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Fiusa VC, Stephanus AD, Couto VF, Alexim GA, Severino TMM, Nogueira ACC, Guimarães AJBA, Soares AASM, Bilevicius E, Batista V, Staffico A, Sposito AC, Carvalho LSFD. Clinical Predictors of Heart Failure after STEMI: Data from a Middle-Income Country with Limited Access to Percutaneous Coronary Intervention. Arq Bras Cardiol 2025; 122:e20240447. [PMID: 40197875 PMCID: PMC12058137 DOI: 10.36660/abc.20240447] [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] [Received: 06/27/2024] [Revised: 11/25/2024] [Accepted: 01/15/2025] [Indexed: 04/10/2025] Open
Abstract
BACKGROUND Heart failure (HF) is a common complication of ST-elevation myocardial infarction (STEMI) in low- and middle-income countries (LMICs), where cardiovascular mortality is disproportionately high. Primary percutaneous coronary intervention (PCI) has reduced post-STEMI HF incidence in high-income countries. However, access to this standard of care is poor in LMICs, and data in these settings remain scarce. OBJECTIVE To identify predictors of HF following STEMI in a LMIC with limited access to PCI, aiming at better management and outcomes. METHODS This retrospective cohort study analyzed 2,467 STEMI patients admitted to two Brazilian public hospitals between January/2015 and February/2020. All participants received pharmacological thrombolysis and underwent coronarography within 48h post-admission. The primary outcome was symptomatic HF, defined as dyspnea with chest X-ray evidence of congestion, from 48h post-admission until discharge. Stepwise binary logistic regression was used to identify HF predictors. Significance was defined as p-values<0.05. RESULTS The population was 61.9% male, mean age was 58.3±12.6 years, and 39.9% developed post-STEMI HF. HF was more common among older men with cardiovascular-kidney-metabolic (CKM) disease, larger infarcts, and left anterior descending artery involvement. Medications were often underprescribed at discharge, especially aldosterone antagonists (11.0%). HF was notably more frequent among individuals with failed thrombolysis (47.0%). CONCLUSIONS This regionally representative cohort from a LMIC with limited access to PCI showed that older men with CKM disease are particularly vulnerable to post-STEMI HF, and that HF pharmacotherapy at discharge needs optimization. The high HF incidence among patients with failed thrombolysis highlights the need to expand PCI availability.
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Affiliation(s)
- Vinícius C Fiusa
- Universidade Católica de Brasília, Brasília, DF - Brasil
- Escola Superior de Ciências da Saúde, Brasília, DF - Brasil
- Instituto Aramari Apo, Brasília, DF - Brasil
| | | | - Victor F Couto
- Universidade Católica de Brasília, Brasília, DF - Brasil
| | | | | | - Ana Claudia C Nogueira
- Universidade Católica de Brasília, Brasília, DF - Brasil
- Escola Superior de Ciências da Saúde, Brasília, DF - Brasil
- Instituto Aramari Apo, Brasília, DF - Brasil
| | - Adriana J B A Guimarães
- Universidade Católica de Brasília, Brasília, DF - Brasil
- Escola Superior de Ciências da Saúde, Brasília, DF - Brasil
| | | | | | | | | | - Andrei C Sposito
- Instituto Aramari Apo, Brasília, DF - Brasil
- Universidade Estadual de Campinas,Campinas, SP - Brasil
- Clarity Healthcare Intelligence, Jundiaí, SP - Brasil
| | - Luiz Sérgio F de Carvalho
- Universidade Católica de Brasília, Brasília, DF - Brasil
- Escola Superior de Ciências da Saúde, Brasília, DF - Brasil
- Instituto Aramari Apo, Brasília, DF - Brasil
- Universidade Estadual de Campinas,Campinas, SP - Brasil
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Xu BZ, Wang B, Chen JP, Xu JG, Wu XY. Construction and validation of a personalized risk prediction model for in-hospital mortality in patients with acute myocardial infarction undergoing percutaneous coronary intervention. Clinics (Sao Paulo) 2025; 80:100580. [PMID: 39893830 PMCID: PMC11840486 DOI: 10.1016/j.clinsp.2025.100580] [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: 04/29/2024] [Accepted: 01/03/2025] [Indexed: 02/04/2025] Open
Abstract
BACKGROUND Although emergency Percutaneous Coronary Intervention (PCI) has been shown to reduce mortality in patients with Acute Myocardial Infarction (AMI), the risk of in-hospital death remains high. In this study, the authors aimed to identify risk factors associated with in-hospital mortality in AMI patients who underwent PCI, develop a nomogram prediction model, and evaluate its effectiveness. METHODS The authors retrospectively analyzed data from 1260 patients who underwent emergency PCI at Dongyang People's Hospital between June 1, 2013, and December 31, 2021. Patients were divided into two groups based on in-hospital mortality: the death group (n = 61) and the survival group (n = 1199). Clinical data between the two groups were compared. The Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to select non-zero coefficients of predictive factors. Multivariable logistic regression analysis was then performed to identify independent risk factors for in-hospital mortality in AMI patients after emergency PCI. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed, and its predictive performance was evaluated using the c-index. Internal validation was performed using the bootstrap method with 1000 resamples. The Hosmer-Lemeshow test was used to assess the goodness of fit, and a calibration curve was plotted to evaluate the model's calibration. RESULTS LASSO regression identified d-dimer, B-type natriuretic peptide, white blood cell count, heart rate, aspartate aminotransferase, systolic blood pressure, and the presence of postoperative respiratory failure as important predictive factors for in-hospital mortality in AMI patients after PCI. Multivariable logistic regression analysis showed that d-dimer, B-type natriuretic peptide, white blood cell count, systolic blood pressure, and the presence of postoperative respiratory failure were independent factors for in-hospital mortality. A nomogram model for predicting the risk of in-hospital mortality in AMI patients after PCI was constructed using these independent predictive factors. The Hosmer-Lemeshow test yielded a Chi-Square value of 9.43 (p = 0.331), indicating a good fit for the model, and the calibration curve closely approximated the ideal model. The c-index for internal validation was 0.700 (0.560‒0.834), further confirming the predictive performance of the model. Clinical decision analysis demonstrated that the nomogram model had good clinical utility, with an area under the ROC curve of 0.944 (95 % CI 0.903‒0.963), indicating excellent discriminative ability. CONCLUSION This study identified B-type natriuretic peptide, white blood cell count, systolic blood pressure, d-dimer, and the presence of respiratory failure as independent factors for in-hospital mortality in AMI patients undergoing emergency PCI. The nomogram model based on these factors showed high predictive accuracy and feasibility.
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Affiliation(s)
- Bing-Zheng Xu
- The Wenzhou Medical College Dongyang Hospital Emergency Department, Zhejiang, China
| | - Bin Wang
- The Wenzhou Medical College Dongyang Hospital Emergency Department, Zhejiang, China
| | - Jian-Ping Chen
- The Wenzhou Medical College Dongyang Hospital Emergency Department, Zhejiang, China
| | - Jin-Gang Xu
- The Wenzhou Medical College Dongyang Hospital Emergency Department, Zhejiang, China
| | - Xiao-Ya Wu
- The Wenzhou Medical College Dongyang Hospital Emergency Department, Zhejiang, China.
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Zia-Ul-Sabah, Alqahtani SAM, Wani JI, Aziz S, Durrani HK, Patel AA, Rangraze I, Mirdad RT, Alfayea MA, Shahrani S. Stress hyperglycaemia ratio is an independent predictor of in-hospital heart failure among patients with anterior ST-segment elevation myocardial infarction. BMC Cardiovasc Disord 2024; 24:751. [PMID: 39732650 DOI: 10.1186/s12872-024-04362-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2024] [Accepted: 11/18/2024] [Indexed: 12/30/2024] Open
Abstract
BACKGROUND Stress hyperglycaemia ratio (SHR) has been reported to be independently and significantly associated with various adverse cardiovascular events as well as mortality. Moreover, in-hospital heart failure following acute myocardial infarction has been demonstrated to account for majority of all heart failure (HF) cases with anterior myocardial infarction showing higher rates of HF. However, the association between SHR and in-hospital HF following an anterior ST-elevation myocardial infarction (STEMI) has not been reported earlier. Therefore, the present study aimed at identifying the relationship between SHR and in-hospital HF post STEMI. METHODS In this retrospective study electronic health records of 512 patients who presented with anterior STEMI from 01 January 2022 to 31 January 2024 were analysed. Based on the development of in-hospital HF, the enrolled patients were stratified into two groups: Group I, comprising of 290 patients who developed in-hospital HF and Group II comprising of 222 patients who did not develop in-hospital HF. ROC and Multivariable logistic regression analyses were performed to assess the relationship between SHR and in-hospital HF. RESULTS The results revealed that SHR is a significant independent predictor of in-hospital HF (OR: 3.53; 95%CI: 2.02-6.15; p < 0.001). Apart from SHR, the results also identified age, nosocomial pneumonia, ventricular fibrillation, LVEF, and NT-pro-BNP levels as other independent predictors. ROC analysis showed that SHR independently had a moderate discriminative power with AUC: 0.683, 95% CI 0.605-0.762; p = 0.04, which was almost comparable to the combined predictive value of other independent risk factors (AUC: 0.726, 95% CI 0.677-0.784). Noticeably, combining SHR and other identified independent predictors demonstrated a significant predictive power (AUC: 0.813, 95% CI 0.757-0.881; p = 0.01). CONCLUSION SHR is an independent predictor for in-hospital HF in anterior wall STEMI patients.
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Affiliation(s)
- Zia-Ul-Sabah
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia.
- Prince Faisal bin Khalid Cardiac Centre, Abha, Saudi Arabia.
| | | | - Javed Iqbal Wani
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Shahid Aziz
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Humayoun Khan Durrani
- Department of Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ayyub Ali Patel
- Department of Clinical Biochemistry, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Imran Rangraze
- Department of Internal Medicine, Ras Al Khaimah Medical and Health Sciences University, Ras Al Khaimah, UAE
| | - Rasha Tarek Mirdad
- Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Muad Ali Alfayea
- Department of Medicine, Aseer Central Hospital, Abha, Saudi Arabia
| | - Sara Shahrani
- Prince Faisal bin Khalid Cardiac Centre, Abha, Saudi Arabia
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Yaliqin N, Aimaier S, Adi D, Ma YT, Yu ZX. Impact of Duration of Diabetes Mellitus on Long-Term Outcome in Type 2 Diabetic Patients with Primary Percutaneous Coronary Intervention after the First Myocardial Infarction. Cardiology 2024; 149:297-313. [PMID: 38763137 DOI: 10.1159/000538032] [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: 10/20/2023] [Accepted: 02/21/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Diabetes mellitus (DM) increases the risk of mortality in patients with acute myocardial infarction (AMI). The impact of the diabetes duration on the long-term outcome of those with percutaneous coronary intervention (PCI) after the first AMI is unclear. In this study, we evaluated the predictive value of diabetes duration in the occurrence of major adverse cardiovascular and cerebrovascular events (MACCEs). METHODS A total of 394 type 2 DM patients with PCI after the first AMI were enrolled and were divided into two groups by the diabetes duration: a short-DM group with diabetes duration of <5 years and a long-DM group with a duration of ≥5 years. The clinical endpoint was MACCEs. RESULTS Multivariate Cox regression analysis found that the diabetes duration was independently associated with increased occurrence of MACCEs (HR: 1.512, 95% CI: 1.033, 2.215, p = 0.034), along with hypertension, Killip class III or IV, creatinine, multivessel disease, and continuous hypoglycemic therapy. After adjusting for the confounding variables, a nested Cox model showed that diabetes duration was still an independent risk factor of MACCEs (HR: 1.963, 95% CI: 1.376, 2.801, p < 0.001). The Kaplan-Meier survival curve illustrated a significantly high risk of MACCEs (HR: 2.045, p < 0.0001) in long-duration DM patients. After propensity score matching, a longer diabetes duration was associated with an increased risk of MACCE occurrence. CONCLUSION Long-duration diabetes was independently associated with poor clinical outcomes after PCI in patients with their first myocardial infarction. Despite the diabetes duration, continuous hypoglycemic therapy significantly improved long-term clinical outcomes.
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Affiliation(s)
- Nazila Yaliqin
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China,
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China,
| | - Salamaiti Aimaier
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Dilare Adi
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Yi-Tong Ma
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
| | - Zi-Xiang Yu
- Heart Center, Department of Cardiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- State Key Laboratory of Pathogenesis, Prevention and Treatment of High Incidence Diseases in Central Asia, Urumqi, China
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Akhtar KH, Khan MS, Baron SJ, Zieroth S, Estep J, Burkhoff D, Butler J, Fudim M. The spectrum of post-myocardial infarction care: From acute ischemia to heart failure. Prog Cardiovasc Dis 2024; 82:15-25. [PMID: 38242191 DOI: 10.1016/j.pcad.2024.01.017] [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: 01/15/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024]
Abstract
Heart failure (HF) is the leading cause of mortality in patients with acute myocardial infarction (AMI), with incidence ranging from 14% to 36% in patients admitted due to AMI. HF post-MI develops due to complex inter-play between macrovascular obstruction, microvascular dysfunction, myocardial stunning and remodeling, inflammation, and neuro-hormonal activation. Cardiogenic shock is an extreme presentation of HF post-MI and is associated with a high mortality. Early revascularization is the only therapy shown to improve survival in patients with cardiogenic shock. Treatment of HF post-MI requires prompt recognition and timely introduction of guideline-directed therapies to improve mortality and morbidity. This article aims to provide an up-to-date review on the incidence and pathogenesis of HF post-MI, current strategies to prevent and treat onset of HF post-MI, promising therapeutic strategies, and knowledge gaps in the field.
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Affiliation(s)
- Khawaja Hassan Akhtar
- Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | | | - Suzanne J Baron
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
| | - Shelley Zieroth
- Section of Cardiology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jerry Estep
- Section of Heart Failure & Transplantation, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, Columbia University Medical Center, New York City, NY, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA; Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Marat Fudim
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA; Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland.
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Liang J, Zhang Z. Predictors of in-hospital heart failure in patients with acute anterior wall ST-segment elevation myocardial infarction. Int J Cardiol 2023; 375:104-109. [PMID: 36638919 DOI: 10.1016/j.ijcard.2023.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/14/2022] [Accepted: 01/08/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND Heart failure (HF) is a severe complication of acute ST-segment elevation myocardial infarction (STEMI). Its incidence is associated with myocardial infarction location, and it occurs frequently after acute anterior wall STEMI due to the larger infarct size. However, predictors of in-hospital HF in patients with acute anterior wall STEMI are inadequately defined. We aimed to determine potential predictors of HF in patients with acute anterior wall STEMI during hospitalization. METHODS A total of 714 consecutive patients who were diagnosed with acute anterior wall STEMI and underwent primary percutaneous coronary intervention (pPCI) between January 2013 to August 2019 were enrolled retrospectively. We assigned the patients to HF and non-HF groups. The clinical parameters were subjected to univariate analysis and logistic regression analysis to obtain the independent predictors. RESULTS Among the 714 patients enrolled in the present study (mean age 61.0 ± 13.8 years, men 80.7%), 387 (54.2%) had in-hospital HF. According to a multivariate logistic regression analysis, ventricular fibrillation (VF, OR: 5.66, 95% CI: 2.25-14.23, P < 0.001) was the most striking independent predictor of in-hospital HF. Community-acquired pneumonia (CAP, OR: 4.72, 95% CI: 2.44-9.10, P < 0.001), age (OR: 1.03, 95% CI: 1.01-1.04, P < 0.001), left ventricular ejection fraction (LVEF, OR: 0.96, 95% CI: 0.93-0.97, P < 0.001), and peak N-terminal pro-brain natriuretic peptide (NT-pro-BNP, OR: 1.06, 95% CI: 1.02-1.11, P = 0.006) were also independently associated with in-hospital HF. CONCLUSION VF, CAP, age, LVEF, and peak NT-pro-BNP were independently associated with in-hospital HF in patients with acute anterior wall STEMI.
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Affiliation(s)
- Jingkang Liang
- Department of Health Management Center, The Second Affiliated Hospital of Guangdong Medical University, Zhanjiang 524000, China.
| | - Zenghui Zhang
- Department of Cardiology, The First Affiliated Hospital of Jinan University, Guangzhou 510000, China
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Dayem KA, Younis O, Zarif B, Attia S, AbdelSalam A. Impact of dapagliflozin on cardiac function following anterior myocardial infarction in non-diabetic patients - DACAMI (a randomized controlled clinical trial). Int J Cardiol 2023; 379:9-14. [PMID: 36889650 DOI: 10.1016/j.ijcard.2023.03.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/06/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023]
Abstract
BACKGROUND The role of Sodium-glucose co-transporter 2 inhibitors (SGLT2i) in heart failure is established. Early data also suggests their favorable role in patients with acute coronary syndromes, but more evidence is still needed. METHODS In this dual center, double-blinded randomized controlled trial, non-diabetic patients (N = 100) who presented with anterior ST- elevation myocardial infarction (STEMI) & had undergone successful primary percutaneous coronary intervention, but their left ventricular ejection fraction was below 50%, were randomized to dapagliflozin 10 mg or a placebo once daily. The primary endpoint was a change in cardiac function assessed by N-terminal pro-Brain Natriuretic Peptide - NT-proBNP measured at baseline & 12 weeks post the cardiac event &/or echocardiographic parameters (left ventricular ejection fraction, left ventricular diastolic dimension & left ventricular mass index) assessed at baseline, 4-weeks & 12-weeks post the cardiac event. RESULTS From October 2021 to April 2022, 100 patients were randomized. The mean drop of NT- proBNP in the study group was more significant compared to the control group by 10.17% (95% CI: -3.28-19.67, p-value 0.034). In addition, the decrease in the left ventricular mass index (LV mass index) was also significant in the study group compared to the control group by 11.46% (95% CI: -19.37 to -3.56, p-value 0.029). CONCLUSIONS Dapagliflozin seems to have a role in preventing left ventricular dysfunction & maintaining cardiac function following anterior ST-elevation myocardial infarction. More Large-scale trials need to be done to confirm these findings further. This trial is locally registered at the National Heart Institute, Cairo - Egypt, and Faculty of Medicine, Ain Shams University, with reference numbers CTN1012021 & MS-07/2022, respectively. It is also registered retrospectively at the US National Institutes of Health (ClinicalTrial.gov) with identifier number: NCT05424315 - June 16th,2022.
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Affiliation(s)
- Khairy Abdel Dayem
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
| | - Omar Younis
- Cardiology, National Heart Institute, 5 Ibn Al Nafees Square, Al Kit Kat, Giza 3755204, Egypt.
| | - Bassem Zarif
- Cardiology, National Heart Institute, 5 Ibn Al Nafees Square, Al Kit Kat, Giza 3755204, Egypt
| | - Sameh Attia
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
| | - Ahmed AbdelSalam
- Cardiology, Ain Shams University, 38 Abbassia Square, Abbassia, Cairo 1181, Egypt
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Xu K, Wu M, Huang M, Zhuo X, Weng Y, Chen X. Carbohydrate antigen 125 combined with N-terminal pro-B-type natriuretic peptide in the prediction of acute heart failure following ST-elevation myocardial infarction. Medicine (Baltimore) 2022; 101:e32129. [PMID: 36482545 PMCID: PMC9726410 DOI: 10.1097/md.0000000000032129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The value of serum carbohydrate antigen 125 (CA125) combined with N-terminal pro-B-type natriuretic peptide (NT-proBNP) in the evaluation of acute heart failure (AHF) after ST-segment elevation myocardial infarction (STEMI) remains unclear. The aim of this study was to evaluate the efficacy of CA125 combined with NT-proBNP in predicting AHF following STEMI. A total of 233 patients with STEMI were evaluated, including 39 patients with Killip II-IV and 194 patients with Killip I. The optimal cutoff point for predicting AHF was determined by receiver operating characteristic (ROC) curve, and the independent predictors of AHF were evaluated by multiple logistic regression. According to the cutoff value, it was divided into three groups: C1 = CA125 < 13.20 and NT-proBNP < 2300 (n = 138); C2 = CA125 ≥ 13.20 or NT-proBNP ≥ 2300 (n = 59); C3 = CA125 ≥ 13.20 and NT-proBNP ≥ 2300 (n = 36). Differences between groups were compared by odds ratio (OR). The levels of CA125 and NT-proBNP in AHF group were higher than those in non-AHF group (19.90 vs 10.00, P < .001; 2980.00 vs 1029.50, P < .001, respectively). The optimal cutoff values of CA125 and NT-proBNP for predicting AHF were 13.20 and 2300, both of which were independent predictors of AHF. The incidence of AHF during hospitalization was highest in C3 (69.44%), middle in C2 (20.34%) and lowest in C1 (1.45%). After adjustment for clinical confounding variables, compared with C1: C2 (OR = 6.41, 95% CI: 1.22-33.84, P = .029), C3 (OR = 19.27, 95% CI: 3.12-118.92, P = .001). Elevated CA125 and NT-proBNP are independent predictors of AHF in STEMI patients, and their combination can improve the recognition efficiency.
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Affiliation(s)
- Kaizu Xu
- Department of Cardiology, Affiliated Hospital of Putian University, Putian, China
| | - Meifang Wu
- Department of Cardiology, Affiliated Hospital of Putian University, Putian, China
| | - Meinv Huang
- Department of Cardiology, Affiliated Hospital of Putian University, Putian, China
| | - Xiuping Zhuo
- Department of Cardiology, Affiliated Hospital of Putian University, Putian, China
| | - Yujuan Weng
- Department of Ultrasound, Affiliated Hospital of Putian University, Putian, China
| | - Xi Chen
- Department of Cardiology, Affiliated Hospital of Putian University, Putian, China
- * Correspondence: Xi Chen, Department of Cardiology, Affiliated Hospital of Putian University, Putian 351100, China (e-mail: )
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Tschugguel W. A transitive perspective on the relief of psychosomatic symptoms. Front Psychol 2022; 13:821566. [PMID: 36317186 PMCID: PMC9616690 DOI: 10.3389/fpsyg.2022.821566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
A key element of successful psychotherapy for the treatment of psychosomatic disorders is that patients recognize and change the meaning of their experiences. Such changes are brought about by appropriate verbal referencing of symptoms currently experienced within a given narrative. The present theoretical paper argues that changes are not based on better, more adaptive narratives per se, but on the transition (or linkage) process itself that is experienced between different narratives. This view is theoretically justified in various ways: first, it is accounted for through contemporary spatiotemporal neuroscience, which aims to connect mental and structural aspects via a common dynamic property or, according to Northoff, the "common currency" of a brain's orientation along its embeddedness in its contextual world, i.e., body and environment. Second, it is justified through the physics concept of "spontaneous symmetry breaking," which is used analogously to "suffering from symptoms." If the sufferer is willing to experience a process of "going back," that is, moving away from the previous narrative (or aspect) by verbally relating to the felt aspects of the symptom in question (i.e., approaching its meaning), they are moving toward symmetry or an underlying dynamic alignment with their world context. Clinical predictions are derived from the theoretical arguments.
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Affiliation(s)
- Walter Tschugguel
- Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
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10
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Huang X, Yang S, Chen X, Zhao Q, Pan J, Lai S, Ouyang F, Deng L, Du Y, Chen J, Hu Q, Guo B, Liu J. Development and validation of a clinical predictive model for 1-year prognosis in coronary heart disease patients combine with acute heart failure. Front Cardiovasc Med 2022; 9:976844. [PMID: 36312262 PMCID: PMC9609152 DOI: 10.3389/fcvm.2022.976844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background The risk factors for acute heart failure (AHF) vary, reducing the accuracy and convenience of AHF prediction. The most common causes of AHF are coronary heart disease (CHD). A short-term clinical predictive model is needed to predict the outcome of AHF, which can help guide early therapeutic intervention. This study aimed to develop a clinical predictive model for 1-year prognosis in CHD patients combined with AHF. Materials and methods A retrospective analysis was performed on data of 692 patients CHD combined with AHF admitted between January 2020 and December 2020 at a single center. After systemic treatment, patients were discharged and followed up for 1-year for major adverse cardiovascular events (MACE). The clinical characteristics of all patients were collected. Patients were randomly divided into the training (n = 484) and validation cohort (n = 208). Step-wise regression using the Akaike information criterion was performed to select predictors associated with 1-year MACE prognosis. A clinical predictive model was constructed based on the selected predictors. The predictive performance and discriminative ability of the predictive model were determined using the area under the curve, calibration curve, and clinical usefulness. Results On step-wise regression analysis of the training cohort, predictors for MACE of CHD patients combined with AHF were diabetes, NYHA ≥ 3, HF history, Hcy, Lp-PLA2, and NT-proBNP, which were incorporated into the predictive model. The AUC of the predictive model was 0.847 [95% confidence interval (CI): 0.811–0.882] in the training cohort and 0.839 (95% CI: 0.780–0.893) in the validation cohort. The calibration curve indicated good agreement between prediction by nomogram and actual observation. Decision curve analysis showed that the nomogram was clinically useful. Conclusion The proposed clinical prediction model we have established is effective, which can accurately predict the occurrence of early MACE in CHD patients combined with AHF.
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Affiliation(s)
- Xiyi Huang
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Shaomin Yang
- Department of Radiology, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Xinjie Chen
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Qiang Zhao
- Department of Cardiovascular Medicine, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Jialing Pan
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Shaofen Lai
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Fusheng Ouyang
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Lingda Deng
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Yongxing Du
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Jiacheng Chen
- Department of Clinical Laboratory, The Affiliated Shunde Hospital of Guangzhou Medical University, Foshan, China
| | - Qiugen Hu
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China
| | - Baoliang Guo
- Department of Radiology, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,*Correspondence: Baoliang Guo,
| | - Jiemei Liu
- Department of Rehabilitation Medicine, Shunde Hospital, Southern Medical University, Foshan, Guangdong, China,Jiemei Liu,
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11
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Bachar A, Benmessaoud FA, Diatta A, Fadoum H, Haroun AE, Oukerraj L, Cherti M. Predictive factors of heart failure in acute coronary syndrome: Institutional cross-sectional study. Ann Med Surg (Lond) 2022; 81:104332. [PMID: 36147130 PMCID: PMC9486600 DOI: 10.1016/j.amsu.2022.104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 11/26/2022] Open
Abstract
Background Heart failure complicating acute coronary syndrome (ACS) remains a challenge because it is associated with a high risk of mortality at 1 year. Our objective is to highlight the factors frequently associated with heart failure following an ACS and thus deduce the predictive factors for the occurrence of heart failure. Methods ACS patients who were managed between 01/01/2021 to 06/30/2021 at the authors’ institution were included retrospectively in the analysis. Results One hundred twenty-one patients (121) included. Eighty-seven were males (72%), and the mean age was 59.4 ± 8.8. Most patients were smokers (58.7%),40% were diabetic, and 40.5% were hypertensive. Dyslipidemia was found in 37.2% of cases. 75% of patients were admitted for STEMI, and 25% for NSTEMI. The majority of patients (67.5%) were admitted out of time. The anterior electrical territory was found as a factor in the occurrence of heart failure (OR = 5.47, 95% CI (2.16–15.26), P = 0.0005). Among the patients who presented a heart failure, 64% had an LVEF <40%, and only 3% with an LVEF >50% (P < 0.001). Also, 76% had a Wall Motion Index Score (WMSI) of 1.5 (P < 0.001). Angioplasty was the treatment of choice in 65%, aortocoronary bypass in 7% of cases, and medical treatment alone, associated or not with ischemia/viability tests in 28% of cases. Patients admitted out of time (>12 h) were found to be a factor in the occurrence of HF (OR = 3.31,95% CI (1.21–10,60), P = 0.02). The outcome was favorable in 93% of cases. We observed 9 cases of complications including 4 deaths from cardiogenic, septic, and hemorrhagic shock. Conclusions This study allows us to identify patients at risk of developing heart failure and patients with a more reserved prognosis. Besides, our findings will allow our peers and colleagues to be able to detect early these factors and optimize adequate management to avoid heart failure. Heart failure complicating acute coronary syndrome (ACS) remains a challenge. It is associated with a high risk of mortality at 1 year. The delay in care is a determining factor in the occurrence of complications. Our health system have a weakness that should be corrected. The deadlines are far from the recommended deadlines.
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12
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Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Association between total ischemic time and in-hospital mortality after emergency PCI in patients with acute ST-segment elevation myocardial infarction: a retrospective study. BMC Cardiovasc Disord 2022; 22:80. [PMID: 35246059 PMCID: PMC8896149 DOI: 10.1186/s12872-022-02526-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Symptom-to-balloon time (SBT) represents the total ischemic time in ST-elevated myocardial infarction (STEMI) and is associated with poor long-term outcomes. The study aimed to explore the association between SBT and in-hospital mortality after emergency percutaneous coronary intervention (PCI) in patients with acute STEMI. Methods This retrospective, multicenter, observational study included patients admitted to the Hebei General Hospital, Baoding No. 1 Central Hospital, and Cangzhou Central Hospital from January 2016 to December 2018. The outcome was all-cause mortality during the hospital stay. Logistic regression models were established to explore the association between SBT and all-cause mortality during the hospital stay. Results This study included 1169 patients: 876 males of 59.6 ± 11.4 years of age, and 293 females 66.3 ± 13.3 years of age. A first analysis showed EF had an interaction with SBT (P = 0.01). In patients with EF ≥ 50%, SBT was not an independent risk factor for postoperative all-cause mortality in the hospital (all P > 0.05). In patients with EF < 50%, SBT was an independent risk factor for postoperative all-cause mortality in the hospital [model 3: 1.51 (1.17, 1.54), P for trend = 0.01]. Conclusions SBT was independently associated with all-cause mortality in the hospital after PCI in patients with acute STEMI and EF < 50%. Specifically, the risk of in-hospital mortality for those with SBT ≥ 361 min is increased by 51% compared with those with SBT ≤ 120 min.
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Affiliation(s)
- Nan Gao
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China.,Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Xiaoyong Qi
- School of Graduate, Hebei Medical University, No. 361 Zhongshan East Street, Changan District, Shijiazhuang, Hebei Province, 050000, People's Republic of China. .,Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Gang Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
| | - Xiao Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, 050000, Hebei Province, People's Republic of China
| | - Ning Zhu
- Department of Cardiology, Baoding No. 1 Central Hospital, Baoding, 071000, Hebei Province, People's Republic of China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei Province, People's Republic of China
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13
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Wang WH, Mar GY, Wei KC, Cheng CC, Huang WC. Risk Factors and Outcomes of Heart Failure Following First-Episode of Acute Myocardial Infarction-A Case Series Study of 161,384 Cases. Healthcare (Basel) 2021; 9:healthcare9101382. [PMID: 34683062 PMCID: PMC8544413 DOI: 10.3390/healthcare9101382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Heart failure (HF) is one of the important complications of acute myocardial infarction (AMI), but the epidemiology, associated risks and outcomes have not been well investigated in the era of broad use of fluoroscopy-guided angiographic intervention. Methods: We analysed 161,384 subjects who had experienced the first episode of AMI during 1 January 2000 and 31 December 2012 using the Taiwan National Health Insurance Research Database. Results: During the index AMI hospitalization, 23.6% of cases developed HF. Female, ≥65 years-old, non-ST-segment elevation type of MI, diabetes mellitus (DM), peripheral vascular occlusion disease (PAOD), chronic obstructive pulmonary disease (COPD), atrial fibrillation, and ventricular tachycardia/fibrillation (VT/VF) were associated with higher risks of developing HF. HF cases had inferior survival outcomes compared to non-HF cases in both the short and long term. Among those HF patients, ≥65 years, DM, PAOD, and VT/VF were associated with worse outcomes. On the contrary, coronary reperfusion intervention and treat-to-target pharmacologic treatment were associated with favourable survival outcomes. Conclusions: HF remains common in the modern age and poses negative impacts in survival of AMI patients. It highlights that prudent prevention and early treatment of HF during AMI hospitalization is an important medical issue.
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Affiliation(s)
- Wen-Hwa Wang
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- College of Management, I-Shou University, Kaohsiung 824, Taiwan
- Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
| | - Guang-Yuan Mar
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
- Superintendent, Kaohsiung Municipal United Hospital, Kaohsiung 804, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan;
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
| | - Chin-Chang Cheng
- Department of Cardiology, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan; (W.-H.W.); (G.-Y.M.); (C.-C.C.)
- Shu-Zen Junior College of Medicine and Management, Kaohsiung 821, Taiwan
| | - Wei-Chun Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 813, Taiwan
- Department of Physical Therapy, Fooyin University, Kaohsiung 831, Taiwan
- Correspondence:
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14
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He QY, Yu XY, Xiao Z, Sun X, Zhu WF, Yi XQ, Chen Q, Zhang JH, Chen SX, Zhou X, Nie HY, Shang HC, Chen XF. Comparison of the Efficacy of Danhong Injections at Different Time-points During the Perioperative Period of Acute Myocardial Infarction: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Front Pharmacol 2021; 12:643446. [PMID: 33995051 PMCID: PMC8117241 DOI: 10.3389/fphar.2021.643446] [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] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/01/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: Danhong injections (DHI) are widely used in the treatment of acute myocardial infarction (AMI). As there are no guidelines for the timing of DHI in the peri-percutaneous coronary intervention (PCI) period for AMI, we investigated the effects of DHI timing. Methods: We reviewed reports published before September 30, 2020 in PubMed, embase, the Cochrane Central Register of Controlled Trials, the Chinese BioMedical database, Chinese VIP database, Wanfang database, and Chinese National Knowledge Infrastructure database. Only randomized controlled trials of DHI with percutaneous coronary intervention for AMI were included. Methodological quality was assessed using the Cochrane evaluation manual 5.3.3 criteria. A meta-analysis was performed, and forest plots were drawn. Results: We included 23 studies which all revealed that patients in DHI groups had better efficacy than control groups. Subgroup analysis revealed that DHI administered intraoperatively and continued postoperatively was more effective in increasing left ventricular ejection fraction when compared to other time-points (p < 0.001). The pre- and intraoperative use of DHI could improve reflow more effectively than conventional treatment, while the effect was not significant in the postoperative intervention study (p = 0.654). The 16 postoperative interventions revealed that the effect of DHI at 14 days was better than that at 7 and 10 days for hs-CRP (p = 0.013), the 10-days treatment produced better results for CK-MB than for the other treatments (p < 0.001) and a dosage of 30 ml proved most effective for IL-6 (p < 0.001). Conclusion: DHI proved to be superior to conventional Western medicine in reducing the incidence of adverse cardiac events, promoting reperfusion, improving cardiac function, reducing inflammatory factors, and protecting the myocardium. DHI should be administered early in the perioperative period and continued postoperatively because of its ability to improve cardiac function. Furthermore, in the PCI postoperative, 30 ml is recommended to inhibit IL-6 levels, for patients with high hs-CRP, a course of 14 days is most effective, for patients with obvious abnormalities of CK-MB, a 10-days course of treatment is recommended. However, due to the limited number and quality of the original randomized controlled trials, our conclusions need large, multi-centre RCTs to validation.
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Affiliation(s)
- Qing-Ying He
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xin-Yu Yu
- Preventive Treatment Center, Hongdu Hospital of Traditional Chinese Medicine Affiliated to Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Zheng Xiao
- Department of General Practice, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xin Sun
- Chinese Evidence-based Medicine Centre and CREAT Group, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Wei-Feng Zhu
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xing-Qian Yi
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Qian Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Jia-Hui Zhang
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Shu-Xian Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Xu Zhou
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - He-Yun Nie
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Hong-Cai Shang
- Key Laboratory of Chinese Internal Medicine of Ministry of Education and Beijing, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiao-Fan Chen
- Evidence-Based Medicine Research Centre, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
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15
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Kai T, Ono Y, Matsushima S, Shinohara K, Nakashima R, Kawahara T, Katsuki M, Fujino T, Hashimoto T, Higo T, Tsutsui H. Undiagnosed Cardiac Sarcoidosis Causing Refractory Heart Failure After Acute Myocardial Infarction due to Thromboembolism. Int Heart J 2021; 62:437-440. [PMID: 33731532 DOI: 10.1536/ihj.20-586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 61-year-old woman suffered chest pain and was admitted to a nearby hospital emergency department. She was diagnosed with acute myocardial infarction probably due to thromboembolism in the left anterior descending coronary artery and aspiration thrombectomy was performed. Afterwards, she developed refractory heart failure with severe global left ventricular dysfunction and was transferred to our hospital. An 18F-FDG-PET/CT scan revealed abnormal 18F-FDG uptake in non-infarcted regions of the left ventricle. Non-caseating granulomas were detected by biopsy from a skin eruption. She was diagnosed with cardiac sarcoidosis. In cases of refractory heart failure which cannot be explained only by myocardial infarction, evaluation of other undiagnosed cardiomyopathies is important for optimal management.
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Affiliation(s)
- Takashi Kai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Yoshiyasu Ono
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University.,Department of Cardiology, Munakata Suikokai General Hospital
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Keisuke Shinohara
- Department of Experimental and Clinical Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Ryosuke Nakashima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Takuro Kawahara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Masato Katsuki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Takeo Fujino
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Toru Hashimoto
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University.,Department of Advanced Cardiopulmonary Failure, Faculty of Medical Sciences, Kyushu University
| | - Taiki Higo
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University
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16
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Jenča D, Melenovský V, Stehlik J, Staněk V, Kettner J, Kautzner J, Adámková V, Wohlfahrt P. Heart failure after myocardial infarction: incidence and predictors. ESC Heart Fail 2020; 8:222-237. [PMID: 33319509 PMCID: PMC7835562 DOI: 10.1002/ehf2.13144] [Citation(s) in RCA: 339] [Impact Index Per Article: 67.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/14/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
Aims The aim of the present paper was to provide an up‐to‐date view on epidemiology and risk factors of heart failure (HF) development after myocardial infarction. Methods and results Based on literature review, several clinical risk factors and biochemical, genetic, and imaging biomarkers were identified to predict the risk of HF development after myocardial infarction. Conclusions Heart failure is still a frequent complication of myocardial infarction. Timely identification of subjects at risk for HF development using a multimodality approach, and early initiation of guideline‐directed HF therapy in these patients, can decrease the HF burden.
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Affiliation(s)
- Dominik Jenča
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vojtěch Melenovský
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Stehlik
- Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Vladimír Staněk
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jiří Kettner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Faculty of Medicine, Dentistry of the Palacký University, Olomouc, Czech Republic
| | - Věra Adámková
- Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Peter Wohlfahrt
- Third Faculty of Medicine, Charles University, Prague, Czech Republic.,Division of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Preventive Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.,Centre for Cardiovascular Prevention, First Faculty of Medicine and Thomayer Hospital, Charles University, Videnska 800, Prague 4, 140 59, Czech Republic
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17
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Gao N, Qi X, Dang Y, Li Y, Wang G, Liu X, Zhu N, Fu J. Establishment and validation of a risk model for prediction of in-hospital mortality in patients with acute ST-elevation myocardial infarction after primary PCI. BMC Cardiovasc Disord 2020; 20:513. [PMID: 33297955 PMCID: PMC7727168 DOI: 10.1186/s12872-020-01804-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 11/30/2020] [Indexed: 12/18/2022] Open
Abstract
Background Currently, how to accurately determine the patient prognosis after a percutaneous coronary intervention (PCI) remains unclear and may vary among populations, hospitals, and datasets. The aim of this study was to establish a prediction model of in-hospital mortality risk after primary PCI in patients with acute ST-elevated myocardial infarction (STEMI). Methods This was a multicenter, observational study of patients with acute STEMI who underwent primary PCI. The outcome was in-hospital mortality. The least absolute shrinkage and selection operator (LASSO) method was used to select the features that were the most significantly associated with the outcome. A regression model was built using the selected variables to select the significant predictors of mortality. Receiver operating characteristic (ROC) curve and decision curve analysis (DCA) were used to evaluate the performance of the nomogram. Results Totally, 1169 and 316 patients were enrolled in the training and validation sets, respectively. Fourteen predictors were identified by the LASSO analysis: sex, Killip classification, left main coronary artery disease (LMCAD), grading of thrombus, TIMI classification, slow flow, application of IABP, administration of β-blocker, ACEI/ARB, symptom-to-door time (SDT), symptom-to-balloon time (SBT), syntax score, left ventricular ejection fraction (LVEF), and CK-MB peak. The mortality risk prediction nomogram achieved good discrimination for in-hospital mortality (training set: C-statistic = 0.987; model calibration: P = 0.722; validation set: C-statistic = 0.984, model calibration: P = 0.669). Area under the curve (AUC) values for the training and validation sets are 0.987 (95% CI: 0.981–0.994, P = 0.003) and 0.990 (95% CI: 0.987–0.998, P = 0.007), respectively. DCA shows that the nomogram can achieve good net benefit. Conclusions A novel nomogram was developed and is a simple and accurate tool for predicting the risk of in-hospital mortality in patients with acute STEMI who underwent primary PCI.
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Affiliation(s)
- Nan Gao
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Xiaoyong Qi
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China.
| | - Yi Dang
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Yingxiao Li
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Gang Wang
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei, China
| | - Xiao Liu
- Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei, China
| | - Ning Zhu
- Department of Internal Medicine, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinguo Fu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, Hebei, China
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18
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Zhang X, Wang S, Sun L, Fang S, Yu B. Prognostic value of D-dimer in acute myocardial infarction complicated by heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:4118-4125. [PMID: 33103360 PMCID: PMC7755008 DOI: 10.1002/ehf2.13027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/22/2022] Open
Abstract
Aims The prevalence of heart failure (HF) after acute myocardial infarction (AMI) is common. Contemporary data are lacking on the prognostic utility of the measurement of biomarker for patients with AMI complicated by HF according to preserved (HFpEF) and reduced ejection fraction (HFrEF). We aim to assess the association between D‐dimer levels and all‐cause mortality in patients with AMI complicated by different HF subtypes during hospitalization in the context of other risk factors. Methods and results We enrolled 4495 patients with AMI with complete clinical and laboratory variable assessments in this cohort. D‐dimer levels were measured on admission immediately at baseline. We used Cox proportional hazards analysis to assess this association accounting for 18 relevant clinical variables. During the index hospitalization, 589 patients with AMI developed HFpEF, 513 patients with AMI developed HFrEF, and 3393 patients with AMI did not develop HF. The patients were divided into HFpEF, HFrEF, and non‐HF groups accordingly. The median length of follow‐up was 1 year (range: 1 to 24 months). During the whole follow‐up, 58 (15.5%), 107 (27.9%), and 96 (4.2%) of the patients experienced death event in HFpEF, HFrEF, and non‐HF groups, respectively. In each group, the patients were divided into high or low D‐dimer levels according to D‐dimer concentration (145 ng/mL). In the fully adjusted model, the risk of all‐cause mortality of those patients with high D‐dimer levels was 2.09 [95% confidence intervals (CI): 1.08 to 4.02, P = 0.02] times as high as the risk of patients with low D‐dimer levels in HFpEF group. When analysing D‐dimer as a continuous variable, this associations still existed. But there was no significant association between D‐dimer concentration and all‐cause mortality in HFrEF [hazard ratio (HR): 1.25, CI: 0.76 to 2.04, P = 0.37] or non‐HF (HR: 1.56, CI: 0.98 to 2.47, P = 0.06), respectively, after fully adjustment for other key clinical variables. Conclusions High D‐dimer levels on admission were found to be strongly associated with the subsequent cumulative incidence of all‐cause mortality in patients with AMI complicated by HFpEF.
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Affiliation(s)
- Xiaoyuan Zhang
- Department of CardiologyHospital of Harbin Medical University246 Xuefu Road, Nangang District, HarbinHeilongjiang150086China
- The Key Laboratory of Myocardial IschemiaChinese Ministry of EducationHarbin, HeilongjiangChina
| | - Shanjie Wang
- Department of CardiologyHospital of Harbin Medical University246 Xuefu Road, Nangang District, HarbinHeilongjiang150086China
- The Key Laboratory of Myocardial IschemiaChinese Ministry of EducationHarbin, HeilongjiangChina
| | - Liping Sun
- Department of CardiologyHospital of Harbin Medical University246 Xuefu Road, Nangang District, HarbinHeilongjiang150086China
| | - Shaohong Fang
- Department of CardiologyHospital of Harbin Medical University246 Xuefu Road, Nangang District, HarbinHeilongjiang150086China
- The Key Laboratory of Myocardial IschemiaChinese Ministry of EducationHarbin, HeilongjiangChina
| | - Bo Yu
- Department of CardiologyHospital of Harbin Medical University246 Xuefu Road, Nangang District, HarbinHeilongjiang150086China
- The Key Laboratory of Myocardial IschemiaChinese Ministry of EducationHarbin, HeilongjiangChina
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19
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Tsukui T, Sakakura K, Taniguchi Y, Yamamoto K, Seguchi M, Jinnouchi H, Wada H, Fujita H. Factors associated with poor clinical outcomes of ST-elevation myocardial infarction in patients with door-to-balloon time <90 minutes. PLoS One 2020; 15:e0241251. [PMID: 33091051 PMCID: PMC7580980 DOI: 10.1371/journal.pone.0241251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/11/2020] [Indexed: 12/22/2022] Open
Abstract
Background Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes. Methods This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization. Result The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m2) (vs. >20 kg/m2: HR 2.80, 95% CI 1.39–5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06–5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30–4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79–5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71–5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32–0.92, p = 0.02) was inversely associated with MACE. Conclusion Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.
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Affiliation(s)
- Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
- * E-mail:
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroyuki Jinnouchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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Post-PCI acute heart failure is an independent predictor of long-term mortality in patients with chronic kidney disease. Int J Cardiol 2020; 320:119-123. [PMID: 32464252 DOI: 10.1016/j.ijcard.2020.05.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/30/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to clarify the association of post-percutaneous coronary intervention (PCI) acute heart failure (AHF) with all-cause long-term mortality in patients with chronic kidney disease (CKD). METHODS In this prospective, observational study, 610 patients with CKD and coronary artery disease (CAD) undergoing PCI were included in the final analysis. Patients were divided to the non post-PCI AHF group (n = 557) and the post-PCI AHF group (n = 53). The diagnosis of post-PCI AHF was based on symptoms, prior cardiovascular history, and potential cardiac and noncardiac precipitants. RESULTS The overall incidence of post-PCI AHF was 53/610 (8.7%). The incidence of all-cause long-term mortality was significantly higher in the post-PCI AHF group than in the non post-PCI AHF group (50.9% vs 23.2%, P < .01). The median follow-up period was 7.3 years (interquartile range: 3.7-8.4). After adjusting for left ventricular ejection fraction <40% at discharge, CKD stage, acute myocardial infarction, age and smoking, post-PCI AHF was the strongest predictor of all-cause long-term mortality (hazard ratio: 8.08; 95% CI: 3.04-21.48; P < .01). CONCLUSIONS In patients with CKD and CAD undergoing PCI, post-PCI AHF is the strongest predictor of all-cause long-term mortality.
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21
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Trivunović B, Crvenkov T, Matić D. Influence of cardiac insufficiency as a complication of acute myocardial infarction on one-year mortality in patients treated with primary percutaneous coronary intervention. MEDICINSKI PODMLADAK 2020. [DOI: 10.5937/mp71-23747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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22
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Xanthopoulos A, Butler J, Parissis J, Polyzogopoulou E, Skoularigis J, Triposkiadis F. Acutely decompensated versus acute heart failure: two different entities. Heart Fail Rev 2019; 25:907-916. [PMID: 31802377 DOI: 10.1007/s10741-019-09894-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Heart failure (HF) has been classified in chronic HF (CHF) and acute HF (AHF). The latter has been subdivided in acutely decompensated chronic HF (ADCHF) defined as the deterioration of preexisting CHF and de novo AHF defined as the rapid development of new symptoms and signs of HF that requires urgent medical attention. However, ADCHF and de novo AHF have fundamental pathophysiological differences. Most importantly, the typical illness trajectory of HF, which is similar to that of other chronic organ diseases including lung, renal, and liver failure, features a gradual decline, with acute episodes usually related to disease evolution followed by partial recovery. Thus, ADCHF should be considered part of the natural history of CHF and renamed CHF exacerbation (CHFE) in accordance with the appropriate terminology used in chronic obstructive pulmonary disease. AHF, in turn, should include only acute de novo HF. The clinical implications of this paradigm shift will be in CHFE the change in focus from in-hospital to optimal ambulatory CHF management aiming at primary and secondary CHFE prevention, while in AHF, the institution of measures for in-hospital limitation of cardiac injury and prevention or retardation of symptomatic CHF development.
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Affiliation(s)
- Andrew Xanthopoulos
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - John Parissis
- Heart Failure Unit, Second Cardiology Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eftihia Polyzogopoulou
- Emergency Medicine Department, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Skoularigis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece
| | - Filippos Triposkiadis
- Department of Cardiology, Larissa University General Hospital, P.O. Box 1425, 411 10, Larissa, Greece.
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23
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Lee SH, Lee SR, Rhee KS, Chae JK, Kim WH. Usefulness of Myocardial Longitudinal Strain in Prediction of Heart Failure in Patients with Successfully Reperfused Anterior Wall ST-segment Elevation Myocardial Infarction. Korean Circ J 2019; 49:960-972. [PMID: 31074229 PMCID: PMC6753029 DOI: 10.4070/kcj.2018.0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 01/25/2023] Open
Abstract
Background and Objectives Acute myocardial infarction-related heart failure (HF) is associated with poor outcome. This study was designed to investigate the usefulness of global longitudinal strain (GLS), global circumferential strain (GCS) and mean longitudinal strain of left anterior descending artery territory (LSant) measured by 2-dimensional speckle tracking echocardiography (2D STE) in prediction of acute anterior wall ST-segment elevation myocardial infarction (ant-STEMI)-related HF. Methods A total of 171 patients with ant-STEMI who underwent successful primary coronary intervention and had available 2D STE data were enrolled. Patients were divided into 3 groups: in-hospital HF, post-discharge HF, and no-HF groups. Results In-hospital and post-discharge HF developed in 39 (22.8%) and 13 (7.6%) of patients, respectively and 113 patients (69.6%) remained without HF. Multivariate analysis showed that GLS was the only factor significantly associated with the development of in-hospital HF. For post-discharge HF, LSant was the only independent predictor. Other echocardiographic or laboratory parameters did not show independent association with the development of ant-STEMI-related HF. Conclusions GLS is a powerful echocardiographic parameter related to development of in-hospital HF and LSant was significantly associated with post-discharge HF in patients with successfully reperfused ant-STEMI.
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Affiliation(s)
- Sun Hwa Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
| | - Sang Rok Lee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Kyoung Suk Rhee
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Won Ho Kim
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea.,Research Institute of Clinical Medicine of Chonbuk National University, Jeonju, Korea.,Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
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Papai G, Csato G, Racz I, Szabo G, Barany T, Racz A, Szokol M, Sarman B, Edes IF, Czuriga D, Kolozsvari R, Edes I. The transtelephonic electrocardiogram-based triage is an independent predictor of decreased hospital mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. J Telemed Telecare 2018; 26:216-222. [PMID: 30526257 PMCID: PMC7222284 DOI: 10.1177/1357633x18814335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The transtelephonic electrocardiogram has been shown to have a great value in the management of out-of-hospital chest pain emergencies. In our previous study it not only improved the pre-hospital medical therapy and time to intervention, but also the in-hospital mortality in ST-segment elevation myocardial infarction. It was hypothesised that the higher in-hospital survival rate could be due to improved transtelephonic electrocardiogram-based pre-hospital management (electrocardiogram interpretation and teleconsultation) and consequently, better coronary perfusion of patients at the time of hospital admission. To test this hypothesis, our database of ST-segment elevation myocardial infarction patients was evaluated retrospectively for predictors (including transtelephonic electrocardiogram) that may influence in-hospital survival. METHODS AND RESULTS The ST-segment elevation myocardial infarction patients were divided into two groups, namely (a) hospital death patients (n = 49) and (b) hospital survivors (control, n = 726). Regarding pre-hospital medical management, the transtelephonic electrocardiogram-based triage (odds ratio 0.48, confidence interval 0.25-0.92, p = 0.0261) and the administration of optimal pre-hospital medical therapy (acetylsalicylic acid and/or clopidogrel and glycoprotein IIb/IIIa inhibitor) were the most important independent predictors for a decreased risk in our model. At the same time, age, acute heart failure (Killip class >2), successful pre-hospital resuscitation and total occlusion of the infarct-related coronary artery before percutaneous coronary intervention were the most important independent predictors for an increased risk of in-hospital mortality. DISCUSSION In ST-segment elevation myocardial infarction patients, (a) an early transtelephonic electrocardiogram-based teleconsultation and triage, (b) optimal pre-hospital antithrombotic medical therapy and (c) the patency and better perfusion of the infarct-related coronary artery on hospital admission are important predictors of a lower in-hospital mortality rate.
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Affiliation(s)
| | - Gabor Csato
- Hungarian National Ambulance Service, Hungary
| | - Ildiko Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Gabor Szabo
- Division of Cardiology, University of Debrecen, Hungary
| | - Tamas Barany
- Division of Cardiology, University of Debrecen, Hungary
| | - Agnes Racz
- Division of Cardiology, University of Debrecen, Hungary
| | - Miklos Szokol
- Division of Cardiology, University of Debrecen, Hungary
| | | | - Istvan F Edes
- Heart and Vascular Center, Semmelweis University, Hungary
| | | | | | - Istvan Edes
- Division of Cardiology, University of Debrecen, Hungary
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25
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Cahill TJ, Kharbanda RK. Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk. World J Cardiol 2017; 9:407-415. [PMID: 28603587 PMCID: PMC5442408 DOI: 10.4330/wjc.v9.i5.407] [Citation(s) in RCA: 137] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/20/2017] [Accepted: 03/13/2017] [Indexed: 02/06/2023] Open
Abstract
Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.
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26
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Arrigo M, Parissis JT, Akiyama E, Mebazaa A. Understanding acute heart failure: pathophysiology and diagnosis. Eur Heart J Suppl 2016. [DOI: 10.1093/eurheartj/suw044] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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27
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Arrigo M, Gayat E, Parenica J, Ishihara S, Zhang J, Choi DJ, Park JJ, Alhabib KF, Sato N, Miro O, Maggioni AP, Zhang Y, Spinar J, Cohen-Solal A, Iwashyna TJ, Mebazaa A. Precipitating factors and 90-day outcome of acute heart failure: a report from the intercontinental GREAT registry. Eur J Heart Fail 2016; 19:201-208. [PMID: 27790819 DOI: 10.1002/ejhf.682] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/12/2016] [Accepted: 09/21/2016] [Indexed: 12/11/2022] Open
Abstract
AIMS Several clinical conditions may precipitate acute heart failure (AHF) and influence clinical outcome. In this study we hypothesized that precipitating factors are independently associated with 90-day risk of death in AHF. METHODS AND RESULTS The study population consisted of 15 828 AHF patients from Europe and Asia. The primary outcome was 90-day all-cause mortality according to identified precipitating factors of AHF [acute coronary syndrome (ACS), infection, atrial fibrillation (AF), hypertension, and non-compliance]. Mortality at 90 days was 15.8%. AHF precipitated by ACS or by infection showed increased 90-day risk of death compared with AHF without identified precipitants [hazard ratio (HR) 1.69, 95% confidence interval (CI) 1.44-1.97, P < 0.001; and HR 1.51, 95% CI 1.18-1.92, P = 0.001), while AHF precipitated by AF showed lower 90-day risk of death (HR 0.56, 95% CI 0.42-0.75, P < 0.001), after multivariable adjustment. The risk of death in AHF precipitated by ACS was the highest during the first week after admission, while in AHF precipitated by infection the risk of death had a delayed peak at week 3. In AHF precipitated by AF, a trend toward reduced risk of death during the first weeks was shown. At weeks 5-6, AHF precipitated by ACS, infection, or AF showed similar risk of death to that of AHF without identified precipitants. CONCLUSIONS Precipitating factors are independently associated with 90-day mortality in AHF. AHF precipitated by ACS or infection is independently associated with higher, while AHF precipitated by AF is associated with lower 90-day risk of death.
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Affiliation(s)
- Mattia Arrigo
- INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France.,Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Etienne Gayat
- INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France
| | - Jiri Parenica
- Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Shiro Ishihara
- Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Jian Zhang
- Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong-Ju Choi
- Division Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Jin Joo Park
- Division Cardiology, Cardiovascular Center, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul, South Korea
| | - Khalid F Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Naoki Sato
- Division of Cardiology and Intensive Care Unit, Nippon Medical School Musashi-Kosugi Hospital, Kawasaki, Japan
| | - Oscar Miro
- Emergency Department, Hospital Clínic and 'Emergencies: Processes and Pathologies' Research Group, IDIBAPS, Barcelona, Spain
| | | | - Yuhui Zhang
- Heart Failure Center Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jindrich Spinar
- Department of Cardiology, University Hospital Brno and Medical Faculty, Masaryk University, Brno, Czech Republic
| | - Alain Cohen-Solal
- INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Cardiology, APHP-Lariboisière University Hospital, Paris, France
| | | | - Alexandre Mebazaa
- INSERM UMR-S 942, Université Paris Diderot, PRES Sorbonne Paris Cité, and Department of Anaesthesiology and Critical Care Medicine, APHP-Saint Louis Lariboisière University Hospitals, Paris, France
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Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention. Int J Cardiol 2016; 221:433-42. [DOI: 10.1016/j.ijcard.2016.07.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/04/2016] [Indexed: 11/19/2022]
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29
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Parodi G, Storey RF. Dyspnoea management in acute coronary syndrome patients treated with ticagrelor. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 4:555-60. [PMID: 25267878 PMCID: PMC4657388 DOI: 10.1177/2048872614554108] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 09/14/2014] [Indexed: 11/20/2022]
Abstract
The occurrence of dyspnoea in acute coronary syndrome (ACS) patients has always been considered a challenging diagnostic and therapeutic clinical scenario. P2Y12 platelet receptor inhibitors (i.e., clopidogrel, prasugrel and ticagrelor) are currently the cornerstone of treatment of ACS patients. Thus, in the last few years, the potential association between ACS and dyspnoea has also become more challenging with the increasing use of ticagrelor in these patients due to its beneficial effects on ischaemic event prevention and mortality, since ticagrelor can induce dyspnoea as a side effect. The present article is intended to review the current literature regarding dyspnoea occurrence in ACS patients, especially those treated with ticagrelor, and to propose ticagrelor-associated dyspnoea management recommendations based on current knowledge.
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Affiliation(s)
- Guido Parodi
- Department of Heart and Vessels, Careggi Hospital, Florence, Italy Post-graduate School in Cardiology, University of Florence, Italy
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
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Atar D, Arheden H, Berdeaux A, Bonnet JL, Carlsson M, Clemmensen P, Cuvier V, Danchin N, Dubois-Randé JL, Engblom H, Erlinge D, Firat H, Halvorsen S, Hansen HS, Hauke W, Heiberg E, Koul S, Larsen AI, Le Corvoisier P, Nordrehaug JE, Paganelli F, Pruss RM, Rousseau H, Schaller S, Sonou G, Tuseth V, Veys J, Vicaut E, Jensen SE. Effect of intravenous TRO40303 as an adjunct to primary percutaneous coronary intervention for acute ST-elevation myocardial infarction: MITOCARE study results. Eur Heart J 2014; 36:112-9. [PMID: 25179768 DOI: 10.1093/eurheartj/ehu331] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM The MITOCARE study evaluated the efficacy and safety of TRO40303 for the reduction of reperfusion injury in patients undergoing revascularization for ST-elevation myocardial infarction (STEMI). METHODS Patients presenting with STEMI within 6 h of the onset of pain randomly received TRO40303 (n = 83) or placebo (n = 80) via i.v. bolus injection prior to balloon inflation during primary percutaneous coronary intervention in a double-blind manner. The primary endpoint was infarct size expressed as area under the curve (AUC) for creatine kinase (CK) and for troponin I (TnI) over 3 days. Secondary endpoints included measures of infarct size using cardiac magnetic resonance (CMR) and safety outcomes. RESULTS The median pain-to-balloon time was 180 min for both groups, and the median (mean) door-to-balloon time was 60 (38) min for all sites. Infarct size, as measured by CK and TnI AUCs at 3 days, was not significantly different between treatment groups. There were no significant differences in the CMR-assessed myocardial salvage index (1-infarct size/myocardium at risk) (mean 52 vs. 58% with placebo, P = 0.1000), mean CMR-assessed infarct size (21.9 g vs. 20.0 g, or 17 vs. 15% of LV-mass) or left ventricular ejection fraction (LVEF) (46 vs. 48%), or in the mean 30-day echocardiographic LVEF (51.5 vs. 52.2%) between TRO40303 and placebo. A greater number of adjudicated safety events occurred in the TRO40303 group for unexplained reasons. CONCLUSION This study in STEMI patients treated with contemporary mechanical revascularization principles did not show any effect of TRO40303 in limiting reperfusion injury of the ischaemic myocardium.
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Affiliation(s)
- Dan Atar
- Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Håkan Arheden
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | | | - Jean-Louis Bonnet
- Assistance Publique Hôpitaux de Marseille, Hôpital La Timone, Marseille, France
| | - Marcus Carlsson
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Peter Clemmensen
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Valérie Cuvier
- Trophos SA, Luminy Biotech Enterprises, Marseille, France
| | - Nicolas Danchin
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | | | - Henrik Engblom
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - David Erlinge
- Department of Cardiology, Lund University, Lund, Sweden
| | | | - Sigrun Halvorsen
- Department of Cardiology B, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Wilfried Hauke
- Trophos SA, Luminy Biotech Enterprises, Marseille, France
| | - Einar Heiberg
- Department of Clinical Physiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Sasha Koul
- Department of Cardiology, Lund University, Lund, Sweden
| | - Alf-Inge Larsen
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | | | | | | | - Hélène Rousseau
- Clinical Research Unit, Lariboisière Hospital, Paris, France
| | | | | | - Vegard Tuseth
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Julien Veys
- Trophos SA, Luminy Biotech Enterprises, Marseille, France
| | - Eric Vicaut
- Clinical Research Unit, Lariboisière Hospital, Paris, France
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Meimoun P, M'barek D, Dragomir C, Luycx-Bore A, Elmkies F, Boulanger J, Zemir H, Martis S, Neykova A, Tzvetkov B, Clerc J. [Incidence, associated factors, and follow-up of hospital heart failure complicating acute anterior myocardial infarction successfully treated by primary angioplasty]. Ann Cardiol Angeiol (Paris) 2013; 62:293-300. [PMID: 24054406 DOI: 10.1016/j.ancard.2013.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
UNLABELLED Heart failure (HF) complicating acute myocardial infarction (AMI) is of poor prognosis and is often associated with patient's characteristics and success of reperfusion strategies. However, few data is available regarding the high-risk subgroup of patients with anterior AMI treated successfully by primary angioplasty. The aim of the study was to assess the incidence, associated factors, and the future of HF occurring during hospitalisation, in the setting of anterior AMI treated successfully by primary angioplasty. METHODS Eighty-five consecutive patients with anterior AMI treated successfully by primary angioplasty (final angiographic TIMI flow grade=3, without residual stenosis) were included. Clinical, biochemical, angiographic, and echocardiographic data were prospectively collected and compared between patients with (Killip 2 and 3) and without HF during hospitalisation. RESULTS Fifteen patients had HF (18%) during hospitalisation and 70 did not. By comparison to patients without HF, patients with HF were more frequently diabetics, had troponin peak and CPK, leucocytes count, and fasting glucose higher, LVEF and wall motion score index in the left anterior descending territory (WMSi-lad) poorer, and a lower non-invasive coronary flow reserve (CFR) in the LAD 24hours after angioplasty (all, P<0.05). In multivariate analysis, fasting glucose, leucocytes count after angioplasty, CFR and WMSi-lad were independently associated with HF, even after adjusting with angiographic variables (all, P<0.05). At 6months, patients with HF had less recovery of LV function and higher frequency of adverse LV remodelling (58% versus 20%, P<0.01) by comparison to patients without HF. CONCLUSION In conclusion, HF is not uncommon even after successful primary angioplasty for anterior AMI (nearly one patient out of 5), is associated with hyperglycaemia and inflammation, a poor microvascular reperfusion, and left ventricular systolic function, and is more frequently complicated by adverse LV remodelling and lack of LV recovery.
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Affiliation(s)
- P Meimoun
- Service de cardiologie-USIC, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiegne, France.
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Ersbøll M, Valeur N, Mogensen UM, Andersen MJ, Møller JE, Hassager C, Søgaard P, Køber L. Relationship between Left Ventricular Longitudinal Deformation and Clinical Heart Failure during Admission for Acute Myocardial Infarction: A Two-Dimensional Speckle-Tracking Study. J Am Soc Echocardiogr 2012; 25:1280-9. [DOI: 10.1016/j.echo.2012.09.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Indexed: 11/15/2022]
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MITOCARE Study Group. Rationale and Design of the MITOCARE Study: A Phase II, Multicenter, Randomized, Double-Blind, Placebo-Controlled Study to Assess the Safety and Efficacy of TRO40303 for the Reduction of Reperfusion Injury in Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction. Cardiology 2012. [DOI: 10.1159/000342981] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: the HORIZONS-AMI trial. Am Heart J 2011; 162:663-70. [PMID: 21982658 DOI: 10.1016/j.ahj.2011.08.002] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Accepted: 08/03/2011] [Indexed: 01/26/2023]
Abstract
BACKGROUND Congestive heart failure (CHF) is a major source of morbidity, mortality, and health-care resource consumption. However, the incidence of symptomatic CHF after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has rarely been fully reported. We therefore examined the early and late incidence, predictors, and implications of CHF in the large-scale, prospective, randomized HORIZONS-AMI trial. METHODS AND RESULTS New York Heart Association (NYHA) functional classification was prospectively collected from patient-level data at baseline, 30 days, 6 months, and at 1 and 2 years from 3,343 patients with STEMI undergoing PCI at 123 centers in 11 countries. The baseline incidence of CHF (before the index STEMI) was 2.6%, increasing to 4.6% 1 month after primary PCI (P < .0001), 4.7% at 1 year, and 5.1% at 2 years. The incidence of NYHA class III/IV symptoms was 0.4% at baseline and 0.8% at 2 years (P = .03). CHF at 1 year was associated with diabetes (P < .0001), dyslipidemia (P = .009), previous MI (P < .0001), previous revascularization (P = .01), anterior STEMI (P = .02), and baseline TIMI grade 0 flow (P = .01) but not procedural anticoagulation with bivalirudin versus heparin + GPIIb/IIIa inhibitors (P = .93) or use of drug-eluting versus bare metal stents (P = .66). Among patients in whom CHF was not present at baseline but developed after PCI, the rate of all-cause mortality was significantly higher during 2-year follow-up (7.3% vs 2.0%, P < .0001), as was cardiac mortality (2.4% vs 0.8%, P = .004), reinfarction (9.4% vs 5.2%, P = .0009), stent thrombosis (7.0% vs 3.8%, P = .007), and ischemic target vessel revascularization (19.4% vs 11.8%, P < .0001). CONCLUSION In the HORIZONS-AMI trial, the development of new-onset CHF within 2 years after contemporary PCI, although infrequent, was associated with significantly increased rates of mortality and major adverse ischemic events.
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Shah AM, Uno H, Køber L, Velazquez EJ, Maggioni AP, MacDonald MR, Petrie MC, McMurray JJV, Califf RM, Pfeffer MA, Solomon SD. The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction. Eur J Heart Fail 2011; 12:1229-37. [PMID: 20965879 DOI: 10.1093/eurjhf/hfq179] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIMS Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown. METHODS AND RESULTS The Valsartan in Acute Myocardial Infarction trial (VALIANT) enrolled 14 703 patients with acute MI complicated by HF, systolic dysfunction, or both. We compared the risk of death, HF hospitalization, and/or recurrent MI among patients with and without diabetes using Cox proportional hazards models. To assess the relationship between diabetes, LVEF and outcomes, we assessed the relative influence of baseline LVEF on outcomes in diabetic and non-diabetic patients. Totally, 11 325 subjects (3095 diabetics) with site-reported LVEF and known diabetes status were included. At any given LVEF, diabetes was associated with a higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.37, 95% CI 1.25-1.51], death or HF hospitalization (adjusted HR 1.42, 95% CI 1.31-1.51), and death or recurrent MI (adjusted HR 1.36, 95% CI 1.24-1.48). Diabetes modified the relationship between LVEF and death or HF hospitalization (P for interaction = 0.0109), such that the association between diabetes and increased risk was greater in magnitude at higher LVEF. No interaction was noted between diabetes and LVEF on risk of all-cause mortality or death or recurrent MI. CONCLUSION Diabetes is associated with a higher risk of death or HF hospitalization across the spectrum of LVEF in high-risk post-MI patients. The magnitude of reduction in risk of death or HF hospitalization associated with increasing LVEF is significantly attenuated among patients with diabetes when compared to patients without diabetes.
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Affiliation(s)
- Amil M Shah
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02445, USA
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Saia F, Grigioni F, Marzocchi A, Branzi A. Management of acute left ventricular dysfunction after primary percutaneous coronary intervention for ST elevation acute myocardial infarction. Am Heart J 2010; 160:S16-21. [PMID: 21147287 DOI: 10.1016/j.ahj.2010.10.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary percutaneous coronary intervention (PCI) decreases myocardial damage and reduces the occurrence of mechanical complications and acute heart failure in patients with ST elevation myocardial infarction (STEMI). Nevertheless, left ventricular (LV) dysfunction remains the leading cause of in-hospital mortality in all subsets of patients and particularly for those in whom primary PCI fails to reopen the infarct-related artery. The clinical scenarios of acute LV failure are heart failure and cardiogenic shock, both conditions being associated with extremely poor outcomes. It has been estimated that LV failure accounts for >75% of the cases of shock complicating acute STEMI. As compared to similar situations, the decision-making process in these patients can potentially benefit from the known coronary anatomy and, in many instances, from the immediate implantation of an intraaortic balloon pump at the time of PCI in selected groups of patients. A thorough clinical and instrumental evaluation is mandatory to discriminate patients who will likely recover (either spontaneously or with further conventional procedures) from those who have irreversible myocardial injury and should be screened for LV assist devices and/or emergent heart transplantation. In this review, we provide a practical diagnostic and therapeutic algorithm that may be helpful for the clinical management of patients with acute LV failure after primary PCI.
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Affiliation(s)
- Francesco Saia
- Institute of Cardiology, University of Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
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