scholarly journals Changes over Time in Hemoglobin A1C (HbA1C) Levels Predict Long-Term Survival Following Acute Myocardial Infarction among Patients with Diabetes Mellitus

2021 ◽  
Vol 10 (15) ◽  
pp. 3232
Author(s):  
Ygal Plakht ◽  
Harel Gilutz ◽  
Arthur Shiyovich
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Hemoglobin A1c ◽  
Prognostic Significance ◽  
Diabetic Patients ◽  
Term Survival ◽  
Patients With Diabetes ◽  
One Year ◽  
Hba1c Levels

Frequent fluctuations of hemoglobin A1c (HbA1C) values predict patient outcomes. However, data regarding prognoses depending on the long-term changes in HbA1C among patients after acute myocardial infarction (AMI) are scarce. We evaluated the prognostic significance of HbA1C levels and changes among diabetic patients (n = 4066) after non-fatal AMI. All the results of HbA1C tests up to the 10-year follow-up were obtained. The changes (∆) of HbA1C were calculated in each patient. The time intervals of ∆HbA1C values were classified as rapid (<one year) and slow (≥one year) changes. The outcome was all-cause mortality. The highest mortality rates of 53.8% and 35.5% were found in the HbA1C < 5.5–7% and ∆HbA1C = −2.5–(−2%) categories. A U-shaped association was observed between HbA1C and mortality: adjOR = 1.887 and adjOR = 1.302 for HbA1C < 5.5% and ≥8.0%, respectively, as compared with 5.5–6.5% (p < 0.001). Additionally, ∆HbA1C was associated with the outcome (U-shaped): adjOR = 2.376 and adjOR = 1.340 for the groups of <−2.5% and ≥2.5% ∆HbA1C, respectively, as compared to minimal ∆HbA1C (±0.5%) (p < 0.001). A rapid increase in HbA1C (but not decrease) was associated with a greater risk of mortality. HbA1C values and their changes are significant prognostic markers for long-term mortality among AMI-DM patients. ∆HbA1C and its timing, in addition to absolute HbA1C values, should be monitored.

Long term survival after early unloading with Impella CP® in acute myocardial infarction complicated by cardiogenic shock

2018 ◽  
Vol 9 (2) ◽  
pp. 149-157 ◽  
Author(s):  
Tobias Loehn ◽  
William W O’Neill ◽  
Bjoern Lange ◽  
Christian Pfluecke ◽  
Tina Schweigler ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Left Ventricular ◽  
Ventricular Assist Devices ◽  
Term Survival ◽  
Long Term Outcome ◽  
Device Implantation ◽  
One Year

Background: The use of percutaneous left ventricular assist devices in patients with acute myocardial infarction complicated by cardiogenic shock (AMICS) is evolving. The aim of the study was to assess the long-term outcome of patients with AMICS depending on early initiation of Impella CP® support prior to a percutaneous coronary intervention (PCI). Methods: We retrospectively reviewed all patients who underwent PCI and Impella CP® support between 2014 and 2016 for AMICS at our institution. We compared survival to discharge between those with support initiation before (pre-PCI) and after (post-PCI) PCI. Results: A total of 73 consecutive patients (69±12 years old, 27.4% female) were supported with Impella CP® and underwent PCI for AMICS (34 pre-PCI vs. 39 post-PCI). All patients were admitted with cardiogenic shock, and 58.9% sustained cardiac arrest. Survival at discharge was 35.6%. Compared with the post-PCI group, patients in the pre-PCI group had more lesions treated ( p=0.03), a higher device weaning rate ( p=0.005) and higher survival to discharge as well as to 30 and 90 days after device implantation, respectively (50.0% vs. 23.1%, 48.5% vs. 23.1%, 46.9 vs. 20.5%, p < 0.05). Kaplan–Meier analysis showed a higher survival at one year (31.3% vs. 17.6%, log-rank p-value=0.03) in the pre-PCI group. Impella support initiation before PCI was an independent predictor of survival up to 180 days after device implantation. Conclusions: In this small, single-centre, non-randomized study Impella CP® initiation prior to PCI was associated with higher survival rates at discharge and up to one year in AMICS patients presenting with high risk for in-hospital mortality.

5197Correlates and prognostic significance of nuisance bleeding after acute myocardial infarction. The FAST-MI programme

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Danchin ◽  
E Puymirat ◽  
K Isaaz ◽  
P Druelles ◽  
O Dibon ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Prognostic Significance ◽  
Female Gender ◽  
Diabetic Patients ◽  
Younger Patients ◽  
P2y12 Inhibitors ◽  
One Year

Abstract Background Following acute myocardial infarction (AMI), most patients receive potent antithrombotic medications, which may promote nuisance bleedings (ecchymoses, minor nose or dental bleeds etc.). Little information is available on the factors related to nuisance bleedings, nor on their prognostic significance in post-AMI patients. Aims and methods A health status questionnaire was sent to all patients participating in the nationwide French FAST-MI cohorts (2010 and 2015) one year after the acute episode, with a specific question on the presence of nuisance bleedings. Overall, 3968 patients answered the question on the presence nuisance bleedings. In the 2010 cohorts, we also analysed whether the presence of nuisance bleedings at one year was an independent correlate of 5-year mortality. Results 54% of the patients reported the presence of nuisance bleedings (59% in 2010 and 51% in 2015). In univariate analyses, nuisance bleedings were more frequently found in younger patients, women, patients with STEMI, current smokers, patients treated with PCI, those receiving newer P2Y12 inhibitors or ACE-inhibitors but less frequent in patients with diabetes, hypertension, or those receiving ARBs or direct oral anticoagulants. Using logistic regression analysis, however, the only independent correlates of nuisance bleedings were: female gender (OR 1.45, 1.25–1.68), age ≤60 years (OR 1.22, 1.06–1.41), VKAs (OR 1.72, 1.28–2.31), clopidogrel (OR 1.62, 1.29–2.03), prasugrel (OR 3.16, 2.43–4.09), ticagrelor (OR 2.61, 2.04–3.35) at discharge, diabetes (OR 0.74, 0.63–0.88) and year 2015 vs 2010 (OR 0.62, 0.53–0.73). In the 2010 cohort, the presence of nuisance bleeding at one year was not a predictor of mortality at 5 years (90% survival in both patients with or without nuisance bleedings; adjusted HR 0.96, 95% CI 0.69–1.33) (Figure). Figure 1. 5-yr survival by nuisance bleed Conclusion Nuisance bleedings one year after AMI are extremely frequent. They are more common in women, younger patients, in patients receiving P2Y12 inhibitors, especially newer P2Y12-i, and in those receiving VKAs; in contrast, diabetic patients report less nuisance bleedings. The presence of nuisance bleeding at one year does not appear to impact 5-year mortality. Acknowledgement/Funding Amgen, AstraZeneca, Bayer, Daiichi-Sankyo, Eli-Lilly, GSK, MSD, Novartis, Pfizer, Sanofi, Servier

scholarly journals Diabetes and Long-Term Survival After Acute Myocardial Infarction:

Circulation ◽  
2001 ◽  
Vol 103 (suppl_1) ◽  
pp. 1349-1349
Author(s):  
Kenneth J Mukamal ◽  
Richard W Nesto ◽  
Mylan C Cohen ◽  
James E Muller
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Total Mortality ◽  
Cox Proportional Hazards ◽  
Diabetic Patients ◽  
Coronary Risk Factors ◽  
Previous Myocardial Infarction ◽  
Term Survival ◽  
Long Term Survival

0027 Some, but not all, recent studies have found that diabetes is independently associated with long-term mortality following hospitalization for acute myocardial infarction. These studies have also failed to control for certain possible confounding factors, such as alcohol use, physical exertion, and socioeconomic status. In the Determinants of Myocardial Infarction Onset Study, trained interviewers performed chart reviews and face-to-face interviews with 1935 patients hospitalized with acute myocardial infarction between 1989 and 1993. We used Cox proportional hazards regression to determine the effect of diabetes on long-term survival after adjustment for sociodemographic characteristics, medical history, and acute infarct-related complications. Of the 1935 patients, 320 (17%) died during a median follow-up of 3.8 years. Diabetes was associated with higher total mortality in adjusted analyses (hazard ratio 1.6; 95% confidence interval, 1.3-2.1). The magnitude of the effect of diabetes was identical to that of a previous myocardial infarction. The effect of diabetes was not significantly modified by age, smoking, household income, use of thrombolytic therapy, type of hypoglycemic treatment, or duration of diagnosed diabetes, but the mortality risk associated with diabetes was higher among women than among men (adjusted hazard ratios 2.8 versus 1.3; p=0.02). In summary, diabetes is independently associated with increased mortality following acute myocardial infarction, particularly among women. The increase in risk is of the same magnitude as a previous myocardial infarction and provides further support for aggressive treatment of coronary risk factors among diabetic patients.

scholarly journals The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction

2017 ◽  
Vol 16 (1) ◽  
Author(s):  
Mei-Tzu Wang ◽  
Sheng-Che Lin ◽  
Pei-Ling Tang ◽  
Wang-Ting Hung ◽  
Chin-Chang Cheng ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Diabetic Patients ◽  
Term Survival ◽  
Long Term Survival ◽  
The Impact

scholarly journals Influence of admission plasma glucose level on short- and long-term prognosis in patients with ST-segment elevation myocardial infarction

2010 ◽  
Vol 67 (4) ◽  
pp. 291-295 ◽  
Author(s):  
Violeta Mladenovic ◽  
Vladimir Zdravkovic ◽  
Marina Jovic ◽  
Rada Vucic ◽  
Violeta Iric-Cupic ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Plasma Glucose ◽  
Statistical Significance ◽  
Prognostic Significance ◽  
Diabetic Patients ◽  
Mortality And Morbidity ◽  
St Segment Elevation ◽  
Risk Of Mortality ◽  
One Year

Background/Aim. Hyperglicemia is common in patients with ST-elevation myocardial infarction (STEMI) and is associated with high risk of mortality and morbidity. Relationship between admission plasma glucose (APG) levels and mortality in diabetic and nondiabetic patients with STEMI needs further investigation. The aim of this study was to analyse the short- and longterm prognostic significance of APG levels in patients with STEMI with and without diabetes. Methods. This study included 115 patients with STEMI, 86 (74,8%) nondiabetic and 29 (25,2%) dibaetic patients, in which we performed a prospective analysis of the relationship between APG levels and shortand long-term mortality. Results. Comparison of APG levels between nondiabetic (8.32 ? 2.4 mmol/L) and diabetic (10.09 ? 2.5 mmol/L) patients showed statistically significantly higher average APG levels in diabetic patients (p = 0.001). In all patients observed who died either after one month or one year after STEMI, average APG values were significantly higher in comparison with those in survived patients. There was no statistical significance in average APG levels in the diabetic patients with STEMI who died after one month and those who survived (10.09 ? 2.68 vs 10.0 ? 2.51 mmol/L, respectively; p = 0.657), as well as those who died after one year and those who survived (10.1 ? 1.92 vs 10.09 ? 2.8 mmol/L, respectively; p = 0.996). There was, however, statistical significance in average APG levels in the nondiabetic patients with STEMI who died after one month and those who survived (9.97 ? 2.97 vs 7.91 ? 2.08 mmol/L, respectively; p = 0.001), as well as those who died after one year and those who survived (9.17 ? 2.49 vs 7.84 ? 2.24 mmol/L, respectively; p = 0.013). Conclusion. Acute hyperglicemia in the settings of STEMI worsenes the prognosis in patients with and without diabetes. Our study showed that nondiabetic patients with high APG levels are at higher risk of mortality than patients with a known history of diabetes.

scholarly journals Long-term survival benefit of ramipril in patients with acute myocardial infarction complicated by heart failure

Heart ◽  
2021 ◽  
Vol 107 (5) ◽  
pp. 389-395
Author(s):  
Jianhua Wu ◽  
Alistair S Hall ◽  
Chris P Gale
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Life Expectancy ◽  
Survival Benefit ◽  
Ace Inhibition ◽  
Survival Times ◽  
Term Survival ◽  
Long Term Survival

AimsACE inhibition reduces mortality and morbidity in patients with heart failure after acute myocardial infarction (AMI). However, there are limited randomised data about the long-term survival benefits of ACE inhibition in this population.MethodsIn 1993, the Acute Infarction Ramipril Efficacy (AIRE) study randomly allocated patients with AMI and clinical heart failure to ramipril or placebo. The duration of masked trial therapy in the UK cohort (603 patients, mean age=64.7 years, 455 male patients) was 12.4 and 13.4 months for ramipril (n=302) and placebo (n=301), respectively. We estimated life expectancy and extensions of life (difference in median survival times) according to duration of follow-up (range 0–29.6 years).ResultsBy 9 April 2019, death from all causes occurred in 266 (88.4%) patients in placebo arm and 275 (91.1%) patients in ramipril arm. The extension of life between ramipril and placebo groups was 14.5 months (95% CI 13.2 to 15.8). Ramipril increased life expectancy more for patients with than without diabetes (life expectancy difference 32.1 vs 5.0 months), previous AMI (20.1 vs 4.9 months), previous heart failure (19.5 vs 4.9 months), hypertension (16.6 vs 8.3 months), angina (16.2 vs 5.0 months) and age >65 years (11.3 vs 5.7 months). Given potential treatment switching, the true absolute treatment effect could be underestimated by 28%.ConclusionFor patients with clinically defined heart failure following AMI, ramipril results in a sustained survival benefit, and is associated with an extension of life of up to 14.5 months for, on average, 13 months treatment duration.

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