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Xie C, Zheng N, Li M, Zhang Z, Huang D, Xiao M, Chen D, He C, Zuo Z, Chen X. Comparative Analysis of Therapeutic Efficacy and Adverse Reactions among Various Thrombolytic Agents. TOXICS 2024; 12:458. [PMID: 39058110 PMCID: PMC11280831 DOI: 10.3390/toxics12070458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2024] [Revised: 05/28/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024]
Abstract
Thrombosis is a major health concern that contributes to the development of several cardiovascular diseases and a significant number of fatalities worldwide. While stent surgery is the current recommended treatment according to the guidelines, percutaneous coronary intervention (PCI) is the optimal approach for acute myocardial infarction (AMI). However, in remote areas with limited resources, PCI procedures may not be feasible, leading to a delay in treatment and irreversible outcomes. In such cases, preoperative thrombolysis becomes the primary choice for managing AMI in remote settings. The market for thrombolytic drugs is continuously evolving, and identifying a safe and effective thrombolytic agent for treating AMI is crucial. This study evaluated Urokinase, Alteplase, and Recombinant Human TNK Tissue-type Plasminogen Activator for Injection (rhTNK) as representatives of first-, second-, and third-generation thrombolytic drugs, respectively. The research included in vitro thrombolysis experiments, exposure of human cardiomyocytes, zebrafish tail vein injections, and vascular endothelial transgenic zebrafish models. The findings revealed that rhTNK is the most effective thrombolytic drug with the least adverse effects and lowest bleeding rate, highlighting its potential as the preferred treatment option for AMI. The order of thrombolytic effectiveness was Urokinase < Alteplase < rhTNK, with adverse effects on cardiomyocytes post-thrombolytic therapy ranking similarly as Urokinase < Alteplase < rhTNK, while the bleeding rate after thrombolysis followed the order of Urokinase > Alteplase > rhTNK.
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Affiliation(s)
- Chenxi Xie
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Naying Zheng
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361005, China; (N.Z.); (C.H.)
| | - Mingmei Li
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Zhiyang Zhang
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Dongqin Huang
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Meizhu Xiao
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Dongdong Chen
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
| | - Chengyong He
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361005, China; (N.Z.); (C.H.)
| | - Zhenghong Zuo
- State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen 361005, China; (N.Z.); (C.H.)
| | - Xintan Chen
- Chest Pain Center, Anxi County Hospital, Quanzhou 362300, China; (C.X.); (M.L.); (Z.Z.); (D.H.); (M.X.); (D.C.)
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Manla Y, Almahmeed W. The Pandemic of Coronary Heart Disease in the Middle East and North Africa: What Clinicians Need to Know. Curr Atheroscler Rep 2023; 25:543-557. [PMID: 37615785 PMCID: PMC10471667 DOI: 10.1007/s11883-023-01126-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE OF REVIEW Coronary heart disease (CHD) is the leading cause of morbidity, mortality, and disability in the Middle East and North Africa (MENA). While the prevention, diagnosis, and management of CHD have been detailed in international guidelines, we aimed in this review to quantify the pandemic of CHD in the MENA region and highlight regional patient characteristics, clinical challenges, and future directions to optimize CHD care in the region. RECENT FINDINGS Patients with CHD in the MENA feature younger age at presentation and worse prognosis in women. Despite the high burden of CHD risk factors, many of these factors remain underrecognized, undertreated, and uncontrolled. Additionally, CHD care is hampered by poor patient awareness, inefficient preventive strategies, and limited access to guideline-recommended therapeutics. All stakeholders involved in healthcare should work together to develop and execute strategies aimed at tackling the burden of CHD in the MENA.
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Affiliation(s)
- Yosef Manla
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Wael Almahmeed
- Department of Cardiology, Heart, Vascular and Thoracic Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Muoghalu CG, Ekong N, Wyns W, Ofoegbu CC, Newell M, Ebirim DA, Alex-Ojei ST. A Systematic Review of the Efficacy and Safety of Tenecteplase Versus Streptokinase in the Management of Myocardial Infarction in Developing Countries. Cureus 2023; 15:e44125. [PMID: 37750155 PMCID: PMC10518219 DOI: 10.7759/cureus.44125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2023] [Indexed: 09/27/2023] Open
Abstract
Myocardial infarction (MI) is a significant cause of morbidity and mortality in low- and middle-income countries. Fibrinolytic agents and percutaneous coronary intervention (PCI) are the main approaches for the recanalization and reperfusion of the myocardium following MI. Many studies have shown that PCI is superior to thrombolytics due to better outcomes and decreased mortality. Nevertheless, PCI's mortality gain over thrombolysis decreases as the time between presentation and PCI procedure increases. Furthermore, PCI is not widely available in most developing countries; thus, it cannot be delivered promptly. Most patients in developing countries cannot afford the cost of PCI. Thus, thrombolytic therapy remains essential to managing MI in developing countries and should not be disregarded. Tenecteplase (TNK) and streptokinase (SK) are the two most widely used fibrinolytics in managing MI in underdeveloped nations. Despite their widespread availability, comparative studies on them have been inconclusive. This study aims to review the available literature on the effectiveness and safety of TNK versus SK in managing MI in resource-poor nations. The study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) extension and analyzed according to Cochrane guidelines on synthesis without meta-analysis. A comprehensive literature search for studies comparing TNK and STK was conducted on EMBASE, Cochrane Library, Web of Science, CINAHL, Scopus, Google Scholar, and Ovid version of MEDLINE databases. A reference list of the eligible articles and systematic reviews was also screened. A narrative synthesis of the available data was done by representing the data on the effect direction plot, followed by vote counting. Of the 2284 references retrieved from the databases, only 17 studies met the inclusion criteria and were selected for final analysis. The study suggested that TNK is more effective in complete ST-segment resolution (80% vs 10% on the effect direction plot) and symptom relief (80% vs 20%) than SK. SK and TNK were comparable in achieving successful fibrinolysis (50% vs 50%). For the safety parameters, TNK is associated with a lesser risk of major bleeding than SK (88.9% vs 11.1%) and minor bleeding (25% vs 75%). SK was linked with a higher risk of hypotension/shock (77.8% vs 11.1%) and anaphylaxis/allergy (100% vs 0%). Long-term mortality was higher in the SK arm (100% vs 0%). In-hospital mortality is comparable between the two agents (37.5% vs 37.5%). There is conflicting evidence regarding other safety and efficacy endpoints. Compared to SK, TNK results in better complete ST-segment resolution and symptom relief. A higher risk of long-term mortality, increased risk of major and minor bleeding, hypotension, and allergy/anaphylaxis was observed in patients who received SK. Both agents were comparable in terms of in-hospital mortality and successful fibrinolysis. Controversy exists regarding which agent is linked with increased risk of 30-35-day mortality benefit and stroke. Randomized controlled trials (RCTs) with large sample sizes are needed to establish TNK vs SK superiority in efficacy and safety. The long-term duration of follow-up of the mortality rate of the two agents is also essential, as most patients in these regions cannot afford the recommended PCI post-fibrinolysis.
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Affiliation(s)
| | - Ndianabasi Ekong
- Department of Medicine, Medical Center, Akwa Ibom State College of Education, Afaha Nsit, NGA
| | - William Wyns
- Department of Medicine, University of Galway, Galway, IRL
| | | | - Micheal Newell
- Department of Surgery, University of Galway, Galway, IRL
| | | | - Sandra T Alex-Ojei
- Department of Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, NGA
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Wu C, Li L, Wang S, Zeng J, Yang J, Xu H, Zhao Y, Wang Y, Li W, Jin C, Gao X, Yang Y, Qiao S. Fibrinolytic therapy use for ST-segment elevation myocardial infarction and long-term outcomes in China: 2-year results from the China Acute Myocardial Infarction Registry. BMC Cardiovasc Disord 2023; 23:103. [PMID: 36814182 PMCID: PMC9948459 DOI: 10.1186/s12872-023-03105-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 02/02/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Data on fibrinolytic therapy use for ST-segment elevation myocardial infarction (STEMI) and long-term clinical outcomes in developing countries are limited. We aimed to investigate the management and 2-year mortality of fibrinolytic-treated patients in China. METHODS A total of 19,112 patients with STEMI from 108 hospitals participated in the China Acute Myocardial Infarction registry between January 2013 and September 2014. We investigated the 2-year all-cause mortality among patients treated with fibrinolysis. Non-invasive clinical indexes were used to diagnose successful fibrinolysis or not. RESULTS Only 1823 patients (9.5%) enrolled in the registry underwent fibrinolysis and 679 (37.2%) could be treated within 3 h after symptom onset. The overall use of rescue percutaneous coronary intervention was 8.9%. Successful fibrinolysis, which could be achieved in 1428 patients (78.3%), was related to types of fibrinolytic agents, symptom to needle time, infarction site, and Killip class. Follow-up data were available for 1745 patients (95.7%). After multivariate adjustment, successful fibrinolysis was strongly associated with a decreased risk of death compared with failed fibrinolysis at 2 years (8.5% vs. 29.0%, hazard ratio: 0.27, 95% confidence interval: 0.20-0.35). CONCLUSION Within a minority of STEMI patients in the CAMI registry underwent fibrinolysis, most of them could achieve successful clinical reperfusion, presenting a much benign 2-year survival outcome than those with failed fibrinolysis. Quality improvement initiatives focusing on fibrinolysis are warranted to achieve its promise fully. TRIAL REGISTRATION URL: https// www. CLINICALTRIALS gov . Unique identifier: NCT01874691. Registered 11/06/2013.
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Affiliation(s)
- Chao Wu
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Ling Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Shuqing Wang
- Internal Medicine‑Cardiovascular Department, The First Hospital of Qiqihar, Affiliated Qiqihar Hospital, Southern Medical University, Qiqihar, Heilongjiang Province, People's Republic of China
| | - Jianping Zeng
- Department of Cardiology, Xiangtan Central Hospital, Xiangtan, Hunan Province, People's Republic of China
| | - Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Yanyan Zhao
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Yang Wang
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Wei Li
- Medical Research & Biometrics Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, People's Republic of China
| | - Chen Jin
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
| | - Shubin Qiao
- Coronary Heart Disease Center, Department of Cardiology, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, No.167 BeiLiShi Rd, Xicheng District, Beijing, 100037, People's Republic of China
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Bagyawantha NMY, Coombes ID, Gawarammana I, Fahim M. Impact of a clinical pharmacist on optimising the quality use of medicines according to the acute coronary syndrome (ACS) secondary prevention guidelines and medication adherence following discharge in patients with ACS in Sri Lanka: a prospective non-randomised controlled trial study protocol. BMJ Open 2023; 13:e059413. [PMID: 36759028 PMCID: PMC9923319 DOI: 10.1136/bmjopen-2021-059413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Ensuring quality use of medicines (QUM) through clinical pharmacy services can improve therapeutic outcomes of patients diagnosed with acute coronary syndrome (ACS). The major objective of this study is to demonstrate the added value of a clinical pharmacist to the medical and nursing team providing care to patients with ACS on the continuation of quality use of the patients' medicine after discharge. STUDY DESIGN This protocol outlines a prospective, non-blinded, non-randomised, controlled interventional study. STUDY SETTING The study will be conducted at the professorial medical wards of a tertiary care teaching hospital in Sri Lanka. PARTICIPANTS Sample size will be 746 patients in both control and intervention arms. Patients diagnosed with ACS who are 18 years old or above and expected to visit the hospital for their routine clinic follow-ups after discharge will be recruited and randomised 1:1 to either the intervention group or the control group. Patients who are diagnosed and suffering from psychological disorders will be excluded from this study. INTERVENTIONS The planned interventions that will be delivered at discharge include review and optimisation of medications, assessing patient adherence and providing discharge medication counselling. Data will be collected at recruitment, 1 month, 3 months and 6 months' time intervals in both groups. Improvement of patients' medication adherence, reduction of hospital readmissions, reduction of drug-related problems, the attitude of doctors and nurses towards clinical pharmacy services and the cost-effectiveness of the clinical pharmacy services will be the major outcomes of this study. ETHICS AND DISSEMINATION Ethical approval for this study has been obtained from the ethics review committee, Faculty of Medicine, University of Peradeniya (2019/EC/26) and the trial is registered at the Sri Lanka Clinical Trials Registry. The results of this study will be disseminated via conference proceedings, journal publications and thesis presentations. TRIAL REGISTRATION NUMBER SLCTR/2019/039.
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Affiliation(s)
- Nanayakkara Muhandiramalaya Yasakalum Bagyawantha
- Department of Pharmacy, Faculty of Allied Health Sciences, University of Peradeniya, Peradeniya, Central, Sri Lanka
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
| | - Ian D Coombes
- School of Pharmacy, The University of Queensland, Saint Lucia, Queensland, Australia
- Collaboration of Australians and Sri Lankans for Pharmacy Practice, Education and Research (CASPPER), Brisbane, Queensland, Australia
| | - Indika Gawarammana
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Central, Sri Lanka
| | - Mohamed Fahim
- South Asian Clinical Toxicology Research Collaboration (SACTRC), Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka
- School of Pharmacy, University of Sydney, Sydney, New South Wales, Australia
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Chiang HP, Aguiar MOD, Tavares BG, Rosa VEE, Gomes SB, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Sbano JC, Rochitte CE, Filho RK, Ramires JAF, Porter TR, Mathias W, Tsutsui JM. The Impact of Sonothrombolysis on Left Ventricular Diastolic Function and Left Atrial Mechanics Preventing Left Atrial Remodeling in Patients With ST Elevation Acute Myocardial Infarction. J Am Soc Echocardiogr 2022; 36:504-513. [PMID: 36535625 DOI: 10.1016/j.echo.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 12/01/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The diagnostic ultrasound-guided high mechanical index impulses during an intravenous microbubble infusion (sonothrombolysis) improve myocardial perfusion in acute ST segment elevation myocardial infarction, but its effect on left ventricular diastolic dysfunction (DD), left atrial (LA) mechanics and remodeling is unknown. We assessed the effect of sonothrombolysis on DD grade and LA mechanics. METHODS One hundred patients (59 ± 10 years; 34% women) were randomized to receive either high mechanical index impulses plus percutaneous coronary intervention (PCI) (therapy group) or PCI only (control group) (n = 50 in each group). Diastolic dysfunction grade and LA mechanics were assessed immediately before and after PCI and at 48 to 72 hours, 1 month, and 6 months of follow-up. Diastolic dysfunction grades were classified as grades I, II, and III. The LA mechanics was obtained by two-dimensional speckle-tracking echocardiography-derived global longitudinal strain (GLS). RESULTS As follow-up time progressed, increased DD grade was observed more frequently in the control group than in the therapy group at 1 month and 6 months of follow-up (all P < .05). The LA-GLS values were incrementally higher in the therapy group when compared with the control group at 48 to 72 hours, 24.0% ± 7.3% in the therapy group versus 19.6% ± 7.2% in the control group, P = .005; at 1 month, 25.3% ± 6.3% in the therapy group versus 21.5% ± 8.3% in the control group, P = .020; and at 6 months, 26.2% ± 8.7% in the therapy group versus 21.6% ± 8.5% in the control group, P = .015. The therapy group was less likely to experience LA remodeling (odds ratio, 2.91 [1.10-7.73]; P = .03). LA-GLS was the sole predictor of LA remodeling (odds ratio, 0.79 [0.67-0.94]; P = .006). CONCLUSION Sonothrombolysis is associated with better DD grade and LA mechanics, reducing LA remodeling.
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Affiliation(s)
- Hsu Po Chiang
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil.
| | - Miguel O D Aguiar
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Bruno G Tavares
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Vitor E E Rosa
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Sergio Barros Gomes
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Mucio T Oliveira
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Alexandre Soeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose C Nicolau
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Henrique B Ribeiro
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - João C Sbano
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Carlos E Rochitte
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Roberto Kalil Filho
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | - Jose A F Ramires
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
| | - Jeane M Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil; Fleury Group, São Paulo, Brazil
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Sex Differences in Acute Coronary Syndromes: A Global Perspective. J Cardiovasc Dev Dis 2022; 9:jcdd9080239. [PMID: 36005403 PMCID: PMC9409655 DOI: 10.3390/jcdd9080239] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/19/2022] [Accepted: 07/21/2022] [Indexed: 02/06/2023] Open
Abstract
Despite increasing evidence and improvements in the care of acute coronary syndromes (ACS), sex disparities in presentation, comorbidities, access to care and invasive therapies remain, even in the most developed countries. Much of the currently available data are derived from more developed regions of the world, particularly Europe and the Americas. In contrast, in more resource-constrained settings, especially in Sub-Saharan Africa and some parts of Asia, more data are needed to identify the prevalence of sex disparities in ACS, as well as factors responsible for these disparities, particularly cultural, socioeconomic, educational and psychosocial. This review summarizes the available evidence of sex differences in ACS, including risk factors, pathophysiology and biases in care from a global perspective, with a focus on each of the six different World Health Organization (WHO) regions of the world. Regional trends and disparities, gaps in evidence and solutions to mitigate these disparities are also discussed.
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Mullasari AS, Victor SM, Alexander T. STEMI India: reimagining STEMI networks in low- and middle-income countries: Reimagining STEMI. ASIAINTERVENTION 2022; 8:17-23. [PMID: 35350796 PMCID: PMC8922460 DOI: 10.4244/aij-d-22-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/21/2022] [Indexed: 06/06/2023]
Abstract
Effective treatment for ST-elevation myocardial infarction (STEMI) includes the 24/7 availability of reperfusion therapy, which is crucial for good clinical outcomes. In low- and middle-income countries, this is hindered by disparities in resource utilisation, irregularities in access to health care and organisational gaps. Due to the inaccessibility of primary percutaneous coronary intervention (PCI) for most patients, the more feasible and practical approach of pharmacoinvasive management must be incorporated into the systems of care for STEMI. This review focuses on the development of STEMI India, a not-for-profit organisation that aims to advance the field of STEMI management by imparting and disseminating the latest information from around the world on STEMI management to all those involved in STEMI care. The STEMI India model system of care includes a 3-model framework, based on infrastructure and workforce availability, and tailored to meet the needs of the society it caters to. After the successful implementation of the "Tamil Nadu STEMI" project, a nationwide system of care for STEMI has been developed, which has been endorsed by the Cardiological Society of India (CSI) and the Association of Physicians of India (API).
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Cardiogenic Shock Among Patients with and without Acute Myocardial Infarction in a Latin American Country: A Single-Institution Study. Glob Heart 2021; 16:78. [PMID: 34900569 PMCID: PMC8641529 DOI: 10.5334/gh.988] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/28/2021] [Indexed: 11/29/2022] Open
Abstract
Background: Latin America has limited information about the full spectrum cardiogenic shock (CS) and its hospital outcome. This study sought to examine the temporal trends, clinical features and outcomes of patients with CS in a coronary care unit of single Mexican institution. Methods: This was a retrospective study of consecutive patients hospitalized with CS in a Mexican teaching hospital between 2006–2019. Patients were classified according to the presence or absence of acute myocardial infarction (AMI). Results: Of 22,747 admissions, 833 (3.7%) exhibited CS. Among patients with AMI (n = 12,438), 5% had AMI–CS, and in patients without AMI (n = 10,309), 2.3% developed CS (non-AMI–CS). Their median age was 63 years and 70.5% were men. Cardiovascular risk factors were more frequent among the AMI–CS group, whereas a history of heart failure was greater in non-AMI–CS patients (70.1%). In AMI-CS patients, the median delay time was 17.2 hours from the onset of AMI symptoms to hospital admission. Overall, the median left ventricular ejection fraction (LVEF) was 30%. Patients with CS at admission showed end-organ dysfunction, evidenced by lactic acidosis, renal impairment, and elevated liver transaminases. Of the 620 AMI–CS patients, the main cause was left ventricular dysfunction in 71.3%, mechanical complications in 15.2% and right ventricular infarction in 13.5%. Among the 213 non-AMI–CS patients, valvular heart disease (49.3%) and cardiomyopathies (42.3%) were the most frequent etiologies. In-hospital all-cause mortality rates were 69.7% and 72.3% in the AMI–CS and non-AMI–CS groups, respectively. Among AMI–CS patients, renal dysfunction, diabetes, older age, depressed LVEF, absence of revascularization and the use of mechanical ventilation were independent predictors of in-hospital mortality. However, in the non-AMI–CS group, only low LVEF and high lactate levels proved significant. Conclusions: This study demonstrates differences in the epidemiology of CS compared to high-income countries; the high mortality reflects critically ill patients and the lack of contemporary effective therapies in the population studied.
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Fanta K, Daba FB, Asefa ET, Melaku T, Chelkeba L, Fekadu G, Gudina EK. Management and 30-Day Mortality of Acute Coronary Syndrome in a Resource-Limited Setting: Insight From Ethiopia. A Prospective Cohort Study. Front Cardiovasc Med 2021; 8:707700. [PMID: 34604351 PMCID: PMC8484752 DOI: 10.3389/fcvm.2021.707700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Despite the fact that the burden, risk factors, and clinical characteristics of acute coronary syndrome (ACS) have been studied widely in developed countries, limited data are available from sub-Saharan Africa. Therefore, this study aimed at evaluating the clinical characteristics, treatment, and 30-day mortality of patients with ACS admitted to tertiary hospitals in Ethiopia. Methods: A total of 181 ACS patients admitted to tertiary care hospitals in Ethiopia were enrolled from March 15 to November 15, 2018. The clinical characteristics, management, and 30-day mortality were evaluated by ACS subtype. The Cox proportional hazards model was used to determine the predictors of 30-day all-cause mortality. A p-value < 0.05 was considered statistically significant. Results: The majority (61%) of ACS patients were admitted with ST-segment elevation myocardial infarction (STEMI). The mean age was 56 years, with male predominance (62.4%). More than two-thirds (67.4%) of patients presented to hospital after 12 h of symptom onset. Dyslipidemia (48%) and hypertension (44%) were the most common risk factors identified. In-hospital dual antiplatelet and statin use was high (>90%), followed by beta-blockers (81%) and angiotensin-converting enzyme inhibitors (ACEIs; 72%). Late reperfusion with percutaneous coronary intervention (PCI) was done for only 13 (7.2%), and none of the patients received early reperfusion therapy. The 30-day all-cause mortality rate was 25.4%. On multivariate Cox proportional hazards model analysis, older age [hazard ratio (HR) = 1.03, 95% CI = 1.003-1.057], systolic blood pressure (HR = 0.99, 95% CI = 0.975-1.000), serum creatinine (HR = 1.32, 95% CI = 1.056-1.643), Killip class > II (HR = 4.62, 95% CI = 2.502-8.523), ejection fraction <40% (HR = 2.75, 95% CI = 1.463-5.162), and STEMI (HR = 2.72, 95% CI = 1.006-4.261) were independent predictors of 30-day mortality. Conclusions: The 30-day all-cause mortality rate was unacceptably high, which implies an urgent need to establish a nationwide program to reduce pre-hospital delay, promoting the use of guideline-directed medications, and increasing access to reperfusion therapy.
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Affiliation(s)
- Korinan Fanta
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Fekede Bekele Daba
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Elsah Tegene Asefa
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Tsegaye Melaku
- Department of Clinical Pharmacy, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Legese Chelkeba
- Department of Pharmacology and Clinical Pharmacy, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ginenus Fekadu
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR China
- Department of Clinical Pharmacy, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Esayas Kebede Gudina
- Department of Internal Medicine, Institute of Health, Jimma University, Jimma, Ethiopia
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Franken M, Giugliano RP, Goodman SG, Baracioli LM, Godoy LC, Furtado RHM, Lima FG, Nicolau JC. Performance of acute coronary syndrome approaches in Brazil: a report from the BRACE (Brazilian Registry in Acute Coronary SyndromEs). EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:284-292. [PMID: 31400191 DOI: 10.1093/ehjqcco/qcz045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/02/2019] [Accepted: 08/08/2019] [Indexed: 01/09/2023]
Abstract
AIMS Diagnostic and therapeutic tools have a significant impact on morbidity and mortality associated with acute coronary syndromes (ACS). Data about ACS performance measures are scarce in Brazil, and improving its collection is an objective of the Brazilian Registry in Acute Coronary syndromEs (BRACE). METHODS AND RESULTS The BRACE is a cross-sectional, observational epidemiological registry of ACS patients. Stratified 'cluster sampling' methodology was adopted to obtain a representative picture of ACS. A performance score (PS) varying from 0 to 100 was developed to compare studied parameters. Performance measures alone and the PS were compared between institutions, and the relationship between the PS and outcomes was evaluated. A total of 1150 patients, median age 63 years, 64% male, from 72 hospitals were included in the registry. The mean PS for the overall population was 65.9% ± 20.1%. Teaching institutions had a significantly higher PS (71.4% ± 16.9%) compared with non-teaching hospitals (63.4% ± 21%; P < 0.001). Overall in-hospital mortality was 5.2%, and the variables that correlated independently with in-hospital mortality included: PS-per point increase (OR = 0.97, 95% CI 0.95-0.98, P < 0.001), age-per year (OR = 1.06, 95% CI 1.03-1.09, P < 0.001), chronic kidney disease (OR = 3.12, 95% CI 1.08-9.00, P = 0.036), and prior angioplasty (OR = 0.25, 95% CI 0.07-0.84, P = 0.025). CONCLUSIONS In BRACE, the adoption of evidence-based therapies for ACS, as measured by the performance score, was independently associated with lower in-hospital mortality. The use of diagnostic tools and therapeutic approaches for the management of ACS is less than ideal in Brazil, with high variability especially among different regions of the country.
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Affiliation(s)
- Marcelo Franken
- Cardiology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein 627/701, 4th Floor, São Paulo 05652900, Brazil
| | - Robert P Giugliano
- Thrombolysis in Myocardial Infarction (TIMI) Study Group, Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA
| | - Shaun G Goodman
- Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto M5B 1W8, Canada
| | - Luciano Moreira Baracioli
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo 05403900, Brazil
| | - Lucas Colombo Godoy
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo 05403900, Brazil.,Peter Munk Cardiac Centre, Toronto General Hospital, University of Toronto, Canada
| | - Remo H M Furtado
- Cardiology Department, Hospital Israelita Albert Einstein, Av. Albert Einstein 627/701, 4th Floor, São Paulo 05652900, Brazil.,Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo 05403900, Brazil
| | - Felipe Gallego Lima
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo 05403900, Brazil
| | - Jose Carlos Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Enéas de Carvalho Aguiar, 44, Sao Paulo 05403900, Brazil
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Dewi PEN, Thavorncharoensap M. Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue.
AIM: This study aims to review the utilization rate of statin among patients with ACS.
METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist.
RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients.
CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.
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13
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Ayad SW, El Zawawy TH, Lotfy MI, Naguib AM, El Amrawy AM. Incidence and impact of totally occluded culprit coronary artery in patients with non-ST segment elevation myocardial infarction acute coronary syndrome. Egypt Heart J 2021; 73:36. [PMID: 33826020 PMCID: PMC8026781 DOI: 10.1186/s43044-021-00160-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Significance of totally occluded culprit coronary artery in patients presenting with non-ST segment elevation myocardial infarction (NSTEMI) is underestimated. The aim of the study was to evaluate the incidence and impact of totally occluded culprit artery on in-hospital and 6 months follow-up outcomes of NSTEMI acute coronary syndrome (ACS) patients. Results We collected retrospectively data of 500 NSTEMI patients who presented to our hospital from June 2016 to June 2017. All patients underwent PCI within 72 h of presentation. We excluded patients with cardiogenic shock, prior CABG, and STEMI. Patients were divided into two groups according to pre-procedural culprit vessel thrombolysis in myocardial infarction (TIMI) flow. Group 1, TIMI flow 0 total coronary occlusion, included 112 patients (22.4%). Group 2, TIMI flow 1–3 non-total occlusion, included 388 patients (77.6%). Group 1 patients had significantly higher incidence of smoking (p=0.01), significantly higher level of cardiac enzymes (p<0.001), significantly more collaterals (p<0.001), and significantly more LCX and RCA as the culprit vessel (p<0.01), while group 2 patients had significantly higher incidence of diabetes (p=0.02) and significantly more LAD as the culprit vessel. There were no significant differences between the two groups regarding the major adverse cardiac and cerebrovascular events (MACCE) in-hospital (5.3% in totally occluded group vs. 1% in non-totally occluded group, p=0.07), but group 1 patients had significantly higher incidence of in-hospital arrhythmia (8.9% in group 1 vs. 1% in group 2, p=0.007). After 6 months follow-up, there were no significant differences regarding MACCE between the 2 groups after 6 months follow-up (5.4% in group 1 vs. 4.6% of group 2, P=0.24). Conclusion 22.4% of NSTEMI patients have a totally occluded culprit artery. The presence of an occluded culprit artery did not significantly affect the clinical outcomes of NSTEMI patients either in-hospital or after 6 months follow-up but was associated with significantly higher incidence of in-hospital arrhythmia.
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Affiliation(s)
- Sherif W Ayad
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | - Tarek H El Zawawy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Mohamed I Lotfy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M Naguib
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed M El Amrawy
- Department of Cardiology, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Sex and gender differences in presentation, treatment and outcomes in acute coronary syndrome, a 10 year study from a multi-ethnic Asian population: The Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome (NCVD-ACS) registry. PLoS One 2021; 16:e0246474. [PMID: 33556136 PMCID: PMC7869989 DOI: 10.1371/journal.pone.0246474] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Sex and gender differences in acute coronary syndrome (ACS) have been well studied in the western population. However, limited studies have examined the trends of these differences in a multi-ethnic Asian population. OBJECTIVES To study the trends in sex and gender differences in ACS using the Malaysian NCVD-ACS Registry. METHODS Data from 24 hospitals involving 35,232 ACS patients (79.44% men and 20.56% women) from 1st. Jan 2012 to 31st. Dec 2016 were analysed. Data were collected on demographic characteristics, coronary risk factors, anthropometrics, treatments and outcomes. Analyses were done for ACS as a whole and separately for ST-segment elevation myocardial infarction (STEMI), Non-STEMI and unstable angina. These were then compared to published data from March 2006 to February 2010 which included 13,591 ACS patients (75.8% men and 24.2% women). RESULTS Women were older and more likely to have diabetes mellitus, hypertension, dyslipidemia, previous heart failure and renal failure than men. Women remained less likely to receive aspirin, beta-blocker, angiotensin-converting enzyme inhibitor (ACE-I) and statin. Women were less likely to undergo angiography and percutaneous coronary intervention (PCI) despite an overall increase. In the STEMI cohort, despite a marked increase in presentation with Killip class IV, women were less likely to received primary PCI or fibrinolysis and had longer median door-to-needle and door-to-balloon time compared to men, although these had improved. Women had higher unadjusted in-hospital, 30-Day and 1-year mortality rates compared to men for the STEMI and NSTEMI cohorts. After multivariate adjustments, 1-year mortality remained significantly higher for women with STEMI (adjusted OR: 1.31 (1.09-1.57), p<0.003) but were no longer significant for NSTEMI cohort. CONCLUSION Women continued to have longer system delays, receive less aggressive pharmacotherapies and invasive treatments with poorer outcome. There is an urgent need for increased effort from all stakeholders if we are to narrow this gap.
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15
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Tern PJW, Ho AKH, Sultana R, Ahn Y, Almahmeed W, Brieger D, Chew DP, Fong AYY, Hwang J, Kim Y, Komuro I, Maemura K, Mohd-Ali R, Quek DKL, Reid C, Tan JWC, Wan-Ahmad WA, Yasuda S, Yeo KK. Comparative overview of ST-elevation myocardial infarction epidemiology, demographics, management, and outcomes in five Asia-Pacific countries: a meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 7:6-17. [PMID: 32584986 DOI: 10.1093/ehjqcco/qcaa057] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/16/2020] [Accepted: 06/25/2020] [Indexed: 11/13/2022]
Abstract
The aim of this study is to gain insight into the differences in demographics of ST-elevation myocardial infarction (STEMI) patients in Asia-Pacific, as well as inter-country variation in treatment and mortality outcomes. Systematic review of published studies and reports from known registries in Australia, Japan, Korea, Singapore, and Malaysia that began data collection after the year 2000. Supplementary self-report survey questionnaire on public health data answered by representative cardiologists working in these countries. Twenty studies comprising of 158 420 patients were included in the meta-analysis. The mean age was 61.6 years. Chronic kidney disease prevalence was higher in Japan, while dyslipidaemia was low in Korea. Use of aspirin, P2Y12 inhibitors, and statins were high throughout, but ACEi/ARB and β-blocker prescriptions were lower in Japan and Malaysia. Reperfusion strategies varied greatly, with high rates of primary percutaneous coronary intervention (pPCI) in Korea (91.6%), whilst Malaysia relies far more on fibrinolysis (72.6%) than pPCI (9.6%). Similarly, mortality differed, with 1-year mortality from STEMI was considerably greater in Malaysia (17.9%) and Singapore (11.2%) than in Korea (8.1%), Australia (7.8%), and Japan (6.2%). The countries were broadly similar in development and public health indices. Singapore has the highest gross national income and total healthcare expenditure per capita, whilst Malaysia has the lowest. Primary PCI is available in all countries 24/7/365. Despite broadly comparable public health systems, differences exist in patient profile, in-hospital treatment, and mortality outcomes in these five countries. Our study reveals areas for improvements. The authors advocate further registry-based multi-country comparative studies focused on the Asia-Pacific region.
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Affiliation(s)
- Paul Jie Wen Tern
- Department of Medicine, Singapore General Hospital, Outram Rd, Singapore 169608
| | - Aaron Kwun Hang Ho
- School of Medicine, Gaol Walk, University College Cork, Cork, T12 YN60, Republic of Ireland
| | - Rehena Sultana
- Graduate Medical School, Duke-National University of Singapore, 8 College Rd, Singapore 169857
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, Zayed The First St - Jazeerat Al Maryah Sowwah Square, Abu Dhabi, United Arab Emirates
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Hospital Rd, Concord NSW 2139, Australia
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Level 5, Room 5E209 Flinders Medical Centre, Bedford Park SA 5042, Australia
| | - Alan Yean Yip Fong
- Department of Cardiology, Clinical Research Center, Sarawak General Hospital, Jalan Hospital, 93586 Kuching, Sarawak, Malaysia
| | - Jinyong Hwang
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsangnam-do, Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, Republic of Korea, 50-1 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, South Korea
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7 Chome-3-1 Hongo, Bunkyo City, Tokyo 113-8655, Japan
| | - Koji Maemura
- Department of Cardiovascular Medicine, Graduate School of Biomedical Sciences, Nagasaki University, 1-14 Bunkyomachi, Nagasaki, 852-8521, Japan
| | - Rosli Mohd-Ali
- Department of Cardiology, National Heart Institute, IJN, 145, Jalan Tun Razak, 50400 Kuala Lumpur, Malaysia
| | - David Kwang Leng Quek
- Department of Cardiology, Pantai Hospital Kuala Lumpur, 8, Jalan Bukit Pantai, Bangsar, 59100 Kuala Lumpur, Wilayah Persekutuan Kuala Lumpur, Malaysia
| | - Christopher Reid
- School of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne VIC 3004, Australia
| | - Jack Wei Chieh Tan
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609
| | - Wan Azman Wan-Ahmad
- Faculty of Medicine, University Malaya Medical Center, Jalan Universiti, 59100 Kuala Lumpur, Selangor, Malaysia
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 6-1 Kishibeshinmachi, Suita, Osaka 564-8565, Japan
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, 5 Hospital Dr, Singapore 169609
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Shaheen S, Wafa A, Mokarab M, Zareef B, Bendary A, Abdelhameed T, Rashwan A, Seleem M, Elmasry M, Abdelhady Y, Abdelrazik G, Ibrahim A, Ghareeb M, Aly K, Saraya M, Wadie M, Youssef M. Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. Egypt Heart J 2020; 72:35. [PMID: 32607863 PMCID: PMC7326745 DOI: 10.1186/s43044-020-00069-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.
Conclusion
Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.
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Araiza-Garaygordobil D, Gopar-Nieto R, Cabello-López A, Martinez-Amezcua P, Eid-Lidt G, Baeza-Herrera LA, Gonzalez-Pacheco H, Briseño-De la Cruz JL, Sierra-Lara Martinez D, Mendoza-García S, Altamirano-Castillo A, Arias-Mendoza A. Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City. CJC Open 2020; 3:409-418. [PMID: 34027343 PMCID: PMC8129473 DOI: 10.1016/j.cjco.2020.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 11/13/2020] [Indexed: 12/22/2022] Open
Abstract
Background A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting. Methods This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days. Results We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding (P = 0.15). Conclusions In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited.
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Affiliation(s)
- Diego Araiza-Garaygordobil
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Rodrigo Gopar-Nieto
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Alejandro Cabello-López
- Occupational Health Research Unit, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, México
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Guering Eid-Lidt
- Department of Interventional Cardiology, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Luis A Baeza-Herrera
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | - Héctor Gonzalez-Pacheco
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | | | | | - Salvador Mendoza-García
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
| | | | - Alexandra Arias-Mendoza
- Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México
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Two-year outcomes post-discharge in Asian patients with acute coronary syndrome: Findings from the EPICOR Asia study. Int J Cardiol 2020; 315:1-8. [DOI: 10.1016/j.ijcard.2020.05.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 02/28/2020] [Accepted: 05/06/2020] [Indexed: 12/29/2022]
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Dharma S, Dakota I, Andriantoro H, Firdaus I, Gunawan Limadhy I, Van de Werf F. Trends in reperfusion therapy for acute ST-segment elevation myocardial infarction in an academic percutaneous coronary intervention center in the metropolitan area of a developing country: insights from the Jakarta Acute Coronary Syndrome registry. Coron Artery Dis 2020; 32:466-467. [PMID: 32804781 DOI: 10.1097/mca.0000000000000939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Surya Dharma
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita
| | - Iwan Dakota
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita
| | - Hananto Andriantoro
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita
| | - Isman Firdaus
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita
| | - Indra Gunawan Limadhy
- Indonesian Cardiovascular Research Center, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia
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Sezavar SH, Hassanzadeh M, Akhlagh Moayed D, Tabandeh M, Ghasemi M, Abdi S, Firoozi I, Golbidi P, Pourjafari M, Taslimi N, Akhlaghi AA, Hashemian M. Current practice of percutaneous coronary intervention on patients with acute coronary syndrome in Iran: A prospective observational study. Med J Islam Repub Iran 2020; 34:13. [PMID: 32551302 PMCID: PMC7293802 DOI: 10.34171/mjiri.34.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Indexed: 11/26/2022] Open
Abstract
Background: Frequent Percutaneous Coronary Intervention (PCI) procedures are being performed on a daily basis in Iran. However, no study has been reported on the current PCI practice in patients with acute coronary syndrome (ACS) in Iran. We aimed to describe the clinical characteristics and treatment patterns in Iranian ACS patients treated with PCI.
Methods: Between February 2017 and July 2017, ACS patients presented to 5 referral hospitals in two major cities of Iran (Tehran and Shiraz) were included in this observational study if aged > 18 years and underwent PCI for ACS during hospitalization; and their clinical and procedural characteristics were collected. All data were entered into SPSS v.21 and descriptive statistics were performed.
Results: Of a total of 314 patients, 228 (73%) were males, 162 (52%) were diagnosed with ST-elevation myocardial infarction and 152 (48%) with Unstable angina/ Non-ST elevation myocardial infarction. Trans-femoral approach was more often (64%) used for PCI procedures. Stent placement was the most frequent (98%) treatment strategy on PCI, with drug-eluting stent selected in the majority of subjects (98%). The overall rate of PCI success was 95%, with 4.1% PCI-related complications, and 1.6% post-PCI bleeding events. The vast majority of the study patients (99%) were discharged with dual anti-platelet therapy.
Conclusion: In this study, we observed a high level of adherence to the currently accepted guidelines in the current PCI practice on ACS patients in Iran. Also we found our practice is highly in line with the global reduction trend in the PCI-related complications.
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Affiliation(s)
- Seyed Hashem Sezavar
- Research Center for Prevention of Cardiovascular Disease, Institute of Endocrinology & Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Hassanzadeh
- Department of Internal Medicine, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Massoud Ghasemi
- Department of Cardiology, Imam Khomeini Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | | | | | - Ali Asghar Akhlaghi
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
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21
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Sidhu NS, Rangaiah SKK, Ramesh D, Veerappa K, Manjunath CN. Clinical Characteristics, Management Strategies, and In-Hospital Outcomes of Acute Coronary Syndrome in a Low Socioeconomic Status Cohort: An Observational Study From Urban India. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820918897. [PMID: 32425627 PMCID: PMC7218326 DOI: 10.1177/1179546820918897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/23/2020] [Indexed: 01/24/2023]
Abstract
Background: Coronary artery disease is the leading cause of mortality in India. There is scarcity of data on demographic profile and outcomes of acute coronary syndrome (ACS) in low socioeconomic status (SES) population of India. Objectives: This study was undertaken to determine the clinical presentation, management strategies, and in-hospital outcomes of ACS in low SES population. Methods: We conducted 1-year prospective observational cohort study of ACS patients admitted at Employees State Insurance Corporation unit of our tertiary care cardiac center. Clinical parameters, management strategies, and in-hospital outcomes of 621 patients enrolled during the study period from February 2015 to January 2016 were studied. Results: Mean age of patients was 56.06 ± 11.29 years. Majority (62%) of the patients had ST elevation myocardial infarction (STEMI), whereas Non-ST elevation acute coronary syndrome (NSTE-ACS) was seen in 38% of the patients. Median time from symptom onset to hospital admission was 285 min with wide range from 105 to 1765 min. Coronary angiography was performed in 81% of patient population. Single-vessel disease (SVD) was the most common pattern (seen in 43.3%) of coronary artery involvement with left anterior descending coronary artery (LAD) being the most frequently involved vessel (62.8%). Pharmaco-invasive approach was the preferred strategy. Overall percutaneous coronary intervention (PCI) rates were 59.1% (62.1% in STEMI and 54.2% in NSTE-ACS). Overall in-hospital mortality was 3.2%, being significantly higher in STEMI (4.2%) as compared with NSTE-ACS (1.7%). Conclusions: With implementation of evidence-based pharmacotherapy and interventions, outcomes comparable with developed countries can be achieved even in low SES populations of developing world.
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Affiliation(s)
- Navdeep Singh Sidhu
- Department of Cardiology, Guru Gobind Singh Medical College and Hospital, Faridkot, India
| | | | - Dwarikaprasad Ramesh
- Department of Cardiology, Vydehi Institute of Medical Sciences and Research Centre, Bengaluru, India
| | - Kumaraswamy Veerappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, India
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22
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Aguiar MO, Tavares BG, Tsutsui JM, Fava AM, Borges BC, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Chiang HP, Sbano JC, Goldsweig A, Rochitte CE, Lopes BB, Ramirez JA, Kalil Filho R, Porter TR, Mathias W. Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2020; 13:e009536. [DOI: 10.1161/circimaging.119.009536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background:
It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment–elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling.
Methods:
One hundred patients with ST-segment–elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging.
Results:
Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%;
P
=0.56) before treatment. The therapy group presented a behavior significantly different than control group over time (
P
<0.001). The perfusion defect was smaller in the therapy at 48 to 72 hours even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy versus 18.8±9.9% control;
P
=0.015). The left ventricular global longitudinal strain was higher in the therapy than control immediately after percutaneous coronary intervention (14.1±4.1% versus 12.0±3.3%;
P
=0.012), and this difference was maintained until 6 months (17.1±3.5% versus 13.6±3.6%;
P
<0.001). The only predictor of left ventricular remodeling was treatment with sonothrombolysis: the control group was more likely to exhibit left ventricular remodeling with an odds ratio of 2.79 ([95% CI, 0.13–6.86];
P
=0.026).
Conclusions:
Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment–elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.
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Affiliation(s)
- Miguel O.D. Aguiar
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Bruno G. Tavares
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Jeane M. Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Agostina M. Fava
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Bruno C. Borges
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Mucio T. Oliveira
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Alexandre Soeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Jose C. Nicolau
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Hsu P. Chiang
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - João C.N. Sbano
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Andrew Goldsweig
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Carlos E. Rochitte
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Bernardo B.C. Lopes
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - José A.F. Ramirez
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Roberto Kalil Filho
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
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23
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Hai JJ, Wong CK, Un KC, Wong KL, Zhang ZY, Chan PH, Lam YM, Chan WS, Lam CC, Tam CC, Wong YT, Yung SY, Chan KW, Siu CW, Lau CP, Tse HF. Guideline-Based Critical Care Pathway Improves Long-Term Clinical Outcomes in Patients with Acute Coronary Syndrome. Sci Rep 2019; 9:16814. [PMID: 31728003 PMCID: PMC6856182 DOI: 10.1038/s41598-019-53348-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/21/2019] [Indexed: 01/07/2023] Open
Abstract
Implementation of a critical care pathway (CCP) for acute coronary syndrome (ACS) has been shown to improve early compliance to guideline-directed therapies and reduce early mortality. Nevertheless its long-term impact on the compliance with medications or clinical outcomes remains unknown. Between 2004 and 2015, 2023 consecutive patients were admitted to our coronary care unit with ACS. We retrospectively compared the outcomes of 628 versus 1059 patients (mean age 66.1 ± 13.3 years, 74% male) managed before and after full implementation of a CCP. Compared with standard care, implementation of the CCP significantly increased coronary revascularization and long-term compliance with guideline-directed medical therapy (both P < 0.01). After a mean follow-up of 66.5 ± 44.0 months, 46.7% and 22.2% patients admitted before and after implementation of the CCP, respectively, died. Kaplan-Meier analyses showed that patients managed by CCP had better overall survival (P = 0.03) than those managed with standard care. After adjustment for clinical covariates and coronary anatomy, CCP remained independently predictive of better survival from all-cause mortality [hazard ratio (HR): 0.75, 95%confidence intervals (CI): 0.62-0.92, P < 0.01]. Stepwise multivariate cox regression model showed that both revascularization (HR: 0.55, 95%CI: 0.45-0.68, P < 0.01) and compliance to statin (HR: 0.70, 95%CI: 0.58-0.85, P < 0.01) were accountable for the improved outcome.
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Affiliation(s)
- Jo-Jo Hai
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Chun-Ka Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Ka-Chun Un
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Ka-Lam Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Zhe-Yu Zhang
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Pak-Hei Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Yui-Ming Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Wing-Sze Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Cheung-Chi Lam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Chor-Cheung Tam
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Yiu-Tung Wong
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - See-Yue Yung
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Ki-Wan Chan
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Chung-Wah Siu
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China
| | - Chu-Pak Lau
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, Queen Mary Hospital, the University of Hong Kong, Hong Kong, China.
- Division of Cardiology, Department of Medicine, the University of Hong Kong Shenzhen Hospital, Shenzhen, China.
- Shenzhen Institutes of Research and Innovation, University of Hong Kong, Shenzhen, China.
- Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, the University of Hong Kong, Hong Kong, China.
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24
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Epidemiology and risk factors of patients with types of acute coronary syndrome presenting to a tertiary care hospital in Sri Lanka. BMC Cardiovasc Disord 2019; 19:229. [PMID: 31638908 PMCID: PMC6805431 DOI: 10.1186/s12872-019-1217-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 10/04/2019] [Indexed: 12/28/2022] Open
Abstract
Background Acute Coronary Syndrome (ACS) is one of the leading causes of death worldwide and studies have shown higher mortality rates and premature death in South Asian countries. The occurrence and effect of risk factors differ by type ofACS.Epidemiological studies in the Sri Lankan population are limited. Methods This is a cross sectional descriptive study conducted at the Teaching Hospital Peradeniya, Sri Lanka among patients presenting with ACS. Data was collected by an interviewer administered structured questionnaire and epidemiological patterns and risk factors were analyzed. Results The sample of 300 patients had a mean age of 61.3+/− 12.6 and male sex showed higher association with all three type of ACS compared to female with a P value of 0.001. This study showed higher mean age of 62.2 ± 11.4 years amongst unstable angina (UA) patients and 61.9 ± 14.5 years amongst non ST elevation myocardial infarction (NSTEMI) patients compared to 59.2 ± 11.2 years for ST elevation myocardial infarction (STEMI) patients with no significant statistical difference (P = 0.246). Approximately 55.8% STEMI patients, 39.8% UA and 35.5% NSTEMI patients were smokers indicating a significant association between smoking and STEMI (P = 0.017). Nearly 54.5% STEMI, 35.4% UA and 32.7% NSTEMI patients consumed alcohol and there was a very strong association between alcohol consumption and STEMI (P = 0.006). Almost 51.8% NSTEMI patients, 47.8% UA patients and 29.9% STEMI patients had hypertension(HT) (P = 0.008) indicating significant association of HT with UA and NSTEMI. About 33.6% UA patients and 30.0% NSTEMI patients had DM whilst only 22.1% of STEMI patients had DM of no significance (p = 0.225). Around 15.0% patients with UA, 25.5% with NSTEMI and 11.7% with STEMI had dyslipidemia (P = 0.032). There was a very strong association between a past history of ACS or stable angina with NSTEMI and UA (P = 0.001). Conclusion Smoking and alcohol abuse are significantly associated with STEMI.Patients with NSTEMI or Unstable Angina had higher rates of hypertension and were more likely to have a history of ACS or stable angina than STEMI patients. Patients with NSTEMI were more likely than patients with STEMI or UA to have dyslipidemia.
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25
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Bogale K, Mekonnen D, Nedi T, Woldu MA. Treatment Outcomes of Patients with Acute Coronary Syndrome Admitted to Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819839417. [PMID: 31024218 PMCID: PMC6472164 DOI: 10.1177/1179546819839417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/27/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute coronary syndrome (ACS) refers to a spectrum of conditions compatible with acute myocardial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood flow. OBJECTIVE The objective of the study was to assess the treatment outcome and associated factors for ACS. METHODS A retrospective cross-sectional study was conducted from January 1, 2012 to December 31, 2014. RESULTS Of 124 ACS patients who were admitted during the 3 years' period, 90 (72.6%) were diagnosed with ST segment elevation myocardial infarction (STEMI). The mean age was 56.3 ± 13.7 years. The average length of hospital stay was 9.77 ± 6.42 days. The average time from onset of ACS symptoms to presentation in the emergency department was 3.8 days (91.7 hours). In about 76 (61.3%) patients, hypertension was the leading risk factor for development of ACS, and 36.4% of ACS patients were either Killip class III or IV. Biomarkers were measured for 118 (95.2%) patients, and 79.2% of patients had ejection fraction of less than 40% and 29.2% had less than 30%. In-hospital medication use includes loading dose of aspirin (79%), anticoagulants (77.4%), beta blockers (88.1%), statins (85.5%), morphine (12.9%), and nitrates (35.5%). The in-hospital mortality was 27.4%. The predictors for in-hospital mortality were age (P = .042), time from symptom onset to presentation (P = .001), previous history of hypertension (P = .025), being Killip class III and IV (P = .001), and STEMI diagnosis (P = .005). CONCLUSIONS The medical management of ACS patients in Tikur Anbessa Specialized Hospital (TASH) was in line with the recommendations of international guidelines but in-hospital mortality was extremely high (27.4%).
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Affiliation(s)
| | - Desalew Mekonnen
- Department of Internal medicine, School
of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
| | - Minyahil Alebachew Woldu
- Department of Pharmacology and Clinical
Pharmacy, School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia
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26
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Marie D, Mingou JS, Dia K, Gbadamassi SEOK, Fall PD, Diao M, Mboup MC. Clinical Presentation, Risk Factor, and Outcomes of Acute Coronary Syndrome in Women at an Urban Referral Center in Dakar, Senegal. Glob Heart 2019; 14:35-39. [PMID: 30905691 DOI: 10.1016/j.gheart.2019.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2017] [Revised: 09/03/2018] [Accepted: 01/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cardiovascular disease is on the rise in Sub-Saharan countries. Recently, consistent studies have reported sex differences in the epidemiology of acute coronary syndrome (ACS). Although, data on the incidence of ACS in Sub-Saharan countries are not rare, few focused closely on women. OBJECTIVES The purpose of this study was to examine risk factors, clinical presentations, and management strategies in women with ACS. METHODS This was a retrospective study conducted at the Cardiology Department of Principal Hospital of Dakar over a period of 60 months (January 1, 2010, to December 31, 2014), in Dakar, Senegal. Medical records of female subjects admitted for ACS on the basis of anginal pain at rest, suggestive electrocardiographic changes, and elevated troponin I levels were included. We collected and analyzed the epidemiological, clinical, paraclinical, and evolutionary data of the patients. RESULTS Hospital prevalence of ACS in women was 2.32%, meaning 38.1% of patients were admitted for ACS during the same period. The mean age of patients was 68.8 ± 9.5 years; 52% of them were aged between 60 and 69 years. The risk factors in our patients were dominated by hypertension found (63.3%) and diabetes (54.1%). Active smoking was found in 6 patients (6.1%). One-half of patients had more than 1 risk factor. Chest pain was present in 94 patients (95.9%). The average time delay before medical care was administered was 53.9 ± 18 h. Thirty patients showed signs of left ventricular failure (Killip classes I and II). Electrocardiography revealed ACS with persistent ST-segment elevation in 53 patients (54.1%) and non-ST-segment elevation ACS in 45 patients (45.9%). Mean troponin I level was 1.68 ± 2.3 ng/ml. Doppler echocardiography revealed impaired segmental kinetics in more than one-half of patients. The mean ventricular ejection fraction was 43.8 ± 10.1%. Thrombolysis was performed in 10 patients, accounting for 10.2% of patients with ST-segment elevation. The evolution during hospitalization after a mean hospital stay of 9.5 ± 3.7 days was favorable in 66 patients (67.3%). Six deaths (6.1%) were recorded. Complications was dominated by pulmonary edema. CONCLUSIONS Our study confirms that ACS is not a "man's only" disease in Sub-Saharan countries. The major concern is that there appeared to be continuing evidence of suboptimal treatment and intervention in women with ACS in current practice.
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Affiliation(s)
- Djibril Marie
- Department of Cardiology and Internal Medication, Military Hospital of Ouakam, Dakar, Senegal.
| | - Joseph S Mingou
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Khadidiatou Dia
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | | | - Pape D Fall
- Department of Cardiology, Principal Hospital of Dakar, Dakar, Senegal
| | - Maboury Diao
- Department of Cardiology, University Cheickh Anta Diop, Dakar, Senegal
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27
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Yao H, Ekou A, Hadéou A, N'Djessan JJ, Kouamé I, N'Guetta R. Medium and long-term follow-up after ST-segment elevation myocardial infarction in a sub-Saharan Africa population: a prospective cohort study. BMC Cardiovasc Disord 2019; 19:65. [PMID: 30894133 PMCID: PMC6425633 DOI: 10.1186/s12872-019-1043-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 03/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Major in-hospital mortality rate in patients with ST-segment Elevation Myocardial Infarction (STEMI) in Sub-Saharan Africa has been reported. Data on follow-up in these patients with STEMI are scarce. We aimed to assess medium and long-term prognosis in patients with STEMI admitted to Abidjan Heart Institute. Methods Prospective cohort study including 260 patients admitted for STEMI to Abidjan Heart Institute, from January 1, 2012 to December 31, 2015. We compared mortality and nonfatal cardiovascular complications in revascularized and non-revascularized groups. Survival curve was generated with the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Results Of the 260 patients followed up on a median period of 39 months [28–68 months], 94 patients (36.1%) were revascularized and 166 (63.8%) were non-revascularized. Crude all-cause mortality was 10.4%. It was significantly higher in non-revascularized patients (p = 0.04). There was no difference in the occurrence of nonfatal cardiovascular complications in the 2 groups. In multivariable Cox regression, age ≥ 70 years, female gender and heart failure were the predictive factors for death after adjustment. Conclusions STEMI remains an important cause of mortality in our practice. Healthcare policies should be developed to improve patient care and long-term outcomes.
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Affiliation(s)
- Hermann Yao
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire.
| | - Arnaud Ekou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Aurore Hadéou
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Jean-Jacques N'Djessan
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Isabelle Kouamé
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
| | - Roland N'Guetta
- Intensive Care Unit, Abidjan Heart Institute, 01 BPV 206 Abidjan, Abidjan, Côte d'Ivoire
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Sonothrombolysis in ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2832-2842. [PMID: 30894317 DOI: 10.1016/j.jacc.2019.03.006] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/25/2019] [Accepted: 03/06/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Preclinical studies have demonstrated that high mechanical index (MI) impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion (sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI). OBJECTIVES This study tested the clinical effectiveness of sonothrombolysis in patients with STEMI. METHODS Patients with their first STEMI were prospectively randomized to either diagnostic ultrasound-guided high MI impulses during an intravenous Definity (Lantheus Medical Imaging, North Billerica, Massachusetts) infusion before, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (n = 50 in each group). A reference first STEMI group (n = 203) who arrived outside the randomization window was also analyzed. Angiographic recanalization before PCI, ST-segment resolution, infarct size by magnetic resonance imaging, and systolic function (LVEF) at 6 months were compared. RESULTS ST-segment resolution occurred in 16 (32%) high MI PCI versus 2 (4%) PCI-only patients before PCI, and angiographic recanalization was 48% in high MI/PCI versus 20% in PCI only and 21% in the reference group (p < 0.001). Infarct size was reduced (29 ± 22 g high MI/PCI vs. 40 ± 20 g PCI only; p = 0.026). LVEF was not different between groups before treatment (44 ± 11% vs. 43 ± 10%), but increased immediately after PCI in the high MI/PCI group (p = 0.03), and remained higher at 6 months (p = 0.015). Need for implantable defibrillator (LVEF ≤30%) was reduced in the high MI/PCI group (5% vs. 18% PCI only; p = 0.045). CONCLUSIONS Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI. (Therapeutic Use of Ultrasound in Acute Coronary Artery Disease; NCT02410330).
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The Use of Oral Beta-Blockers and Clinical Outcomes in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes: a Long-Term Follow-Up Study. Cardiovasc Drugs Ther 2018; 32:435-442. [DOI: 10.1007/s10557-018-6818-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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de Barros IL, Costa L, Bezerra B, Gomes R, Morais N, Strunz CMC, Novaes M, Gebara OCE, Pedrosa RP, Nicolau JC. Predictors of subclinical carotid atherosclerosis in middle-aged women. PLoS One 2018; 13:e0197582. [PMID: 29791465 PMCID: PMC5965873 DOI: 10.1371/journal.pone.0197582] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 05/06/2018] [Indexed: 01/25/2023] Open
Abstract
Background Traditional strategies for primary cardiovascular prevention have been insufficient in reducing the high rates of coronary ischemic events in women, probably because these women are often stratified into low-risk groups. However, cardiovascular diseases continue to be the main cause of morbidity and mortality in women worldwide. We hypothesized that carotid atherosclerosis (CA) is common in middle-aged women. Methods We prospectively evaluated asymptomatic peri- and post-menopausal women with no cardiovascular diseases or the use of hormone therapy from two gynecologic clinics. All the patients underwent full clinical and laboratory evaluation and underwent a B-mode ultrasound for carotid evaluations. The presence of CA was defined as the presence of plaque and/or carotid intima-media thickness (CIMT)>1.00 mm. We performed logistic regression to evaluate independent predictors of CA. Results We studied 823 women (age: 54.4±5.4 years; body mass index-BMI: 28.5±4.9 kg/m2; diabetes:10%; hypertension: 58%). The prevalence of CA was 12.7% for the entire population and 11% for the low-risk sub-group as defined by a Framingham risk score <5%. In the multivariate model, age: odds ratio (OR) = 1.54, 95% confidence interval (CI) = 1.25–1.89,p<0.001; current smoker status: OR = 2.69, 95% CI = 1.48–4.91, p = 0.001; total cholesterol: OR = 1.13, 95% CI = 1.03–1.24, p = 0.008; and systolic blood pressure: OR = 1.01, 95% CI = 1.00–1.02, p = 0.030 remained independently associated with CA. Conclusion Subclinical CA is common among asymptomatic middle-aged women, and traditional risk factors are independently associated with CA. These findings are particularly relevant for improving cardiovascular health in women.
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Affiliation(s)
- Isly L. de Barros
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
- Hospital Universitário Oswaldo Cruz (HUOC)–University of Pernambuco, Recife, Brazil
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE)–University of Pernambuco, Recife, Brazil
- * E-mail:
| | - Laura Costa
- Centro Integrado de Saúde Amaury de Medeiros (CISAM)–University of Pernambuco, Recife, Brazil
| | - Bento Bezerra
- Hospital Universitário Oswaldo Cruz (HUOC)–University of Pernambuco, Recife, Brazil
| | - Rafael Gomes
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE)–University of Pernambuco, Recife, Brazil
| | - Natanael Morais
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
| | - Célia M. C. Strunz
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
| | - Moacir Novaes
- Hospital Universitário Oswaldo Cruz (HUOC)–University of Pernambuco, Recife, Brazil
| | | | - Rodrigo Pinto Pedrosa
- Pronto Socorro Cardiológico de Pernambuco (PROCAPE)–University of Pernambuco, Recife, Brazil
| | - José C. Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, Brasil
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Kang JE, Yu JM, Choi JH, Chung IM, Pyun WB, Kim SA, Lee EK, Han NY, Yoon JH, Oh JM, Rhie SJ. Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome. J Clin Pharm Ther 2018; 43:366-376. [PMID: 29468708 DOI: 10.1111/jcpt.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.
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Affiliation(s)
- J E Kang
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, National Medical Center, Seoul, Korea
| | - J M Yu
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - J H Choi
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Konkuk University Medical Center, Seoul, Korea
| | - I-M Chung
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - W B Pyun
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - S A Kim
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - E K Lee
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - N Y Han
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - J-H Yoon
- College of Pharmacy, Pusan National University, Busan, Korea
| | - J M Oh
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - S J Rhie
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea.,College of Pharmacy, Ewha Womans University, Seoul, Korea
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Turk-Adawi K, Sarrafzadegan N, Fadhil I, Taubert K, Sadeghi M, Wenger NK, Tan NS, Grace SL. Cardiovascular disease in the Eastern Mediterranean region: epidemiology and risk factor burden. Nat Rev Cardiol 2017; 15:106-119. [PMID: 28933782 DOI: 10.1038/nrcardio.2017.138] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Eastern Mediterranean region (EMR) comprises 22 countries or territories spanning from Morocco in the west to Pakistan in the east, and contains a population of almost 600 million people. Like many other developing regions, the burden of disease in the EMR has shifted in the past 30 years from primarily communicable diseases to noncommunicable diseases such as cardiovascular disease (CVD). Cardiovascular mortality in the EMR, mostly attributable to ischaemic heart disease, is expected to increase more dramatically in the next decade than in any other region except Africa. The most prominent CVD risk factors in this region include tobacco consumption, physical inactivity, depression, obesity, hypertension, and diabetes mellitus. Many individuals living in the EMR are unaware of their risk factor status, and even if treated, these risk factors are often poorly controlled. Furthermore, infrequent use of emergency medical services, delays in access to care, and lack of access to cardiac catheterization affects the timely diagnosis of CVD. Treatment of CVD is also suboptimal in this region, consisting primarily of thrombolysis, with insufficient provision of timely revascularization. In this Review, we summarize what is known about CVD burden, risk factors, and treatment strategies for individuals living in the EMR. This information will hopefully aid decision-makers when devising strategies on how to improve CVD prevention and management in this region.
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Affiliation(s)
- Karam Turk-Adawi
- Public Health Department, College of Health Sciences, Qatar University, Al Jamea Street, Doha, Qatar
| | - Nizal Sarrafzadegan
- Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran.,School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, British Columbia V6T 1Z3, Canada
| | - Ibtihal Fadhil
- Noncommunicable Diseases, World Health Organization, East Mediterranean Regional Office, Monazamet El Seha El Alamia Street, extension of Abdel Razak El Sanhouri Street, Nasr City, Cairo, Egypt
| | - Kathryn Taubert
- International Science and Health Strategies, American Heart Association, Aeschengraben 14, Basel 4051, Switzerland
| | - Masoumeh Sadeghi
- Cardiac Rehabilitation Research Center. Cardiovascular Research Institute. Isfahan University of Medical Sciences, Khorram Ave, Isfahan, Iran
| | - Nanette K Wenger
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, 49 Jesse Hill Jr. Drive SE, Atlanta, Georgia 30303, USA
| | - Nigel S Tan
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada
| | - Sherry L Grace
- University Health Network, 585 University Ave, Toronto, Ontario M5G 2N2, Canada.,School of Kinesiology and Health Science, York University, Bethune 368, 4700 Keele Street, Toronto, Ontario, M3J 1P3, Canada
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Jinatongthai P, Kongwatcharapong J, Foo CY, Phrommintikul A, Nathisuwan S, Thakkinstian A, Reid CM, Chaiyakunapruk N. Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis. Lancet 2017; 390:747-759. [PMID: 28831992 DOI: 10.1016/s0140-6736(17)31441-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/20/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Fibrinolytic therapy offers an alternative to mechanical reperfusion for ST-segment elevation myocardial infarction (STEMI) in settings where health-care resources are scarce. Comprehensive evidence comparing different agents is still unavailable. In this study, we examined the effects of various fibrinolytic drugs on clinical outcomes. METHODS We did a network meta-analysis based on a systematic review of randomised controlled trials comparing fibrinolytic drugs in patients with STEMI. Several databases were searched from inception up to Feb 28, 2017. We included only randomised controlled trials that compared fibrinolytic agents as a reperfusion therapy in adult patients with STEMI, whether given alone or in combination with adjunctive antithrombotic therapy, against other fibrinolytic agents, a placebo, or no treatment. Only trials investigating agents with an approved indication of reperfusion therapy in STEMI (streptokinase, tenecteplase, alteplase, and reteplase) were included. The primary efficacy outcome was all-cause mortality within 30-35 days and the primary safety outcome was major bleeding. This study is registered with PROSPERO (CRD42016042131). FINDINGS A total of 40 eligible studies involving 128 071 patients treated with 12 different fibrinolytic regimens were assessed. Compared with accelerated infusion of alteplase with parenteral anticoagulants as background therapy, streptokinase and non-accelerated infusion of alteplase were significantly associated with an increased risk of all-cause mortality (risk ratio [RR] 1·14 [95% CI 1·05-1·24] for streptokinase plus parenteral anticoagulants; RR 1·26 [1·10-1·45] for non-accelerated alteplase plus parenteral anticoagulants). No significant difference in mortality risk was recorded between accelerated infusion of alteplase, tenecteplase, and reteplase with parenteral anticoagulants as background therapy. For major bleeding, a tenecteplase-based regimen tended to be associated with lower risk of bleeding compared with other regimens (RR 0·79 [95% CI 0·63-1·00]). The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy increased the risk of major bleeding by 1·27-8·82-times compared with accelerated infusion alteplase plus parenteral anticoagulants (RR 1·47 [95% CI 1·10-1·98] for tenecteplase plus parenteral anticoagulants plus glycoprotein inhibitors; RR 1·88 [1·24-2·86] for reteplase plus parenteral anticoagulants plus glycoprotein inhibitors). INTERPRETATION Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged. FUNDING None.
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Affiliation(s)
- Peerawat Jinatongthai
- Division of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Ubon Ratchathani University, Ubon Ratchathani, Thailand
| | | | - Chee Yoong Foo
- National Clinical Research Centre, Kuala Lumpur, Malaysia; School of Pharmacy, Monash University Malaysia, Selangor, Malaysia
| | - Arintaya Phrommintikul
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Surakit Nathisuwan
- Clinical Pharmacy Division, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
| | - Ammarin Thakkinstian
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Christopher M Reid
- School of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia; School of Public Health, Curtin University, Perth, WA, Australia
| | - Nathorn Chaiyakunapruk
- School of Pharmacy, Monash University Malaysia, Selangor, Malaysia; Center of Pharmaceutical Outcomes Research (CPOR), Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, Phitsanulok, Thailand; School of Pharmacy, University of Wisconsin, Madison, WI, USA; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Goodman SG, Nicolau JC, Requena G, Maguire A, Blankenberg S, Chen JY, Granger CB, Grieve R, Pocock SJ, Simon T, Yasuda S, Vega AM, Brieger D. Longer-term oral antiplatelet use in stable post-myocardial infarction patients: Insights from the long Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease (TIGRIS) observational study. Int J Cardiol 2017; 236:54-60. [DOI: 10.1016/j.ijcard.2017.02.062] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 02/13/2017] [Accepted: 02/19/2017] [Indexed: 11/27/2022]
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Lana MLL, Beaton AZ, Brant LCC, Bozzi ICRS, de Magalhães O, Castro LRDA, da Silva Júnior FCT, da Silva JLP, Ribeiro ALP, Nascimento BR. Factors associated with compliance to AHA/ACC performance measures in a myocardial infarction system of care in Brazil. Int J Qual Health Care 2017; 29:499-506. [DOI: 10.1093/intqhc/mzx059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/15/2017] [Indexed: 11/14/2022] Open
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Johnson-Agbakwu CE, Flynn P, Asiedu GB, Hedberg E, Breitkopf CR. Adaptation of an Acculturation Scale for African Refugee Women. J Immigr Minor Health 2017; 18:252-62. [PMID: 24573644 DOI: 10.1007/s10903-014-9998-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Newly-arrived African refugees are a vulnerable group of immigrants for whom no validated acculturation measures exist. A valid measurement tool is essential to understand how acculturative processes impact health and health disparities. We adapted the Bicultural Involvement Questionnaire (BIQ) to characterize its reliability among ethnic Somali women residing in Minnesota, and Somali, Somali Bantu, and Burundian women in Arizona. Surveys were administered to 164 adult women. Analyses were conducted along socio-demographic variables of ethnicity, geographic residence, age, and length of time in the United States through t tests and one-way analysis of variance. Exploratory factor analysis was conducted on the modified BIQ. Exploratory factor analyses yielded five subscales: "Speak Native Language", "Speak English Language", "Enjoy Native Activities", "Enjoy American Activities", and "Desired Ideal Culture". The subscales of the modified BIQ possessed Cronbach's α ranging from 0.68 to 0.92, suggestive that all subscales had acceptable to excellent internal consistency. The modified BIQ maintained its psychometric properties across geographic regions of resettled Central and East African refugees.
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Affiliation(s)
- Crista E Johnson-Agbakwu
- Southwest Interdisciplinary Research Center, Arizona State University, 411 N Central Ave, Suite 720, MC 4320, Phoenix, AZ, 85004, USA.
| | - Priscilla Flynn
- Office of Women's Health, Mayo Clinic, Rochester, MN, USA.,School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Gladys B Asiedu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Eric Hedberg
- Morrison Institute for Public Policy, Arizona State University, Phoenix, AZ, USA
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Santos RCDOD, Goulart AC, Kisukuri ALX, Brandão RM, Sitnik D, Staniak HL, Bittencourt MS, Lotufo PA, Bensenor IM, Santos IDS. Time-To-Treatment of Acute Coronary Syndrome and Unit of First Contact in the ERICO Study. Arq Bras Cardiol 2016; 107:323-330. [PMID: 27849262 PMCID: PMC5102478 DOI: 10.5935/abc.20160138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 06/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background To the best of our knowledge, there are no studies evaluating the influence
of the unit of the first contact on the frequency and time of
pharmacological treatment during an acute coronary syndrome (ACS) event. Objectives The main objective was to investigate if the unit of first contact influenced
the frequency and time of aspirin treatment in the Strategy of Registry of
Acute Coronary Syndrome (ERICO) study. Methods We analyzed the pharmacological treatment time in 830 ERICO participants -
700 individuals for whom the hospital was the unit of first contact and 130
who initially sought primary care units. We built logistic regression models
to study whether the unit of first contact was associated with a treatment
time of less than three hours. Results Individuals who went to primary care units received the first aspirin dose in
those units in 75.6% of the cases. The remaining 24.4% received aspirin at
the hospital. Despite this finding, individuals from primary care still had
aspirin administered within three hours more frequently than those who went
to the hospital (76.8% vs 52.6%; p<0.001 and 100% vs. 70.7%; p=0.001 for
non ST-elevation ACS and ST-elevation myocardial infarction, respectively).
In adjusted models, individuals coming from primary care were more likely to
receive aspirin more quickly (odds ratio: 3.66; 95% confidence interval:
2.06-6.51). Conclusions In our setting, individuals from primary care were more likely to receive
aspirin earlier. Enhancing the ability of primary care units to provide
early treatment and safe transportation may be beneficial in similar
settings.
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Affiliation(s)
| | - Alessandra Carvalho Goulart
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | | | - Rodrigo Martins Brandão
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Debora Sitnik
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Henrique Lane Staniak
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
| | - Marcio Sommer Bittencourt
- Hospital Universitário da Universidade de São Paulo, Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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Pre- and in-hospital antithrombotic management patterns and in-hospital outcomes in patients with acute coronary syndrome: data from the Turkish arm of the EPICOR study. Anatol J Cardiol 2016; 16:900-915. [PMID: 27443472 PMCID: PMC5324909 DOI: 10.14744/anatoljcardiol.2016.6755] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective: To evaluate the acute phase (pre- and in-hospital) antithrombotic management patterns (AMPs) and in-hospital outcomes for patients hospitalized with an acute coronary syndrome (ACS). Methods: In total, 1034 patients [514 patients with ST-segment elevation myocardial infarction (STEMI) and 520 with unstable angina/non-STEMI (UA/NSTEMI)] hospitalized for ACS within 24 h of symptom onset were included in this multicenter prospective registry study conducted at 34 hospitals across Turkey. Patient characteristics, index event description, pre- and in-hospital AMPs, and clinical outcomes were evaluated. Results: Majority (89.1%) of patients did not receive pre-hospital treatment. Overall 87.9% patients with STEMI and 55.6% patients with NSTEMI underwent percutaneous coronary intervention and dual antiplatelet therapy (DAPT) was based mainly on acetylsalicylic acid (ASA) and clopidogrel during hospitalization (99.8% and 98.2%, respectively). DAPT use at discharge was 98.4% and 86.8%, respectively. The percentage of patients with STEMI who received pre-hospital care, in-hospital cardiac catheterization, and pre and/or in-hospital triple antiplatelet therapy was higher than that of patients with UA/NSTEMI. In addition, higher rate of in-hospital hemorrhagic (2.3% vs. 0.8%) and cardiac ischemic (1.2% vs. 0.4% for MI and 1.6% vs. 0.8% for recurrent ischemia) complications and earlier induction of pre and/or in-hospital antiplatelet therapy and cardiac catheterization were also noted in patients with STEMI than in those with UA/NSTEMI. Conclusion: Our findings revealed in-hospital and at-discharge management to be mainly based on DAPT in patients with ACS. Interventional strategies were used in the majority of patients with STEMI, while the usage and timing of immediate pre-hospital ECG from symptom onset should be improved in these patients.
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Seligman B, Vedanthan R, Fuster V. Acute coronary syndromes in low- and middle-income countries: Moving forward. Int J Cardiol 2016; 217 Suppl:S10-2. [PMID: 27381860 DOI: 10.1016/j.ijcard.2016.06.213] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
Abstract
Cardiovascular disease remains the leading cause of death worldwide, particularly in low- and middle-income countries (LMICs), with substantial mortality from acute coronary syndromes. These deaths, when compared against high-income countries, occur at younger ages, and, beyond the lives lost, often result in economic privation for families deprived of a breadwinner and indebted by the oftentimes catastrophic cost of inpatient medical care. This burden will likely grow in scale in the years ahead as more countries pass through the epidemiologic transition. Billions around the world are beginning to experience the comforts that even modestly increased incomes can provide, including diets high in fats and sugars, more sedentary lifestyles, and tobacco and alcohol use and abuse. Health care systems in many of these countries are ill-equipped to prevent the harms caused by these lifestyles, as well as treat the acute coronary syndromes that result from them-including insufficient access to appropriate facilities and medications, difficulties with transport, and low awareness of the symptoms and need for emergent evaluation.
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Affiliation(s)
- Benjamin Seligman
- School of Medicine and Department of Biology, Stanford University, Stanford, CA, USA.
| | - Rajesh Vedanthan
- Zena and Michael A. Weiner Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Valentin Fuster
- Zena and Michael A. Weiner Cardiovascular Institute, and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Mathias W, Tsutsui JM, Tavares BG, Xie F, Aguiar MO, Garcia DR, Oliveira MT, Soeiro A, Nicolau JC, Lemos PA, Rochitte CE, Ramires JA, Kalil R, Porter TR. Diagnostic Ultrasound Impulses Improve Microvascular Flow in Patients With STEMI Receiving Intravenous Microbubbles. J Am Coll Cardiol 2016; 67:2506-15. [DOI: 10.1016/j.jacc.2016.03.542] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 03/17/2016] [Indexed: 10/21/2022]
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Annemans L, Danchin N, Van de Werf F, Pocock S, Licour M, Medina J, Bueno H. Prehospital and in-hospital use of healthcare resources in patients surviving acute coronary syndromes: an analysis of the EPICOR registry. Open Heart 2016; 3:e000347. [PMID: 27127635 PMCID: PMC4847130 DOI: 10.1136/openhrt-2015-000347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/22/2015] [Accepted: 01/24/2016] [Indexed: 01/14/2023] Open
Abstract
Objective The aim of this report is to provide insight into real-world healthcare resource use (HCRU) during the critical management of patients surviving acute coronary syndromes (ACS), using data from EPICOR (long-tErm follow-up of antithrombotic management Patterns In acute CORonary syndrome patients) (NCT01171404). Methods EPICOR was a prospective, multinational, observational study that enrolled 10 568 ACS survivors from 555 hospitals in 20 countries in Europe and Latin America, between September 2010 and March 2011. HCRU was evaluated in patients with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation ACS (NSTE-ACS), with or without a history of cardiovascular disease (CVD). Multivariable analysis was performed to determine factors that affected resource use. Results Before hospitalisation, more patients with STEMI than with NSTE-ACS had their first ECG (44.1% vs 36.4%, p<0.0001) and received antithrombotic medication (26.6% vs 15.2%, p<0.0001). Patients with NSTE-ACS with prior CVD were less likely than those without to be catheterised (73.1% vs 82.8%, p<0.0001). More patients with STEMI than with NSTE-ACS had percutaneous coronary intervention (77.1% vs 54.9%, p<0.0001), but fewer underwent coronary artery bypass grafting (1.2% vs 3.7%, p<0.0001). Multivariable analysis showed that resource use, including length of hospital stay and coronary revascularisation, was significantly influenced by multiple factors, including ACS type, site characteristics and region (all p≤0.05). Conclusions In this large-scale, real-life study, findings were generally in line with clinical logic, although site characteristics and region still significantly affected resource use. Moreover, and unexpectedly, resource use tended to be slightly higher in patients without a history of CVD. Trial registration number NCT01171404 (ClinicalTrials.gov).
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Affiliation(s)
- Lieven Annemans
- Department of Public Health , I-CHER Interuniversity Centre for Health Economics Research , Ghent University , Ghent , Belgium
| | - Nicolas Danchin
- Département de Cardiologie , Hôpital Européen Georges Pompidou & Université René Descartes , Paris , France
| | - Frans Van de Werf
- Department of Cardiovascular Medicine , University Hospitals Leuven , Leuven , Belgium
| | - Stuart Pocock
- London School of Hygiene and Tropical Medicine , London , UK
| | - Muriel Licour
- Medical Department , AstraZeneca France , Rueil Malmaison Cedex , France
| | - Jesús Medina
- Observational Research Centre, Payer & Real World Evidence, AstraZeneca , Madrid , Spain
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC); Cardiology Department, Instituto de Investigación i+12, Hospital Universitario 12 de Octubre; Universidad Complutense de Madrid, Madrid, Spain
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Li J, Li X, Ross JS, Wang Q, Wang Y, Desai NR, Xu X, Nuti SV, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Fibrinolytic therapy in hospitals without percutaneous coronary intervention capabilities in China from 2001 to 2011: China PEACE-retrospective AMI study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:232-243. [PMID: 26787648 DOI: 10.1177/2048872615626656] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Fibrinolytic therapy is the primary reperfusion strategy for ST-segment elevation myocardial infarction in China, and yet little is known about the quality of care regarding its use and whether it has changed over time. This issue is particularly important in hospitals without the capacity for cardiovascular intervention. METHODS Using a sequential cross-sectional study with two-stage random sampling in 2001, 2006, and 2011, we characterised the use, timing, type and dose of fibrinolytic therapy in a nationally representative sample of patients with ST-segment elevation myocardial infarction admitted to hospitals without the ability to perform percutaneous coronary intervention. RESULTS We identified 5306 patients; 2812 (53.0%) were admitted within 12 hours of symptom onset, of whom 2463 (87.6%) were ideal candidates for fibrinolytic therapy. The weighted proportion of ideal candidates receiving fibrinolytic therapy was 45.8% in 2001, 50.0% in 2006, and 53.0% in 2011 ( Ptrend=0.0042). There were no regional differences in fibrinolytic therapy use. Almost all ideal patients (95.1%) were treated after admission to the hospital rather than in the emergency department. Median admission to needle time was 35 minutes (interquartile range 10-82) in 2011, which did not improve from 2006. Underdosing was common. Urokinase, with little evidence of efficacy, was used in 90.2% of patients. CONCLUSIONS Over the past decade in China, the potential benefits of fibrinolytic therapy were compromised by underuse, patient and hospital delays, underdosing and the predominant use of urokinase, an agent for which there is little clinical evidence. There are ample opportunities for improvement.
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Affiliation(s)
- Jing Li
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Xi Li
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Joseph S Ross
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,3 Section of General Internal Medicine, Yale School of Medicine, USA.,4 The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA.,5 Department of Health Policy and Management, Yale School of Public Health, USA
| | - Qing Wang
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
| | - Yongfei Wang
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Nihar R Desai
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Xiao Xu
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,7 Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, USA
| | - Sudhakar V Nuti
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA
| | - Frederick A Masoudi
- 8 Division of Cardiology, University of Colorado Anschutz Medical Campus, USA
| | - John A Spertus
- 9 Saint Luke's Mid America Heart Institute/University of Missouri-Kansas City, USA
| | - Harlan M Krumholz
- 2 Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, USA.,4 The Robert Wood Johnson Foundation Clinical Scholars Program, Yale School of Medicine, USA.,5 Department of Health Policy and Management, Yale School of Public Health, USA.,6 Section of Cardiovascular Medicine, Yale School of Medicine, USA
| | - Lixin Jiang
- 1 National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, People's Republic of China
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Kassaian SE, Masoudkabir F, Sezavar H, Mohammadi M, Pourmoghaddas A, Kojouri J, Ghaffari S, Sanaati H, Alaeddini F, Pourmirza B, Mir E. Clinical characteristics, management and 1-year outcomes of patients with acute coronary syndrome in Iran: the Iranian Project for Assessment of Coronary Events 2 (IPACE2). BMJ Open 2015; 5:e007786. [PMID: 26671947 PMCID: PMC4679985 DOI: 10.1136/bmjopen-2015-007786] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To assess contemporary data on characteristics, management and 1-year postdischarge outcomes in Iranian patients hospitalised with acute coronary syndrome (ACS). SETTING 11 tertiary care hospitals in 5 major cities in the Islamic Republic of Iran. PARTICIPANTS Patients aged ≥ 20 and ≤ 80 years discharged alive with confirmed diagnosis of ACS including ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI) and high-risk unstable angina (HR-UA). PRIMARY AND SECONDARY OUTCOME MEASURES Patients were followed up regarding the use of medications and the end points of the study at 1 month and 1 year after discharge. The primary end point of the study was 1-year postdischarge major adverse cardiac and cerebrovascular events (MACCEs), defined as mortality (cardiac and non-cardiac), ACS and cerebrovascular attack (stroke and/or transient ischaemic attack). The secondary end points were hospital admission because of congestive heart failure, revascularisation by coronary artery bypass grafting surgery or percutaneous coronary intervention (PCI), and major and minor bleeds. RESULTS A total of 1799 patients (25.7% STEMI and 74.3% HR-UA/NSTEMI) discharged alive with confirmed diagnosis of ACS were included in the final analysis. During hospitalisation, the majority of the patients received aspirin (98.6%), clopidogrel (91.8%), anticoagulants (93.4%), statins (94.3%) and β-blockers (89.3%). Reperfusion therapy was performed in 62.6% of patients with STEMI (46.3% thrombolytic therapy and 17.3% primary PCI). The mean door-to-balloon and door-to-needle times were 82.9 and 45.6 min, respectively. In our study, 64.7% and 79.5% of the patients in HR-UA/NSTEMI and STEMI groups, respectively, underwent coronary angiography. During the 12 months after discharge, MACCEs occurred in 15.0% of all patients. CONCLUSIONS Our study showed that the composition of Iranian patients with ACS regarding the type of ACS is similar to that in developed European countries and is unlike that in developing countries of the Middle East and Africa. We found that our patients with ACS are treated with high levels of adherence to guideline-recommended in-hospital medications.
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Affiliation(s)
- Seyed Ebrahim Kassaian
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzad Masoudkabir
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hashem Sezavar
- Department of Cardiology, Rasul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadi
- Department of Cardiology, Javad-Al-Aemmeh Heart Hospital & Research Center, Mashhad, Iran
| | - Ali Pourmoghaddas
- Department of Cardiology, Khorshid Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Javad Kojouri
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Samad Ghaffari
- Cardiovascular Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamidreza Sanaati
- Department of Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Farshid Alaeddini
- Department of Research, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Elham Mir
- Sanofi Iran Medical Department, Tehran, Iran
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Medagama A, Bandara R, De Silva C, Galgomuwa MP. Management of acute coronary syndromes in a developing country; time for a paradigm shift? an observational study. BMC Cardiovasc Disord 2015; 15:133. [PMID: 26497226 PMCID: PMC4619422 DOI: 10.1186/s12872-015-0125-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 10/16/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited contemporary data on the presentation, management and outcomes of acute coronary syndromes (ACS) in Sri Lanka. We aimed to identify the critical issues that limit optimal management of ACS in Sri Lanka. METHODS We performed a prospectively observational study of 256 consecutive patients who presented with ACS between November 2011 and May 2012 at a tertiary care general medical unit in Sri Lanka. RESULTS We evaluated data on presentation, management, in-hospital mortality, and major adverse cardiovascular events (MACE) of participants. Smoking, alcohol abuse, and obesity were more common in patients with ST elevation myocardial infarction (STEMI) (P < 0.05). Discharge diagnoses were STEMI in 32.8 % (84/256) and unstable angina (UA)/non-ST elevation myocardial infarction [NSTEMI] in 67.1 % (172/256) of participants. The median time (IQR) from onset of pain to presentation was 60 (319) minutes for STEMI and 120 (420) for UA/NSTEMI (P = 0.058). A median delay of 240 min was noted in patients who had presented initially to smaller hospitals. Cardiac markers were assessed in only 35 % of participants. In-hospital anti-platelet use was high (>92 %). Only 70.2 % of STEMI patients received fibrinolytic therapy. Fewer than 20 % of patients were received fibrinolytic therapy within 30 min of arrival. Major adverse cardiac events (MACE) were recorded in 11.9 % of subjects with STEMI and 11.6 % of those with UA/NSTEMI (P = 0.5). According to logistic regression analysis, body mass index (P = 0.045) and duration of diabetes (P = 0.03) were significant predictors of in-hospital MACE. On discharge, aspirin, thienopyridine, and statins were prescribed to more than 90 % of patients. Only one patient underwent coronary angiography during the index admission. CONCLUSIONS Delays in presentation and in initiation of thrombolytic therapy and coronary interventions are key hurdles that need attention to optimize ACS care in Sri Lanka.
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Affiliation(s)
- Arjuna Medagama
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka.
| | - Ruwanthi Bandara
- Professorial Medical Unit, Teaching Hospital, Peradeniya, Sri Lanka.
| | - Chinthani De Silva
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka.
| | - Manoj Prasanna Galgomuwa
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Galaha Rd, Peradeniya, 20400, Sri Lanka.
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Huo Y, Lee SWL, Sawhney JPS, Kim HS, Krittayaphong R, Nhan VT, Alonso-Garcia A, Han YL, Ge J, Chin CT, Ong TK, Jan S, Itoh Y, Vega AM, Pocock S. Rationale, Design, and Baseline Characteristics of the EPICOR Asia Study (Long-tErm follow-uP of antithrombotic management patterns In Acute CORonary Syndrome patients in Asia). Clin Cardiol 2015. [PMID: 26206158 DOI: 10.1002/clc.22431] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND In-hospital and postdischarge mortality for acute coronary syndromes (ACS) vary across Asia and remain generally poorer than globally. The relationship between real-life antithrombotic management patterns (AMPs) and ACS-related outcomes in Asia is unclear. METHODS EPICOR Asia (Long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients in Asia) (NCT01361386) is a prospective, multinational, observational study of patients discharged after hospitalization for an ACS, with 2-year follow-up. The aim is to describe short- and long-term (up to 2 years post-index event) AMPs in patients hospitalized for ACS and to record clinical outcomes, healthcare resource use, and self-reported health status. Pre- and in-hospital management, AMPs, and associated outcomes, with particular focus on ischemic and bleeding events, will be recorded during the 2-year follow up. RESULTS Between June 2011 and May 2012, 13 005 patients were enrolled. From these, 12 922 patients surviving an ACS (6616 with STEMI, 2570 with NSTEMI, and 3736 with UA) were eligible for inclusion from 219 hospitals across 8 countries and regions in Asia: China (n = 8214), Hong Kong (n = 177), India (n = 2468), Malaysia (n = 100), Singapore (n = 93), South Korea (n = 705), Thailand (n = 957), and Vietnam (n = 208). CONCLUSIONS EPICOR Asia will provide information regarding clinical management and AMPs for ACS patients in Asia. Impact of AMPs on clinical outcomes, healthcare resource use, and self-reported health status both during hospitalization and up to 2 years after discharge will also be described.
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Affiliation(s)
- Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Stephen W-L Lee
- Department of Medicine, Queen Mary Hospital, Hong Kong SAR, China
| | | | - Hyo-Soo Kim
- Clinical Research Institute, Seoul National University Hospital, Seoul, Korea
| | | | - Vo T Nhan
- Department of Medicine, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Angeles Alonso-Garcia
- Cardiovascular Science Research Centre, St. George's University of London, London, United Kingdom
| | - Ya Ling Han
- Department of Cardiology, Shenyang Northern Hospital, Shenyang, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai, China
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore and Duke-NUS Graduate Medical School, Singapore
| | - Tiong K Ong
- Department of Cardiology, Sarawak General Hospital, Kuching, Malaysia
| | - Stephen Jan
- Health Economics Program, The George Institute for Global Health, University of Sydney, Sydney, Australia
| | - Yohji Itoh
- Clinical Science Division, AstraZeneca, Osaka, Japan
| | - Ana Maria Vega
- Observational Research Centre, Global Medical Affairs, AstraZeneca, Madrid, Spain
| | - Stuart Pocock
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Hassanein M, Abdelhamid M, Ibrahim B, Elshazly A, Aboleineen MW, Sobhy H, Nasr G, Elmesseiry F, Abdelmoniem A, Ashmawy M, Farag N, Youssef A, Elbahry A, Elrakshy Y, Sobhy M, Khairy Abdel Dayem TM, Ebeid H, Reda A, Boshra H, Saleh A, Maggioni AP. Clinical characteristics and management of hospitalized and ambulatory patients with heart failure-results from ESC heart failure long-term registry-Egyptian cohort. ESC Heart Fail 2015; 2:159-167. [PMID: 28834678 PMCID: PMC6410554 DOI: 10.1002/ehf2.12046] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/11/2015] [Accepted: 05/26/2015] [Indexed: 11/05/2022] Open
Abstract
Aims Our aim is to describe the clinical characteristics and management of patients hospitalized with acute heart failure (HHF) and ambulatory patients with chronic heart failure (CHF) in Egypt and compare them with heart failure (HF) patients from other countries in the European Society of Cardiology‐Heart Failure (ESC‐HF) registry. Methods and results The ESC‐HF Long‐term Registry is a prospective, multi‐centre, observational study of patients presenting to cardiology centres in member countries of the ESC. From April 2011 to February 2014, a total of 2145 patients with HF were recruited from 20 centres all over Egypt. Of these patients, 1475 (68.8%) were hospitalized with HHF, while 670 (31.2%) had CHF. Less than one‐third (32.1%) of all patients were females. HHF patients {median age of 61 years [interquartile range (IQR), 53–69]} were older than CHF patients [median age of 57 years (IQR,46‐64)]; P < 0.0001. They had more diabetes mellitus (45.4% vs. 31.8%; P < 0.0001). Left ventricular ejection fraction > 45% was present in 22% of HHF vs. 25.6% of CHF (P = 0.17). Atrial fibrillation existed in about a quarter of all patients (24.5%). Ischaemic heart disease was the main cause of HF in Egyptian patients. All‐cause in‐hospital mortality was 5%. Egyptian patients presented at a much earlier age than in other regions in the registry. They had more diabetes mellitus. Atrial fibrillation prevalence was remarkably lower. Other co‐morbidities (renal dysfunction, stroke, and peripheral arterial disease) occurred less frequently. Conclusion Patients in the Egyptian cohort exhibited distinct features from HF patients in other countries in the ESC‐HF Long‐term Registry.
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Affiliation(s)
| | | | | | - Ahmed Elshazly
- Gamal Abdel Nasser Insurance Hospital, Alexandria, Egypt
| | | | | | | | | | | | | | | | | | | | - Yahia Elrakshy
- Alexandria University Students' Hospital, Alexandria, Egypt
| | | | | | - Hamdy Ebeid
- Damanhour General Hospital, Damanhour, Egypt
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Bandara R, Medagama A, Munasinghe R, Dinamithra N, Subasinghe A, Herath J, Ratnayake M, Imbulpitiya B, Sulaiman A. Management and outcomes of acute ST-segment-elevation myocardial infarction at a tertiary-care hospital in Sri Lanka: an observational study. BMC Cardiovasc Disord 2015; 15:1. [PMID: 25592444 PMCID: PMC4361140 DOI: 10.1186/1471-2261-15-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/09/2015] [Indexed: 11/06/2022] Open
Abstract
Background Sri Lanka is a developing country with a high rate of cardiovascular mortality. It is still largely dependent on thrombolysis for primary management of acute myocardial infarction. The aim of this study was to present current data on the presentation, management, and outcomes of acute ST-segment-elevation myocardial infarction (STEMI) at a tertiary-care hospital in Sri Lanka. Methods Eighty-one patients with acute STEMI presenting to a teaching hospital in Peradeniya, Sri Lanka, were included in this observational study. Results Median interval between symptom onset and hospital presentation was 60 min (mean 212 min). Thrombolysis was performed in 73% of patients. The most common single reason for not performing thrombolysis was delayed presentation. Median door-to-needle time was 64 min (mean, 98 min). Only 16.9% of patients received thrombolysis within 30 min, and none underwent primary PCI. Over 98% of patients received aspirin, clopidogrel, and a statin on admission. Intravenous and oral beta blockers were rarely used. Follow-up data were available for 93.8% of patients at 1 year. One-year mortality rate was 12.3%. Coronary intervention was performed in only 7.3% of patients post infarction. Conclusion Late presentation to hospital remains a critical factor in thrombolysis of STEMI patients in Sri Lanka. Thrombolysis was not performed within 30 min of admission in the majority of patients. First-contact physicians should receive further training on effective thrombolysis, and there is an urgent need to explore the ways in which PCI and post-infarction interventions can be incorporated into treatment protocols.
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Affiliation(s)
| | - Arjuna Medagama
- Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
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González-Pacheco H, Márquez MF, Arias-Mendoza A, Álvarez-Sangabriel A, Eid-Lidt G, González-Hermosillo A, Azar-Manzur F, Altamirano-Castillo A, Briseño-Cruz JL, García-Martínez A, Mendoza-García S, Martínez-Sánchez C. Clinical features and in-hospital mortality associated with different types of atrial fibrillation in patients with acute coronary syndrome with and without ST elevation. J Cardiol 2014; 66:148-54. [PMID: 25480145 DOI: 10.1016/j.jjcc.2014.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Revised: 11/05/2014] [Accepted: 11/06/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND In patients with an acute coronary syndrome (ACS), no conclusive agreement has been reached to date regarding the association between the different types of atrial fibrillation (AF) and the in-hospital mortality risk. We conducted a retrospective cohort study in patients with ACS to determine the prognostic implications of the different types of AF. METHODS We analyzed 6705 consecutive patients with ACS admitted to a coronary care unit (CCU), including 3094 with ST segment elevation myocardial infarction (STEMI) and 3611 with non-ST-elevation acute coronary syndrome (NSTE-ACS). We identified the patients with pre-existing AF, new-onset AF at admission, and new-onset AF at the CCU. RESULTS The overall incidence of AF was documented in 360 (5.4%) of the patients (STEMI, 5%; NSTE-ACS, 5.6%), 140 (2.1%) of whom had pre-existing AF, and 220 (3.2%) of whom had new-onset AF (AF at admission, 1.3%; AF at the CCU, 1.9%). The patients with AF had high-risk clinical characteristics and developed major adverse events more frequently than did the patients without AF. The unadjusted in-hospital mortality risk was significantly higher in the patients with pre-existing AF (STEMI, 3.79-fold; NSTE-ACS, 3.4-fold) and AF at the CCU (STEMI, 2.02-fold; NSTE-ACS, 8.09-fold). After adjusting for the multivariate analysis, only the AF at the CCU in the NSTE-ACS group was associated with a 4.40-fold increase in the in-hospital mortality risk (odds ratio 4.40, CI 1.82-10.60, p=0.001). In the STEMI group, the presence of any type of AF was not associated with an increased risk of mortality. CONCLUSION Among the different types of AF in patients with ACS, only the new-onset AF that developed during the CCU stay in patients with NSTE-ACS was associated with a 4.40-fold increase in the in-hospital mortality risk.
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Affiliation(s)
| | - Manlio F Márquez
- Cardiac Electrophysiology Laboratory, National Institute of Cardiology, Mexico City, Mexico
| | | | | | - Guering Eid-Lidt
- Catheterization Laboratory, National Institute of Cardiology, Mexico City, Mexico
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Lu HT, Nordin R, Wan Ahmad WA, Lee CY, Zambahari R, Ismail O, Liew HB, Sim KH, NCVD Investigators OBOT. Sex Differences in Acute Coronary Syndrome in a Multiethnic Asian
Population: Results of the Malaysian National Cardiovascular Disease
Database—Acute Coronary Syndrome (NCVD-ACS) Registry. Glob Heart 2014; 9:381-90. [DOI: 10.1016/j.gheart.2014.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Revised: 05/27/2014] [Accepted: 06/04/2014] [Indexed: 01/20/2023] Open
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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