scholarly journals The importance of GRACE score in health care planning of patients after acute myocardial infarction

2021 ◽  
Vol 24 (82) ◽  
pp. 34-38
Author(s):  
Marina Đorđević ◽  
Jelica Davidović ◽  
Radmila Resimić ◽  
Dijana Otašević ◽  
Nataša Marković-Nikolić ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Health Care ◽  
Acute Myocardial Infarction ◽  
Patient Care ◽  
Adverse Outcomes ◽  
Nursing Interventions ◽  
Care Planning ◽  
Care Assessment ◽  
Grace Score

Introduction: Acute myocardial infarction (AIM) is ischemic myocardial necrosis and is associated with a number of adverse outcomes that complicate patient health care. Assessment of patient status, risk factors, and adverse outcomes has a significant impact on patient care planning after AIM. The GRACE (Global Registry of Acute Coronary Events) score is of great importance in risk stratification in these patients. Objective: To determine the importance of determining the GRACE score in order to set priorities in the planning of patient care after acute myocardial infarction. Method: A retrospective study examined 50 patients, both sexes, aged 28 to 75 years, with a diagnosis of acute myocardial infarction, undergoing percutaneous coronary intervention (PKI), who were treated at the Zvezdara Clinical Hospital in Belgrade during the research period, from January to March 2020. Data were taken from the medical records of these patients. During the study, AIM type, comorbidities, CVD risk factors, GRACE score and frequency of complex nursing interventions in patients with low, moderate, and high-risk of adverse cardiac events were monitored. Results: Out of a total of 50 examinees with AIM treated with PKI, 74% had STEMI and 26% NSTEMI. 84% of patients had positive family history, 64% hypertension, 2% diabetes, 48% obesity, 52% were smokers and 6% of them were using alcohol. The values of the GRACE score were increased as follows: in four patients more than 140, while in one of them a moderate value was recorded, and in one low value of the GRACE score. In the course of six months, three patients, who had high GRACE scores on hospitalization, had a lethal outcome. Complex nursing interventions in the intensive care unit are more common in patients who have high GRACE score values after AIM. Conclusion: The GRACE score can be used as an important guideline in planning the health care of patients after an acute myocardial infarction.

The combined impact of Type D personality and depression on cardiovascular events after acute myocardial infarction

2021 ◽  
pp. 1-11
Author(s):  
Yini Wang ◽  
Xueqin Gao ◽  
Zhenjuan Zhao ◽  
Ling Li ◽  
Guojie Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Significant Risk ◽  
Type D Personality ◽  
Adverse Outcomes ◽  
Combined Effect ◽  
Continuous Variables ◽  
Type D

Abstract Background Type D personality and depression are the independent psychological risk factors for adverse outcomes in cardiovascular patients. The aim of this study was to examine the combined effect of Type D personality and depression on clinical outcomes in patients suffering from acute myocardial infarction (AMI). Methods This prospective cohort study included 3568 patients diagnosed with AMI between February 2017 and September 2018. Type D personality and depression were assessed at baseline, while the major adverse cardiac event (MACE) rate (cardiac death, recurrent non-fatal myocardial infarction, revascularization, and stroke) and in-stent restenosis (ISR) rate were analyzed after a 2-year follow-up period. Results A total of 437 patients developed MACEs and 185 had ISR during the follow-up period. The Type D (+) depression (+) and Type D (+) depression (−) groups had a higher risk of MACE [95% confidence interval (CI) 1.74–6.07] (95% CI 1.25–2.96) and ISR (95% CI 3.09–8.28) (95% CI 1.85–6.22). Analysis of Type D and depression as continuous variables indicated that the main effect of Type D, depression and their combined effect were significantly associated with MACE and ISR. Moreover, Type D (+) depression (+) and Type D (+) depression (−) emerged as significant risk factors for MACE and ISR in males, while only Type D (+) depression (+) was associated with MACE and ISR in female patients. Conclusions These findings suggest that patients complicated with depression and Type D personality are at a higher risk of adverse cardiovascular outcomes. Individual assessments of Type D personality and depression, and comprehensive interventions are required.

scholarly journals Risk Factors and Timing of Acute Myocardial Infarction Associated With Pregnancy: Insights From the National Inpatient Sample

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Courtney A. Balgobin ◽  
Xiaoyue Zhang ◽  
Fabio V. Lima ◽  
Cecilia Avila ◽  
Puja B. Parikh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Postpartum Period ◽  
Significant Risk ◽  
Adverse Outcomes ◽  
Labor And Delivery ◽  
National Inpatient Sample ◽  
Cerebrovascular Events ◽  
In Pregnancy

Background Pregnancy increases the risk of acute myocardial infarction (AMI). The purpose of this study was to examine timing and risk factors for AMI in pregnancy and poor outcome. Methods and Results National Inpatient Sample (2003–2015) was screened in pregnancy, labor and delivery, and postpartum. There were 11 297 849 records extracted with 913 instances of AMI (0.008%). One hundred eleven (12.2%) women experienced AMI during labor and delivery, 338 (37.0%) during pregnancy and most during the postpartum period (464; 50.8%). The prevalence of AMI in pregnancy has increased ( P =0.0005). Most major adverse cardiovascular and cerebrovascular events occurred in the postpartum period (63.5%). Inpatient mortality was 4.5%. Predictors of AMI include known coronary artery disease (odds ratio [OR], 517.4; 95% CI, 420.8–636.2), heart failure (OR, 8.2; 95% CI, 1.9–35.2), prior valve replacement (OR, 6.4; 95% CI, 2.4–17.1), and atrial fibrillation (OR, 2.7; CI, 1.5–4.7; P <0.001). Risk factors of traditional atherosclerosis including hyperlipidemia, obesity, tobacco history, substance abuse, and thrombophilia were identified ( P <0.001). Gestational hypertensive disorders (eclampsia OR, 6.0; 95% CI, 3.3–10.8; preeclampsia OR, 3.2; 95% CI, 2.5–4.2) were significant risk factors in predicting AMI. Risk factors associated with major adverse cardiovascular and cerebrovascular events included prior percutaneous coronary intervention (OR, 6.6; 95% CI, 1.4–31.2) and pre‐eclampsia (OR, 2.3; 95% CI, 1.3–3.9). Conclusions AMI is associated with modifiable, nonmodifiable, and obstetric risk factors. These risk factors can lead to devastating adverse outcomes and highlight the need for risk factor modification and public health resource initiatives toward the goal of decreasing AMI in the pregnant population.

scholarly journals Predictors of lethality in young patients with acute myocardial infarction

2017 ◽  
Vol 95 (8) ◽  
pp. 713-718
Author(s):  
A. A. Garganeeva ◽  
Kseniya N. Borel ◽  
S. A. Okrugin ◽  
E. A. Kuzheleva
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Young Patients ◽  
Adverse Outcomes ◽  
Medical Community ◽  
Early Evaluation ◽  
Risk Of Death ◽  
Group 2 ◽  
Group 1

The profile and combination of risk factors vary among patients with acute myocardial infarction (AMI) in different age groups. Their screening may help to improve prognosis in a young population. Aim. To identify the predictors of lethality in young patients with AMI. Material and methods. Using the data from the acute myocardial infarction registry, two groups of patients under 45 years were formed: deceased (group 1) and survivors (group 2) after AMI. Results. Patients in group 1 were younger than in group 2. Atypical pain syndrome or syncope were documented in 21,1% of the patients in group 1. For patients who died in different hospitals (n=13), duration of period between pain onset and ambulance call and between ambulance call and arrival were shorter in group 1. Only 38,5% of them were delivered to specialized units. The fraction of patients admitted to cardiological departments among survivors was 93,3% (p<0.001). Some patients of both groups reported changes in the state of health before AMI. In group 1, they often were nonspecific (weakness, blood pressure changes etc.). The risk of death for smokers was twice that for non-smokers. Hospitalization in a specialized hospital as well as timely seeking medical aid in case of unstable angina increased the chance of survival. Conclusions. An early appeal for help is very important for young patients with new/worsening symptoms threatening rapid onset of death. As far as patients having no histories of coronary disorders are concerned, efforts of the medical community should be focused on extensive screening of risk factors and their effective correction with the development of stratification scales for the early evaluation of the likelihood of adverse outcomes.

P1757GLP-1 levels predict cardiovascular risk in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Kahles ◽  
M V Rueckbeil ◽  
R W Mertens ◽  
A C Foldenauer ◽  
M C Arrivas ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Cardiovascular Risk ◽  
Receiver Operating Characteristic Curve ◽  
Operating Characteristic ◽  
Troponin T ◽  
Characteristic Curve ◽  
Adverse Outcomes ◽  
Operating Characteristic Curve ◽  
Grace Score

Abstract Background Glucagon-like peptide 1 (GLP-1) is a gut incretin hormone, which induces post-prandial glucose-dependent insulin secretion. GLP-1 receptor agonists improve cardiovascular outcomes in patients with diabetes at high cardiovascular risk. We recently found GLP-1 levels to be increased in patients with acute myocardial infarction. Purpose The aim of this study was to assess the predictive capacity of GLP-1 for cardiovascular outcome in patients with myocardial infarction. Methods Total GLP-1 levels, NT-proBNP concentrations and the Global Registry of Acute Coronary Events (GRACE) score were assessed at time of admission in 918 patients with myocardial infarction presenting with acute chest pain. Among these 597 patients presented with NSTEMI and 321 with STEMI. The primary composite outcome of the study was the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke with a median follow-up of 311 days. Results Kaplan-Meier survival plots (separated by tertiles with cut-off values 35.44 and 53.45) and univariate cox regression analyses found GLP-1 values to be associated with adverse outcome (combined endpoint and all-cause mortality) (logarithmized GLP-1 values HR: 5.459; p<0.0001). Further adjustment for age, sex, previous cardiovascular disease, diabetes, hypertension, hypercholesterinemia, kreatinin, CRP, troponin T and NT-proBNP levels did not affect the association of GLP-1 with adverse outcomes (p=0.0341). Receiver operating characteristic curve analyses illustrated that GLP-1 is a strong indicator for early events (area under the curve of the combined endpoint at 7 days: 0.79; 14 days: 0.81; 30 days: 0.80 and 183 days: 0.64), which proved to be superior to Troponin T, serum creatinin, NT-proBNP and CRP within the first 100 days. Adjustment of the GRACE risk estimate by GLP-1 increased the area under the receiver-operating characteristic curve (AUC) after 1 month from 0.86 to 0.89 in NSTEMI patients. Addition of GLP-1 to a model containing GRACE and NT-proBNP led to a further improvement in model performance (increase in AUC from 0.88 for GRACE + NT-proBNP to 0.90 for GRACE + NT-proBNP + GLP-1). Conclusion GLP-1 is a new biomarker of cardiovascular risk and adverse outcomes in patients with acute myocardial infarction and improves the predictive value of the GRACE score in patients with NSTEMI.

scholarly journals Nursing interventions in the management of patients with acute myocardial infarction / Sestrinske intervencije u zbrinjavanju bolesnika sa akutnim infarktom miokarda

2014 ◽  
Vol 1 (1) ◽  
pp. 28
Author(s):  
Areta Ognjenović
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Nursing Interventions ◽  
Human Relations ◽  
Cvd Risk ◽  
Appropriate Therapy ◽  
Unhealthy Diet ◽  
Coronary Care

Cardiovascular disease (CVD) is one of the leading health problems of today and the leading cause of death worldwide. Occurrence of CVD risk factors contribute most, unhealthy diet and sedentary lifestyle. Most CVD could be prevented by addressing risk factors (smoking, obesity, physical inactivity, high blood pressure, diabetes and elevated lipids) improving nutrition and socio-economic conditions of life. The most common form of coronary heart disease, acute myocardial infarction (MI), which is characterized by high mortality and major functional deficit, and its management require urgent, contemporary and appropriate therapy which involved a team of doctors and nurses - technicians. Each participant in a team which cares for people with IM should be as professionally qualified and theoretically. In this team nurses - technicians play an important role especially in coronary care units. A nurse in the coronary care unit not only provides patient care he needs and to mediate between patients and doctors, but also responsible for the observation of the patient by the minute and begin therapy on its own initiative when necessary. The role of nurses requires a stable, intelligent person, enthusiastic with good human relations. It should be left to the patient’s impression of the competence, experience and understanding.

scholarly journals Incidence and risk factors of delirium after percutaneous coronary intervention in individuals hospitalised for acute myocardial infarction: protocol for a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e044564
Author(s):  
Kaizhuang Huang ◽  
Jiaying Lu ◽  
Yaoli Zhu ◽  
Tao Cheng ◽  
Dahao Du ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Systematic Review ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Risk Factor ◽  
Meta Analysis ◽  
Coronary Intervention ◽  
Cochrane Library ◽  
Percutaneous Coronary

IntroductionDelirium in the postoperative period is a wide-reaching problem that affects important clinical outcomes. The incidence and risk factors of delirium in individuals with acute myocardial infarction (AMI) after primary percutaneous coronary intervention (PCI) has not been completely determined and no relevant systematic review and meta-analysis of incidence or risk factors exists. Hence, we aim to conduct a systematic review and meta-analysis to ascertain the incidence and risk factors of delirium among AMI patients undergoing PCI.Methods and analysesWe will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, PsycINFO, CINAHL and Google Scholar from their inception to the search date. Prospective cohort and cross-sectional studies that described the incidence or at least one risk factor of delirium will be eligible for inclusion. The primary outcome will be the incidence of postoperative delirium. The quality of included studies will be assessed using a risk of bias tool for prevalence studies and the Cochrane guidelines. Heterogeneity of the estimates across studies will be assessed. Incidence and risk factors associated with delirium will be extracted. Incidence data will be pooled. Each risk factor reported in the included studies will be recorded together with its statistical significance; narrative and meta-analytical approaches will be employed. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses.Ethics and disseminationThis proposed systematic review and meta-analysis is based on published data, and thus there is no requirement for ethics approval. The study will provide an up to date and accurate incidence and risk factors of delirium after PCI among patients with AMI, which is necessary for future research in this area. The findings of this study will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42020184388.

Managed care improves prognosis in acute myocardial infarction survivors. Data from the MAnaged Care for Acute Myocardial Infarction Survivors (MACAMIS) Programme

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Jankowski ◽  
R Topor-Madry ◽  
M Gasior ◽  
U Ceglowska ◽  
Z Eysymontt ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analysis ◽  
Managed Care ◽  
Care Programme ◽  
Wide System ◽  
Care Assessment ◽  
Acute Mi ◽  
One Year ◽  
Overall Mortality

Abstract Background Mortality following acute myocardial infarction (MI) remains high despite progress in pharmacotherapy and interventional treatment. In 2017 a nation-wide system of managed care for MI survivors comprising a continuum of acute treatment of MI, staged revascularization, cardiac rehabilitation, cardiac electrotherapy and cardiac ambulatory care within one year following MI was implemented in Poland. The managed care programme (MCP) includes also the quality of care assessment based on clinical measures (e.g. cardiovascular risk factors control) as well as on the rate of minor and major cardiovascular events. The goal of the analysis was to assess the overall mortality of MI survivors participating and not participating in the MCP. Methods The database of survivors of acute MI discharged from hospital from October 1, 2017 to December 31, 2018 was analyzed. Patients who died within 10 days after discharge were excluded from the analysis. The primary end-point was defined as death from any cause. Propensity-Score Matching (PSM) using nearest neighbor matching was used to form comparable groups of patients participating and not participating in the MCP. The Cox proportional hazard regression analysis was used to assess the relation between MCP and the overall mortality. Results MCP was implemented in the first stage in 48 hospitals spread around the country (about 34% of all hospitals treating acute MI patients in Poland). Out of 87739 analyzed patients (age: 68.1±11.9 years; 55581 men and 32158 women) 34064 were hospitalized in hospitals with MCP implemented. Altogether 10404 patients (11.9% of the whole cohort; 30.5% of those hospitalized in hospitals with MCP implemented) participated in MCP. They were matched with 10404 patients not participating in the MCP. During 324.8±140.5 days of follow-up 7413 patients died. One-year mortality was lower in patients participating in the MCP both when we analyzed the whole cohort (4.4% vs. 9.5%; p&lt;0.001) as well as when we limited the analysis to the PSM groups (4.4% vs. 6.5%; p&lt;0.001, figure 1). MCP was related to the overall mortality in univariate (HR 0.43 [0.39–0.48]) as well as in multivariate analysis (0.64 [0.57–0.71]) in the whole cohort as well as in the PSM cohort (HR 0.63 [0.56–0.72] and 0.64 [0.56–0.72] for the univariate and multivariate analysis respectively). When we limited the analysis to hospitals in which MCP was implemented one-year mortality was 4.3% vs. 6.3% (p&lt;0.001) whereas univariate HR was 0.51 (0.44–0.60) and multivariate HR 0.52 (0.44–0.61). Conclusion The implemented in Poland nation-wide system of managed care for MI survivors is related to improved survival. Therefore, the Ministry of Health plans to implement the programme in all cardiac centers in Poland. Funding Acknowledgement Type of funding source: None

The Role of Uric Acid in the Acute Myocardial Infarction: A Narrative Review

Angiology ◽  
2021 ◽  
pp. 000331972110125
Author(s):  
Atalay Demiray ◽  
Baris Afsar ◽  
Adrian Covic ◽  
Masanari Kuwabara ◽  
Charles J. Ferro ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Uric Acid ◽  
Adverse Outcomes ◽  
Narrative Review ◽  
Background Information ◽  
Pathophysiological Role ◽  
Artery Disease ◽  
Pathologic Processes

Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation, and endothelial dysfunction. Thus, it is not surprising that increased SUA is associated with various adverse outcomes including cardiovascular (CV) diseases. Recent epidemiological evidence suggests that increased SUA may be related to acute myocardial infarction (AMI). Accumulating data also showed that elevated UA has pathophysiological role in the development of AMI. However, there are also studies showing that SUA is not related to the risk of AMI. In this narrative review, we summarized the recent literature data regarding SUA and AMI after providing some background information for the association between UA and coronary artery disease. Future studies will show whether decreasing SUA levels is beneficial for outcomes related to AMI and the optimum SUA levels for best outcomes in CV diseases.

scholarly journals PREDICTORS OF ACUTE MYOCARDIAL INFARCTION AND ADVERSE OUTCOMES IN PATIENTS HOSPITALIZED WITH INFLUENZA

2021 ◽  
Vol 77 (18) ◽  
pp. 201
Author(s):  
Homam Moussa Pacha ◽  
Yasar Sattar ◽  
Talha Ahmad ◽  
Abhijeet Dhoble ◽  
Konstantinos Charitakis ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Adverse Outcomes
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