CAP in 2014, including 8270 with P-CAP. Overall, 33.8% and 90.5% had ≥ 1 HR and ≥ 1 AR comorbidity, respectively. Cardiac diseases were the most frequent AR comorbidity (all CAP: 77.4%). Transfer in ICU occurred for 5.4% of CAP patients and 19.4% for P-CAP. Short-term and 1-year in-hospital mortality rates were 10.9% and 23% of CAP patients, respectively, significantly lower for P-CAP patients: 9.2% and 19.8% (HR 0.88 [95% CI 0.84–0.93], p < .0001). Both terms of mortality increased mostly with age, and with the number of comorbidities and combination of AR and HR comorbidities, in addition of specific comorbidities. Conclusions Not only specific comorbidities, but also the number of combined comorbidities and the combination of AR and HR comorbidities may impact the outcome of hospitalized CAP and P-CAP patients.

Download Full-text