scholarly journals Prognosis Between ST-Elevation and Non-ST-elevation Myocardial Infarction in Older Adult Patients

2022 ◽  
Vol 8 ◽  
Author(s):  
Shih-Sheng Chang ◽  
Chiung-Ray Lu ◽  
Ke-Wei Chen ◽  
Zhe-Wei Kuo ◽  
Shao-Hua Yu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Older Adult ◽  
Odds Ratio ◽  
Coronary Revascularization ◽  
Adult Patients ◽  
St Elevation Myocardial Infarction ◽  
Crude Odds Ratio ◽  
St Elevation ◽  
The Difference

Background: Whether there is a difference in prognosis between elderly patients with ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) remains mysterious.Methods: We conducted a retrospective cohort study by analyzing the data in the Longitudinal Health Insurance Database (LHID) in Taiwan to explore differences between STEMI and NSTEMI with respect to in-hospital and long-term (3-year) outcomes among older adult patients (aged ≥65 years). Patients were further stratified based on whether they received coronary revascularization.Results: In total, 5,902 patients aged ≥65 years with acute myocardial infarction (AMI) who underwent revascularization (2,254) or medical therapy alone (3,648) were included. In the revascularized group, no difference was observed in cardiovascular (CV) and all-cause mortality during hospitalization or at 3-year follow-up between the two AMIs. Conversely, in the non-revascularized group, patients with NSTEMI had higher crude odds ratio (cOR) for all-cause death during hospitalization [cOR: 1.33, 95% confidence interval (CI) = 1.07–1.65] and at 3-year follow-up (cOR: 1.47, 95% CI = 1.21–1.91) relative to patients with STEMI. However, after multivariable adjustments, only NSTEMI indicated fewer in-hospital CV death [adjusted odds ratio (aOR): 0.75, 95% CI = 0.58–0.98] than STEMI in non-revascularized group. Moreover, major bleeding was not different between patients with STEMI or NSTEMI aged ≥65 years old.Conclusion: Classification of AMI is not associated with the difference of in-hospital or 3-year CV and all-cause death in older adult patients received revascularization. In a 3-year follow-up period, STEMI was an independent predictor of a higher incidence of revascularization after the index event. Non-ST-elevation myocardial infarction had more incidence of MACE than patients with STEMI did in both treatment groups.

scholarly journals The Cadillac Risk Score Accurately Identifies Patients at Low Risk for In-Hospital Mortality and Adverse Cardiovascularevents Following St Elevation Myocardial Infarction.

2021 ◽  
Author(s):  
Ryan S. Wilson ◽  
Peter Malamas ◽  
Brent Dembo ◽  
Sumeet K Lall ◽  
Ninad Zaman DO ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Score ◽  
Odds Ratio ◽  
Risk Group ◽  
Low Risk ◽  
St Elevation Myocardial Infarction ◽  
Clinical Events ◽  
St Elevation ◽  
Event Rates

Abstract Background: The CADILLAC risk score was developed to identify patients at low risk for adverse cardiovascular events following ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI). Methods: We performed a single center retrospective review of STEMI hospitalizations treated with PPCI from 2014 to 2018. Patients were stratified using the CADILLAC risk score into low risk group versus intermediate to high risk group. Patients presenting with cardiac arrest or cardiogenic shock were excluded from the study. The primary outcome was adverse clinical events during initial hospitalization. Secondary outcomes were adverse clinical events at 30 days and 1 year following index hospitalization. Results: The study included 314 patients. It was found that patients with a low CADILLAC score had significantly lower adverse clinical events compared to the intermediate-high CADILLAC score group (10/213 (4.7%) vs. 15/128 (11.7%), odds ratio = 0.37, 95% CI 0.16-0.85, p= 0.028). Additionally, patients with a low CADILLAC score had significantly lower adverse clinical event rates at 30 day and 1 year follow up. The mortality rate was 0% for patients defined at low risk by CADILLAC score during hospitalization, as well up to 1 year follow up. ROC curve predicting in hospital event rate showed CADILLAC (C=0.66, odds ratio 1.18; 95% CI 1.04 - 1.33; p=0.0064). Conclusion: Patients defined as low risk by the CADILLAC score following a STEMI were associated with lower event rates when compared to those with an intermediate-high CADILLAC score.

Safety and effectiveness of antithrombotic strategies in older adult patients with atrial fibrillation and non–ST elevation myocardial infarction

2012 ◽  
Vol 163 (4) ◽  
pp. 720-728 ◽  
Author(s):  
Emil L. Fosbol ◽  
Tracy Y. Wang ◽  
Shuang Li ◽  
Jonathan P. Piccini ◽  
Renato D. Lopes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Atrial Fibrillation ◽  
Older Adult ◽  
Adult Patients ◽  
St Elevation Myocardial Infarction ◽  
St Elevation

Abstract P28: Comparison of Short- and Long-Term Mortality Between Older Asian and White Patients with Non–ST-Elevation Myocardial Infarction: Findings from CRUSADE-CMS Database

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Weixian Xu ◽  
DaJuanicia N Holmes ◽  
Richard C Becker ◽  
Matthew T Roe ◽  
Eric D Peterson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Proportional Hazards ◽  
Coronary Revascularization ◽  
Patient Characteristics ◽  
Cox Proportional Hazards ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
The Difference ◽  
White Patients

Background: While previous studies have shown similar in-hospital mortality between Asian and White patients with non-ST elevation myocardial infarction (NSTEMI), little is known about their longer-term mortality differences. Methods: We linked Medicare claims data to detailed clinical data for 37702 NSTEMI patients ≥65 years of age from 444 CRUSADE hospitals between 2003 and 2006 to examine longitudinal outcomes. All-cause 30-day and 1-year mortality were compared between Asian and White patients by Cox proportional hazards modeling adjusting for differences in baseline patient characteristics. Results: Compared with White patients, Asians (n= 307) were younger, more frequently had hypertension, diabetes, and renal insufficiency, and less likely to have had a prior MI or coronary revascularization. There were no significant differences in rates of cardiac catheterization (60.7% vs. 58.0%, p=0.26), PCI (32.2% vs. 31.6%, p=0.73), and CABG (9.2% vs. 8.5%, p=0.62) between Whites and Asians respectively. While the difference in risk-adjusted mortality was not statistically significant between Asian and White patients at 30-days (HR 0.70, 95% CI 0.48 - 1.01), lower 1-year mortality (adjusted HR 0.62, 95% CI 0.48 - 0.79) and 1-year mortality conditional on surviving 30 days (adjusted HR 0.56, 95% CI 0.40 - 0.78) were observed among Asians (Figure). Conclusions: While short-term outcomes were similar between Asian and White NSTEMI patients ≥65 years of age, Asians had better outcomes at 1 year. Further study is needed to determine whether more complete follow-up and use of secondary prevention strategies in Asians help to explain these long-term differences in outcome.

scholarly journals Cardiogenic shock and radial access in patients with an acute ST elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Zahn ◽  
M Hochadel ◽  
B Schumacher ◽  
M Pauschinger ◽  
C Stellbrink ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Strong Variation ◽  
Access Site ◽  
Femoral Access ◽  
Radial Access ◽  
St Elevation ◽  
The Difference

Abstract Background Cardiogenic shock (CS) in patients (pts) with acute ST elevation myocardial infarction (STEMI) is the strongest predictor of hospital mortality. Radial in contrast to femoral access in STEMI pts might be associated with a lower mortality. However, little is known on radial access in CS pts. Methods We retrospectively analysed all STEMI pts between 2009 and 2015 who sufferend from CS and who were included into the ALKK PCI registry. Pts treated via a radial access were compared to those treated via a femoral access. Results Between 2009 and 2015 23796 STEMI pts were included in the registry. 1763 (7.4%) of pts were in CS. The proportion of radial access was 6.6%: in 2009 4.0% and in 2015 19.6%, p for trend <0.0001 with a strong variation between the participating centres (0% to 37%). Conclusions Radial access was only used in 6.6% of STEMI pts presenting in CS. However, a significant increase in the use of radial access was observed over time (2009: 4%, 2015 19.6%, p<0.001), with a great variance in its use between the participating hospitals. Despite similar pt characteristics the difference in hospital mortality according to access site has to be interpretated with caution. Funding Acknowledgement Type of funding source: None

Early vascular responses to ultrathin biodegradable polymer sirolimus-eluting stent for the treatment of st-elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Oishi ◽  
T Shinke ◽  
H Tanaka ◽  
K Ogura ◽  
K Arai ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Clinical Outcomes ◽  
Antiplatelet Therapy ◽  
St Elevation Myocardial Infarction ◽  
Current Generation ◽  
Vascular Responses ◽  
Post Procedure ◽  
St Elevation ◽  
Sirolimus Eluting Stent

Abstract Background Recent clinical study suggests newer-generation drug-eluting stents (DES) that combine ultrathin strut and nano-coating with biodegradable polymers sirolimus-eluting stent (BP-SES) could improve long-term clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) over current generation DES. However, safety profiles in very early phase have not been systematically addressed. Objective and method We exploratory investigate early vascular response following BP-SES implantation in patients with STEMI to reveal mechanism of the favorable clinical outcomes in recent studies using frequency domain-optical coherence tomography (FD-OCT). Consecutive twenty patients with STEMI who underwent FD-OCT immediately after primary PCI and were eligible for follow-up FD-OCT at 2 weeks after implantation were enrolled between June 2018 and November 2019. Results Twenty patients (age 62.7±11.3 years, male 85.0%) were enrolled with frequencies of hypertension (45.0%), diabetes mellitus (35.0%), dyslipidemia (55.0%) and smoking (80.0%). Aspiration catheter were used in all patients, and 1.13±0.34 stents were used. Only one patient (5.0%) received chronic antiplatelet therapy with aspirin prior to the onset of STEMI. All patients started to receive prasugrel as thienopyridine from this event and continued dual antiplatelet therapy for 2 weeks. The percentage of uncovered struts significantly decreased from post-procedure to 2W follow-up (69±18% post-procedure versus 30±11% at 2W follow up, p<0.0001). Malapposed struts also decreased (5.6±5.7% post-procedure versus0.9±1.2% at 2W follow up, p<0.0001).The average protrusion area of athero-thrombotic burden numerically decreased (0.37±0.19 at post-procedure versus 0.34±0.14 mm2 at 2W follow up, p=0.19) and its volume showed similar tendency (10.60±6.40 at post-procedure versus 9.36±5.14 mm3 at 2W follow up, p=0.19). Conclusion(s) This study firstly elucidated very early vascular responses following ultrathin strut BP-SES implantation in STEMI patients, showing early progression of strut coverage and resolution of athero-thrombotic materials. This technology may have a potential to overcome the current generation DESs in this clinical setting. Thrombus, uncovered and malapposed struts Funding Acknowledgement Type of funding source: None

Abstract 3774: Cost Effectiveness Of Enoxaparin In Patients With ST-elevation Myocardial Infarction: Results From EXTRACT-TIMI 25

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Zefeng Zhang ◽  
Paul Kolm ◽  
Wei Zhang ◽  
Edward Ewen ◽  
Claudine Jurkovitz ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cost Effectiveness ◽  
Unfractionated Heparin ◽  
Cost Effective ◽  
St Elevation Myocardial Infarction ◽  
Published Data ◽  
Outpatient Procedures ◽  
Life Years ◽  
St Elevation ◽  
The Difference

Background: The efficacy of enoxaparin versus unfractionated heparin in the setting of ST-elevation myocardial infarction (STEMI) has been demonstrated in EXTRACT-TIMI 25, with 17% reductions in relative risk in the primary endpoint of death or nonfatal recurrent myocardial infarction (MI) (p<0.0001). This study considers the cost effectiveness of enoxaparin versus unfractionated heparin with fibrinolysis based on EXTRACT-TIMI 25. Methods: The ITT population of 20,479 patients from 48 countries were monitored for clinical and adverse events during the index hospitalization and through 30 days. Trial-wide resource utilization from all participating countries was used in the analysis while all costs were based on 2004 US costs. Medicare Fee Schedule was used for outpatient procedures and DRGs were applied for index and subsequent hospitalizations costs. Lost life years associated with 30-day in-trial events (death, MI and stroke) were estimated from published data from Framingham. Results: Overall, costs of index hospitalizations and outpatient procedures were lower, while costs for the subsequent hospitalization were higher for the enoxaparin patients. Total 30 days’ costs remained lower for enoxaparin, although the difference did not reach significance. Life years lost were significantly less with enoxaparin. For lifetime, when costs beyond the trial period were considered, the costs of enoxaparin in patients with STEMI were $506 higher, and the incremental cost-effectiveness ratio of enoxaparin compared to UFH was $4,369 per life year gained, with 99.9% of estimates falling below the $50,000 per life year gained threshold. Conclusions: Enoxaparin is effective in reducing mortality or nonfatal MI, and is highly cost-effective strategy in the US settings for the treatment of STEMI patients.

Abstract 5605: Real World Comparison of Long Term Mortality after Primary Percutanous Coronary Intervention (PPCI) versus Fibrinolysis for Acute St Elevation Myocardial Infarction: Initial Experience from the 24 Hour PPCI Program in Nova Scotia

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Boniface Chan ◽  
Helen Curran ◽  
Michael P Love ◽  
Stephen Fort
Keyword(s):  
Myocardial Infarction ◽  
Nova Scotia ◽  
Real World ◽  
Cox Regression ◽  
Coronary Intervention ◽  
St Elevation Myocardial Infarction ◽  
Coronary Artery Patency ◽  
St Elevation ◽  
Door To Balloon

Background Randomized controlled trials indicate that acute ST elevation myocardial infarction (STEMI) patients have better clinical outcomes if rapid, complete and stable coronary artery patency can be achieved. The Queen Elizabeth II Health Sciences Center in Halifax, Nova Scotia (QEIIHSC) commenced a 24 hour PPCI program in November 2005. This real world study compares 2 year mortality in STEMI patients treated by PPCI versus patients treated by fibrinolysis with provisional rescue PCI within Nova Scotia, Canada. Methods This was a single center retrospective cohort study. All consecutive Nova Scotia, fibrinolytic and PPCI eligible STEMI patients presenting within 12 hours of symptom onset between July 1 st 2005 and June 30 th 2006 treated by PPCI at the QEIIHSC or fibrinolyis outside the QEIIHSC were included. The outcome measure was all cause mortality censored on June 30 th 2007. The crude and independent association between PPCI versus fibrinolysis on mortality was estimated using a Cox regression model. Results Data for 423 eligible patients (100% of cohort) comprised of 359/423 (85%) patients treated with fibrinolytics and 64/359 (18%) treated by PPCI were analyzed. The median follow-up was 1.4 years. The median (Q25 to Q75) door to needle times in the fibrinolytic group and corresponding door to balloon times in the PPCI group were: 0.5 (.3 to .9) and 1.5 (1.1 to 1.9) hours respectively. PPCI was associated with a consistent trend toward lower mortality versus fibrinolysis during hospitalization: 2/64 (3.1%) vs. 29/359 (8.1%), P=0.16 and at 30 days 2/64 (3.1%) vs. 32/359 (15%), P=0.12. This association was significant at 1 and 2 year follow-up: 2/64 (3.1%) vs. 41/359 (11%), P=0.043 and 2/64 (3.1%) vs. 45/359 (12%), P=0.027 respectively. This corresponded with an independent HR for 2 year mortality of: 0.1 (.01 to 0.8), p=0.03. Conclusion Initial data from the PPCI program at the QEIIHSC in Halifax, Nova Scotia indicates that PPCI was associated significant reductions in mortality versus fibrinolysis for real world patients presenting with STEMI. This mortality reduction was achieved in the early pilot phase of a PPCI program with evolving door to balloon timelines versus an established fibrinolytic program with acceptable door to needle timelines.

ECG of the month

2021 ◽  
Vol 16 (1) ◽  
pp. 1-1
Author(s):  
Charles Bloe
Keyword(s):  
Myocardial Infarction ◽  
Chest Pain ◽  
Acute Chest Pain ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
Lost To Follow Up

In this issue's ECG of the month, Charles Bloe highlights a case of a 36-year-old woman presenting with severe acute chest pain after previously being lost to follow up post ST-elevation myocardial infarction.

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