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Lechner I, Reindl M, Metzler B, Reinstadler SJ. Temporal trends in ACS outcomes: Balancing technological advances with patient complexity. Int J Cardiol 2024; 415:132442. [PMID: 39151485 DOI: 10.1016/j.ijcard.2024.132442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 08/06/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Ivan Lechner
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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2
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Liu S, Jiang Z, Zhang Y, Pang S, Hou Y, Liu Y, huang Y, Peng N, Tang Y. A nomogramic model for predicting the left ventricular ejection fraction of STEMI patients after thrombolysis-transfer PCI. Front Cardiovasc Med 2023; 10:1178417. [PMID: 37745105 PMCID: PMC10517723 DOI: 10.3389/fcvm.2023.1178417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
Background The prognosis of ST-segment elevation myocardial infarction (STEMI) is closely linked to left ventricular ejection fraction (LVEF). In contrast to primary percutaneous coronary intervention (PPCI), thrombolysis-transfer PCI (TTPCI) is influenced by multiple factors that lead to heterogeneity in cardiac function and prognosis. The aim of this study is to develop a nomogram model for predicting early LVEF in STEMI patients with TTPCI, based on routine indicators at admission. Method We retrospectively reviewed data from patients diagnosed with STEMI at five network hospitals of our PCI center who performed TTPCI as door-to-balloon time (the interval between arrival at the hospital and intracoronary balloon inflation) over 120 min, from February 2018 to April 2022. Categorical variables were analyzed using Pearson χ2 tests or Fisher exact tests, while Student's t-test or Mann-Whitney U-test was used to compare continuous variables. Subsequently, independent risk factors associated with reduced LVEF one week after TTPCI were identified through comprehensive analysis by combining All-Subsets Regression with Logistic Regression. Based on these indicators, a nomogram model was developed, and validated using the area under the receiver operating characteristic (ROC) curve and the Bootstrap method. Results A total of 288 patients were analyzed, including 60 with LVEF < 50% and 228 with LVEF ≥ 50%. The nomogram model based on six independent risk factors including age, heart rate (HR), hypertension, smoking history, Alanine aminotransferase (ALT), and Killip class, demonstrated excellent discrimination with an AUC of 0.84 (95% CI: 0.78-0.89), predicted C-index of 0.84 and curve fit of 0.713. Conclusions The nomogram model incorporating age, HR, hypertension, smoking history, ALT and Killip class could accurately predict the early LVEF ≥ 50% probability of STEMI patients undergoing TTPCI, and enable clinicians' early evaluation of cardiac function in STEMI patients with TTPCI and early optimization of treatment.
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Affiliation(s)
- Shuai Liu
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Zhihui Jiang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Pharmacy, General Hospital of Southern Theater Command, Guangzhou, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou, China
| | - Yuanyuan Zhang
- Department of Geriatrics, General Hospital of Southern Theater Command, Guangzhou, China
| | - Shuwen Pang
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yan Hou
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
| | - Yipei Liu
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Yuekang huang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Na Peng
- Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- The First School of Clinical Medicine, Southern Medical University Guangzhou, Guangzhou, China
| | - Youqing Tang
- Department of Emergency Medicine, General Hospital of Southern Theater Command, Guangzhou, China
- Department of Emergency Medicine, Guangdong Second Provincial General Hospital, Guangzhou, China
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Docherty KF, Jackson AM, Macartney M, Campbell RT, Petrie MC, Pfeffer MA, McMurray JJ, Jhund PS. Declining risk of heart failure hospitalization following first acute myocardial infarction in Scotland between 1991-2016. Eur J Heart Fail 2023; 25:1213-1224. [PMID: 37401485 PMCID: PMC10946471 DOI: 10.1002/ejhf.2965] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/05/2023] Open
Abstract
AIM Mortality from acute myocardial infarction (AMI) has declined, increasing the pool of survivors at risk of later development of heart failure (HF). However, coronary reperfusion limits infarct size and secondary prevention therapies have improved. In light of these competing influences, we examined long-term trends in the risk of HF hospitalization (HFH) following a first AMI occurring in Scotland over 25 years. METHODS AND RESULTS All patients in Scotland discharged alive after a first AMI between 1991 and 2015 were followed until a first HFH or death until the end of 2016 (minimum follow-up 1 year, maximum 26 years). A total of 175 672 people with no prior history of HF were discharged alive after a first AMI during the period of study. A total of 21 445 (12.2%) patients had a first HFH during a median follow-up of 6.7 years. Incidence of HFH (per 1000 person-years) at 1 year following discharge from a first AMI decreased from 59.3 (95% confidence interval [CI] 54.2-64.7) in 1991 to 31.3 (95% CI 27.3-35.8) in 2015, with consistent trends seen for HF occurring within 5 and 10 years. Accounting for the competing risk of death, the adjusted risk of HFH at 1 year after discharge decreased by 53% (95% CI 45-60%), with similar decreases at 5 and 10 years. CONCLUSION The incidence of HFH following AMI in Scotland has decreased since 1991. These trends suggest that better treatment of AMI and secondary prevention are having an impact on the risk of HF at a population level.
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Affiliation(s)
| | - Alice M. Jackson
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | | | - Ross T. Campbell
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Mark C. Petrie
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
| | - Marc A. Pfeffer
- Cardiovascular Division, Brigham & Women's HospitalHarvard Medical SchoolBostonMAUSA
| | | | - Pardeep S. Jhund
- BHF Cardiovascular Research CentreUniversity of GlasgowGlasgowUK
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De Luca L, Riccio C, Navazio A, Valente S, Cipriani M, Corda M, De Nardo A, Francese GM, Napoletano C, Tizzani E, Roncon L, Caldarola P, Gulizia MM, Gabrielli D, Oliva F, Colivicchi F. ANMCO position paper on the management of hypercholesterolaemia in patients with acute coronary syndrome. Eur Heart J Suppl 2023; 25:D312-D322. [PMID: 37213800 PMCID: PMC10194822 DOI: 10.1093/eurheartjsupp/suad100] [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] [Indexed: 05/23/2023]
Abstract
Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS. In this position paper, Italian Association of Hospital Cardiologists proposes a decision algorithm on early adoption of lipid-lowering strategies at hospital discharge and short-term follow-up of patients with ACS, in the light of the multiple evidence generated in recent years on the treatment of hypercholesterolaemia and the available therapeutic options, considering current reimbursement criteria.
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Affiliation(s)
- Leonardo De Luca
- Corresponding author. Tel: 00390658704419, Fax: 00390658704423, ;
| | - Carmine Riccio
- UOSD Follow-up del Paziente Post-Acuto, Dipartimento Cardio-Vascolare, AORN Sant'Anna e San Sebastiano, Caserta 81100, Italy
| | - Alessandro Navazio
- SOC Cardiologia Ospedaliera, Presidio Ospedaliero Arcispedale Santa Maria Nuova, Azienda USL di Reggio Emilia—IRCCS, Reggio Emilia 42121, Italy
| | - Serafina Valente
- Dipartimento Cardio-Toracico, AOU Senese, Ospedale Santa Maria alle Scotte, Siena 53100, Italy
| | - Manlio Cipriani
- UOC Cardiologia, ISMETT (Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), Palermo 90121, Italy
| | - Marco Corda
- S.C. Cardiologia, Azienda Ospedaliera G. Brotzu, Cagliari 09121, Italy
| | - Alfredo De Nardo
- UO Cardiologia-UTIC, Ospedale Civile ‘G. Jazzolino’, Vibo Valentia 89900, Italy
| | - Giuseppina Maura Francese
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania 95100, Italy
| | - Cosimo Napoletano
- UOC Cardiologia-UTIC-Emodinamica, Presidio Ospedaliero ‘G. Mazzini’, Teramo 64100, Italy
| | - Emanuele Tizzani
- Dipartimento di Cardiologia, Ospedale degli Infermi, Rivoli (TO), Torino 10098, Italy
| | - Loris Roncon
- UOC Cardiologia, Ospedale Santa Maria della Misericordia, Rovigo 45100, Italy
| | | | - Michele Massimo Gulizia
- UOC Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione ‘Garibaldi’, Catania 95100, Italy
| | - Domenico Gabrielli
- Dipartimento di Scienze Cardio-Toraco-Vascolari, UOC Cardiologia, AO San Camillo-Forlanini, Circonvallazione Gianicolense, 87, 00152 Roma, Italy
| | - Fabrizio Oliva
- Unità di Cure Intensive Cardiologiche, Cardiologia 1-Emodinamica, Dipartimento Cardiotoracovascolare ‘A. De Gasperis’, ASST Grande Ospedale Metropolitano Niguarda, Milano 20162, Italy
| | - Furio Colivicchi
- UOC Cardiologia Clinica e Riabilitativa, Presidio Ospedaliero San Filippo Neri—ASL Roma 1, Roma 00176, Italia
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Moscucci F, Lavalle F, Politi C, Campanale A, Baggio G, Sciomer S. Acute coronary syndrome in women: a new and specific approach is needed. Eur J Prev Cardiol 2022; 29:e305-e308. [PMID: 35881512 DOI: 10.1093/eurjpc/zwac143] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/11/2022] [Indexed: 12/20/2022]
Affiliation(s)
- Federica Moscucci
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Franco Lavalle
- OMCEO (Provincial Order Council of Surgeons and Dentists), Bari, Italy
- G.I.S.e G. (Gender and Health Italian Group), Italy
| | - Cecilia Politi
- Internal Medicine Department, Gender Medicine Area F.A.D.O.I., Isernia, Italy
| | - Antonella Campanale
- Medical Device and Pharmaceutical Service-Italian Ministry of Health, Rome, Italy
| | - Giovanella Baggio
- Department of Medicine, University of Padua, Padua, Italy
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
| | - Susanna Sciomer
- Department of Clinical and Internal Medicine, Anesthesiology and Cardiovascular Sciences, University of Rome 'Sapienza', Rome, Italy
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De Luca L, D’Errigo P, Rosato S, Mureddu GF, Badoni G, Seccareccia F, Baglio G. Impact of myocardial revascularization on long-term outcomes in a nationwide cohort of first acute myocardial infarction survivors. Eur Heart J Suppl 2022; 24:C225-C232. [PMID: 35663587 PMCID: PMC9155238 DOI: 10.1093/eurheartj/suac013] [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] [Indexed: 11/21/2022]
Abstract
The long-term clinical benefits of myocardial revascularization in a contemporary, nationwide cohort of acute myocardial infarction (AMI) survivors are unclear. We aimed to compare the mortality rates and clinical outcomes at 8 years of patients admitted in Italy for a first AMI managed with or without myocardial revascularization during the index event. This is a national retrospective cohort study that enrolled patients admitted for a first AMI in 2012 in all Italian hospitals who survived at 30 days. The outcomes of interest were all-cause mortality, major cardio-cerebrovascular events (MACCE), and re-hospitalization for heart failure (HF) at 8 years. Time to events was analysed using a Cox and Fine and Gray multivariate regression model. A total of 127 431 patients with AMI were admitted to Italian hospitals in 2012. The study cohort consisted of 62 336 AMI events, of whom 63.8% underwent percutaneous or surgical revascularization ≤30 days of the index hospital admission. At 8 years, the cumulative incidence of all-cause death was 36.5% (24.6% in revascularized and 57.6% in not revascularized patients). After multiple corrections, the hazard ratio (HR) for all-cause mortality in revascularized vs. not revascularized patients was 0.61 (P < 0.0001). The rate of MACCE was 45.7% and 65.8% (adjusted HR 0.83; P < 0.0001), while re-hospitalizations for HF occurred in 17.6% and 29.8% (adjusted HR 0.97; P = 0.16) in AMI survivors revascularized and not revascularized, respectively. In our contemporary nationwide cohort of patients at their first AMI episode, those who underwent myocardial revascularization within 1 month from the index event compared to those not revascularized presented an adjusted 39% risk reduction in all-cause mortality and 17% in MACCE at 8-year follow-up.
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Affiliation(s)
- Leonardo De Luca
- Department of Cardiosciences, A.O. San Camillo-Forlanini, Circonvallazione Gianicolense 87, 00152 Rome, Italy
- UniCamillus-Saint Camillus International, University of Health Sciences, Rome, Italy
| | - Paola D’Errigo
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Rosato
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | | | - Gabriella Badoni
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Fulvia Seccareccia
- National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy
| | - Giovanni Baglio
- Italian National Agency for Regional Healthcare Services, Rome, Italy
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Zhao D, Liu Y, Chen S, Xu Z, Yang X, Shen H, Zhang S, Li Y, Zhang H, Zou C, Ma X. Predictive Value of Blood Urea Nitrogen to Albumin Ratio in Long-Term Mortality in Intensive Care Unit Patients with Acute Myocardial Infarction: A Propensity Score Matching Analysis. Int J Gen Med 2022; 15:2247-2259. [PMID: 35256854 PMCID: PMC8898044 DOI: 10.2147/ijgm.s349722] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/15/2022] [Indexed: 12/22/2022] Open
Abstract
Background Blood urea nitrogen to albumin ratio (BAR) has been implicated in predicting outcomes of various inflammatory-related diseases. However, the predictive value of BAR in long-term mortality in patients with acute myocardial infarction (AMI) has not yet been evaluated. Methods In this retrospective cohort study, the patients were recruited from the Medical Information Mart for Intensive Care III (MIMIC III) database and categorized into two groups by a cutoff value of BAR. Kaplan–Meier (K-M) analysis and Cox proportional hazard model were performed to determine the predictive value of BAR in long-term mortality following AMI. In order to adjust the baseline differences, a 1:1 propensity score matching (PSM) was carried out and the results were further validated. Results A total of 1827 eligible patients were enrolled. The optimal cutoff value of BAR for four-year mortality was 7.83 mg/g. Patients in the high BAR group tended to have a longer intensive care unit (ICU) stay and a higher rate of one-, two-, three- and four-year mortality (all p<0.001) compared with those in the low BAR group. K-M curves indicated a significant difference in four-year survival (p<0.001) between low and high BAR groups. The Cox proportional hazards model showed that higher BAR (>7.83) was independently associated with increased four-year mortality in the entire cohort, with a hazard ratio (HR) of 1.478 [95% CI (1.254–1.740), p<0.001]. After PSM, the baseline characteristics of 312 pairs of patients in the high and low BAR groups were well balanced, and similar results were observed in K-M curve (p=0.003). Conclusion A higher BAR (>7.83) was associated with four-year mortality in patients with AMI. As an easily available biomarker, BAR can predict the long-term mortality in AMI patients independently.
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Affiliation(s)
- Diming Zhao
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Yilin Liu
- Department of Ophthalmology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Shanghao Chen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Zhenqiang Xu
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Xiaomei Yang
- Department of Anesthesiology, Shandong Provincial Hospital affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Hechen Shen
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Shijie Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Yi Li
- Department of Cardiovascular Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Haizhou Zhang
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Chengwei Zou
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
| | - Xiaochun Ma
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, People’s Republic of China
- Department of Cardiovascular Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People’s Republic of China
- Correspondence: Xiaochun Ma, Tel +8615169196737, Email
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Girerd N. The growing importance of heart failure in myocardial infarction. Int J Cardiol 2022; 352:100-101. [DOI: 10.1016/j.ijcard.2022.01.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 01/31/2022] [Indexed: 11/05/2022]
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