scholarly journals Post-ST-Segment Elevation Myocardial Infarction Follow-Up Care During the COVID-19 Pandemic and the Possible Benefit of Telemedicine: An Observational Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Audrey A. Y. Zhang ◽  
Nicholas W. S. Chew ◽  
Cheng Han Ng ◽  
Kailun Phua ◽  
Yin Nwe Aye ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Safety Endpoint ◽  
The Impact

Background: Infectious control measures during the COVID-19 pandemic have led to the propensity toward telemedicine. This study examined the impact of telemedicine during the pandemic on the long-term outcomes of ST-segment elevation myocardial infarction (STEMI) patients.Methods: This study included 288 patients admitted 1 year before the pandemic (October 2018–December 2018) and during the pandemic (January 2020–March 2020) eras, and survived their index STEMI admission. The follow-up period was 1 year. One-year primary safety endpoint was all-cause mortality. Secondary safety endpoints were cardiac readmissions for unplanned revascularisation, non-fatal myocardial infarction, heart failure, arrythmia, unstable angina. Major adverse cardiovascular events (MACE) was defined as the composite outcome of each individual safety endpoint.Results: Despite unfavorable in-hospital outcomes among patients admitted during the pandemic compared to pre-pandemic era, both groups had similar 1-year all-cause mortality (11.2 vs. 8.5%, respectively, p = 0.454) but higher cardiac-related (14.1 vs. 5.1%, p < 0.001) and heart failure readmissions in the pandemic vs. pre-pandemic groups (7.1 vs. 1.7%, p = 0.037). Follow-up was more frequently conducted via teleconsultations (1.2 vs. 0.2 per patient/year, p = 0.001), with reduction in physical consultations (2.1 vs. 2.6 per patient/year, p = 0.043), during the pandemic vs. pre-pandemic era. Majority achieved guideline-directed medical therapy (GDMT) during pandemic vs. pre-pandemic era (75.9 vs. 61.6%, p = 0.010). Multivariable Cox regression demonstrated achieving medication target doses (HR 0.387, 95% CI 0.164–0.915, p = 0.031) and GDMT (HR 0.271, 95% CI 0.134–0.548, p < 0.001) were independent predictors of lower 1-year MACE after adjustment.Conclusion: The pandemic has led to the wider application of teleconsultation, with increased adherence to GDMT, enhanced medication target dosing. Achieving GDMT was associated with favorable long-term prognosis.

scholarly journals Myocardial Work and long-term prognosis in patients after ST-segment elevation acute myocardial infarction

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
A Timoteo ◽  
L Moura Branco ◽  
A Galrinho ◽  
T Mano ◽  
P Rio ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Global Longitudinal Strain ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Elevation Acute Myocardial Infarction

Abstract Background Left ventricular (LV) global longitudinal strain has demonstrated incremental prognostic value over LV ejection fraction (LVEF) in patients with ST-segment-elevation acute myocardial infarction. However, LV global longitudinal strain (GLS) does not take into consideration the effect of afterload. Myocardial work (MW) by speckle-tracking echocardiography integrates blood pressure measurements (afterload) with LV GLS and it has been recently demonstrated that Global Work Efficiency (GWE) is associated with long-term all-cause mortality. It remains to be demonstrated if MW indices are associated with hard cardiovascular endpoints. The present study aimed to investigate the prognostic value of global LV MW obtained from pressure-strain loops with echocardiography in patients with ST-segment-elevation myocardial infarction. Methods A total of 100 consecutive ST-segment-elevation myocardial infarction patients (mean age, 61±12 years; 75% men) that survived to discharge were retrospectively analysed. LVEF, GLS and all LVMW indices were measured by transthoracic echocardiography before discharge (4.6±2.0 days after admission). All patients had at least a two-year follow-up (mean follow-up of 833±172 days). Outcomes: all-cause mortality, major acute cardiovascular events (a composite of cardiovascular mortality, myocardial infarction, stroke, unplanned cardiovascular admission) and heart failure hospitalization. Results In the two-year follow-up, 6 patients died, there were 17 patients with MACE, and 3 patients were hospitalized with heart failure. We confirmed that for all-cause mortality, GWE showed higher discrimination, compared to GLS (Table 1), with a cut-off of 83% (log-rank <0,001). For MACE, the performance of all methods is suboptimal, with an AUC <0.65 for all variables, except for GLS. For heart failure admission, performance is slightly better, but GLS is still the better parameter to predict this event. Conclusions LVGWE is a better predictor of all-cause mortality compared to GLS, but MW indices failed to demonstrate a prognostic impact in long-term cardiovascular events. Prospective studies are warranted to confirm this finding. FUNDunding Acknowledgement Type of funding sources: None. Table 1

Frailty as an instrument for evaluation of elderly patients with non-ST-segment elevation myocardial infarction: A follow-up after more than 5 years

2018 ◽  
Vol 25 (17) ◽  
pp. 1813-1821 ◽  
Author(s):  
Niklas Ekerstad ◽  
Staffan Pettersson ◽  
Karen Alexander ◽  
David Andersson ◽  
Sofia Eriksson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
Frail Patients ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Mortality

Background There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. Design This was a prospective, observational study conducted at three centres. Methods and results Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5–7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), ( P < 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51–2.81; P < 0.001) together with age ( P < 0.001), ejection fraction ( P = 0.012) and Charlson comorbidity index ( P = 0.018). Conclusions In elderly non-ST-segment elevation myocardial infarction patients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascular patients with complex needs.

Interaction of ischaemic postconditioning and thrombectomy in patients with ST-elevation myocardial infarction

Heart ◽  
2019 ◽  
Vol 106 (1) ◽  
pp. 24-32 ◽  
Author(s):  
Lars Nepper-Christensen ◽  
Dan Eik Høfsten ◽  
Steffen Helqvist ◽  
Jens Flensted Lassen ◽  
Hans-Henrik Tilsted ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Primary Endpoint ◽  
Coronary Intervention ◽  
Primary Pci ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Significant Difference ◽  
All Cause Mortality

ObjectiveThe Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction – Ischaemic Postconditioning (DANAMI-3-iPOST) did not show improved clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with ischaemic postconditioning. However, the use of thrombectomy was frequent and thrombectomy may in itself diminish the effect of ischaemic postconditioning. We evaluated the effect of ischaemic postconditioning in patients included in DANAMI-3-iPOST stratified by the use of thrombectomy.MethodsPatients with STEMI were randomised to conventional primary percutaneous coronary intervention (PCI) or ischaemic postconditioning plus primary PCI. The primary endpoint was a combination of all-cause mortality and hospitalisation for heart failure.ResultsFrom March 2011 until February 2014, 1234 patients were included with a median follow-up period of 35 (interquartile range 28 to 42) months. There was a significant interaction between ischaemic postconditioning and thrombectomy on the primary endpoint (p=0.004). In patients not treated with thrombectomy (n=520), the primary endpoint occurred in 33 patients (10%) who underwent ischaemic postconditioning (n=326) and in 35 patients (18%) who underwent conventional treatment (n=194) (adjusted hazard ratio (HR) 0.55 (95%confidence interval (CI) 0.34 to 0.89), p=0.016). In patients treated with thrombectomy (n=714), there was no significant difference between patients treated with ischaemic postconditioning (n=291) and conventional PCI (n=423) on the primary endpoint (adjusted HR 1.18 (95% CI 0.62 to 2.28), p=0.62).ConclusionsIn this post-hoc study of DANAMI-3-iPOST, ischaemic postconditioning, in addition to primary PCI, was associated with reduced risk of all-cause mortality and hospitalisation for heart failure in patients with STEMI not treated with thrombectomy.Trial registration numberNCT01435408.

Impact of new onset atrial fibrillation on long-term prognosis in patients with acute ST-segment elevation myocardial infarction

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.A Baturova ◽  
M.M Demidova ◽  
J Carlson ◽  
D Erlinge ◽  
P.G Platonov
Keyword(s):  
Clinical Characteristics ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
All Cause Mortality ◽  
Long Term Follow Up ◽  
Long Term Prognosis ◽  
New Onset

Abstract Introduction New onset AF is a known complication in patients with acute ST-segment elevation myocardial infarction (STEMI). However, whether new-onset AF affects the long-term prognosis to the same extent as pre-existing AF is not fully clarified and prescription of oral anticoagulants (OAC) in patients with new-onset AF remains a matter of debates. Purpose We aimed to assess the impact of new-onset AF in STEMI patients undergoing primary percutaneous intervention (PCI) on outcome during long-term follow-up in comparison with pre-existing AF and to evaluate effect of OAC therapy in patients with new-onset AF on survival. Methods Study sample comprised of 2277 consecutive patients with STEMI admitted to a tertiary care hospital for primary PCI from 2007 to 2010 (age 66±12 years, 70% male). AF prior to STEMI was documented by record linkage with the Swedish National Patient Register and review of ECGs obtained from the digital archive containing ECGs recorded in the hospital catchment area since 1988. SWEDEHEART registry was used as the source of information regarding clinical characteristics and events during index admission, including new-onset AF and OAC at discharge. All-cause mortality was assessed using the Swedish Cause-of-Death Register 8 years after discharge. Results AF prior to STEMI was documented in 177 patients (8%). Among patients without pre-existing AF (n=2100), new-onset AF was identified in 151 patients (7%). Patients with new-onset AF were older than those without AF history (74±9 vs 65±12 years, p&lt;0.001), but did not differ in regard to other clinical characteristics. Among 2149 STEMI survivors discharged alive, 523 (24%) died during 8 years of follow-up. OAC was prescribed at discharge in 45 (32%) patients with new onset AF and in 49 (31%) patients with pre-existing AF, p=0.901. In a univariate analysis, both new-onset AF (HR 2.18, 95% CI 1.70–2.81, p&lt;0.001) and pre-existing AF (HR 2.80, 95% CI 2.25–3.48, p&lt;0.001) were associated with all-cause mortality, Figure 1. After adjustment for age, gender, cardiac failure, diabetes, BMI and smoking history, new-onset AF remained an independent predictor of all-cause mortality (HR 1.40, 95% CI 1.02–1.92, p=0.037). OAC prescribed at discharge in patients with new-onset AF was not significantly associated with survival (univariate HR 0.86, 95% CI 0.50–1.50, p=0.599). Conclusion New-onset AF developed during hospital admission with STEMI is common and independently predicts all-cause mortality during long-term follow-up after STEMI with risk estimates similar to pre-existing AF. The effect of OAC on survival in patients with new-onset AF is inconclusive as only one third of them received OAC therapy at discharge. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

scholarly journals Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

2019 ◽  
Vol 20 (1) ◽  
pp. 105-115 ◽  
Author(s):  
Christel Bruggmann ◽  
Juan F. Iglesias ◽  
Marianne Gex-Fabry ◽  
Rachel Fesselet ◽  
Pierre Vogt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Real World ◽  
St Segment Elevation ◽  
Follow Up Study ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment
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