An Artificial Intelligence-Based Alarm Strategy Facilitates Management of Acute Myocardial Infarction

(1) Background: While an artificial intelligence (AI)-based, cardiologist-level, deep-learning model for detecting acute myocardial infarction (AMI), based on a 12-lead electrocardiogram (ECG), has been established to have extraordinary capabilities, its real-world performance and clinical applications are currently unknown. (2) Methods and Results: To set up an artificial intelligence-based alarm strategy (AI-S) for detecting AMI, we assembled a strategy development cohort including 25,002 visits from August 2019 to April 2020 and a prospective validation cohort including 14,296 visits from May to August 2020 at an emergency department. The components of AI-S consisted of chest pain symptoms, a 12-lead ECG, and high-sensitivity troponin I. The primary endpoint was to assess the performance of AI-S in the prospective validation cohort by evaluating F-measure, precision, and recall. The secondary endpoint was to evaluate the impact on door-to-balloon (DtoB) time before and after AI-S implementation in STEMI patients treated with primary percutaneous coronary intervention (PPCI). Patients with STEMI were alerted precisely by AI-S (F-measure = 0.932, precision of 93.2%, recall of 93.2%). Strikingly, in comparison with pre-AI-S (N = 57) and post-AI-S (N = 32) implantation in STEMI protocol, the median ECG-to-cardiac catheterization laboratory activation (EtoCCLA) time was significantly reduced from 6.0 (IQR, 5.0–8.0 min) to 4.0 min (IQR, 3.0–5.0 min) (p < 0.01). The median DtoB time was shortened from 69 (IQR, 61.0–82.0 min) to 61 min (IQR, 56.8–73.2 min) (p = 0.037). (3) Conclusions: AI-S offers front-line physicians a timely and reliable diagnostic decision-support system, thereby significantly reducing EtoCCLA and DtoB time, and facilitating the PPCI process. Nevertheless, large-scale, multi-institute, prospective, or randomized control studies are necessary to further confirm its real-world performance.

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Circulating MiR-19b-3p, MiR-134-5p and MiR-186-5p are Promising Novel Biomarkers for Early Diagnosis of Acute Myocardial Infarction

Cellular Physiology and Biochemistry ◽

10.1159/000443053 ◽

2016 ◽

Vol 38 (3) ◽

pp. 1015-1029 ◽

Cited By ~ 68

Author(s):

Ke-Jing Wang ◽

Xin Zhao ◽

Yu-Zhou Liu ◽

Qiu-Tang Zeng ◽

Xiao-Bo Mao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Troponin I ◽

Early Stage ◽

Diagnostic Efficiency ◽

Plasma Samples ◽

Circulating Mirnas ◽

Peak Expression ◽

And Gender ◽

The Impact

Background/Aims: Recent studies have shown that circulating microRNAs (miRNAs) are emerging as promising biomarkers for cardiovascular diseases. This study aimed to determine whether miR-19b-3p, miR-134-5p and miR-186-5p can be used as novel indicators for acute myocardial infarction (AMI). Methods: To investigate the kinetic expression of the three selected miRNAs, we enrolled 18 patients with AMI and 20 matched controls. Plasma samples were collected from each participant, and total RNA was extracted. Quantitative real-time PCR and ELISA assays were used to investigate the expression of circulating miRNAs and cardiac troponin I (cTnI), respectively. Plasma samples from another age- and gender-matched cohort were collected to investigate the impact of medications for AMI on the expression of the selected miRNAs. Results: Levels of plasma miR-19b-3p, miR-134-5p and miR-186-5p were significantly increased in early stage of AMI. Plasma miR-19b-3p and miR-134-5p levels reached peak expression immediately after admission (T0), whereas miR-186-5p achieved peak expression at 4 h after T0. All of these times were earlier than the peak for cTnI (8 h after T0). In addition, all three miRNAs were positively correlated with cTnI. Receiver Operating Characteristic (ROC) analysis indicated that each single miRNA showed considerable diagnostic efficiency for predicting AMI. Furthermore, combining all three miRNAs in a panel increased the efficiency of distinguishing between patients with AMI and controls. Moreover, we found that heparin and medications for AMI did not impact the expression of these circulating miRNAs. Conclusion: Circulating miR-19b-3p, miR-134-5p and miR-186-5p could be considered promising novel diagnostic biomarkers for the early phase of AMI.

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Impact of cancer on short-term in-hospital mortality after primary acute myocardial infarction

Open Heart ◽

10.1136/openhrt-2021-001860 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001860

Author(s):

Robert Zheng ◽

Kenya Kusunose ◽

Yuichiro Okushi ◽

Yoshihiro Okayama ◽

Michikazu Nakai ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Large Scale ◽

Total Mortality ◽

Short Term ◽

Diagnosis Procedure Combination ◽

Patients With Cancer ◽

Cancer Group ◽

The Impact

BackgroundCardiovascular diseases are the second most common cause of mortality among cancer survivors, after death from cancer. We sought to assess the impact of cancer on the short-term outcomes of acute myocardial infarction (AMI), by analysing data obtained from a large-scale database.MethodsThis study was based on the Diagnosis Procedure Combination database in the Japanese Registry of All Cardiac and Vascular Diseases and the Diagnosis Procedure Combination. We identified patients who were hospitalised for primary AMI between April 2012 and March 2017. Propensity Score (PS) was estimated with logistic regression model, with cancer as the dependent variable and 21 clinically relevant covariates. The main outcome was in-hospital mortality.ResultsWe split 1 52 208 patients into two groups with or without cancer. Patients with cancer tended to be older (cancer group 73±11 years vs non-cancer group 68±13 years) and had smaller body mass index (cancer group 22.8±3.6 vs non-cancer 23.9±4.3). More patients in the non-cancer group had hypertension or dyslipidaemia than their cancer group counterparts. The non-cancer group also had a higher rate of percutaneous coronary intervention (cancer 92.6% vs non-cancer 95.2%). Patients with cancer had a higher 30-day mortality (cancer 6.0% vs non-cancer 5.3%) and total mortality (cancer 8.1% vs non-cancer 6.1%) rate, but this was statistically insignificant after PS matching.ConclusionCancer did not significantly impact short-term in-hospital mortality rates after hospitalisation for primary AMI.

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Combining High-Sensitivity Cardiac Troponin I and Cardiac Troponin T in the Early Diagnosis of Acute Myocardial Infarction

Circulation ◽

10.1161/circulationaha.117.032003 ◽

2018 ◽

Vol 138 (10) ◽

pp. 989-999 ◽

Cited By ~ 21

Author(s):

Noreen van der Linden ◽

Karin Wildi ◽

Raphael Twerenbold ◽

John W. Pickering ◽

Martin Than ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

Validation Cohort ◽

Diagnostic Study ◽

Blood Draw ◽

Unique Identifier ◽

Original Cohort ◽

Rule Out

Background: Combining 2 signals of cardiomyocyte injury, cardiac troponin I (cTnI) and T (cTnT), might overcome some individual pathophysiological and analytical limitations and thereby increase diagnostic accuracy for acute myocardial infarction with a single blood draw. We aimed to evaluate the diagnostic performance of combinations of high-sensitivity (hs) cTnI and hs-cTnT for the early diagnosis of acute myocardial infarction. Methods: The diagnostic performance of combining hs-cTnI (Architect, Abbott) and hs-cTnT (Elecsys, Roche) concentrations (sum, product, ratio, and a combination algorithm) obtained at the time of presentation was evaluated in a large multicenter diagnostic study of patients with suspected acute myocardial infarction. The optimal rule-out and rule-in thresholds were externally validated in a second large multicenter diagnostic study. The proportion of patients eligible for early rule-out was compared with the European Society of Cardiology 0/1 and 0/3 hour algorithms. Results: Combining hs-cTnI and hs-cTnT concentrations did not consistently increase overall diagnostic accuracy as compared with the individual isoforms. However, the combination improved the proportion of patients meeting criteria for very early rule-out. With the European Society of Cardiology 2015 guideline recommended algorithms and cut-offs, the proportion meeting rule-out criteria after the baseline blood sampling was limited (6% to 24%) and assay dependent. Application of optimized cut-off values using the sum (9 ng/L) and product (18 ng 2 /L 2 ) of hs-cTnI and hs-cTnT concentrations led to an increase in the proportion ruled-out after a single blood draw to 34% to 41% in the original (sum: negative predictive value [NPV] 100% [95% confidence interval (CI), 99.5% to 100%]; product: NPV 100% [95% CI, 99.5% to 100%]) and in the validation cohort (sum: NPV 99.6% [95% CI, 99.0–99.9%]; product: NPV 99.4% [95% CI, 98.8–99.8%]). The use of a combination algorithm (hs-cTnI <4 ng/L and hs-cTnT <9 ng/L) showed comparable results for rule-out (40% to 43% ruled out; NPV original cohort 99.9% [95% CI, 99.2–100%]; NPV validation cohort 99.5% [95% CI, 98.9–99.8%]) and rule-in (positive predictive value [PPV] original cohort 74.4% [95% Cl, 69.6–78.8%]; PPV validation cohort 84.0% [95% Cl, 79.7–87.6%]). Conclusions: New strategies combining hs-cTnI and hs-cTnT concentrations may significantly increase the number of patients eligible for very early and safe rule-out, but do not seem helpful for the rule-in of acute myocardial infarction. Clinical Trial Registration: URL (APACE): https://www.clinicaltrial.gov . Unique identifier: NCT00470587. URL (ADAPT): www.anzctr.org.au . Unique identifier: ACTRN12611001069943.

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Two-Hour Algorithm for Rapid Triage of Suspected Acute Myocardial Infarction Using a High-Sensitivity Cardiac Troponin I Assay

Clinical Chemistry ◽

10.1373/clinchem.2019.305193 ◽

2019 ◽

Vol 65 (11) ◽

pp. 1437-1447 ◽

Cited By ~ 9

Author(s):

Thomas Nestelberger ◽

Jasper Boeddinghaus ◽

Jaimi Greenslade ◽

William A Parsonage ◽

Martin Than ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Predictive Value ◽

Cardiac Troponin ◽

Troponin I ◽

Validation Cohort ◽

High Sensitivity ◽

Final Diagnosis ◽

Derivation Cohort ◽

Rule Out

Abstract BACKGROUND We aimed to derive and externally validate a 0/2-h algorithm using the high-sensitivity cardiac troponin I (hs-cTnI)-Access assay. METHODS We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI) in 2 prospective diagnostic studies using central adjudication. Two independent cardiologists adjudicated the final diagnosis, including all available medical information including cardiac imaging. hs-cTnI-Access concentrations were measured at presentation and after 2 h in a blinded fashion. RESULTS AMI was the adjudicated final diagnosis in 164 of 1131 (14.5%) patients in the derivation cohort. Rule-out by the hs-cTnI-Access 0/2-h algorithm was defined as 0-h hs-cTnI-Access concentration <4 ng/L in patients with an onset of chest pain >3 h (direct rule-out) or a 0-h hs-cTnI-Access concentration <5 ng/L and an absolute change within 2 h <5 ng/L in all other patients. Derived thresholds for rule-in were a 0-h hs-cTnI-Access concentration ≥50 ng/L (direct rule-in) or an absolute change within 2 h ≥20 ng/L. In the derivation cohort, these cutoffs ruled out 55% of patients with a negative predictive value (NPV) of 99.8% (95% CI, 99.3–100) and sensitivity of 99.4% (95% CI, 96.5–99.9), and ruled in 30% of patients with a positive predictive value (PPV) of 73% (95% CI, 66.1–79). In the validation cohort, AMI was the adjudicated final diagnosis in 88 of 1280 (6.9%) patients. These cutoffs ruled out 77.9% of patients with an NPV of 99.8% (95% CI, 99.3–100) and sensitivity of 97.7% (95% CI, 92.0–99.7), and ruled in 5.8% of patients with a PPV of 77% (95% CI, 65.8–86) in the validation cohort. CONCLUSIONS Safety and efficacy of the l hs-cTnI-Access 0/2-h algorithm for triage toward rule-out or rule-in of AMI are very high. TRIAL REGISTRATION APACE, NCT00470587; ADAPT, ACTRN1261100106994; IMPACT, ACTRN12611000206921.

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Peripheral artery disease is associated with high in-hospital mortality particularly in males with acute myocardial infarction in a nationwide real-world setting

VASA ◽

10.1024/0301-1526/a000512 ◽

2016 ◽

Vol 45 (2) ◽

pp. 169-174 ◽

Cited By ~ 10

Author(s):

Eva Freisinger ◽

Nasser M. Malyar ◽

Holger Reinecke

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Hospital Mortality ◽

Real World ◽

Large Scale ◽

Female Gender ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Cardiovascular Morbidity And Mortality

Abstract. Background: Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular morbidity and mortality. The objective of this nationwide analysis was to explore the association of PAD with in-hospital mortality in patients hospitalized for acute myocardial infarction (AMI). Patients and methods: Data on all in-patient hospitalizations in Germany are continuously transferred to the Federal Statistical Office (DESTATIS), as required by federal law. These case-based data on AMI in the years 2005, 2007 and 2009 were analyzed regarding ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) as the primary diagnoses and concomitant PAD as the secondary diagnosis with respect to age and gender related disparity. Results: We analyzed 619,103 AMI cases, including 270,026 (43.6 %) with STEMI and 349,077 (56.4 %) with NSTEMI. The PAD ratio was 3.4 % in STEMI and 5.7 % in NSTEMI. In STEMI, in-hospital mortality was 15.6 % in cases with PAD vs. 12.0 % without, and 12.0 % vs. 9.8 % in NSTEMI, respectively (P < 0.001; 2009). Although female gender was associated with a significantly higher in-hospital mortality, the presence of PAD particularly negatively affected in-hospital mortality in men (+ 60 % male vs - 11 % female in STEMI; + 33 % male vs - 3 % female in NSTEMI). Conclusions: Our data demonstrate the adverse impact of concomitant PAD on in-hospital mortality in AMI, in a large-scale, real-world scenario. Further research, particularly with a focus on gender, is needed to identify diagnostic and therapeutic measures to reduce the remarkably high in-hospital mortality of AMI patients with concomitant PAD.

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P4629Long-term outcomes in patients with ST-segment elevation myocardial infarction according to modalities of reperfusion therapy: data from china acute myocardial infarction (CAMI) registry

European Heart Journal ◽

10.1093/eurheartj/ehz745.1011 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

X J Gao ◽

J G Yang ◽

Y J Yang ◽

C Wu ◽

S B Qiao ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Real World ◽

Symptom Onset ◽

Reperfusion Therapy ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

Real World Setting ◽

St Segment ◽

The Impact

Abstract Background Although primary percutaneous coronary intervention (pPCI) is the optimal reperfusion method for ST-segment elevation myocardial infarction (STEMI), it remains difficult to implement in many areas. Some STEMI patients have to accept fibrinolytic therapy and no reperfusion therapy instead. Purpose The aim of this study was to describe the impact of reperfusion therapy on the long-term outcomes of STEMI patients in China. Methods Using data from the China Acute Myocardial Infarction (CAMI) registry, we analyzed the 2-year outcomes of 18,075 STEMI patients symptom onset within 7 days from January 2013 to September 2014 according to the type of reperfusion therapy. The primary endpoint was a composite of major adverse cardiovascular event (MACE), defined as all-cause mortality, myocardial infarction or stroke. Results 7798 (43%) were treated with pPCI and 1798 (10%) underwent fibrinolysis; 8479 (47%) did not receive any reperfusion. The 2-year MACE was 9.6% following pPCI, 15.7% following fibrinolysis, and 21.5% for patients without reperfusion therapy (P<0.0001). Adjusted hazard ratios for 2-year MACE were 0.71 (95% confidence interval [CI] 0.65–0.78, P<0.0001) for pPCI versus no reperfusion and 0.92 (95% CI 0.82–1.03, P=0.16) for fibrinolysis versus no reperfusion. Compared with patients without reperfusion, fibrinolysis only showed benefit in patients presented within 3 hours of symptom onset (HR 0.70, 95% CI 0.57–0.85, P=0.0005), whereas pPCI was associated with significantly decreased 2-year MACE rate in patients presented within 3 hours (HR 0.53, 95% CI 0.44–0.64, P<0.0001), 3–6 hours (HR 0.60, 95% CI 0.51–0.71, P<0.0001) and >6 hours (HR 0.86, 95% CI 0.76–0.97, P=0.01) of symptom onset. Adjusted cumulative MACE rate Conclusions In a real-world setting, early reperfusion is the optimal strategy for STEMI. Fibrinolysis was not associated with better outcome in STEMI patients admitted >3 hours of symptom onset in Chinese real world setting. Acknowledgement/Funding Ministry of Science and Technology of China (Grant No. 2011BAI11B02)

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Impact of Malnutrition on Long-Term Mortality in Elderly Patients with Acute Myocardial Infarction

10.20944/preprints201811.0311.v1 ◽

2018 ◽

Author(s):

Klara Komici ◽

Dino Franco Vitale ◽

Angela Mancini ◽

Leonardo Bencivenga ◽

Maddalena Conte ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Nutritional Status ◽

Elderly Patients ◽

Troponin I ◽

Mini Nutritional Assessment ◽

The Impact ◽

Grace Score ◽

Long Term Mortality

Background: Malnutrition is a frequent condition in the elderly and is associated with prolonged hospitalization and increased mortality. However, the impact of malnutrition among elderly patients with acute myocardial infarction has not been clarified yet. Methods and Results: We have enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI) who underwent to the evaluation of nutritional status by Mini Nutritional Assessment (MNA) and of mortality risk by Grace score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse GFR, lower SBP, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that Grace score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95% CI = 1.34–2.32 and HR = 0.56, 95% CI = 0.42–0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included compared to the partial models without MNA. Conclusions: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with/at risk of malnutrition in order to apply interventions to improve nutritional status and maybe survival in this population.

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P1735Two-hour algorithm for early diagnosis of acute myocardial infarction using a novel high-sensitivity cardiac troponin I assay

European Heart Journal ◽

10.1093/eurheartj/ehz748.0489 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

T Nestelberger ◽

J Boeddinghaus ◽

J Greenslade ◽

L Cullen ◽

W Parsonage ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Predictive Value ◽

Cardiac Troponin ◽

Troponin I ◽

Validation Cohort ◽

High Sensitivity ◽

Final Diagnosis ◽

Cardiac Troponin I

Abstract Background We aimed to derive and externally validate a 0/2h-algorithm using the novel high-sensitivity cardiac troponin I (hs-cTnI-Access) assay. Methods We enrolled patients presenting to the emergency department with symptoms suggestive of acute myocardial infarction (AMI) in two prospective chest pain trials. Two independent cardiologists adjudicated the final diagnosis including all available medical information including cardiac imaging. Hs-cTnI concentrations were measured at presentation and after 2h. Primary diagnostic endpoint was the derivation and validation of an hs-cTnI-Access specific 0/2h-algorithm. Primary prognostic endpoint was overall survival of patients after 30- and 720-days of follow-up. Results AMI was the adjudicated final diagnosis in 164/1131 (14.5%) patients in the derivation and in 88/1280 (6.9%) patients in the validation cohort. Median hs-cTnI Access concentrations at presentation were significantly higher in patients with AMI as compared to patients with non-AMI in both cohorts (104 ng/L versus 3.4 ng/L and 29 ng/L vs. 2.3 ng/L, p-value both <0.001) Applying the derived hs-cTnI-Access 0/2h-algorithm (Figure 1A) to the validation cohort (Figure 1B), 77.9% of patients were ruled-out (sensitivity 97.7% [95% CI, 92–99.7], negative predictive value [NPV] 99.8% [95% CI, 99.3–100]), and 5.8% of patients were ruled-in (specificity 98.6% [95% CI, 97.7–99.2], positive predictive value [PPV] 77% [95% CI, 65.8–86]). Among 1617 patients ruled-out for AMI in both cohorts together, 3 (0.2%) patients with AMI have been missed, of whom 2 patients had type 2 myocardial infarction (both with tachyarrhythmia). Patients ruled-out by the 0/2h-algorithm had a survival rate of 98.4% and 99.9% after two years or one year of follow up in both cohorts, respectively. Figure 1 Conclusions Diagnostic performance of the hs-cTnI Access 0/2h-algorithm for triage of AMI is excellent with high safety for rule-out and high accuracy for rule-in. Acknowledgement/Funding European Union, Swiss National Foundation, University Hospital Basel, University Basel

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Two-Hour Algorithm for Triage toward Rule-Out and Rule-In of Acute Myocardial Infarction by Use of High-Sensitivity Cardiac Troponin I

Clinical Chemistry ◽

10.1373/clinchem.2015.249508 ◽

2016 ◽

Vol 62 (3) ◽

pp. 494-504 ◽

Cited By ~ 63

Author(s):

Jasper Boeddinghaus ◽

Tobias Reichlin ◽

Louise Cullen ◽

Jaimi H Greenslade ◽

William A Parsonage ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Cardiac Troponin ◽

Troponin I ◽

Validation Cohort ◽

External Validation ◽

High Sensitivity ◽

Final Diagnosis ◽

Derivation Cohort ◽

Rule Out

Abstract BACKGROUND The early triage of patients toward rule-out and rule-in of acute myocardial infarction (AMI) is challenging. Therefore, we aimed to develop a 2-h algorithm that uses high-sensitivity cardiac troponin I (hs-cTnI). METHODS We prospectively enrolled 1435 (derivation cohort) and 1194 (external validation cohort) patients presenting with suspected AMI to the emergency department. The final diagnosis was adjudicated by 2 independent cardiologists. hs-cTnI was measured at presentation and after 2 h in a blinded fashion. We derived and validated a diagnostic algorithm incorporating hs-cTnI values at presentation and absolute changes within the first 2 h. RESULTS AMI was the final diagnosis in 17% of patients in the derivation and 13% in the validation cohort. The 2-h algorithm developed in the derivation cohort classified 56% of patients as rule-out, 17% as rule-in, and 27% as observation. Resulting diagnostic sensitivity and negative predictive value (NPV) were 99.2% and 99.8% for rule-out; specificity and positive predictive value (PPV) were 95.2% and 75.8% for rule-in. Applying the 2-h algorithm in the external validation cohort, 60% of patients were classified as rule-out, 13% as rule-in, and 27% as observation. Diagnostic sensitivity and NPV were 98.7% and 99.7% for rule-out; specificity and PPV were 97.4% and 82.2% for rule-in. Thirty-day survival was 100% for rule-out patients in both cohorts. CONCLUSIONS A simple algorithm incorporating hs-cTnI baseline values and absolute 2-h changes allowed a triage toward safe rule-out or accurate rule-in of AMI in the majority of patients.

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Impact of smoke-free legislation on acute myocardial infarction and stroke mortality: Tianjin, China, 2007–2015

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054477 ◽

2019 ◽

Vol 29 (1) ◽

pp. 61-67 ◽

Cited By ~ 3

Author(s):

Hong Xiao ◽

Hui Zhang ◽

Dezheng Wang ◽

Chengfeng Shen ◽

Zhongliang Xu ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Large Scale ◽

National Level ◽

Interrupted Time Series ◽

Stroke Mortality ◽

Series Design ◽

The Impact ◽

Interrupted Time Series Design

BackgroundSmoke-free legislation is an effective way to protect the population from the harms of secondhand smoke and has been implemented in many countries. On 31 May 2012, Tianjin became one of the few cities in China to implement smoke-free legislation. We investigated the impact of smoke-free legislation on mortality due to acute myocardial infarction (AMI) and stroke in Tianjin.MethodsAn interrupted time series design adjusting for underlying secular trends, seasonal patterns, population size changes and meteorological factors was conducted to analyse the impact of the smoke-free law on the weekly mortality due to AMI and stroke. The study period was from 1 January 2007 to 31 December 2015, with a 3.5-year postlegislation follow-up.ResultsFollowing the implementation of the smoke-free law, there was a decline in the annual trends of AMI and stroke mortality. An incremental 16% (rate ratio (RR): 0.84; 95% CI: 0.83 to 0.85) decrease per year in AMI mortality and a 2% (RR: 0.98; 95% CI: 0.97 to 0.99) annual decrease in stroke mortality among the population aged ≥35 years in Tianjin was observed. Immediate postlegislation reductions in mortality were not statistically significant. An estimated 10 000 (22%) AMI deaths were prevented within 3.5 years of the implementation of the law.ConclusionThe smoke-free law in Tianjin was associated with reductions in AMI mortality. This study reinforces the need for large-scale, effective and comprehensive smoke-free laws at the national level in China.

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