Effects of the coronavirus disease 2019 pandemic on the number of hospitalizations for myocardial infarction: regional differences. Population analysis of 7 million people

2020 ◽  
Author(s):  
Mariusz Gąsior ◽  
Marek Gierlotka ◽  
Agnieszka Tycińska ◽  
Adam Wojtaszczyk ◽  
Michał Skrzypek ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regional Differences ◽  
Population Analysis

Regional variation in appropriate care for ST-elevation myocardial infarction in Finland

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
E Reissell ◽  
S Lumme ◽  
M Satokangas ◽  
K Manderbacka
Keyword(s):  
Myocardial Infarction ◽  
Regional Variation ◽  
Regional Differences ◽  
Coronary Intervention ◽  
Register Data ◽  
St Elevation Myocardial Infarction ◽  
Academic Affiliation ◽  
Episode Of Care ◽  
Appropriate Care ◽  
St Elevation

Abstract Background Timely primary percutaneous coronary intervention (PCI) is currently the treatment of choice for ST-elevation myocardial infarction (STEMI). Although cardiac units were established in all central hospitals in late 1990s for sparsely populated Finland, studies have shown that regional variation has increased. Additionally, the dense Finnish hospital network includes non-cardiac facilities where patients may be inappropriately admitted and then transferred for PCI. We aim to investigate the current regional differences in receiving timely PCI, determinants of these variations and the effect of hospital transfers. Methods Finnish Hospital Discharge Register data on PCIs for STEMI patients in 2015-17 were linked to register data on socio-demographics. In these preliminary analyses we used logistic regression modelling. Results Our results suggest that there were significant regional differences both for timely PCI in STEMI patients and in the probability of hospital transfers during an episode of care. The regional odds ratios (OR) for receiving PCI on time varied from 0.41 (95% confidence interval 0.33-0.52) to 2.73 (2.09-3.57) compared with the capital region when controlling for age, gender and hospital transfers. The ORs for being transferred during an episode of care varied from 0.26 (0.15-0.44) to 16.6 (11.6-23.6). Patients not transferred were more likely to receive PCI (OR 1.89 (1.67-2.15)). Men received PCI on time more often (OR 1.31 (1.18-1.46)) and women were more likely to be transferred (OR 1.29 (1.15-1.45)). Conclusions The probability for receiving PCI on time was related to the size of the hospital's population base and academic affiliation and inversely to transfers between hospitals. Hospital transfers during care episode and atypical symptoms often seen in women may cause critical delays for PCI. Other determinants for variation of timely PCI and its effects on equity will be analysed using multilevel modelling. Key messages Appropriate care for STEMI varies across regions and reflects inept practices in provider network. These findings are more pronounced in women showing persisting gender-related inequity.

scholarly journals Sympathetic stimulation increases dispersion of repolarization in humans with myocardial infarction

2012 ◽  
Vol 302 (9) ◽  
pp. H1838-H1846 ◽  
Author(s):  
Marmar Vaseghi ◽  
Robert L. Lux ◽  
Aman Mahajan ◽  
Kalyanam Shivkumar
Keyword(s):  
Myocardial Infarction ◽  
Regional Differences ◽  
Normal Tissue ◽  
Ventricular Arrhythmias ◽  
Sympathetic Stimulation ◽  
Recovery Interval ◽  
Dispersion Of Repolarization ◽  
Border Zones ◽  
Sympathetic Nervous ◽  
Nitroprusside Infusion

The sympathetic nervous system is thought to play a key role in genesis and maintenance of ventricular arrhythmias. The myocardial effect of sympathetic stimulation on myocardial repolarization in humans is poorly understood. The purpose of this study was to evaluate the effects of direct and reflex sympathetic stimulation on ventricular repolarization in patients with postinfarct cardiomyopathy (ICM). The effects of direct sympathetic stimulation were assessed using isoproterenol, while those of reflex sympathetic stimulation were assessed with nitroprusside infusion in ICM patients ( n = 5). Five patients without cardiomyopathy were also studied. Local repolarization was measured from intracardiac electrograms that were used to calculate the activation recovery interval (ARI), a surrogate of action potential duration. Isoproterenol significantly increased heterogeneity in repolarization in patients with ICM; the decrease in ARI from baseline was 72.9 ± 9.1 ms in more viable regions, 64.5 ± 8.9 ms in the scar, and 54.9 ± 9.1 ms in border zones ( P = 0.0002 and 0.014 comparing normal and scar to border zones, respectively). In response to nitroprusside, the ARI at the border zones decreased significantly more than either scar or surrounding viable myocardium, which showed an increase in ARI ( P = 0.014 and 0.08 comparing normal tissue and scar to border zones, respectively). Furthermore, isoproterenol increased ARI dispersion by 70%, while nitroprusside increased ARI dispersion by 230% when ICM patients were compared to those with structurally normal hearts ( P = 0.0015 and P < 0.001, respectively). In humans, both direct and reflex sympathetic stimulations increase regional differences in repolarization. The normal tissue surrounding the scar appears denervated. Dispersion of ARI in response to sympathetic stimulation is significantly increased in patients with ICM.

Regional differences in LV collagen accumulation and mature cross-linking after myocardial infarction in rats

1994 ◽  
Vol 266 (1) ◽  
pp. H354-H359 ◽  
Author(s):  
R. J. McCormick ◽  
T. I. Musch ◽  
B. C. Bergman ◽  
D. P. Thomas
Keyword(s):  
Myocardial Infarction ◽  
Regional Differences ◽  
Interventricular Septum ◽  
Principal Component ◽  
Left Ventricular ◽  
Viable Myocardium ◽  
Heart Weight ◽  
Cross Linking ◽  
Free Wall ◽  
Collagen Concentration

To determine the extent of and any regional differences in remodeling response of the extracellular matrix (ECM) to myocardial infarction (MI), moderate-to-large transmural infarcts were surgically produced in left ventricular (LV) free wall of rats. Animals were killed 13 wk after surgery. In comparison to age-matched controls, infarction was associated with an overall increase in heart weight, which included hypertrophy of both the right ventricle and LV. Although the remaining viable myocardium in LV free wall was significantly reduced, the interventricular septum was hypertrophied some 30% compared with control tissues (247 +/- 9 vs. 189 +/- 8 mg). Collagen concentration more than doubled in remaining viable free wall (8.92 +/- 0.59 vs. 3.95 +/- 0.25 mg/100 mg, P < 0.0001), and a smaller but still highly significant 27% increase occurred (P < 0.01) in the more remote septum. Degree of covalent cross-linking of collagen fibrils as assessed by hydroxylysylpyridinoline (HP) concentration also revealed regional differences in response of the ECM to infarction. Although HP concentration was increased 60% in viable free wall (P < 0.05) post-MI, it was unchanged in the septum. With respect to collagen characteristics of the transmural infarct per se, the scar exhibited still further increases in both collagen and HP concentrations compared with the already elevated values for these two parameters in viable free wall. The results indicate that any evaluation of the remodeling response of viable myocardium post-MI must include not only the myocyte but also the ECM, the principal component of which is collagen.

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